A framework using cluster-based hybrid network architecture for collaborative virtual surgery.

Science.gov (United States)

Qin, Jing; Choi, Kup-Sze; Poon, Wai-Sang; Heng, Pheng-Ann

2009-12-01

Research on collaborative virtual environments (CVEs) opens the opportunity for simulating the cooperative work in surgical operations. It is however a challenging task to implement a high performance collaborative surgical simulation system because of the difficulty in maintaining state consistency with minimum network latencies, especially when sophisticated deformable models and haptics are involved. In this paper, an integrated framework using cluster-based hybrid network architecture is proposed to support collaborative virtual surgery. Multicast transmission is employed to transmit updated information among participants in order to reduce network latencies, while system consistency is maintained by an administrative server. Reliable multicast is implemented using distributed message acknowledgment based on cluster cooperation and sliding window technique. The robustness of the framework is guaranteed by the failure detection chain which enables smooth transition when participants join and leave the collaboration, including normal and involuntary leaving. Communication overhead is further reduced by implementing a number of management approaches such as computational policies and collaborative mechanisms. The feasibility of the proposed framework is demonstrated by successfully extending an existing standalone orthopedic surgery trainer into a collaborative simulation system. A series of experiments have been conducted to evaluate the system performance. The results demonstrate that the proposed framework is capable of supporting collaborative surgical simulation.

Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma using Mel-5 immunostaining: an update from the University of Minnesota.

Science.gov (United States)

Newman, Jessica; Beal, Matthew; Schram, Sarah E; Lee, Peter K

2013-12-01

Mohs micrographic surgery (MMS) is gaining acceptance as a treatment for lentigo maligna (LM) and lentigo maligna melanoma (LMM), especially with the use of melanocyte-staining immunohistochemical (IHC) stains. In 2006, we reported our 4-year experience with Mel-5 immunostaining, with only one recurrence noted in 200 patients after a mean follow-up of 38.4 months.(1) OBJECTIVES: We present an update regarding our 13-year experience with the use of Mel-5. Patients with primary or recurrent LM or LMM (n = 260) underwent MMS with Mel-5; 174 were followed up to evaluate for recurrence, with a mean follow-up of 34 months. The 200 patients described in the initial case series from 1999 to 2003 were also followed. Of the 460 patients treated from January 1999 to December 2011, five recurrences were noted in four patients; one in the initial case series and four in this new, updated series, including one re-recurrence from the initial series. One melanoma-related death occurred in a patient intermittently lost to follow-up. MMS with Mel-5 immunostaining continues to yield excellent results in the treatment of LM and LMM. © 2013 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

UPDATING NATIONAL TOPOGRAPHIC DATA BASE USING CHANGE DETECTION METHODS

Directory of Open Access Journals (Sweden)

E. Keinan

2016-06-01

Full Text Available The traditional method for updating a topographic database on a national scale is a complex process that requires human resources, time and the development of specialized procedures. In many National Mapping and Cadaster Agencies (NMCA, the updating cycle takes a few years. Today, the reality is dynamic and the changes occur every day, therefore, the users expect that the existing database will portray the current reality. Global mapping projects which are based on community volunteers, such as OSM, update their database every day based on crowdsourcing. In order to fulfil user's requirements for rapid updating, a new methodology that maps major interest areas while preserving associated decoding information, should be developed. Until recently, automated processes did not yield satisfactory results, and a typically process included comparing images from different periods. The success rates in identifying the objects were low, and most were accompanied by a high percentage of false alarms. As a result, the automatic process required significant editorial work that made it uneconomical. In the recent years, the development of technologies in mapping, advancement in image processing algorithms and computer vision, together with the development of digital aerial cameras with NIR band and Very High Resolution satellites, allow the implementation of a cost effective automated process. The automatic process is based on high-resolution Digital Surface Model analysis, Multi Spectral (MS classification, MS segmentation, object analysis and shape forming algorithms. This article reviews the results of a novel change detection methodology as a first step for updating NTDB in the Survey of Israel.

Updating National Topographic Data Base Using Change Detection Methods

Science.gov (United States)

Keinan, E.; Felus, Y. A.; Tal, Y.; Zilberstien, O.; Elihai, Y.

2016-06-01

The traditional method for updating a topographic database on a national scale is a complex process that requires human resources, time and the development of specialized procedures. In many National Mapping and Cadaster Agencies (NMCA), the updating cycle takes a few years. Today, the reality is dynamic and the changes occur every day, therefore, the users expect that the existing database will portray the current reality. Global mapping projects which are based on community volunteers, such as OSM, update their database every day based on crowdsourcing. In order to fulfil user's requirements for rapid updating, a new methodology that maps major interest areas while preserving associated decoding information, should be developed. Until recently, automated processes did not yield satisfactory results, and a typically process included comparing images from different periods. The success rates in identifying the objects were low, and most were accompanied by a high percentage of false alarms. As a result, the automatic process required significant editorial work that made it uneconomical. In the recent years, the development of technologies in mapping, advancement in image processing algorithms and computer vision, together with the development of digital aerial cameras with NIR band and Very High Resolution satellites, allow the implementation of a cost effective automated process. The automatic process is based on high-resolution Digital Surface Model analysis, Multi Spectral (MS) classification, MS segmentation, object analysis and shape forming algorithms. This article reviews the results of a novel change detection methodology as a first step for updating NTDB in the Survey of Israel.

Supreme Court Update

Science.gov (United States)

Taylor, Kelley R.

2009-01-01

"Chief Justice Flubs Oath." "Justice Ginsburg Has Cancer Surgery." At the start of this year, those were the news headlines about the U.S. Supreme Court. But January 2009 also brought news about key education cases--one resolved and two others on the docket--of which school administrators should take particular note. The Supreme Court updates on…

Comparison of Different Computer–Aided Surgery Systems in Skull Base Surgery

OpenAIRE

Ecke, U.; Luebben, B.; Maurer, J.; Boor, S.; Mann, W. J.

2003-01-01

Computer–aided surgery (CAS) based on high–resolution imaging techniques represents an important adjunct to precise intraoperative orientation when anatomical landmarks are distorted or missing. Several commercial systems, mostly based on optical or electromagnetic navigation principles, are on the market. This study investigated the application of EasyGuide®, VectorVision®, and InstaTrak® CAS systems in ENT surgery under practical and laboratory conditions. System accuracy, time required, ha...

LBTool: A stochastic toolkit for leave-based key updates

DEFF Research Database (Denmark)

Yuksel, Ender; Nielson, Hanne Riis; Nielson, Flemming

2012-01-01

Quantitative techniques have been successfully employed in verification of information and communication systems. However, the use of such techniques are still rare in the area of security. In this paper, we present a toolkit that implements transient analysis on a key update method for wireless...... sensor networks. The analysis aims to find out the probability of a network key being compromised at a specific time point, which result in fluctuations over time for a specific key update method called Leave-based key update. For such a problem, the use of current tools is limited in many ways...

Meta-analysis of randomized trials of effect of milrinone on mortality in cardiac surgery: an update.

Science.gov (United States)

Majure, David T; Greco, Teresa; Greco, Massimiliano; Ponschab, Martin; Biondi-Zoccai, Giuseppe; Zangrillo, Alberto; Landoni, Giovanni

2013-04-01

The long-term use of milrinone is associated with increased mortality in chronic heart failure. A recent meta-analysis suggested that it might increase mortality in patients undergoing cardiac surgery. The authors conducted an updated meta-analysis of randomized trials in patients undergoing cardiac surgery to determine if milrinone impacted survival. A meta-analysis. Hospitals. One thousand thirty-seven patients from 20 randomized trials. None. Biomed, Central, PubMed, EMBASE, the Cochrane central register of clinical trials, and conference proceedings were searched for randomized trials that compared milrinone versus placebo or any other control in adult and pediatric patients undergoing cardiac surgery. Authors of trials that did not include mortality data were contacted. Only trials for which mortality data were available were included. Overall analysis showed no difference in mortality between patients receiving milrinone versus control (12/554 [2.2%] in the milrinone group v 10/483 [2.1%] in the control arm; relative risk [RR] = 1.15; 95% confidence interval [CI], 0.55-2.43; p = 0.7) or in analysis restricted to adults (11/364 [3%] in the milrinone group v 9/371 [2.4%] in the control arm; RR = 1.17; 95% CI, 0.54-2.53; p = 0.7). Sensitivity analyses in trials with a low risk of bias showed a trend toward an increase in mortality with milrinone (8/153 [5.2%] in the milrinone arm v 2/152 [1.3%] in the control arm; RR = 2.71; 95% CI, 0.82-9; p for effect = 0.10). Despite theoretic concerns for increased mortality with intravenous milrinone in patients undergoing cardiac surgery, the authors were unable to confirm an adverse effect on survival. However, sensitivity analysis of high-quality trials showed a trend toward increased mortality with milrinone. Copyright © 2013 Elsevier Inc. All rights reserved.

Gating based on internal/external signals with dynamic correlation updates

International Nuclear Information System (INIS)

Wu Huanmei; Zhao Qingya; Berbeco, Ross I; Nishioka, Seiko; Shirato, Hiroki; Jiang, Steve B

2008-01-01

Precise localization of mobile tumor positions in real time is critical to the success of gated radiotherapy. Tumor positions are usually derived from either internal or external surrogates. Fluoroscopic gating based on internal surrogates, such as implanted fiducial markers, is accurate however requiring a large amount of imaging dose. Gating based on external surrogates, such as patient abdominal surface motion, is non-invasive however less accurate due to the uncertainty in the correlation between tumor location and external surrogates. To address these complications, we propose to investigate an approach based on hybrid gating with dynamic internal/external correlation updates. In this approach, the external signal is acquired at high frequency (such as 30 Hz) while the internal signal is sparsely acquired (such as 0.5 Hz or less). The internal signal is used to validate and update the internal/external correlation during treatment. Tumor positions are derived from the external signal based on the newly updated correlation. Two dynamic correlation updating algorithms are introduced. One is based on the motion amplitude and the other is based on the motion phase. Nine patients with synchronized internal/external motion signals are simulated retrospectively to evaluate the effectiveness of hybrid gating. The influences of different clinical conditions on hybrid gating, such as the size of gating windows, the optimal timing for internal signal acquisition and the acquisition frequency are investigated. The results demonstrate that dynamically updating the internal/external correlation in or around the gating window will reduce false positive with relatively diminished treatment efficiency. This improvement will benefit patients with mobile tumors, especially greater for early stage lung cancers, for which the tumors are less attached or freely floating in the lung.

Gating based on internal/external signals with dynamic correlation updates

Energy Technology Data Exchange (ETDEWEB)

Wu Huanmei [Purdue School of Engineering and Technology, Indiana University School of Informatics, IUPUI, Indianapolis, IN (United States); Zhao Qingya [School of Health Sciences, Purdue University, West Lafayette, IN (United States); Berbeco, Ross I [Department of Radiation Oncology, Dana-Farber/Brigham and Womens Cancer Center and Harvard Medical School, Boston, MA (United States); Nishioka, Seiko [NTT East-Japan Sapporo Hospital, Sapporo (Japan); Shirato, Hiroki [Hokkaido University Graduate School of Medicine, Sapporo (Japan); Jiang, Steve B [Department of Radiation Oncology, School of Medicine, University of California, San Diego, CA (United States)], E-mail: hw9@iupui.edu, E-mail: sbjiang@ucsd.edu

2008-12-21

Precise localization of mobile tumor positions in real time is critical to the success of gated radiotherapy. Tumor positions are usually derived from either internal or external surrogates. Fluoroscopic gating based on internal surrogates, such as implanted fiducial markers, is accurate however requiring a large amount of imaging dose. Gating based on external surrogates, such as patient abdominal surface motion, is non-invasive however less accurate due to the uncertainty in the correlation between tumor location and external surrogates. To address these complications, we propose to investigate an approach based on hybrid gating with dynamic internal/external correlation updates. In this approach, the external signal is acquired at high frequency (such as 30 Hz) while the internal signal is sparsely acquired (such as 0.5 Hz or less). The internal signal is used to validate and update the internal/external correlation during treatment. Tumor positions are derived from the external signal based on the newly updated correlation. Two dynamic correlation updating algorithms are introduced. One is based on the motion amplitude and the other is based on the motion phase. Nine patients with synchronized internal/external motion signals are simulated retrospectively to evaluate the effectiveness of hybrid gating. The influences of different clinical conditions on hybrid gating, such as the size of gating windows, the optimal timing for internal signal acquisition and the acquisition frequency are investigated. The results demonstrate that dynamically updating the internal/external correlation in or around the gating window will reduce false positive with relatively diminished treatment efficiency. This improvement will benefit patients with mobile tumors, especially greater for early stage lung cancers, for which the tumors are less attached or freely floating in the lung.

The hierarchy of stability and predictability in orthognathic surgery with rigid fixation: an update and extension

Directory of Open Access Journals (Sweden)

Phillips Ceib

2007-04-01

Full Text Available Abstract A hierarchy of stability exists among the types of surgical movements that are possible with orthognathic surgery. This report updates the hierarchy, focusing on comparison of the stability of procedures when rigid fixation is used. Two procedures not previously placed in the hierarchy now are included: correction of asymmetry is stable with rigid fixation and repositioning of the chin also is very stable. During the first post-surgical year, surgical movements in patients treated for Class II/long face problems tend to be more stable than those treated for Class III problems. Clinically relevant changes (more than 2 mm occur in a surprisingly large percentage of orthognathic surgery patients from one to five years post-treatment, after surgical healing is complete. During the first post-surgical year, patients treated for Class II/long face problems are more stable than those treated for Class III problems; from one to five years post-treatment, some patients in both groups experience skeletal change, but the Class III patients then are more stable than the Class II/long face patients. Fewer patients exhibit long-term changes in the dental occlusion than skeletal changes, because the dentition usually adapts to the skeletal change.

Omega-3 polyunsaturated fatty acids in cardiac surgery patients: An updated systematic review and meta-analysis.

Science.gov (United States)

Langlois, Pascal L; Hardy, Gil; Manzanares, William

2017-06-01

Omega-3 polyunsaturated fatty acids (ω-3 PUFA) supplementation is an attractive therapeutic option for patients undergoing open-heart surgery due to their anti-inflammatory and anti-arrhythmic properties. Several randomized controlled trials (RCT) have found contradictory results for perioperative ω-3 PUFA administration. Therefore, we conducted an updated systematic review and meta-analysis evaluating the effects of perioperative ω-3 PUFA on some clinically important outcomes for cardiac surgery. A systematic literature search was conducted to find RCT evaluating clinical outcomes after ω-3 PUFA therapy in adult patients undergoing cardiac surgery. Intensive care unit (ICU) length of stay (LOS) was the primary outcome; secondary outcomes were hospital LOS, postoperative atrial fibrillation (POAF), mortality and duration of mechanical ventilation (MV). Predefined subgroup analysis and sensibility analysis were performed. A total of 19 RCT including 4335 patients met inclusion criteria. No effect of ω-3 PUFA on ICU LOS was found (weighted mean difference WMD -2.95, 95% confidence interval, CI -10.28 to 4.39, P = 0.43). However, ω-3 PUFA reduced hospital LOS (WMD -1.37, 95% CI -2.41 to -0.33; P = 0.010) and POAF incidence (Odds Ratio OR = 0.78, 95% CI 0.68 to 0.90; P = 0.004). No effects were found on mortality or MV duration. Heterogeneity remained in subgroup analysis and we found a significant POAF reduction when ω-3 PUFA doses were administered to patients exposed to extra-corporeal circulation. Oral/enteral administration seemed to further reduce POAF. In patients undergoing cardiac surgery, ω-3 PUFA supplementation by oral/enteral and parenteral route reduces hospital LOS and POAF. Nonetheless considerable clinical and statistical heterogeneity weaken our findings. Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Guidelines for antibiotic prophylaxis in abdominal surgery for adults

OpenAIRE

Tadeja Pintar; Blaž Trotovšek; Bojana Beović

2014-01-01

Abstract: Background.Evidence based recommendations for antibiotic prophylaxis in abdominal surgery are prepared to reduce postoperative complications and to reduce inappropriate prophylactic antibiotic prescribing. The original guidline address risk factors for surgical site infection (SSI), benefits and risks of antibiotic profilaxis and  indications for surgical antibiotic profilaxis.Update of recommendations is an opportunity to expand and review the evidence supporting recommendations. R...

Update on Minimally Invasive Glaucoma Surgery (MIGS and New Implants

Directory of Open Access Journals (Sweden)

Lívia M. Brandão

2013-01-01

Full Text Available Traditional glaucoma surgery has been challenged by the advent of innovative techniques and new implants in the past few years. There is an increasing demand for safer glaucoma surgery offering patients a timely surgical solution in reducing intraocular pressure (IOP and improving their quality of life. The new procedures and devices aim to lower IOP with a higher safety profile than fistulating surgery (trabeculectomy/drainage tubes and are collectively termed “minimally invasive glaucoma surgery (MIGS.” The main advantage of MIGS is that they are nonpenetrating and/or bleb-independent procedures, thus avoiding the major complications of fistulating surgery related to blebs and hypotony. In this review, the clinical results of the latest techniques and devices are presented by their approach, ab interno (trabeculotomy, excimer laser trabeculotomy, trabecular microbypass, suprachoroidal shunt, and intracanalicular scaffold and ab externo (canaloplasty, Stegmann Canal Expander, suprachoroidal Gold microshunt. The drawback of MIGS is that some of these procedures produce a limited IOP reduction compared to trabeculectomy. Currently, MIGS is performed in glaucoma patients with early to moderate disease and preferably in combination with cataract surgery.

Updating of visual orientation in a gravity-based reference frame.

Science.gov (United States)

Niehof, Nynke; Tramper, Julian J; Doeller, Christian F; Medendorp, W Pieter

2017-10-01

The brain can use multiple reference frames to code line orientation, including head-, object-, and gravity-centered references. If these frames change orientation, their representations must be updated to keep register with actual line orientation. We tested this internal updating during head rotation in roll, exploiting the rod-and-frame effect: The illusory tilt of a vertical line surrounded by a tilted visual frame. If line orientation is stored relative to gravity, these distortions should also affect the updating process. Alternatively, if coding is head- or frame-centered, updating errors should be related to the changes in their orientation. Ten subjects were instructed to memorize the orientation of a briefly flashed line, surrounded by a tilted visual frame, then rotate their head, and subsequently judge the orientation of a second line relative to the memorized first while the frame was upright. Results showed that updating errors were mostly related to the amount of subjective distortion of gravity at both the initial and final head orientation, rather than to the amount of intervening head rotation. In some subjects, a smaller part of the updating error was also related to the change of visual frame orientation. We conclude that the brain relies primarily on a gravity-based reference to remember line orientation during head roll.

A keyword searchable attribute-based encryption scheme with attribute update for cloud storage.

Science.gov (United States)

Wang, Shangping; Ye, Jian; Zhang, Yaling

2018-01-01

Ciphertext-policy attribute-based encryption (CP-ABE) scheme is a new type of data encryption primitive, which is very suitable for data cloud storage for its fine-grained access control. Keyword-based searchable encryption scheme enables users to quickly find interesting data stored in the cloud server without revealing any information of the searched keywords. In this work, we provide a keyword searchable attribute-based encryption scheme with attribute update for cloud storage, which is a combination of attribute-based encryption scheme and keyword searchable encryption scheme. The new scheme supports the user's attribute update, especially in our new scheme when a user's attribute need to be updated, only the user's secret key related with the attribute need to be updated, while other user's secret key and the ciphertexts related with this attribute need not to be updated with the help of the cloud server. In addition, we outsource the operation with high computation cost to cloud server to reduce the user's computational burden. Moreover, our scheme is proven to be semantic security against chosen ciphertext-policy and chosen plaintext attack in the general bilinear group model. And our scheme is also proven to be semantic security against chosen keyword attack under bilinear Diffie-Hellman (BDH) assumption.

An evidence-based clinical guideline for the use of antithrombotic therapies in spine surgery.

Science.gov (United States)

Bono, Christopher M; Watters, William C; Heggeness, Michael H; Resnick, Daniel K; Shaffer, William O; Baisden, Jamie; Ben-Galim, Peleg; Easa, John E; Fernand, Robert; Lamer, Tim; Matz, Paul G; Mendel, Richard C; Patel, Rajeev K; Reitman, Charles A; Toton, John F

2009-12-01

the work group through the modified nominal group technique and is clearly identified as such in the guideline. Fourteen clinical questions were formulated, addressing issues of incidence of DVT and PE in spine surgery and recommendations regarding utilization of mechanical prophylaxis and chemoprophylaxis in spine surgery. The answers to these 14 clinical questions are summarized in this article. The respective recommendations were graded by the strength of the supporting literature that was stratified by levels of evidence. A clinical guideline addressing the use of antithrombotic therapies in spine surgery has been created using the techniques of evidence-based medicine and using the best available evidence as a tool to assist spine surgeons in minimizing the risk of DVT and PE. The entire guideline document, including the evidentiary tables, suggestions for future research, and all references, is available electronically at the NASS Web site (www.spine.org) and will remain updated on a timely schedule.

[Fluid therapy in cardiac surgery. An update].

Science.gov (United States)

Boix, E; Vicente, R; Pérez-Artacho, J

2014-01-01

The anesthetist has 2 major tools for optimizing haemodynamics in cardiac surgery: Vasoactive drugs and the intravascular volume. It is necessary to identify which patients would benefit from one or the other therapies for a suitable response to treatment. Hemodynamic monitoring with the different existing parameters (pressure, volumetric static, volumetric functional and echocardiography) allows the management of these patients to be optimized. In this article a review is presented on the most recent and relevant publications, and the different tools available to control the management of the fluid therapy in this context, and to suggest a few guidelines for the haemodynamics monitoring of patients submitted to cardiac surgery. A systematic search has been made in PubMed, limiting the results to the publications over the last five years up to February 2012. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

New bimaxillary orthognathic surgery planning and model surgery based on the concept of six degrees of freedom

Science.gov (United States)

Jeon, Jaeho; Kim, Yongdeok; Kim, Jongryoul; Kang, Heejea; Ji, Hyunjin

2013-01-01

The aim of this paper was to propose a new method of bimaxillary orthognathic surgery planning and model surgery based on the concept of 6 degrees of freedom (DOF). A 22-year-old man with Class III malocclusion was referred to our clinic with complaints of facial deformity and chewing difficulty. To correct a prognathic mandible, facial asymmetry, flat occlusal plane angle, labioversion of the maxillary central incisors, and concavity of the facial profile, bimaxillary orthognathic surgery was planned. After preoperative orthodontic treatment, surgical planning based on the concept of 6 DOF was performed on a surgical treatment objective drawing, and a Jeon's model surgery chart (JMSC) was prepared. Model surgery was performed with Jeon's orthognathic surgery simulator (JOSS) using the JMSC, and an interim wafer was fabricated. Le Fort I osteotomy, bilateral sagittal split ramus osteotomy, and malar augmentation were performed. The patient received lateral cephalometric and posteroanterior cephalometric analysis in postretention for 1 year. The follow-up results were determined to be satisfactory, and skeletal relapse did not occur after 1.5 years of surgery. When maxillary and mandibular models are considered as rigid bodies, and their state of motion is described in a quantitative manner based on 6 DOF, sharing of exact information on locational movement in 3-dimensional space is possible. The use of JMSC and JOSS will actualize accurate communication and performance of model surgery among clinicians based on objective measurements. PMID:23503161

Comparing consensus guidelines on thromboprophylaxis in orthopedic surgery.

Science.gov (United States)

Struijk-Mulder, M C; Ettema, H B; Verheyen, C C; Büller, H R

2010-04-01

Different guidelines exist regarding the prevention of venous thromboembolism (VTE) in orthopedic surgery. We aimed to compare (inter)national guidelines and analyse differences. MEDLINE, the Cochrane Library and the internet were searched for guidelines on the prevention of VTE in orthopedic surgery. From these, we constructed a table comparing the different antithrombotic regimens during different orthopedic surgical and plaster cast treatments. Eleven guidelines from nine different countries and one international guideline were included. Few guidelines advise on thrombosis prophylaxis after plaster cast immobilization, (prolonged) arthroscopic surgery and isolated lower extremity trauma. Different opinions exist on the sole use of aspirin and mechanical prophylaxis and on the use of vitamin K antagonists after major hip and knee surgery. Based on the same available literature, different guidelines recommend different thromboprophylactic regimens. Ideally, the grade of recommendation should be based on the same level of evidence world-wide. Whilst there is no agreement on the relevance of different endpoints (e.g. asymptomatic DVT), it is very difficult to reach a consensus. Thromboprophylaxis guidelines should be reviewed and updated on a regular basis, because the evidence is evolving rapidly.

Query and Update Efficient B+-Tree Based Indexing of Moving Objects

DEFF Research Database (Denmark)

Jensen, Christian Søndergaard; Lin, Dan; Ooi, Beng Chin

2004-01-01

. This motivates the design of a solution that enables the B+-tree to manage moving objects. We represent moving-object locations as vectors that are timestamped based on their update time. By applying a novel linearization technique to these values, it is possible to index the resulting values using a single B...... are streamed to a database. Indexes for moving objects must support queries efficiently, but must also support frequent updates. Indexes based on minimum bounding regions (MBRs) such as the R-tree exhibit high concurrency overheads during node splitting, and each individual update is known to be quite costly......+-tree that partitions values according to their timestamp and otherwise preserves spatial proximity. We develop algorithms for range and k nearest neighbor queries, as well as continuous queries. The proposal can be grafted into existing database systems cost effectively. An extensive experimental study explores...

Ergonomics in office-based surgery: a survey-guided observational study.

Science.gov (United States)

Esser, Adam C; Koshy, James G; Randle, Henry W

2007-11-01

The practice of office-based surgery is increasing in many specialties. Using Mohs surgery as a model, we investigated the role of ergonomics in office-based surgery to limit work-related musculoskeletal disorders. All Mayo Clinic surgeons currently performing Mohs surgery and Mohs surgeons trained at Mayo Clinic between 1990 and 2004 received a questionnaire survey between May 2003 and September 2004. A sample of respondents were videotaped during surgery. The main outcome measures were survey responses and an ergonomist's identification of potential causes of musculoskeletal disorders. All 17 surgeons surveyed responded. Those surveyed spend a mean of 24 hours per week in surgery. Sixteen said they had symptoms caused by or made worse by performing surgery. Symptom onset occurred on average at age 35.4 years. The most common complaints were pain and stiffness in the neck, shoulders, and lower back and headaches. Videotapes of 6 surgeons revealed problems with operating room setup, awkward posture, forceful exertion, poor positioning, lighting, and duration of procedures. Symptoms of musculoskeletal injuries are common and may begin early in a physician's career. Modifying footwear, flooring, table height, operating position, lighting, and surgical instruments may improve the ergonomics of office-based surgery.

Minimal incision surgery in strabismus: Modified fornix-based approach.

Science.gov (United States)

Pérez-Flores, I

2016-07-01

To evaluate the modified fornix-based technique as an approach for minimal incision surgery in strabismus. The medical records of all consecutive patients that underwent strabismus surgery with fornix-based conjunctival incision between 2007 and 2012 were retrospectively reviewed. As a primary variable, an analysis was made of the wound size depending on the number of stitches. A descriptive study was performed on the variables related to patients and to the type of strabismus and surgery. Out of 153patients identified, 138 with 294 surgeries were included. In 200 (68%) interventions, the incision was sutured with one stitch, in 77 (26.2%) with 2, in 13 (4.4%) with 3, and in 4 (1.4%) with 4, with the mean number of stitches being 1.39±0.64. The mean age of the patients was 39years (2-80), and 36 (26.1%) had previous strabismus surgery, with topical anaesthesia being used in 35 (25.4%) cases. At 3months after surgery deviation was ≤10DP in 114 (82.6%) patients. There were no wound-related complications. The modified fornix-based technique is an effective and safe approach for minimal incision surgery in strabismus, in patients at all ages, with previous history of strabismus surgery and with topical anaesthesia. Copyright © 2015 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

A Kriging Model Based Finite Element Model Updating Method for Damage Detection

Directory of Open Access Journals (Sweden)

Xiuming Yang

2017-10-01

Full Text Available Model updating is an effective means of damage identification and surrogate modeling has attracted considerable attention for saving computational cost in finite element (FE model updating, especially for large-scale structures. In this context, a surrogate model of frequency is normally constructed for damage identification, while the frequency response function (FRF is rarely used as it usually changes dramatically with updating parameters. This paper presents a new surrogate model based model updating method taking advantage of the measured FRFs. The Frequency Domain Assurance Criterion (FDAC is used to build the objective function, whose nonlinear response surface is constructed by the Kriging model. Then, the efficient global optimization (EGO algorithm is introduced to get the model updating results. The proposed method has good accuracy and robustness, which have been verified by a numerical simulation of a cantilever and experimental test data of a laboratory three-story structure.

Exercise-based cardiac rehabilitation after heart valve surgery

DEFF Research Database (Denmark)

Hansen, T B; Zwisler, Ann-Dorthe; Berg, S K

2015-01-01

BACKGROUND: Owing to a lack of evidence, patients undergoing heart valve surgery have been offered exercise-based cardiac rehabilitation (CR) since 2009 based on recommendations for patients with ischaemic heart disease in Denmark. The aim of this study was to investigate the impact of CR...... expensive outpatient visits. Further studies should investigate the benefits of CR to heart valve surgery patients as part of a formal cost-utility analysis....

Guidelines for antibiotic prophylaxis in abdominal surgery for adults

Directory of Open Access Journals (Sweden)

Tadeja Pintar

2014-11-01

Full Text Available Abstract: Background.Evidence based recommendations for antibiotic prophylaxis in abdominal surgery are prepared to reduce postoperative complications and to reduce inappropriate prophylactic antibiotic prescribing. The original guidline address risk factors for surgical site infection (SSI, benefits and risks of antibiotic profilaxis and  indications for surgical antibiotic profilaxis.Update of recommendations is an opportunity to expand and review the evidence supporting recommendations. Recommendations for common surgical procedures in abdominal surgery in adults are included in this guideline.Surgical antibiotic prophylaxis is and adjunct to, not a substitue for, good surgical tecnique. Antibiotic prophylactic should be regarded as one component of an effective policy for the control of healthcare-associated infection. 

Evidence-based surgery

Directory of Open Access Journals (Sweden)

Miran Rems

2007-04-01

Full Text Available Background: Surgery is setting a new ground by the reign of evidence that was brought up by the Evidence Based Medicine (EBM. While experiences and opinion of an expert count the least by the principles of EBM, randomized controlled trials (RCT and other comparative studies have gained their importance. Recommendations that were included in guidelines represent a demanding shift in surgeon’s professional thinking. Their thinking and classical education have not yet been completely based on the results of such studies and are still very very much master-pupil centred. Assessment of someone’s own experiences is threatened by objectivity as negative experiences get recorded in deeper memory. Randomized studies and meta-analyses do appear also in surgery. However, they demand an extra knowledge about critical assessment.Conclusions: Setting a patient to the foreground brings a surgeon’s decision to the field of EBM. The process has already begun and cannot be avoided. Decision hierarchy moves from the experience field to the evidence territory but to a lesser extent when compared to the rest of medicine. There exist objective restrictions with approving a new paradigm. However, these should not stop the process of EBM implementation. Finally, there is an ethic issue to be considered. Too slow activities in research, education and critical assessment can bring the surgeon to the position when a well-informed patient loses his/her trust.

Mechanical bowel preparation for elective colorectal surgery

DEFF Research Database (Denmark)

Guenaga, Katia K F G; Matos, Delcio; Wille-Jørgensen, Peer

2009-01-01

BACKGROUND: The presence of bowel contents during surgery has been related to anastomotic leakage, but the belief that mechanical bowel preparation (MBP) is an efficient agent against leakage and infectious complications is based on observational data and expert opinions only. OBJECTIVES...... with no MBP. Primary outcomes included anastomosis leakage - both rectal and colonic - and combined figures. Secondary outcomes included mortality, peritonitis, reoperation, wound infection, extra-abdominal complications, and overall surgical site infections. DATA COLLECTION AND ANALYSIS: Data were......: Four new trials were included at this update (total 13 RCTs with 4777 participants; 2390 allocated to MBP (Group A), and 2387 to no preparation (Group B), before elective colorectal surgery) .Anastomotic leakage occurred:(i) in 10.0% (14/139) of Group A, compared with 6.6% (9/136) of Group B for low...

Updates in weight loss surgery and gastrointestinal peptides

DEFF Research Database (Denmark)

Svane, Maria Saur; Bojsen-Møller, Kirstine N; Madsbad, Sten

2015-01-01

PURPOSE OF REVIEW: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy are referred to as 'metabolic surgery' due to hormonal shifts with impacts on diabetes remission and weight loss. The purpose of this review is to summarize recent findings in mechanisms underlying beneficial effects...... of weight loss surgery. RECENT FINDINGS: Importantly, gut hormone secretion is altered after RYGB and sleeve gastrectomy due to accelerated transit of nutrients to distal parts of the small intestine, leading to excessive release of L-cell peptide hormones [e.g. glucagon-like peptide-1 (GLP-1), peptide YY......; as demonstrated by relapse of impaired glucose tolerance in studies blocking the GLP-1 receptor by exendin 9-39, and later after major weight loss increased peripheral insulin sensitivity. Gut hormone secretion changes towards a more anorectic profile and is likely important for less caloric intake and weight...

A parallel orbital-updating based plane-wave basis method for electronic structure calculations

International Nuclear Information System (INIS)

Pan, Yan; Dai, Xiaoying; Gironcoli, Stefano de; Gong, Xin-Gao; Rignanese, Gian-Marco; Zhou, Aihui

2017-01-01

Highlights: • Propose three parallel orbital-updating based plane-wave basis methods for electronic structure calculations. • These new methods can avoid the generating of large scale eigenvalue problems and then reduce the computational cost. • These new methods allow for two-level parallelization which is particularly interesting for large scale parallelization. • Numerical experiments show that these new methods are reliable and efficient for large scale calculations on modern supercomputers. - Abstract: Motivated by the recently proposed parallel orbital-updating approach in real space method , we propose a parallel orbital-updating based plane-wave basis method for electronic structure calculations, for solving the corresponding eigenvalue problems. In addition, we propose two new modified parallel orbital-updating methods. Compared to the traditional plane-wave methods, our methods allow for two-level parallelization, which is particularly interesting for large scale parallelization. Numerical experiments show that these new methods are more reliable and efficient for large scale calculations on modern supercomputers.

Virtual reality-based simulators for spine surgery: a systematic review.

Science.gov (United States)

Pfandler, Michael; Lazarovici, Marc; Stefan, Philipp; Wucherer, Patrick; Weigl, Matthias

2017-09-01

Virtual reality (VR)-based simulators offer numerous benefits and are very useful in assessing and training surgical skills. Virtual reality-based simulators are standard in some surgical subspecialties, but their actual use in spinal surgery remains unclear. Currently, only technical reviews of VR-based simulators are available for spinal surgery. Thus, we performed a systematic review that examined the existing research on VR-based simulators in spinal procedures. We also assessed the quality of current studies evaluating VR-based training in spinal surgery. Moreover, we wanted to provide a guide for future studies evaluating VR-based simulators in this field. This is a systematic review of the current scientific literature regarding VR-based simulation in spinal surgery. Five data sources were systematically searched to identify relevant peer-reviewed articles regarding virtual, mixed, or augmented reality-based simulators in spinal surgery. A qualitative data synthesis was performed with particular attention to evaluation approaches and outcomes. Additionally, all included studies were appraised for their quality using the Medical Education Research Study Quality Instrument (MERSQI) tool. The initial review identified 476 abstracts and 63 full texts were then assessed by two reviewers. Finally, 19 studies that examined simulators for the following procedures were selected: pedicle screw placement, vertebroplasty, posterior cervical laminectomy and foraminotomy, lumbar puncture, facet joint injection, and spinal needle insertion and placement. These studies had a low-to-medium methodological quality with a MERSQI mean score of 11.47 out of 18 (standard deviation=1.81). This review described the current state and applications of VR-based simulator training and assessment approaches in spinal procedures. Limitations, strengths, and future advancements of VR-based simulators for training and assessment in spinal surgery were explored. Higher-quality studies with

Architecture of European Plastic Surgery

NARCIS (Netherlands)

Nicolai, J. -P. A.; Banic, A.; Molea, G.; Mazzola, R.; Poell, J. G.

2006-01-01

The architecture of European Plastic Surgery was published in 1996 [Nicolai JPA, Scuderi N. Plastic surgical Europe in an organogram. Eur J Plast Surg 1996; 19: 253-6.] It is the objective of this paper to update information of that article. Continuing medical education (CME), science, training,

Update on value-based medicine.

Science.gov (United States)

Brown, Melissa M; Brown, Gary C

2013-05-01

To update concepts in Value-Based Medicine, especially in view of the Patient Protection and Affordable Care Act. The Patient Protection and Affordable Care Act assures that some variant of Value-Based Medicine cost-utility analysis will play a key role in the healthcare system. It identifies the highest quality care, thereby maximizing the most efficacious use of healthcare resources and empowering patients and physicians.Standardization is critical for the creation and acceptance of a Value-Based Medicine, cost-utility analysis, information system, since 27 million different input variants can go into a cost-utility analysis. Key among such standards is the use of patient preferences (utilities), as patients best understand the quality of life associated with their health states. The inclusion of societal costs, versus direct medical costs alone, demonstrates that medical interventions are more cost effective and, in many instances, provide a net financial return-on-investment to society referent to the direct medical costs expended. Value-Based Medicine provides a standardized methodology, integrating critical, patient, quality-of-life preferences, and societal costs, to allow the highest quality, most cost-effective care. Central to Value-Based Medicine is the concept that all patients deserve the interventions that provide the greatest patient value (improvement in quality of life and/or length of life).

Expanded and updated data and a query pipeline for iBeetle-Base.

Science.gov (United States)

Dönitz, Jürgen; Gerischer, Lizzy; Hahnke, Stefan; Pfeiffer, Stefan; Bucher, Gregor

2018-01-04

The iBeetle-Base provides access to sequence and phenotype information for genes of the beetle Tribolium castaneum. It has been updated including more and updated data and new functions. RNAi phenotypes are now available for >50% of the genes, which represents an expansion of 60% compared to the previous version. Gene sequence information has been updated based on the new official gene set OGS3 and covers all genes. Interoperability with FlyBase has been enhanced: First, gene information pages of homologous genes are interlinked between both databases. Second, some steps of a new query pipeline allow transforming gene lists from either species into lists with related gene IDs, names or GO terms. This facilitates the comparative analysis of gene functions between fly and beetle. The backend of the pipeline is implemented as endpoints of a RESTful interface, such that it can be reused by other projects or tools. A novel online interface allows the community to propose GO terms for their gene of interest expanding the range of animals where GO terms are defined. iBeetle-Base is available at http://ibeetle-base.uni-goettingen.de/. © The Author(s) 2017. Published by Oxford University Press on behalf of Nucleic Acids Research.

Evidence-based guideline update

DEFF Research Database (Denmark)

Tfelt-Hansen, Peer Carsten

2013-01-01

Peer Carsten Tfelt-Hansen, Glostrup, Denmark: According to the recent American Academy of Neurology (AAN) guideline update, a drug can be recommended as possibly effective for migraine prevention if it had demonstrated efficacy in one Class II study.(1) Eight drugs are recommended as possibly...

A Narrative-Expectation-Based Approach to Temporal Update in Discourse Comprehension

Science.gov (United States)

Dery, Jeruen E.; Koenig, Jean-Pierre

2015-01-01

This study concerns the mechanisms involving temporal update in discourse comprehension, comparing traditional approaches based on "Aktionsart" and Iconicity against an approach based on narrative expectations. Our experiments suggest that readers pay more attention to fine-grained discourse properties (such as salient temporal…

Automatic Barometric Updates from Ground-Based Navigational Aids

Science.gov (United States)

1990-03-12

ro fAutomatic Barometric Updates US Department from of Transportation Ground-Based Federal Aviation Administration Navigational Aids Office of Safety...tighter vertical spacing controls , particularly for operations near Terminal Control Areas (TCAs), Airport Radar Service Areas (ARSAs), military climb and...E.F., Ruth, J.C., and Williges, B.H. (1987). Speech Controls and Displays. In Salvendy, G., E. Handbook of Human Factors/Ergonomics, New York, John

Cataract surgery in patients with pseudoexfoliation syndrome: current updates

Directory of Open Access Journals (Sweden)

Fontana L

2017-07-01

Full Text Available Luigi Fontana, Marco Coassin, Alfonso Iovieno, Antonio Moramarco, Luca Cimino Ophthalmology Unit, Arcispedale Santa Maria Nuova – IRCCS, Reggio Emilia, Italy Abstract: Pseudoexfoliation is a ubiquitous syndrome of multifactorial origin affecting elderly people by increasing the risk of cataract and secondary glaucoma development. Despite modern techniques and technologies for cataract surgery, pseudoexfoliation syndrome represents a challenge for surgeons because of the increased weakness of the zonular apparatus and limited pupil dilation. Due to the inherent difficulties during surgery, the risk of vitreous loss in these patients is several times higher than in cataract patients without pseudoexfoliation. Using currently available surgical devices (ophthalmic viscosurgical device, iris retractors and ring dilators, capsular tension ring, etc., the risk of intraoperative complications may be much reduced, allowing the surgeon to handle difficult cases with greater confidence and safety. This review analyzes the methodologic approach to the patient with zonular laxity with the aim of providing useful advices to limit the risks of intraoperative and postoperative complications. From the preoperative planning, to the intraoperative management of the small pupil and phacodonesis, and to the postoperative correction of capsule phimosis and intraocular lens dislocation, a step approach to the surgical management of pseudoexfoliation patients is illustrated. Keywords: pseudoexfoliation syndrome, cataract surgery, zonular laxity, intraocular lens implant, complications

The Development of Time-Based Prospective Memory in Childhood: The Role of Working Memory Updating

Science.gov (United States)

Voigt, Babett; Mahy, Caitlin E. V.; Ellis, Judi; Schnitzspahn, Katharina; Krause, Ivonne; Altgassen, Mareike; Kliegel, Matthias

2014-01-01

This large-scale study examined the development of time-based prospective memory (PM) across childhood and the roles that working memory updating and time monitoring play in driving age effects in PM performance. One hundred and ninety-seven children aged 5 to 14 years completed a time-based PM task where working memory updating load was…

Evidence-based surgery: Dissemination, communication, decision aids

NARCIS (Netherlands)

Knops, A.M.

2013-01-01

Surgeons are expected to make treatment decisions that are based on the best available evidence. Moreover, they are called to recognise that important decisions should also be shared with patients. While dissemination of evidence-based surgery and communication of evidence to patients have been

Exercise-based cardiac rehabilitation for adults after heart valve surgery

DEFF Research Database (Denmark)

Sibilitz, Kirstine Lærum; Berg, Selina Kikkenborg; Tang, Lars Hermann

2016-01-01

BACKGROUND: Exercise-based cardiac rehabilitation may benefit heart valve surgery patients. We conducted a systematic review to assess the evidence for the use of exercise-based intervention programmes following heart valve surgery. OBJECTIVES: To assess the benefits and harms of exercise......-based cardiac rehabilitation compared with no exercise training intervention, or treatment as usual, in adults following heart valve surgery. We considered programmes including exercise training with or without another intervention (such as a psycho-educational component). SEARCH METHODS: We searched...... handsearched Web of Science, bibliographies of systematic reviews and trial registers (ClinicalTrials.gov, Controlled-trials.com, and The World Health Organization International Clinical Trials Registry Platform). SELECTION CRITERIA: We included randomised clinical trials that investigated exercise...

CyanoBase: the cyanobacteria genome database update 2010

OpenAIRE

Nakao, Mitsuteru; Okamoto, Shinobu; Kohara, Mitsuyo; Fujishiro, Tsunakazu; Fujisawa, Takatomo; Sato, Shusei; Tabata, Satoshi; Kaneko, Takakazu; Nakamura, Yasukazu

2009-01-01

CyanoBase (http://genome.kazusa.or.jp/cyanobase) is the genome database for cyanobacteria, which are model organisms for photosynthesis. The database houses cyanobacteria species information, complete genome sequences, genome-scale experiment data, gene information, gene annotations and mutant information. In this version, we updated these datasets and improved the navigation and the visual display of the data views. In addition, a web service API now enables users to retrieve the data in var...

Research of Cadastral Data Modelling and Database Updating Based on Spatio-temporal Process

Directory of Open Access Journals (Sweden)

ZHANG Feng

2016-02-01

Full Text Available The core of modern cadastre management is to renew the cadastre database and keep its currentness,topology consistency and integrity.This paper analyzed the changes and their linkage of various cadastral objects in the update process.Combined object-oriented modeling technique with spatio-temporal objects' evolution express,the paper proposed a cadastral data updating model based on the spatio-temporal process according to people's thought.Change rules based on the spatio-temporal topological relations of evolution cadastral spatio-temporal objects are drafted and further more cascade updating and history back trace of cadastral features,land use and buildings are realized.This model implemented in cadastral management system-ReGIS.Achieved cascade changes are triggered by the direct driving force or perceived external events.The system records spatio-temporal objects' evolution process to facilitate the reconstruction of history,change tracking,analysis and forecasting future changes.

Social media in vascular surgery.

Science.gov (United States)

Indes, Jeffrey E; Gates, Lindsay; Mitchell, Erica L; Muhs, Bart E

2013-04-01

There has been a tremendous growth in the use of social media to expand the visibility of various specialties in medicine. The purpose of this paper is to describe the latest updates on some current applications of social media in the practice of vascular surgery as well as existing limitations of use. This investigation demonstrates that the use of social networking sites appears to have a positive impact on vascular practice, as is evident through the incorporation of this technology at the Cleveland Clinic and by the Society for Vascular Surgery into their approach to patient care and physician communication. Overall, integration of social networking technology has current and future potential to be used to promote goals, patient awareness, recruitment for clinical trials, and professionalism within the specialty of vascular surgery. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Simulation-based certification for cataract surgery

DEFF Research Database (Denmark)

Thomsen, Ann Sofia Skou; Kiilgaard, Jens Folke; Kjaerbo, Hadi

2015-01-01

PURPOSE: To evaluate the EyeSi(™) simulator in regard to assessing competence in cataract surgery. The primary objective was to explore all simulator metrics to establish a proficiency-based test with solid evidence. The secondary objective was to evaluate whether the skill assessment was specific...

Perforated peptic ulcer - an update.

Science.gov (United States)

Chung, Kin Tong; Shelat, Vishalkumar G

2017-01-27

Peptic ulcer disease (PUD) affects 4 million people worldwide annually. The incidence of PUD has been estimated at around 1.5% to 3%. Perforated peptic ulcer (PPU) is a serious complication of PUD and patients with PPU often present with acute abdomen that carries high risk for morbidity and mortality. The lifetime prevalence of perforation in patients with PUD is about 5%. PPU carries a mortality ranging from 1.3% to 20%. Thirty-day mortality rate reaching 20% and 90-d mortality rate of up to 30% have been reported. In this review we have summarized the current evidence on PPU to update readers. This literature review includes the most updated information such as common causes, clinical features, diagnostic methods, non-operative and operative management, post-operative complications and different scoring systems of PPU. With the advancement of medical technology, PUD can now be treated with medications instead of elective surgery. The classic triad of sudden onset of abdominal pain, tachycardia and abdominal rigidity is the hallmark of PPU. Erect chest radiograph may miss 15% of cases with air under the diaphragm in patients with bowel perforation. Early diagnosis, prompt resuscitation and urgent surgical intervention are essential to improve outcomes. Exploratory laparotomy and omental patch repair remains the gold standard. Laparoscopic surgery should be considered when expertise is available. Gastrectomy is recommended in patients with large or malignant ulcer.

Perforated peptic ulcer - an update

Science.gov (United States)

Chung, Kin Tong; Shelat, Vishalkumar G

2017-01-01

Peptic ulcer disease (PUD) affects 4 million people worldwide annually. The incidence of PUD has been estimated at around 1.5% to 3%. Perforated peptic ulcer (PPU) is a serious complication of PUD and patients with PPU often present with acute abdomen that carries high risk for morbidity and mortality. The lifetime prevalence of perforation in patients with PUD is about 5%. PPU carries a mortality ranging from 1.3% to 20%. Thirty-day mortality rate reaching 20% and 90-d mortality rate of up to 30% have been reported. In this review we have summarized the current evidence on PPU to update readers. This literature review includes the most updated information such as common causes, clinical features, diagnostic methods, non-operative and operative management, post-operative complications and different scoring systems of PPU. With the advancement of medical technology, PUD can now be treated with medications instead of elective surgery. The classic triad of sudden onset of abdominal pain, tachycardia and abdominal rigidity is the hallmark of PPU. Erect chest radiograph may miss 15% of cases with air under the diaphragm in patients with bowel perforation. Early diagnosis, prompt resuscitation and urgent surgical intervention are essential to improve outcomes. Exploratory laparotomy and omental patch repair remains the gold standard. Laparoscopic surgery should be considered when expertise is available. Gastrectomy is recommended in patients with large or malignant ulcer. PMID:28138363

Energy Economic Data Base Program (EEDB). Phase V update (1982) report

International Nuclear Information System (INIS)

1983-07-01

This Phase V Update of the Energy Economic Data Base (EEDB) is the latest in a series of cost studies dating back to the late 1960's that have provided the Department of Energy and its predecessor agencies with consistent data on the capital costs of reactor systems of current interest to the Nuclear Energy program and on the comparative costs of large fossil-fueled systems. This report summarizes the detailed data from the EEDB at an intermediate level and summarizes what has been learned from this year's Update. This report also contains fuel cycle and O and M cost data, but the emphasis of the program and the report is on capital costs. The DOE Office of Nuclear Energy summarizes the capital cost data as well as additional fuel cycle and O and M cost data in a separate report, Nuclear Energy Cost Data Base - A Reference Data Base for Nuclear and Coal-Fired Powerplant Power Generation Cost Analysis, DOE/NE-0044

Time to rethink: an evidence-based response from pelvic surgeons to the FDA Safety Communication: "UPDATE on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse".

Science.gov (United States)

Murphy, Miles; Holzberg, Adam; van Raalte, Heather; Kohli, Neeraj; Goldman, Howard B; Lucente, Vincent

2012-01-01

In July of 2011 the U.S. Food and Drug Administration (FDA) released a safety communication entitled "UPDATE on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse." The stated purpose of this communication is to inform health care providers and patients that serious complications with placement of this mesh are not rare and that it is not clear that these repairs are more effective than nonmesh repair. The comments regarding efficacy are based on a systematic review of the scientific literature from 1996-2011 conducted by the FDA. Our review of the literature during this time yields some different conclusions regarding the safety and efficacy of mesh use in prolapse repair. It may be useful to consider this information prior to making recommendations regarding mesh use in prolapse surgery according to the recent UPDATE.

Dutch Lung Surgery Audit: A National Audit Comprising Lung and Thoracic Surgery Patients.

Science.gov (United States)

Berge, Martijn Ten; Beck, Naomi; Heineman, David Jonathan; Damhuis, Ronald; Steup, Willem Hans; van Huijstee, Pieter Jan; Eerenberg, Jan Peter; Veen, Eelco; Maat, Alexander; Versteegh, Michel; van Brakel, Thomas; Schreurs, Wilhemina Hendrika; Wouters, Michel Wilhelmus

2018-04-21

The nationwide Dutch Lung Surgery Audit (DLSA) started in 2012 to monitor and evaluate the quality of lung surgery in the Netherlands as an improvement tool. This outline describes the establishment, structure and organization of the audit by the Dutch Society of Lung Surgeons (NVvL) and the Dutch Society of Cardiothoracic Surgeons (NVT), in collaboration with the Dutch Institute for Clinical Auditing (DICA). In addition, first four-year results are presented. The NVvL and NVT initiated a web-based registration including weekly updated online feedback for participating hospitals. Data verification by external data managers is performed on regular basis. The audit is incorporated in national quality improvement programs and participation in the DLSA is mandatory by health insurance organizations and the National Healthcare Inspectorate. Between 1 January 2012 and 31 December 2015, all hospitals performing lung surgery participated and a total of 19,557 patients were registered from which almost half comprised lung cancer patients. Nationwide the guideline adherence increased over the years and 96.5% of lung cancer patients were discussed in preoperative multidisciplinary teams. Overall postoperative complications and mortality after non-small cell lung cancer surgery were 15.5% and 2.0%, respectively. The audit provides reliable benchmarked information for caregivers and hospital management with potential to start local, regional or national improvement initiatives. Currently, the audit is further completed with data from non-surgical lung cancer patients including treatment data from pulmonary oncologists and radiation oncologists. This will ultimately provide a comprehensive overview of lung cancer treatment in The Netherlands. Copyright © 2018. Published by Elsevier Inc.

Tourette's Disorder: Genetic Update, Neurological Correlates, and Evidence-Based Interventions

Science.gov (United States)

Phelps, LeAdelle

2008-01-01

This article provides an update of the search for genetic markers related to Tourette's Disorder. The probable neurophysiology of the disorder is reviewed. Frequently prescribed medications are related to the probable biological bases of the disorder. Behavioral interventions and assessment tools are examined. It is concluded that evidence based…

Fast-track surgery-an update on physiological care principles to enhance recovery

DEFF Research Database (Denmark)

Kehlet, Henrik

2011-01-01

INTRODUCTION: The concept of fast-track surgery (enhanced recovery programs) has been evolved and been documented to be successful by decreasing length of stay, morbidity and convalescence across procedures. FUTURE STRATEGIES: However, there are several possibilities for further improvement of mo...... of the components of fast-track surgery, where surgical stress, fluid and pain management are key factors. There is an urgent need for better design of studies, especially in minimal invasive surgery to achieve maximal outcome effects when integrated into the fast-track methodology....

Surgery on Fetus Reduces Complications of Spina Bifida

Medline Plus

Full Text Available ... is no longer being updated. Video: Surgery on Fetus Reduces Complications of Spina Bifida Wednesday, March 9, ... Institutes of Health and four research institutions. The fetal surgical procedure also increases the chances that a ...

CyanoBase: the cyanobacteria genome database update 2010.

Science.gov (United States)

Nakao, Mitsuteru; Okamoto, Shinobu; Kohara, Mitsuyo; Fujishiro, Tsunakazu; Fujisawa, Takatomo; Sato, Shusei; Tabata, Satoshi; Kaneko, Takakazu; Nakamura, Yasukazu

2010-01-01

CyanoBase (http://genome.kazusa.or.jp/cyanobase) is the genome database for cyanobacteria, which are model organisms for photosynthesis. The database houses cyanobacteria species information, complete genome sequences, genome-scale experiment data, gene information, gene annotations and mutant information. In this version, we updated these datasets and improved the navigation and the visual display of the data views. In addition, a web service API now enables users to retrieve the data in various formats with other tools, seamlessly.

A Population-Based Analysis of Time to Surgery and Travel Distances for Brachial Plexus Surgery.

Science.gov (United States)

Dy, Christopher J; Baty, Jack; Saeed, Mohammed J; Olsen, Margaret A; Osei, Daniel A

2016-09-01

Despite the importance of timely evaluation for patients with brachial plexus injuries (BPIs), in clinical practice we have noted delays in referral. Because the published BPI experience is largely from individual centers, we used a population-based approach to evaluate the delivery of care for patients with BPI. We used statewide administrative databases from Florida (2007-2013), New York (2008-2012), and North Carolina (2009-2010) to create a cohort of patients who underwent surgery for BPI (exploration, repair, neurolysis, grafting, or nerve transfer). Emergency department and inpatient records were used to determine the time interval between the injury and surgical treatment. Distances between treating hospitals and between the patient's home ZIP code and the surgical hospital were recorded. A multivariable logistic regression model was used to determine predictors for time from injury to surgery exceeding 365 days. Within the 222 patients in our cohort, median time from injury to surgery was 7.6 months and exceeded 365 days in 29% (64 of 222 patients) of cases. Treatment at a smaller hospital for the initial injury was significantly associated with surgery beyond 365 days after injury. Patient insurance type, travel distance for surgery, distance between the 2 treating hospitals, and changing hospitals between injury and surgery did not significantly influence time to surgery. Nearly one third of patients in Florida, New York, and North Carolina underwent BPI surgery more than 1 year after the injury. Patients initially treated at smaller hospitals are at risk for undergoing delayed BPI surgery. These findings can inform administrative and policy efforts to expedite timely referral of patients with BPI to experienced centers. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Surgery on Fetus Reduces Complications of Spina Bifida

Medline Plus

Full Text Available ... This page is no longer being updated. Video: Surgery on Fetus Reduces Complications of Spina Bifida Wednesday, ... the NICHD, describes the study’s findings. Read the Management of Myelomeningocele Study (MOMS) Interview text alternative . The ...

Robotic Anterior and Midline Skull Base Surgery: Preclinical Investigations

International Nuclear Information System (INIS)

O'Malley, Bert W.; Weinstein, Gregory S.

2007-01-01

Purpose: To develop a minimally invasive surgical technique to access the midline and anterior skull base using the optical and technical advantages of robotic surgical instrumentation. Methods and Materials: Ten experimental procedures focusing on approaches to the nasopharynx, clivus, sphenoid, pituitary sella, and suprasellar regions were performed on one cadaver and one live mongrel dog. Both the cadaver and canine procedures were performed in an approved training facility using the da Vinci Surgical Robot. For the canine experiments, a transoral robotic surgery (TORS) approach was used, and for the cadaver a newly developed combined cervical-transoral robotic surgery (C-TORS) approach was investigated and compared with standard TORS. The ability to access and dissect tissues within the various areas of the midline and anterior skull base were evaluated, and techniques to enhance visualization and instrumentation were developed. Results: Standard TORS approaches did not provide adequate access to the midline and anterior skull base; however, the newly developed C-TORS approach was successful in providing the surgical access to these regions of the skull base. Conclusion: Robotic surgery is an exciting minimally invasive approach to the skull base that warrants continued preclinical investigation and development

Frequency response function (FRF) based updating of a laser spot welded structure

Science.gov (United States)

Zin, M. S. Mohd; Rani, M. N. Abdul; Yunus, M. A.; Sani, M. S. M.; Wan Iskandar Mirza, W. I. I.; Mat Isa, A. A.

2018-04-01

The objective of this paper is to present frequency response function (FRF) based updating as a method for matching the finite element (FE) model of a laser spot welded structure with a physical test structure. The FE model of the welded structure was developed using CQUAD4 and CWELD element connectors, and NASTRAN was used to calculate the natural frequencies, mode shapes and FRF. Minimization of the discrepancies between the finite element and experimental FRFs was carried out using the exceptional numerical capability of NASTRAN Sol 200. The experimental work was performed under free-free boundary conditions using LMS SCADAS. Avast improvement in the finite element FRF was achieved using the frequency response function (FRF) based updating with two different objective functions proposed.

A checklist for endonasal transsphenoidal anterior skull base surgery.

Science.gov (United States)

Laws, Edward R; Wong, Judith M; Smith, Timothy R; de Los Reyes, Kenneth; Aglio, Linda S; Thorne, Alison J; Cote, David J; Esposito, Felice; Cappabianca, Paolo; Gawande, Atul

2016-06-01

OBJECT Approximately 250 million surgical procedures are performed annually worldwide, and data suggest that major complications occur in 3%-17% of them. Many of these complications can be classified as avoidable, and previous studies have demonstrated that preoperative checklists improve operating room teamwork and decrease complication rates. Although the authors' institution has instituted a general preoperative "time-out" designed to streamline communication, flatten vertical authority gradients, and decrease procedural errors, there is no specific checklist for transnasal transsphenoidal anterior skull base surgery, with or without endoscopy. Such minimally invasive cranial surgery uses a completely different conceptual approach, set-up, instrumentation, and operative procedure. Therefore, it can be associated with different types of complications as compared with open cranial surgery. The authors hypothesized that a detailed, procedure-specific, preoperative checklist would be useful to reduce errors, improve outcomes, decrease delays, and maximize both teambuilding and operational efficiency. Thus, the object of this study was to develop such a checklist for endonasal transsphenoidal anterior skull base surgery. METHODS An expert panel was convened that consisted of all members of the typical surgical team for transsphenoidal endoscopic cases: neurosurgeons, anesthesiologists, circulating nurses, scrub technicians, surgical operations managers, and technical assistants. Beginning with a general checklist, procedure-specific items were added and categorized into 4 pauses: Anesthesia Pause, Surgical Pause, Equipment Pause, and Closure Pause. RESULTS The final endonasal transsphenoidal anterior skull base surgery checklist is composed of the following 4 pauses. The Anesthesia Pause consists of patient identification, diagnosis, pertinent laboratory studies, medications, surgical preparation, patient positioning, intravenous/arterial access, fluid management

Stem cells: Update and impact on craniofacial surgery

OpenAIRE

Levi, Benjamin; Glotzbach, Jason; Wong, Victor; Nelson, Emily; Hyun, Jeong; Wan, Derrick C.; Gurtner, Geoffrey C.; Longaker, Michael T.

2012-01-01

With the rapidly expanding field of tissue engineering, surgeons have been eager to apply these principles to craniofacial surgery. Tissue engineering strategies combine the use of a cell type placed on a scaffold and subsequently implanted in vivo to address a tissue defect or tissue dysfunction. In this review we will discuss the current clinical need for skeletal and soft tissue engineering faced by craniofacial surgeons and subsequently we will explore cell types and scaffold designs bein...

Reliability based Robustness of Timber Structures through NDT Data Updating

DEFF Research Database (Denmark)

Sousa, Hélder S.; Sørensen, John Dalsgaard; Kirkegaard, Poul Henning

2011-01-01

This work presents a framework for reliability-based assessment of timber structures / members using data gathered from non-destructive test results. These results are used for modeling an update of the mechanical characteristics of timber, using Bayesian methods. Results gathered from ultrasound...... of the structure, thus, being possible to evaluate reliability based in time dependent factors, as well to categorize that structure in terms of robustness. For exemplification of the underlined concepts, three different types of structures are studied....

Clinical Practice Guideline: Hoarseness (Dysphonia) (Update).

Science.gov (United States)

Stachler, Robert J; Francis, David O; Schwartz, Seth R; Damask, Cecelia C; Digoy, German P; Krouse, Helene J; McCoy, Scott J; Ouellette, Daniel R; Patel, Rita R; Reavis, Charles Charlie W; Smith, Libby J; Smith, Marshall; Strode, Steven W; Woo, Peak; Nnacheta, Lorraine C

2018-03-01

Objective This guideline provides evidence-based recommendations on treating patients who present with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology-head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include, but are not limited to, recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a

From time-based to competency-based standards: core transitional competencies in plastic surgery.

Science.gov (United States)

Lutz, Kristina; Yazdani, Arjang; Ross, Douglas

2015-01-01

Competency-based medical education is becoming increasingly prevalent and is likely to be mandated by the Royal College in the near future. The objective of this study was to define the core technical competencies that should be possessed by plastic surgery residents as they transition into their senior (presently postgraduate year 3) years of training. A list of potential core competencies was generated using a modified Delphi method that included the investigators and 6 experienced, academic plastic surgeons from across Canada and the United States. Generated items were divided into 7 domains: basic surgical skills, anesthesia, hand surgery, cutaneous surgery, esthetic surgery, breast surgery, and craniofacial surgery. Members of the Delphi group were asked to rank particular skills on a 4-point scale with anchored descriptors. Item reduction resulted in a survey consisting of 48 skills grouped into the aforementioned domains. This self-administered survey was distributed to all Canadian program directors (n = 11) via e-mail for validation and further item reduction. The response rate was 100% (11/11). Using the average rankings of program directors, 26 "core" skills were identified. There was agreement of core skills across all domains except for breast surgery and esthetic surgery. Of them, 7 skills were determined to be above the level of a trainee at this stage; a further 15 skills were agreed to be important, but not core, competencies. Overall, 26 competencies have been identified as "core" for plastic surgery residents to possess as they begin their senior, on-service years. The nature of these skills makes them suitable for teaching in a formal, simulated environment, which would ensure that all plastic surgery trainees are competent in these tasks as they transition to their senior years of residency. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Interrupted object-based updating of reach program leads to a negative compatibility effect.

Science.gov (United States)

Vainio, Lari

2009-07-01

The author investigated how the motor program elicited by an object's orientation is updated by object-based information while a participant reaches for the object. Participants selected the hand of response according to the thickness of the graspable object and then reached toward the location in which the object appeared. Reach initiation times decreased when the handle of the object was oriented toward the responding hand. This positive compatibility effect turned into a negative compatibility effect (NCE) during reach execution when the object was removed from the display 300 ms after object onset or replaced with a mask at movement onset. The results demonstrate that interrupted object-based updating of an ongoing reach movement triggers the NCE.

Primary Anorectal Melanoma: An Update

Directory of Open Access Journals (Sweden)

P Carcoforo, M.T Raiji, G.M Palini, M Pedriali, U Maestroni, G Soliani, A Detroia, M.V Zanzi, A.L Manna, J.G Crompton, R.C Langan, A Stojadinovic, I Avital

2012-01-01

Full Text Available The anorectum is a rare anatomic location for primary melanoma. Mucosal melanoma is a distinct biological and clinical entity from the more common cutaneous melanoma. It portrays worse prognosis than cutaneous melanoma, with distant metastases being the overwhelming cause of morbidity and mortality. Surgery is the treatment of choice, but significant controversy exists over the extent of surgical resection. We present an update on the state of the art of anorectal mucosal melanoma. To illustrate the multimodality approach to anorectal melanoma, we present a typical patient.

Impact of Milrinone Administration in Adult Cardiac Surgery Patients: Updated Meta-Analysis.

Science.gov (United States)

Ushio, Masahiro; Egi, Moritoki; Wakabayashi, Junji; Nishimura, Taichi; Miyatake, Yuji; Obata, Norihiko; Mizobuchi, Satoshi

2016-12-01

To determine the effects of milrinone on short-term mortality in cardiac surgery patients with focus on the presence or absence of heterogeneity of the effect. A systematic review and meta-analysis. Five hundred thirty-seven adult cardiac surgery patients from 12 RCTs. Milrinone administration. The authors conducted a systematic Medline and Pubmed search to assess the effect of milrinone on short-term mortality in adult cardiac surgery patients. Subanalysis was performed according to the timing for commencement of milrinone administration and the type of comparators. The primary outcome was any short-term mortality. Overall analysis showed no difference in mortality rates in patients who received milrinone and patients who received comparators (odds ratio = 1.25, 95% CI 0.45-3.51, p = 0.67). In subanalysis for the timing to commence milrinone administration and the type of comparators, odds ratio for mortality varied from 0.19 (placebo as control drug, start of administration after cardiopulmonary bypass) to 2.58 (levosimendan as control drug, start of administration after cardiopulmonary bypass). Among RCTs to assess the effect of milrinone administration in adult cardiac surgery patients, there are wide variations of the odds ratios of administration of milrinone for short-term mortality according to the comparators and the timing of administration. This fact may suggest that a simple pooling meta-analysis is not applicable for assessing the risk and benefit of milrinone administration in an adult cardiac surgery cohort. Copyright © 2016 Elsevier Inc. All rights reserved.

How does 'metabolic surgery' work its magic? New evidence for gut microbiota.

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Peck, Bailey C E; Seeley, Randy J

2018-04-01

Metabolic surgery is recommended for the treatment of type 2 diabetes for its potent ability to improve glycemic control. However, the mechanisms underlying the beneficial effects of metabolic surgery are still under investigation. We provide an updated review of recent studies into the molecular underpinnings of metabolic surgery, focusing in on what is known about the role of gut microbiota. Over the last 7 years several reports have been published on the topic, however the field is expanding rapidly. Studies have now linked the regulation of glucose and lipid metabolism, neuronal and intestinal adaptations, and hormonal and nutrient signaling pathways to gut microbiota. Given that the composition of gut microbiota is altered by metabolic surgery, investigating the potential mechanism and outcomes of this change are now a priority to the field. As evidence for a role for microbiota builds, we expect future patients may receive microbe-based therapeutics to improve surgical outcomes and perhaps one day preclude the need for surgical therapies all together. In this review and perspective, we evaluate the current state of the field and its future.

Estimation of beam material random field properties via sensitivity-based model updating using experimental frequency response functions

Science.gov (United States)

Machado, M. R.; Adhikari, S.; Dos Santos, J. M. C.; Arruda, J. R. F.

2018-03-01

Structural parameter estimation is affected not only by measurement noise but also by unknown uncertainties which are present in the system. Deterministic structural model updating methods minimise the difference between experimentally measured data and computational prediction. Sensitivity-based methods are very efficient in solving structural model updating problems. Material and geometrical parameters of the structure such as Poisson's ratio, Young's modulus, mass density, modal damping, etc. are usually considered deterministic and homogeneous. In this paper, the distributed and non-homogeneous characteristics of these parameters are considered in the model updating. The parameters are taken as spatially correlated random fields and are expanded in a spectral Karhunen-Loève (KL) decomposition. Using the KL expansion, the spectral dynamic stiffness matrix of the beam is expanded as a series in terms of discretized parameters, which can be estimated using sensitivity-based model updating techniques. Numerical and experimental tests involving a beam with distributed bending rigidity and mass density are used to verify the proposed method. This extension of standard model updating procedures can enhance the dynamic description of structural dynamic models.

Concepts of incremental updating and versioning

CSIR Research Space (South Africa)

Cooper, Antony K

2004-07-01

Full Text Available of the work undertaken recently by the Working Group (WG). The WG was voted for a Commission by the General Assembly held at the 21st ICC in Durban, South Africa. The basic problem being addressed by the Commission is that a user compiles their data base... or election). Historically, updates have been provided in bulk, with the new data set replacing the old one. User could: ignore update (if it is not significant enough), manually (and selectively) update their data base, or accept the whole update...

Augmented reality-assisted skull base surgery.

Science.gov (United States)

Cabrilo, I; Sarrafzadeh, A; Bijlenga, P; Landis, B N; Schaller, K

2014-12-01

Neuronavigation is widely considered as a valuable tool during skull base surgery. Advances in neuronavigation technology, with the integration of augmented reality, present advantages over traditional point-based neuronavigation. However, this development has not yet made its way into routine surgical practice, possibly due to a lack of acquaintance with these systems. In this report, we illustrate the usefulness and easy application of augmented reality-based neuronavigation through a case example of a patient with a clivus chordoma. We also demonstrate how augmented reality can help throughout all phases of a skull base procedure, from the verification of neuronavigation accuracy to intraoperative image-guidance. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Cataract surgery in a population-based cohort of patients with type 1 diabetes

DEFF Research Database (Denmark)

Grauslund, Jakob; Green, Anders; Sjølie, Anne K

2011-01-01

.05-3.40) were the only statistically significant predictors of cataract surgery. Duration of diabetes, gender, glycaemic regulation, proteinuria, smoking, blood pressure and level of retinopathy were not associated with cataract surgery. Conclusion: Type 1 diabetes is associated with a high long-term incidence......ABSTRACT. Purpose: To estimate the long-term cumulative incidence of cataract surgery and associated risk factors in a 25-year follow-up of a population-based cohort of patients with type 1 diabetes. Methods: Based on insulin prescriptions, a population-based cohort of 727 patients with type 1...... of surgery were 59.3 and 42 years, respectively. Cataract surgery in the cohort took place approximately 20 years earlier compared to non-diabetic persons. In a multivariate regression analysis, baseline age [hazard ratio (HR) 1.89 per 10 years, 95% CI 1.46-2.27] and maculopathy (HR 1.89, 95% CI 1...

A new frequency matching technique for FRF-based model updating

Science.gov (United States)

Yang, Xiuming; Guo, Xinglin; Ouyang, Huajiang; Li, Dongsheng

2017-05-01

Frequency Response Function (FRF) residues have been widely used to update Finite Element models. They are a kind of original measurement information and have the advantages of rich data and no extraction errors, etc. However, like other sensitivity-based methods, an FRF-based identification method also needs to face the ill-conditioning problem which is even more serious since the sensitivity of the FRF in the vicinity of a resonance is much greater than elsewhere. Furthermore, for a given frequency measurement, directly using a theoretical FRF at a frequency may lead to a huge difference between the theoretical FRF and the corresponding experimental FRF which finally results in larger effects of measurement errors and damping. Hence in the solution process, correct selection of the appropriate frequency to get the theoretical FRF in every iteration in the sensitivity-based approach is an effective way to improve the robustness of an FRF-based algorithm. A primary tool for right frequency selection based on the correlation of FRFs is the Frequency Domain Assurance Criterion. This paper presents a new frequency selection method which directly finds the frequency that minimizes the difference of the order of magnitude between the theoretical and experimental FRFs. A simulated truss structure is used to compare the performance of different frequency selection methods. For the sake of reality, it is assumed that not all the degrees of freedom (DoFs) are available for measurement. The minimum number of DoFs required in each approach to correctly update the analytical model is regarded as the right identification standard.

Valence-Dependent Belief Updating: Computational Validation

Directory of Open Access Journals (Sweden)

Bojana Kuzmanovic

2017-06-01

Full Text Available People tend to update beliefs about their future outcomes in a valence-dependent way: they are likely to incorporate good news and to neglect bad news. However, belief formation is a complex process which depends not only on motivational factors such as the desire for favorable conclusions, but also on multiple cognitive variables such as prior beliefs, knowledge about personal vulnerabilities and resources, and the size of the probabilities and estimation errors. Thus, we applied computational modeling in order to test for valence-induced biases in updating while formally controlling for relevant cognitive factors. We compared biased and unbiased Bayesian models of belief updating, and specified alternative models based on reinforcement learning. The experiment consisted of 80 trials with 80 different adverse future life events. In each trial, participants estimated the base rate of one of these events and estimated their own risk of experiencing the event before and after being confronted with the actual base rate. Belief updates corresponded to the difference between the two self-risk estimates. Valence-dependent updating was assessed by comparing trials with good news (better-than-expected base rates with trials with bad news (worse-than-expected base rates. After receiving bad relative to good news, participants' updates were smaller and deviated more strongly from rational Bayesian predictions, indicating a valence-induced bias. Model comparison revealed that the biased (i.e., optimistic Bayesian model of belief updating better accounted for data than the unbiased (i.e., rational Bayesian model, confirming that the valence of the new information influenced the amount of updating. Moreover, alternative computational modeling based on reinforcement learning demonstrated higher learning rates for good than for bad news, as well as a moderating role of personal knowledge. Finally, in this specific experimental context, the approach based on

Operating Room Performance Improves after Proficiency-Based Virtual Reality Cataract Surgery Training

DEFF Research Database (Denmark)

Thomsen, Ann Sofia Skou; Bach-Holm, Daniella; Kjærbo, Hadi

2017-01-01

PURPOSE: To investigate the effect of virtual reality proficiency-based training on actual cataract surgery performance. The secondary purpose of the study was to define which surgeons benefit from virtual reality training. DESIGN: Multicenter masked clinical trial. PARTICIPANTS: Eighteen cataract...... surgeons with different levels of experience. METHODS: Cataract surgical training on a virtual reality simulator (EyeSi) until a proficiency-based test was passed. MAIN OUTCOME MEASURES: Technical performance in the operating room (OR) assessed by 3 independent, masked raters using a previously validated...... task-specific assessment tool for cataract surgery (Objective Structured Assessment of Cataract Surgical Skill). Three surgeries before and 3 surgeries after the virtual reality training were video-recorded, anonymized, and presented to the raters in random order. RESULTS: Novices (non...

Value-based assessment of robotic pancreas and liver surgery.

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Patti, James C; Ore, Ana Sofia; Barrows, Courtney; Velanovich, Vic; Moser, A James

2017-08-01

Current healthcare economic evaluations are based only on the perspective of a single stakeholder to the healthcare delivery process. A true value-based decision incorporates all of the outcomes that could be impacted by a single episode of surgical care. We define the value proposition for robotic surgery using a stakeholder model incorporating the interests of all groups participating in the provision of healthcare services: patients, surgeons, hospitals and payers. One of the developing and expanding fields that could benefit the most from a complete value-based analysis is robotic hepatopancreaticobiliary (HPB) surgery. While initial robot purchasing costs are high, the benefits over laparoscopic surgery are considerable. Performing a literature search we found a total of 18 economic evaluations for robotic HPB surgery. We found a lack of evaluations that were carried out from a perspective that incorporates all of the impacts of a single episode of surgical care and that included a comprehensive hospital cost assessment. For distal pancreatectomies, the two most thorough examinations came to conflicting results regarding total cost savings compared to laparoscopic approaches. The most thorough pancreaticoduodenectomy evaluation found non-significant savings for total hospital costs. Robotic hepatectomies showed no cost savings over laparoscopic and only modest savings over open techniques. Lastly, robotic cholecystectomies were found to be more expensive than the gold-standard laparoscopic approach. Existing cost accounting data associated with robotic HPB surgery is incomplete and unlikely to reflect the state of this field in the future. Current data combines the learning curves for new surgical procedures being undertaken by HPB surgeons with costs derived from a market dominated by a single supplier of robotic instruments. As a result, the value proposition for stakeholders in this process cannot be defined. In order to solve this problem, future studies

World Allergy Organization Anaphylaxis Guidelines: 2013 update of the evidence base.

Science.gov (United States)

Simons, F Estelle R; Ardusso, Ledit R F; Dimov, Vesselin; Ebisawa, Motohiro; El-Gamal, Yehia M; Lockey, Richard F; Sanchez-Borges, Mario; Senna, Gian Enrico; Sheikh, Aziz; Thong, Bernard Y; Worm, Margitta

2013-01-01

The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis are a widely disseminated and used resource for information about anaphylaxis. They focus on patients at risk, triggers, clinical diagnosis, treatment in health care settings, self-treatment in the community, and prevention of recurrences. Their unique strengths include a global perspective informed by prior research on the global availability of essentials for anaphylaxis assessment and management and a global agenda for anaphylaxis research. Additionally, detailed colored illustrations are linked to key concepts in the text [Simons et al.: J Allergy Clin Immunol 2011;127:593.e1-e22]. The recommendations in the original WAO Anaphylaxis Guidelines for management of anaphylaxis in health care settings and community settings were based on evidence published in peer-reviewed, indexed medical journals to the end of 2010. These recommendations remain unchanged and clinically relevant. An update of the evidence base was published in 2012 [Simons et al.: Curr Opin Allergy Clin Immunol 2012;12:389-399]. In 2012 and early 2013, major advances were reported in the following areas: further characterization of patient phenotypes; development of in vitro tests (for some allergens) that help distinguish clinical risk of anaphylaxis from asymptomatic sensitization; epinephrine (adrenaline) research, including studies of a new epinephrine auto-injector for use in community settings, and randomized controlled trials of immunotherapy to prevent food-induced anaphylaxis. Despite these advances, the need for additional prospective studies, including randomized controlled trials of interventions in anaphylaxis is increasingly apparent. This 2013 Update highlights publications from 2012 and 2013 that further contribute to the evidence base for the recommendations made in the original WAO Anaphylaxis Guidelines. Ideally, it should be used in conjunction with these Guidelines and with the 2012

Probabilistic Fatigue Life Updating for Railway Bridges Based on Local Inspection and Repair.

Science.gov (United States)

Lee, Young-Joo; Kim, Robin E; Suh, Wonho; Park, Kiwon

2017-04-24

Railway bridges are exposed to repeated train loads, which may cause fatigue failure. As critical links in a transportation network, railway bridges are expected to survive for a target period of time, but sometimes they fail earlier than expected. To guarantee the target bridge life, bridge maintenance activities such as local inspection and repair should be undertaken properly. However, this is a challenging task because there are various sources of uncertainty associated with aging bridges, train loads, environmental conditions, and maintenance work. Therefore, to perform optimal risk-based maintenance of railway bridges, it is essential to estimate the probabilistic fatigue life of a railway bridge and update the life information based on the results of local inspections and repair. Recently, a system reliability approach was proposed to evaluate the fatigue failure risk of structural systems and update the prior risk information in various inspection scenarios. However, this approach can handle only a constant-amplitude load and has limitations in considering a cyclic load with varying amplitude levels, which is the major loading pattern generated by train traffic. In addition, it is not feasible to update the prior risk information after bridges are repaired. In this research, the system reliability approach is further developed so that it can handle a varying-amplitude load and update the system-level risk of fatigue failure for railway bridges after inspection and repair. The proposed method is applied to a numerical example of an in-service railway bridge, and the effects of inspection and repair on the probabilistic fatigue life are discussed.

Combining Multi-Source Remotely Sensed Data and a Process-Based Model for Forest Aboveground Biomass Updating.

Science.gov (United States)

Lu, Xiaoman; Zheng, Guang; Miller, Colton; Alvarado, Ernesto

2017-09-08

Monitoring and understanding the spatio-temporal variations of forest aboveground biomass (AGB) is a key basis to quantitatively assess the carbon sequestration capacity of a forest ecosystem. To map and update forest AGB in the Greater Khingan Mountains (GKM) of China, this work proposes a physical-based approach. Based on the baseline forest AGB from Landsat Enhanced Thematic Mapper Plus (ETM+) images in 2008, we dynamically updated the annual forest AGB from 2009 to 2012 by adding the annual AGB increment (ABI) obtained from the simulated daily and annual net primary productivity (NPP) using the Boreal Ecosystem Productivity Simulator (BEPS) model. The 2012 result was validated by both field- and aerial laser scanning (ALS)-based AGBs. The predicted forest AGB for 2012 estimated from the process-based model can explain 31% ( n = 35, p forest AGBs, respectively. However, due to the saturation of optical remote sensing-based spectral signals and contribution of understory vegetation, the BEPS-based AGB tended to underestimate/overestimate the AGB for dense/sparse forests. Generally, our results showed that the remotely sensed forest AGB estimates could serve as the initial carbon pool to parameterize the process-based model for NPP simulation, and the combination of the baseline forest AGB and BEPS model could effectively update the spatiotemporal distribution of forest AGB.

The pioneering contribution of italian surgeons to skull base surgery.

Science.gov (United States)

Priola, Stefano M; Raffa, Giovanni; Abbritti, Rosaria V; Merlo, Lucia; Angileri, Filippo F; La Torre, Domenico; Conti, Alfredo; Germanò, Antonino; Tomasello, Francesco

2014-01-01

The origin of neurosurgery as a modern, successful, and separate branch of surgery could be dated back to the end of the 19th century. The most important development of surgery occurred in Europe, particularly in Italy, where there was a unique environment, allowing brilliant open-minded surgeons to perform, with success, neurosurgical operations. Neurosurgery began at the skull base. In everyday practice, we still pay tribute to early Italian neuroanatomists and pioneer neurosurgeons who represented a starting point in a new, obscure, and still challenging field of medicine and surgery during their times. In this paper, we report at a glance the contributions of Tito Vanzetti from Padua (1809-1888), for his operation on a destructive skull base cyst that had, indeed, an intracranial expansion; of Davide Giordano (1864-1954) from Venice, who described the first transnasal approach to the pituitary gland; and, most importantly, of Francesco Durante from Messina (1844-1934), who was the first surgeon in the history of neurosurgery to successfully remove a cranial base meningioma. They carried out the first detailed reported surgical excision of intracranial lesions at the skull base, diagnosed only through clinical signs; used many of the advances of the 19th century; and conceived and performed new operative strategies and approaches. Their operations were radical enough to allow the patient to survive the surgery and, in the case of Durante, for the first time, to obtain more than 12 years of good survival at a time when a tumor of this type would have been fatal. Copyright © 2014 Elsevier Inc. All rights reserved.

Outpatient- and inpatient-based buckling surgery: a comparative study

Directory of Open Access Journals (Sweden)

Lee JC

2014-04-01

Full Text Available Jin Cheol Lee,* Yu Cheol Kim*Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea *Both authors contributed equally to this workPurpose: To evaluate the clinical outcomes of ambulatory buckling surgery, comparing outpatient- with inpatient-based surgery.Methods: The authors performed a retrospective study of 80 consecutive cases of rhegmato genous retinal detachment from January 2009 to December 2011 treated by scleral buckling surgery. Two groups of patients were defined according to inpatient (group 1 or outpatient (group 2 surgery, and a comparison of several parameters between these two groups was performed.Results: Of the 80 subjects in this study, the average age of group 1 (50 patients was 49.7 years, and that of group 2 (30 patients was 47.5 years. There were no statistically significant differences in the average logarithm of the minimum angle of resolution-visual acuity, the condition of the lens, or the presence of retinal lattice degeneration prior to the surgery between the groups. There were no statistically significant differences in the patterns of tear or retinal detachment or in surgical procedure between the groups. Comparing the best-corrected visual acuity after 6 months with that prior to the surgery, the changes in group 1 and group 2 were 0.26 and 0.31, respectively. The functional success rates of group 1 and group 2 after 6 months were 90% and 93%, respectively, and the anatomical success rates of group 1 and group 2 after 6 months were 94% and 96%, respectively, but these were also statistically insignificant.Conclusion: Hospitalization is not essential for buckling surgery in uncomplicated rhegmatogenous retinal detachment surgery.Keywords: ambulatory, scleral buckling, rhegmatogenous retinal detachment

Clinical Practice Guideline: Hoarseness (Dysphonia) (Update) Executive Summary.

Science.gov (United States)

Stachler, Robert J; Francis, David O; Schwartz, Seth R; Damask, Cecelia C; Digoy, German P; Krouse, Helene J; McCoy, Scott J; Ouellette, Daniel R; Patel, Rita R; Reavis, Charles Charlie W; Smith, Libby J; Smith, Marshall; Strode, Steven W; Woo, Peak; Nnacheta, Lorraine C

2018-03-01

Objective This guideline provides evidence-based recommendations on treating patients presenting with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology-head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include but are not limited to recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a

Video-Based Surgical Learning: Improving Trainee Education and Preparation for Surgery.

Science.gov (United States)

Mota, Paulo; Carvalho, Nuno; Carvalho-Dias, Emanuel; João Costa, Manuel; Correia-Pinto, Jorge; Lima, Estevão

2017-10-11

Since the end of the XIX century, teaching of surgery has remained practically unaltered until now. With the dawn of video-assisted laparoscopy, surgery has faced new technical and learning challenges. Due to technological advances, from Internet access to portable electronic devices, the use of online resources is part of the educational armamentarium. In this respect, videos have already proven to be effective and useful, however the best way to benefit from these tools is still not clearly defined. To assess the importance of video-based learning, using an electronic questionnaire applied to residents and specialists of different surgical fields. Importance of video-based learning was assessed in a sample of 141 subjects, using a questionnaire distributed by a GoogleDoc online form. We found that 98.6% of the respondents have already used videos to prepare for surgery. When comparing video sources by formation status, residents were found to use Youtube significantly more often than specialists (p learning is currently a hallmark of surgical preparation among residents and specialists working in Portugal. Based on these findings we believe that the creation of quality and scientifically accurate videos, and subsequent compilation in available video-libraries appears to be the future landscape for video-based learning. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Cloud-Based Applications for Organizing and Reviewing Plastic Surgery Content.

Science.gov (United States)

Luan, Anna; Momeni, Arash; Lee, Gordon K; Galvez, Michael G

2015-01-01

Cloud-based applications including Box, Dropbox, Google Drive, Evernote, Notability, and Zotero are available for smartphones, tablets, and laptops and have revolutionized the manner in which medical students and surgeons read and utilize plastic surgery literature. Here we provide an overview of the use of Cloud computing in practice and propose an algorithm for organizing the vast amount of plastic surgery literature. Given the incredible amount of data being produced in plastic surgery and other surgical subspecialties, it is prudent for plastic surgeons to lead the process of providing solutions for the efficient organization and effective integration of the ever-increasing data into clinical practice.

Application of terrestrial laser scanning to the development and updating of the base map

Directory of Open Access Journals (Sweden)

Klapa Przemysław

2017-06-01

Full Text Available The base map provides basic information about land to individuals, companies, developers, design engineers, organizations, and government agencies. Its contents include spatial location data for control network points, buildings, land lots, infrastructure facilities, and topographic features. As the primary map of the country, it must be developed in accordance with specific laws and regulations and be continuously updated. The base map is a data source used for the development and updating of derivative maps and other large scale cartographic materials such as thematic or topographic maps. Thanks to the advancement of science and technology, the quality of land surveys carried out by means of terrestrial laser scanning (TLS matches that of traditional surveying methods in many respects.

Bariatric surgery and pregnancy: literature review

Directory of Open Access Journals (Sweden)

Pedro Ferrand Miranda

2014-01-01

Full Text Available Obesity has currently reached epidemic proportions, both in Chile and in the world. This condition is associated to a variety of maternal complications in all stages of the vital cycle and during pregnancy. Medical treatment has not proved successful thus resulting in an increase in bariatric surgery in recent years, even when it is not first line treatment. This literature review aims to report updated results of surgical treatment for obesity before and during pregnancy with respect to fertility, gestational diabetes, pre-eclampsia and pregnancy-induced hypertension. It also looks into the possible effects of surgery on fetal development, and its relation to premature delivery, fetal macrosomy, low birth weight and neural tube defects, as well as effects on maternal and fetal outcomes, mainly in nutrition. Lastly, we suggest some recommendations that arise from this review on the role of contraception, nutrition and time between surgery and pregnancy.

Adjuvant Cardioprotection in Cardiac Surgery: Update

Directory of Open Access Journals (Sweden)

Robert Wagner

2014-01-01

Full Text Available Cardiac surgery patients are now more risky in terms of age, comorbidities, and the need for complex procedures. It brings about reperfusion injury, which leads to dysfunction and/or loss of part of the myocardium. These groups of patients have a higher incidence of postoperative complications and mortality. One way of augmenting intraoperative myocardial protection is the phenomenon of myocardial conditioning, elicited with brief nonlethal episodes of ischaemia-reperfusion. In addition, drugs are being tested that mimic ischaemic conditioning. Such cardioprotective techniques are mainly focused on reperfusion injury, a complex response of the organism to the restoration of coronary blood flow in ischaemic tissue, which can lead to cell death. Extensive research over the last three decades has revealed the basic mechanisms of reperfusion injury and myocardial conditioning, suggesting its therapeutic potential. But despite the enormous efforts that have been expended in preclinical studies, almost all cardioprotective therapies have failed in the third phase of clinical trials. One reason is that evolutionary young cellular mechanisms of protection against oxygen handling are not very robust. Ischaemic conditioning, which is among these, is also limited by this. At present, the prevailing belief is that such options of treatment exist, but their full employment will not occur until subquestions and methodological issues with the transfer into clinical practice have been resolved.

Step-based cognitive virtual surgery simulation: an innovative approach to surgical education.

Science.gov (United States)

Oliker, Aaron; Napier, Zachary; Deluccia, Nicolette; Qualter, John; Sculli, Frank; Smith, Brandon; Stern, Carrie; Flores, Roberto; Hazen, Alexes; McCarthy, Joseph

2012-01-01

BioDigital Systems, LLC in collaboration with New York University Langone Medical Center Department of Reconstructive Plastic Surgery has created a complex, real-time, step-based simulation platform for plastic surgery education. These simulators combine live surgical footage, interactive 3D visualization, text labels, and voiceover as well as a high-yield, expert-approved testing mode to create a comprehensive virtual educational environment for the plastic surgery resident or physician.

Mathematical model of bone drilling for virtual surgery system

Science.gov (United States)

Alaytsev, Innokentiy K.; Danilova, Tatyana V.; Manturov, Alexey O.; Mareev, Gleb O.; Mareev, Oleg V.

2018-04-01

The bone drilling is an essential part of surgeries in ENT and Dentistry. A proper training of drilling machine handling skills is impossible without proper modelling of the drilling process. Utilization of high precision methods like FEM is limited due to the requirement of 1000 Hz update rate for haptic feedback. The study presents a mathematical model of the drilling process that accounts the properties of materials, the geometry and the rotation rate of a burr to compute the removed material volume. The simplicity of the model allows for integrating it in the high-frequency haptic thread. The precision of the model is enough for a virtual surgery system targeted on the training of the basic surgery skills.

Bariatric surgery: an evidence-based analysis.

Science.gov (United States)

2005-01-01

To conduct an evidence-based analysis of the effectiveness and cost-effectiveness of bariatric surgery. Obesity is defined as a body mass index (BMI) of at last 30 kg/m(2).() Morbid obesity is defined as a BMI of at least 40 kg/m(2) or at least 35 kg/m(2) with comorbid conditions. Comorbid conditions associated with obesity include diabetes, hypertension, dyslipidemias, obstructive sleep apnea, weight-related arthropathies, and stress urinary incontinence. It is also associated with depression, and cancers of the breast, uterus, prostate, and colon, and is an independent risk factor for cardiovascular disease. Obesity is also associated with higher all-cause mortality at any age, even after adjusting for potential confounding factors like smoking. A person with a BMI of 30 kg/m(2) has about a 50% higher risk of dying than does someone with a healthy BMI. The risk more than doubles at a BMI of 35 kg/m(2). An expert estimated that about 160,000 people are morbidly obese in Ontario. In the United States, the prevalence of morbid obesity is 4.7% (1999-2000). In Ontario, the 2004 Chief Medical Officer of Health Report said that in 2003, almost one-half of Ontario adults were overweight (BMI 25-29.9 kg/m(2)) or obese (BMI ≥ 30 kg/m(2)). About 57% of Ontario men and 42% of Ontario women were overweight or obese. The proportion of the population that was overweight or obese increased gradually from 44% in 1990 to 49% in 2000, and it appears to have stabilized at 49% in 2003. The report also noted that the tendency to be overweight and obese increases with age up to 64 years. BMI should be used cautiously for people aged 65 years and older, because the "normal" range may begin at slightly above 18.5 kg/m(2) and extend into the "overweight" range. The Chief Medical Officer of Health cautioned that these data may underestimate the true extent of the problem, because they were based on self reports, and people tend to over-report their height and under-report their weight

Patient safety issues in office-based surgery and anaesthesia in Switzerland: a qualitative study.

Science.gov (United States)

McLennan, Stuart; Schwappach, David; Harder, Yves; Staender, Sven; Elger, Bernice

2017-08-01

To identify the spectrum of patient safety issues in office-based surgery and anaesthesia in Switzerland. Purposive sample of 23 experts in surgery and anaesthesia and quality and regulation in Switzerland. Data were collected via individual qualitative interviews using a researcher-developed semi-structured interview guide between March 2016 and September 2016. Interviews were transcribed and analysed using conventional content analysis. Issues were categorised under the headings "structure", "process", and "outcome". Experts identified two key overarching patient safety and regulatory issues in relation to office-based surgery and anaesthesia in Switzerland. First, experts repeatedly raised the current lack of data and transparency of the setting. It is unknown how many surgeons are operating in offices, how many and what types of operations are being done, and what the outcomes are. Secondly, experts also noted the limited oversight and regulation of the setting. While some standards exists, most experts felt that more minimal safety standards are needed regarding the requirements that must be met to do office-based surgery and what can and cannot be done in the office-based setting are needed, but they advocated a self-regulatory approach. There is a lack of empirical data regarding the quantity and quality office-based surgery and anaesthesia in Switzerland. Further research is needed to address these research gaps and inform health policy in relation to patient safety in office-based surgery and anaesthesia in Switzerland. Copyright © 2017. Published by Elsevier GmbH.

How update schemes influence crowd simulations

International Nuclear Information System (INIS)

Seitz, Michael J; Köster, Gerta

2014-01-01

Time discretization is a key modeling aspect of dynamic computer simulations. In current pedestrian motion models based on discrete events, e.g. cellular automata and the Optimal Steps Model, fixed-order sequential updates and shuffle updates are prevalent. We propose to use event-driven updates that process events in the order they occur, and thus better match natural movement. In addition, we present a parallel update with collision detection and resolution for situations where computational speed is crucial. Two simulation studies serve to demonstrate the practical impact of the choice of update scheme. Not only do density-speed relations differ, but there is a statistically significant effect on evacuation times. Fixed-order sequential and random shuffle updates with a short update period come close to event-driven updates. The parallel update scheme overestimates evacuation times. All schemes can be employed for arbitrary simulation models with discrete events, such as car traffic or animal behavior. (paper)

A comparative study on lecture based versus case based education on teaching general surgery to medical students

Directory of Open Access Journals (Sweden)

M. Moazeni Bistegani

2013-06-01

Full Text Available Introduction : various methods of teaching have different learning outcomes. Using a combination of teaching and training methods of training may boost education. This study compared lecture based and case based teaching as a combined approach in learning general surgery by medical students. Methods: This study was a quasi-experimental performed on two consecutive groups of 33 and 36 students who were studying general surgery course. The two styles of teaching were lecture-based and real case teaching methods. The final exam included twenty multiple choice questions. The mean scores of each group of students were collected and analyzed accordingly with descriptive tests, Fisher’s test and T-test. Results: The mean final mark of students' who received real case based education was 16.8/20 ± 1.8 and for the lecture group was 12.7± 1.7. There was a significant difference between the two groups (P <0.0001. In both groups, there were significant differences in the mean scores of questions with taxonomy two and three, but not in the questions with taxonomy one. Students' evaluation score of the teacher of the real case group increased by 1.7/20 (8.7% in the case based group compared to the lecture group. Conclusions: Case based teaching of general surgery led to a better outcome and students were more satisfied. It is recommended that case based education of surgery be encouraged.

Radiation-induced osteosarcoma of the jaw treated with skull base surgery

International Nuclear Information System (INIS)

Yamamoto, Misaki; Asato, Ryo; Torii, Hiroko; Kanda, Tomoko; Tamura, Yoshihiro; Hirano, Shigeru; Ito, Juichi; Tanaka, Shinzou

2009-01-01

Head and neck osteosarcomas are rare. A 33-year-old woman received radiation therapy for lymphoepithelioma of the epipharynx in her childhood. After twenty-two years, she presented with a swelling of the right cheek. We did a work up, and diagnosed her radiation-induced osteosarcoma of the jaw. We treated her with neoadjuvant chemotherapy, surgery including skull base resection, and adjuvant chemo-therapy. A small skin recurrence developed after one year, but it was resected under local anesthesia, and there have been no recurrences since. We think that skull base surgery with a combined approach is a useful method in therapy for osteosarcomas in the skull base region. (author)

General surgery workloads and practice patterns in the United States, 2007 to 2009: a 10-year update from the American Board of Surgery.

Science.gov (United States)

Valentine, R James; Jones, Andrew; Biester, Thomas W; Cogbill, Thomas H; Borman, Karen R; Rhodes, Robert S

2011-09-01

To assess changes in general surgery workloads and practice patterns in the past decade. Nearly 80% of graduating general surgery residents pursue additional training in a surgical subspecialty. This has resulted in a shortage of general surgeons, especially in rural areas. The purpose of this study is to characterize the workloads and practice patterns of general surgeons versus certified surgical subspecialists and to compare these data with those from a previous decade. The surgical operative logs of 4968 individuals recertifying in surgery 2007 to 2009 were reviewed. Data from 3362 (68%) certified only in Surgery (GS) were compared with 1606 (32%) with additional American Board of Medical Specialties certificates (GS+). Data from GS surgeons were also compared with data from GS surgeons recertifying 1995 to 1997. Independent variables were compared using factorial ANOVA. GS surgeons performed a mean of 533 ± 365 procedures annually. Women GS performed far more breast operations and fewer abdomen, alimentary tract and laparoscopic procedures compared to men GS (P surgery procedures. GS practice patterns are heterogeneous; gender, age, and practice setting significantly affect operative caseloads. A substantial portion of general surgery procedures currently are performed by GS+ surgeons, whereas GS surgeons continue to perform considerable numbers of specialty operations. Reduced general surgery operative experience in GS+ residencies may negatively impact access to general surgical care. Similarly, narrowing GS residency operative experience may impair specialty operation access.

77 FR 68717 - Updating OSHA Standards Based on National Consensus Standards; Head Protection

Science.gov (United States)

2012-11-16

..., 1918, and 1926 [Docket No. OSH-2011-0184] RIN 1218-AC65 Updating OSHA Standards Based on National Consensus Standards; Head Protection AGENCY: Occupational Safety and Health Administration (OSHA), Labor. ACTION: Proposed rule; withdrawal. SUMMARY: With this notice, OSHA is withdrawing the proposed rule that...

Evidence-based medical review update: pharmacological and surgical treatments of Parkinson's disease: 2001 to 2004.

Science.gov (United States)

Goetz, Christopher G; Poewe, Werner; Rascol, Olivier; Sampaio, Cristina

2005-05-01

The objective of this study is to update a previous evidence-based medicine (EBM) review on Parkinson's disease (PD) treatments, adding January 2001 to January 2004 information. The Movement Disorder Society (MDS) Task Force prepared an EBM review of PD treatments covering data up to January 2001. The authors reviewed Level I (randomized clinical trials) reports of pharmacological and surgical interventions for PD, published as full articles in English (January 2001-January 2004). Inclusion criteria and ranking followed the original program and adhered to EBM methodology. For Efficacy Conclusions, treatments were designated Efficacious, Likely Efficacious, Non-Efficacious, or Insufficient Data. Four clinical indications were considered for each intervention: prevention of disease progression; treatment of Parkinsonism, as monotherapy and as adjuncts to levodopa where indicated; prevention of motor complications; treatment of motor complications. Twenty-seven new studies qualified for efficacy review, and others covered new safety issues. Apomorphine, piribedil, unilateral pallidotomy, and subthalamic nucleus stimulation moved upward in efficacy ratings. Rasagiline, was newly rated as Efficacious monotherapy for control of Parkinsonism. New Level I data moved human fetal nigral transplants, as performed to date, from Insufficient Data to Non- efficacious for the treatment of Parkinsonism, motor fluctuations, and dyskinesias. Selegiline was reassigned as Non-efficacious for the prevention of dyskinesias. Other designations did not change. In a field as active in clinical trials as PD, frequent updating of therapy-based reviews is essential. We consider a 3-year period a reasonable time frame for published updates and are working to establish a Web-based mechanism to update the report in an ongoing manner. Copyright 2005 Movement Disorder Society.

77 FR 68684 - Updating OSHA Standards Based on National Consensus Standards; Head Protection

Science.gov (United States)

2012-11-16

..., 1918, and 1926 [Docket No. OSHA-2011-0184] RIN 1218-AC65 Updating OSHA Standards Based on National Consensus Standards; Head Protection AGENCY: Occupational Safety and Health Administration (OSHA), Labor. ACTION: Final rule; confirmation of effective date. SUMMARY: OSHA is confirming the effective date of its...

Updating Recursive XML Views of Relations

DEFF Research Database (Denmark)

Choi, Byron; Cong, Gao; Fan, Wenfei

2009-01-01

This paper investigates the view update problem for XML views published from relational data. We consider XML views defined in terms of mappings directed by possibly recursive DTDs compressed into DAGs and stored in relations. We provide new techniques to efficiently support XML view updates...... specified in terms of XPath expressions with recursion and complex filters. The interaction between XPath recursion and DAG compression of XML views makes the analysis of the XML view update problem rather intriguing. Furthermore, many issues are still open even for relational view updates, and need...... to be explored. In response to these, on the XML side, we revise the notion of side effects and update semantics based on the semantics of XML views, and present effecient algorithms to translate XML updates to relational view updates. On the relational side, we propose a mild condition on SPJ views, and show...

Phase 9 update (1987) report for the Energy Economic Data Base Program EEDB-IX

International Nuclear Information System (INIS)

1988-07-01

This document is a review of the 1987 update of detailed reference powerplant cost estimates. This distribution is the latest in a series published since 1978. The overall program purpose is to provide periodically updated, detailed base construction cost estimates for large nuclear electric operating plants. These data, which are representative of current US powerplant construction cost experience, are a useful contribution to program planning by the Office of the Assistant Secretary for Nuclear Energy. The ninth update includes three new models as a basis for projecting future costs of both small and large nuclear power plants and examining the potential for cost reduction by incorporation of improved and advanced design features. The models designated as improved include the advantages of modular construction and standardized approach to design and construction. The advanced model includes many of the features of the improved data models as well as application of passive or near-passive safety systems and design simplification

Seizure outcomes in non-resective epilepsy surgery: An update

Science.gov (United States)

Englot, Dario J.; Birk, Harjus; Chang, Edward F.

2016-01-01

In approximately 30% of patients with epilepsy, seizures are refractory to medical therapy, leading to significant morbidity and increased mortality. Substantial evidence has demonstrated the benefit of surgical resection in patients with drug-resistant focal epilepsy, and in the present journal, we recently reviewed seizure outcomes in resective epilepsy surgery. However, not all patients are candidates for or amenable to open surgical resection for epilepsy. Fortunately, several non-resective surgical options are now available at various epilepsy centers, including novel therapies which have been pioneered in recent years. Ablative procedures such as stereotactic laser ablation and stereotactic radiosurgery offer minimally invasive alternatives to open surgery with relatively favorable seizure outcomes, particularly in patients with mesial temporal lobe epilepsy. For certain individuals who are not candidates for ablation or resection, palliative neuromodulation procedures such as vagus nerve stimulation, deep brain stimulation, or responsive neurostimulation may result in a significant decrease in seizure frequency and improved quality of life. Finally, disconnection procedures such as multiple subpial transections and corpus callosotomy continue to play a role in select patients with an eloquent epileptogenic zone or intractable atonic seizures, respectively. Overall, open surgical resection remains the gold standard treatment for drug-resistant epilepsy, although it is significantly under-utilized. While non-resective epilepsy procedures have not replaced the need for resection, there is hope that these additional surgical options will increase the number of patients who receive treatment for this devastating disorder - particularly individuals who are not candidates for or who have failed resection. PMID:27206422

Optimal updating magnitude in adaptive flat-distribution sampling.

Science.gov (United States)

Zhang, Cheng; Drake, Justin A; Ma, Jianpeng; Pettitt, B Montgomery

2017-11-07

We present a study on the optimization of the updating magnitude for a class of free energy methods based on flat-distribution sampling, including the Wang-Landau (WL) algorithm and metadynamics. These methods rely on adaptive construction of a bias potential that offsets the potential of mean force by histogram-based updates. The convergence of the bias potential can be improved by decreasing the updating magnitude with an optimal schedule. We show that while the asymptotically optimal schedule for the single-bin updating scheme (commonly used in the WL algorithm) is given by the known inverse-time formula, that for the Gaussian updating scheme (commonly used in metadynamics) is often more complex. We further show that the single-bin updating scheme is optimal for very long simulations, and it can be generalized to a class of bandpass updating schemes that are similarly optimal. These bandpass updating schemes target only a few long-range distribution modes and their optimal schedule is also given by the inverse-time formula. Constructed from orthogonal polynomials, the bandpass updating schemes generalize the WL and Langfeld-Lucini-Rago algorithms as an automatic parameter tuning scheme for umbrella sampling.

The PMIPv6-Based Group Binding Update for IoT Devices

Directory of Open Access Journals (Sweden)

Jianfeng Guan

2016-01-01

Full Text Available Internet of Things (IoT has been booming with rapid increase of the various wearable devices, vehicle embedded devices, and so on, and providing the effective mobility management for these IoT devices becomes a challenge due to the different application scenarios as well as the limited energy and bandwidth. Recently, lots of researchers have focused on this topic and proposed several solutions based on the combination of IoT features and traditional mobility management protocols, in which most of these schemes take the IoT devices as mobile networks and adopt the NEtwork MObility (NEMO and its variants to provide the mobility support. However, these solutions are in face of the heavy signaling cost problem. Since IoT devices are generally combined to realize the complex functions, these devices may have similar movement behaviors. Clearly analyzing these characters and using them in the mobility management will reduce the signaling cost and improve the scalability. Motivated by this, we propose a PMIPv6-based group binding update method. In particular, we describe its group creation procedure, analyze its impact on the mobility management, and derive its reduction ratio in terms of signaling cost. The final results show that the introduction of group binding update can remarkably reduce the signaling cost.

Ontology-based prediction of surgical events in laparoscopic surgery

Science.gov (United States)

Katić, Darko; Wekerle, Anna-Laura; Gärtner, Fabian; Kenngott, Hannes; Müller-Stich, Beat Peter; Dillmann, Rüdiger; Speidel, Stefanie

2013-03-01

Context-aware technologies have great potential to help surgeons during laparoscopic interventions. Their underlying idea is to create systems which can adapt their assistance functions automatically to the situation in the OR, thus relieving surgeons from the burden of managing computer assisted surgery devices manually. To this purpose, a certain kind of understanding of the current situation in the OR is essential. Beyond that, anticipatory knowledge of incoming events is beneficial, e.g. for early warnings of imminent risk situations. To achieve the goal of predicting surgical events based on previously observed ones, we developed a language to describe surgeries and surgical events using Description Logics and integrated it with methods from computational linguistics. Using n-Grams to compute probabilities of followup events, we are able to make sensible predictions of upcoming events in real-time. The system was evaluated on professionally recorded and labeled surgeries and showed an average prediction rate of 80%.

The Inertia Weight Updating Strategies in Particle Swarm Optimisation Based on the Beta Distribution

Directory of Open Access Journals (Sweden)

Petr Maca

2015-01-01

Full Text Available The presented paper deals with the comparison of selected random updating strategies of inertia weight in particle swarm optimisation. Six versions of particle swarm optimization were analysed on 28 benchmark functions, prepared for the Special Session on Real-Parameter Single Objective Optimisation at CEC2013. The random components of tested inertia weight were generated from Beta distribution with different values of shape parameters. The best analysed PSO version is the multiswarm PSO, which combines two strategies of updating the inertia weight. The first is driven by the temporally varying shape parameters, while the second is based on random control of shape parameters of Beta distribution.

Development of the updated system of city underground pipelines based on Visual Studio

Science.gov (United States)

Zhang, Jianxiong; Zhu, Yun; Li, Xiangdong

2009-10-01

Our city has owned the integrated pipeline network management system with ArcGIS Engine 9.1 as the bottom development platform and with Oracle9i as basic database for storaging data. In this system, ArcGIS SDE9.1 is applied as the spatial data engine, and the system was a synthetic management software developed with Visual Studio visualization procedures development tools. As the pipeline update function of the system has the phenomenon of slower update and even sometimes the data lost, to ensure the underground pipeline data can real-time be updated conveniently and frequently, and the actuality and integrity of the underground pipeline data, we have increased a new update module in the system developed and researched by ourselves. The module has the powerful data update function, and can realize the function of inputting and outputting and rapid update volume of data. The new developed module adopts Visual Studio visualization procedures development tools, and uses access as the basic database to storage data. We can edit the graphics in AutoCAD software, and realize the database update using link between the graphics and the system. Practice shows that the update module has good compatibility with the original system, reliable and high update efficient of the database.

Updating Geospatial Data from Large Scale Data Sources

Science.gov (United States)

Zhao, R.; Chen, J.; Wang, D.; Shang, Y.; Wang, Z.; Li, X.; Ai, T.

2011-08-01

In the past decades, many geospatial databases have been established at national, regional and municipal levels over the world. Nowadays, it has been widely recognized that how to update these established geo-spatial database and keep them up to date is most critical for the value of geo-spatial database. So, more and more efforts have been devoted to the continuous updating of these geospatial databases. Currently, there exist two main types of methods for Geo-spatial database updating: directly updating with remote sensing images or field surveying materials, and indirectly updating with other updated data result such as larger scale newly updated data. The former method is the basis because the update data sources in the two methods finally root from field surveying and remote sensing. The later method is often more economical and faster than the former. Therefore, after the larger scale database is updated, the smaller scale database should be updated correspondingly in order to keep the consistency of multi-scale geo-spatial database. In this situation, it is very reasonable to apply map generalization technology into the process of geo-spatial database updating. The latter is recognized as one of most promising methods of geo-spatial database updating, especially in collaborative updating environment in terms of map scale, i.e , different scale database are produced and maintained separately by different level organizations such as in China. This paper is focused on applying digital map generalization into the updating of geo-spatial database from large scale in the collaborative updating environment for SDI. The requirements of the application of map generalization into spatial database updating are analyzed firstly. A brief review on geospatial data updating based digital map generalization is then given. Based on the requirements analysis and review, we analyze the key factors for implementing updating geospatial data from large scale including technical

SURGERY AND CARDIOVASCULAR SURGERY JOURNALS ANALYSIS.

Science.gov (United States)

Schanaider, Alberto

2015-01-01

To analyze critically the effectiveness and value of bibliometric indicators in journals of Surgery or Cardiovacular Surgery in the context of the postgraduate programs of CAPES Medicine III. A sampling with 16 academic programs and one professional master of Medicine III, encompassing the General and Digestive System Surgery, Cardiovascular Surgery and Multidisciplinary courses with such contents, was evaluated. Thomson Reuters/ISI (JCR), Elsevier/Scopus (SJR), and also Scielo databases were used. Only in seven programs, the teachers had an average of Qualis A1 articles greater than the others strata. Eleven journals in the surgical area are in stratum A1 (5%) and it reaches 25% in Cardiovascular Surgery. Among the six journals with the largest number of publications Qualis A1 in area Medicine III, five are from non-specific areas. The Acta Cirúrgica Brasileira represented 58% of the publications in the stratum A2. There are some obstacles in the Qualis classification with little uniformity among the Medicine areas I, II and III. A permanent committee should be set to update the Qualis, composed by the three medical areas. It should be considered using other index databases and the unification of the Qualis criteria for journals in medicine. Rating criteria of multi and transdisciplinary journals need to be reviewed. It is essential an institutional financial support for national journals chosen by peers aiming to provide a full computerization process and a professional reviewer of the English language, in order to increase the impact factor. Analisar criticamente a eficácia e valor de indicadores bibliométricos dos periódicos da Cirurgia e Cirurgia Cardiovascular no contexto dos Programas de Pós-Graduação da área Medicina III da CAPES. Foi avaliada uma amostragem com 16 programas acadêmicos e um mestrado profissional da área de Medicina III, compreendendo a Cirurgia Geral e do Aparelho Digestivo, a Cirurgia Cardiovascular e Cursos Multidisciplinares

Introducing a methodology for estimating duration of surgery in health services research.

Science.gov (United States)

Redelmeier, Donald A; Thiruchelvam, Deva; Daneman, Nick

2008-09-01

The duration of surgery is an indicator for the quality, risks, and efficiency of surgical procedures. We introduce a new methodology for assessing the duration of surgery based on anesthesiology billing records, along with reviewing its fundamental logic and limitations. The validity of the methodology was assessed through a population-based cohort of patients (n=480,986) undergoing elective operations in 246 Ontario hospitals with 1,084 anesthesiologists between April 1, 1992 and March 31, 2002 (10 years). The weaknesses of the methodology relate to missing data, self-serving exaggerations by providers, imprecisions from clinical diversity, upper limits due to accounting regulations, fluctuations from updates over the years, national differences in reimbursement schedules, and the general failings of claims base analyses. The strengths of the methodology are in providing data that match clinical experiences, correspond to chart review, are consistent over time, can detect differences where differences would be anticipated, and might have implications for examining patient outcomes after long surgical times. We suggest that an understanding and application of large studies of surgical duration may help scientists explore selected questions concerning postoperative complications.

The Development of Time-Based Prospective Memory in Childhood: The Role of Working Memory Updating

NARCIS (Netherlands)

Voigt, B.; Mahy, C.E.V.; Ellis, J.; Schnitzspahn, K.M.; Krause, I.; Altgassen, A.M.; Kliegel, M.

2014-01-01

This large-scale study examined the development of time-based prospective memory (PM) across childhood and the roles that working memory updating and time monitoring play in driving age effects in PM performance. One hundred and ninety-seven children aged 5 to 14 years completed a time-based PM task

77 FR 43018 - Updating OSHA Construction Standards Based on National Consensus Standards; Head Protection...

Science.gov (United States)

2012-07-23

.... OSHA-2011-0184] RIN 1218-AC65 Updating OSHA Construction Standards Based on National Consensus... Health Administration (OSHA), Department of Labor. ACTION: Notice of proposed rulemaking; correction. SUMMARY: OSHA is correcting a notice of proposed rulemaking (NPRM) with regard to the construction...

Update on Research and Application of Problem-Based Learning in Medical Science Education

Science.gov (United States)

Fan, Chuifeng; Jiang, Biying; Shi, Xiuying; Wang, Enhua; Li, Qingchang

2018-01-01

Problem-based learning (PBL) is a unique form of pedagogy dedicated to developing students' self-learning and clinical practice skills. After several decades of development, although applications vary, PBL has been recognized all over the world and implemented by many medical schools. This review summarizes and updates the application and study of…

Postoperative otorhinolaryngologic complications in transnasal endoscopic surgery to access the skull base

Directory of Open Access Journals (Sweden)

Ricardo Landini Lutaif Dolci

Full Text Available Abstract Introduction: The large increase in the number of transnasal endoscopic skull base surgeries is a consequence of greater knowledge of the anatomic region, the development of specific materials and instruments, and especially the use of the nasoseptal flap as a barrier between the sinus tract (contaminated cavity and the subarachnoid space (sterile area, reducing the high risk of contamination. Objective: To assess the otorhinolaryngologic complications in patients undergoing endoscopic surgery of the skull base, in which a nasoseptal flap was used. Methods: This was a retrospective study that included patients who underwent endoscopic skull base surgery with creation of a nasoseptal flap, assessing for the presence of the following post-surgical complications: cerebrospinal fluid leak, meningitis, mucocele formation, nasal synechia, septal perforation (prior to posterior septectomy, internal nasal valve failure, epistaxis, and olfactory alterations. Results: The study assessed 41 patients undergoing surgery. Of these, 35 had pituitary adenomas (macro- or micro-adenomas; sellar and suprasellar extension, three had meningiomas (two tuberculum sellae and one olfactory groove, two had craniopharyngiomas, and one had an intracranial abscess. The complications were cerebrospinal fluid leak (three patients; 7.3%, meningitis (three patients; 7.3%, nasal fossa synechia (eight patients; 19.5%, internal nasal valve failure (six patients; 14.6%, and complaints of worsening of the sense of smell (16 patients; 39%. The olfactory test showed anosmia or hyposmia in ten patients (24.3%. No patient had mucocele, epistaxis, or septal perforation. Conclusion: The use of the nasoseptal flap has revolutionized endoscopic skull base surgery, making the procedures more effective and with lower morbidity compared to the traditional route. However, although mainly transient nasal morbidities were observed, in some cases, permanent hyposmia and anosmia resulted

Perceived gender-based barriers to careers in academic surgery.

Science.gov (United States)

Cochran, Amalia; Hauschild, Tricia; Elder, William B; Neumayer, Leigh A; Brasel, Karen J; Crandall, Marie L

2013-08-01

Women represent roughly 50% of US medical students and one third of US surgery residents. Within academic surgery departments, however, women are disproportionately underrepresented, particularly at senior levels. The aim of this study was to test the hypothesis that female surgeons perceive different barriers to academic careers relative to their male colleagues. A modified version of the Career Barriers Inventory-Revised was administered to senior surgical residents and early-career surgical faculty members at 8 academic medical centers using an online survey tool. Likert-type scales were used to measure respondents' agreement with each survey item. Fisher's exact test was used to identify significant differences on the basis of gender. Respondents included 70 women (44 residents, 26 faculty members) and 84 men (41 residents, 43 faculty members). Women anticipated or perceived active discrimination in the form of being treated differently and experiencing negative comments about their sex, findings that differed notably from those for male counterparts. Sex-based negative attitudes inhibited the career aspirations of female surgeons. The presence of overt and implicit bias resulted in a sense that sex is a barrier to female surgeons' career development in academic surgery. No differences were observed between male and female respondents with regard to career preparation or structural barriers. Female academic surgeons experience challenges that are perceived to differ from their male counterparts. Women who participated in this study reported feeling excluded from the dominant culture in departments of surgery. This study may help guide transformative initiatives within academic surgery departments. Copyright © 2013 Elsevier Inc. All rights reserved.

Automatic Rapid Updating of ATR Target Knowledge Bases

National Research Council Canada - National Science Library

Wells, Barton

1999-01-01

.... Methods of comparing infrared images with CAD model renderings, including object detection, feature extraction, object alignment, match quality evaluation, and CAD model updating are researched and analyzed...

Managing adolescent obesity and the role of bariatric surgery.

Science.gov (United States)

McGinty, Shannon; Richmond, Tracy K; Desai, Nirav K

2015-08-01

This update explores the current management options for adolescent obesity with a specific focus on bariatric surgery. Research has highlighted the serious health complications associated with adolescent obesity and thus emphasized the need for effective interventions. With the increasing severity of obesity seen in younger populations, coupled with the modest effects of most behavioral and even pharmacologic interventions, there has been increased interest in, and attention on, bariatric surgery in younger populations. Recent adult-focused guidelines regarding the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient outline the importance of careful patient selection, in addition to close monitoring, with a particular focus on preventing nutritional deficiencies. Several recent publications have focused on issues specific to bariatric surgery in the adolescent patient including the relationship between a patient's physical and emotional maturity and timing of surgery. Adolescent obesity is prevalent with increasing severity and long-term health implications. To date nonsurgical interventions have had modest effects. Bariatric surgery is becoming more common and has been shown to be well tolerated and effective in adolescents, but requires careful preoperative screening and postoperative monitoring.

Influences on choice of surgery as a career: a study of consecutive cohorts in a medical school.

Science.gov (United States)

Sobral, Dejano T

2006-06-01

To examine the differential impact of person-based and programme-related features on graduates' dichotomous choice between surgical or non-surgical field specialties for first-year residency. A 10-year cohort study was conducted, following 578 students (55.4% male) who graduated from a university medical school during 1994-2003. Data were collected as follows: at the beginning of medical studies, on career preference and learning frame; during medical studies, on academic achievement, cross-year peer tutoring and selective clinical traineeship, and at graduation, on the first-year residency selected. Contingency and logistic regression analyses were performed, with graduates grouped by the dichotomous choice of surgery or not. Overall, 23% of graduates selected a first-year residency in surgery. Seven time-steady features related to this choice: male sex, high self-confidence, option of surgery at admission, active learning style, preference for surgery after Year 1, peer tutoring on clinical surgery, and selective training in clinical surgery. Logistic regression analysis, including all features, predicted 87.1% of the graduates' choices. Male sex, updated preference, peer tutoring and selective training were the most significant predictors in the pathway to choice. The relative roles of person-based and programme-related factors in the choice process are discussed. The findings suggest that for most students the choice of surgery derives from a temporal summation of influences that encompass entry and post-entry factors blended in variable patterns. It is likely that sex-unbiased peer tutoring and selective training supported the students' search process for personal compatibility with specialty-related domains of content and process.

Reimbursement in hospital-based vascular surgery: Physician and practice perspective.

Science.gov (United States)

Perri, Jennifer L; Zwolak, Robert M; Goodney, Philip P; Rutherford, Gretchen A; Powell, Richard J

2017-07-01

The purpose of this study was to determine change in value of a vascular surgery division to the health care system during 6 years at a hospital-based academic practice and to compare physician vs hospital revenue earned during this period. Total revenue generated by the vascular surgery service line at an academic medical center from 2010 through 2015 was evaluated. Total revenue was measured as the sum of physician (professional) and hospital (technical) net revenue for all vascular-related patient care. Adjustments were made for work performed, case complexity, and inflation. To reflect the effect of these variables, net revenue was indexed to work relative value units (wRVUs), case mix index, and consumer price index, which adjusted for work, case complexity, and inflation, respectively. Differences in physician and hospital net revenue were compared over time. Physician work, measured in RVUs per year, increased by 4%; case complexity, assessed with case mix index, increased by 10% for the 6-year measurement period. Despite stability in payer mix at 64% to 69% Medicare, both physician and hospital vascular-related revenue/wRVU decreased during this period. Unadjusted professional revenue/wRVU declined by 14.1% (P = .09); when considering case complexity, physician revenue/wRVU declined by 20.6% (P = .09). Taking into account both case complexity and inflation, physician revenue declined by 27.0% (P = .04). Comparatively, hospital revenue for vascular surgery services decreased by 13.8% (P = .07) when adjusting for unit work, complexity, and inflation. At medical centers where vascular surgeons are hospital based, vascular care reimbursement decreased substantially from 2010 to 2015 when case complexity and inflation were considered. Physician reimbursement (professional fees) decreased at a significantly greater rate than hospital reimbursement for vascular care. This trend has significant implications for salaried vascular surgeons in hospital-based

Robotics in general surgery: an evidence-based review.

Science.gov (United States)

Baek, Se-Jin; Kim, Seon-Hahn

2014-05-01

Since its introduction, robotic surgery has been rapidly adopted to the extent that it has already assumed an important position in the field of general surgery. This rapid progress is quantitative as well as qualitative. In this review, we focus on the relatively common procedures to which robotic surgery has been applied in several fields of general surgery, including gastric, colorectal, hepato-biliary-pancreatic, and endocrine surgery, and we discuss the results to date and future possibilities. In addition, the advantages and limitations of the current robotic system are reviewed, and the advanced technologies and instruments to be applied in the near future are introduced. Such progress is expected to facilitate the widespread introduction of robotic surgery in additional fields and to solve existing problems.

An Update on Less Invasive and Endoscopic Techniques Mimicking the Effect of Bariatric Surgery

Directory of Open Access Journals (Sweden)

Froukje J. Verdam

2012-01-01

Full Text Available Obesity (BMI 30–35 kg/m2 and its associated disorders such as type 2 diabetes, nonalcoholic fatty liver disease, and cardiovascular disease have reached pandemic proportions worldwide. For the morbidly obese population (BMI 35–50 kg/m2, bariatric surgery has proven to be the most effective treatment to achieve significant and sustained weight loss, with concomitant positive effects on the metabolic syndrome. However, only a minor percentage of eligible candidates are treated by means of bariatric surgery. In addition, the expanding obesity epidemic consists mostly of relatively less obese patients who are not (yet eligible for bariatric surgery. Hence, less invasive techniques and devices are rapidly being developed. These novel entities mimic several aspects of bariatric surgery either by gastric restriction (gastric balloons, gastric plication, by influencing gastric function (gastric botulinum injections, gastric pacing, and vagal nerve stimulation, or by partial exclusion of the small intestine (duodenal-jejunal sleeve. In the last decade, several novel less invasive techniques have been introduced and some have been abandoned again. The aim of this paper is to discuss the safety, efficacy, complications, reversibility, and long-term results of these latest developments in the treatment of obesity.

A patient-based questionnaire to assess outcomes of foot surgery: validation in the context of surgery for hallux valgus.

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Dawson, Jill; Coffey, Jane; Doll, Helen; Lavis, Grahame; Cooke, Paul; Herron, Mark; Jenkinson, Crispin

2006-09-01

A patient-based outcome measure with good measurement properties is urgently needed for use in clinical trials of foot surgery. We evaluated an existing foot pain and disability questionnaire (the Manchester Foot Pain and Disability Questionnaire) for its suitability as an outcome measure in the context of hallux valgus corrective surgery. Interviews with patients led to initial changes, resulting in 20 candidate questionnaire items with five response categories each. These were tested in a prospective study of 100 patients (representing 138 foot operations) undergoing hallux valgus corrective surgery. Analysis of underlying factor structure, dimensionality, internal reliability, construct validity and responsiveness of the questionnaire items in relation to (i) SF-36 general health survey and (ii) American Orthopaedic Foot & Ankle Society (AOFAS) hallux clinical scale resulted in a final 16 item questionnaire (the 'Manchester-Oxford Foot Questionnaire' (MOXFQ)), consisting of three domains/scales: 'Walking/standing' (seven items), 'Pain' (five items) and 'Social interaction' (four items) each having good measurement properties. All three domains were unidimensional. The new 16-item MOXFQ has good measurement properties in the context of outcomes assessment of surgery for hallux valgus. Future studies should assess the MOXFQ in the context of surgery for other foot and ankle conditions.

Update on pigment dispersion syndrome and pigmentary glaucoma.

Science.gov (United States)

Okafor, Kingsley; Vinod, Kateki; Gedde, Steven J

2017-03-01

The present article reviews the clinical features and pathogenesis of pigment dispersion syndrome and pigmentary glaucoma and provides an update regarding their diagnosis and management. Newer imaging modalities including ultrasound biomicroscopy and anterior segment optical coherence tomography facilitate visualization of the iris concavity characteristic of eyes with pigment dispersion syndrome and pigmentary glaucoma. Patients with pigmentary glaucoma may be distinguished from those with other glaucoma types by the presence of typical symptoms, personality type, and patterns of diurnal intraocular pressure fluctuation. Although laser iridotomy has been shown to alter iris anatomy in pigmentary glaucoma, it is not proven to slow visual field progression. Multiple trials have validated the safety and efficacy of filtering surgery in treating pigmentary glaucoma, with fewer studies published on the role of micro-invasive glaucoma surgery. Literature from the review period has further defined the unique clinical characteristics of pigment dispersion syndrome and pigmentary glaucoma. Laser surgery has a limited role in the management of these entities, whereas trabeculectomy remains an acceptable first-line surgical treatment. Further studies are needed to define the potential application of the newer micro-invasive glaucoma procedures in pigmentary glaucoma.

Ambulatory orthopaedic surgery patients' knowledge with internet-based education.

Science.gov (United States)

Heikkinen, Katja; Leino-Kilpi, H; Salanterä, S

2012-01-01

There is a growing need for patient education and an evaluation of its outcomes. The aim of this study was to compare ambulatory orthopaedic surgery patients' knowledge with Internet-based education and face-to-face education with a nurse. The following hypothesis was proposed: Internet-based patient education (experiment) is as effective as face-to-face education with a nurse (control) in increasing patients' level of knowledge and sufficiency of knowledge. In addition, the correlations of demographic variables were tested. The patients were randomized to either an experiment group (n = 72) or a control group (n = 75). Empirical data were collected with two instruments. Patients in both groups showed improvement in their knowledge during their care. Patients in the experiment group improved their knowledge level significantly more in total than those patients in the control group. There were no differences in patients' sufficiency of knowledge between the groups. Knowledge was correlated especially with patients' age, gender and earlier ambulatory surgeries. As a conclusion, positive results concerning patients' knowledge could be achieved with the Internet-based education. The Internet is a viable method in ambulatory care.

An update on percutaneous nephrolithotomy

DEFF Research Database (Denmark)

Tefekli, A; Cordeiro, E; de la Rosette, J J M C H

2013-01-01

Since its introduction in late 1970's, percutaneous nephrolithotomy (PNL) has undergone an evolution in both equipment and technique. This evolution still continues today in the era of minimally invasive treatment options, and is evidenced by the numerous publications. PNL is generally advantageous...... in the management of large renal stones (>1.5-2 cm) with high stone-free rates and considerable complication rates. However this technique is especially competing with retrograde intrarenal surgery and laparoscopic techniques. Therefore the CROES Global PNL Study Group prospectively collected data of over 5800...... patients managed with PNL worldwide and analyzed the data in detail, producing more than 25 scientific papers. And this update focuses on the lessons learned from the CROES PCNL Global Study....

77 FR 42988 - Updating OSHA Construction Standards Based on National Consensus Standards; Head Protection...

Science.gov (United States)

2012-07-23

.... OSHA-2011-0184] RIN 1218-AC65 Updating OSHA Construction Standards Based on National Consensus... Administration (OSHA), Department of Labor. ACTION: Direct final rule; correction. SUMMARY: OSHA is correcting a... confusion resulting from a drafting error. OSHA published the DFR on June 22, 2012 (77 FR 37587). OSHA also...

Neurotization of oculomotor, trochlear and abducent nerves in skull base surgery

Institute of Scientific and Technical Information of China (English)

李世亭; 潘庆刚; 刘宁涛; 刘忠; 沈峰

2003-01-01

Objective To anatomically reconstruct the oculomotor nerve, trochlear nerve, and abducent nerve by skull base surgery. Methods Seventeen cranial nerves (three oculomotor nerves, eight trochlear nerves and six abducent nerves) were injured and anatomically reconstructed in thirteen skull base operations during a period from 1994 to 2000. Repair techniques included end-to-end neurosuture or fibrin glue adhesion, graft neurosuture or fibrin glue adhesion. The relationships between repair techniques and functional recovery and the related factors were analyzed.Results Functional recovery began from 3 to 8 months after surgery. During a follow-up period of 4 months to 6 years, complete recovery of function was observed in 6 trochlear nerves (75%) and 4 abducent nerves (67%), while partial functional recovery was observed in the other cranial nerves including 2 trochlear nerves, 2 abducent nerves, and 3 oculomotor nerves.Conclusions Complete or partial functional recovery could be expected after anatomical neurotization of an injured oculomotor, trochlear or abducent nerve. Our study demonstrated that, in terms of functional recovery, trochlear and abducent nerves are more responsive than oculomotor nerves, and that end-to-end reconstruction is more efficient than graft reconstruction. These results encourage us to perform reconstruction for a separated cranial nerve as often as possible during skull base surgery.

Patient perspectives about bariatric surgery unveil experiences, education, satisfaction, and recommendations for improvement.

Science.gov (United States)

Groller, Karen D; Teel, Cynthia; Stegenga, Kristin H; El Chaar, Maher

2018-02-17

Following bariatric surgery, up to 35% of patients struggle with strict regimens and experience weight recidivism within 2 years [1-5]. Accredited weight management centers (WMC) must provide educational programs and support patients in lifestyle changes before and after surgery. Educational programs, however, may not be evidence-based or patient-centered and may vary in curriculum, approach, and educator type [6]. To obtain patient descriptions about the weight loss surgery (WLS) experience, including education, satisfaction, and recommendations for improvement. Participants were recruited from a university hospital-based WMC in Pennsylvania. This qualitative descriptive study used purposive sampling and inductive content analysis. A NEW ME-VERSION 2.0, encompassed themes from semistructured interviews with 11 participants (36% male). Theme 1: Programming and Tools, explained how individuals undergoing WLS found support through educational programming. Theme 2: Updates and Upgrades, identified issues surrounding quality of life and challenges before and after surgery. Theme 3: Lessons Learned and Future Considerations, identified satisfaction levels and recommendations for improving the WLS experience. Participants reported positive experiences, acknowledging educational programs and extensive WMC resources, yet also offered recommendations for improving educational programming. Patient narratives provided evidence about the WLS experience. Achievement of weight goals, adherence to rules, and improved health status contributed to perceptions of WLS success. Participants encouraged educators to identify expected outcomes of educational programming, monitor holistic transformations, foster peer support, and use technology in WMC programming. Results also validated the need for the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program's education requirement (standard 5.1). Future educational research could help develop best practices in WLS

Update Knowledge Base for Long-term Core Cooling Reliability

International Nuclear Information System (INIS)

Agrell, Maria; Sandervag, Oddbjoern; Amri, Abdallah; ); Bang, Young S.; Blomart, Philippe; Broecker, Annette; Pointner, Winfried; Ganzmann, Ingo; Lenogue, Bruno; Guzonas, David; Herer, Christophe; Mattei, Jean-Marie; Tricottet, Matthieu; Masaoka, Hideaki; Soltesz, Vojtech; Tarkiainen, Seppo; Ui, Atsushi; Villalba, Cristina; Zigler, Gilbert

2013-11-01

at that time. Subsequent to the publication of NEA/CSNI/R(95)11, a number of new issues (e.g., chemical effects, downstream effects and long-term effects) have been identified that have reopened the topic of strainer performance. This revised knowledge-base document has been developed to update the knowledge base by incorporating the considerable quantity of research completed, and the lessons learned, since 1996. It was recognized from the beginning that differences in the issue status and the methods (regulatory aspects, resolution of issues and research and development actions) used to address the strainer clogging remained a challenge, and the NEA Sump Clogging Task Team chose to focus on generic issues. The present report includes not only an update of the previous information, but also two new topics on chemical effects and downstream effects. In addition, while NEA/CSNI/R(95)11 focused on BWRs, the present update includes a significant amount of new information related to PWRs, leading in particular to a very much expanded Appendix on 'Experimental Investigations and Test Facilities'. This document was prepared by the NEA Sump Clogging Task Team

Long-term results of RTOG trial 8911 (USA Intergroup 113): a random assignment trial comparison of chemotherapy followed by surgery compared with surgery alone for esophageal cancer.

Science.gov (United States)

Kelsen, David P; Winter, Katryn A; Gunderson, Leonard L; Mortimer, Joanne; Estes, Norman C; Haller, Daniel G; Ajani, Jaffer A; Kocha, Walter; Minsky, Bruce D; Roth, Jack A; Willett, Christopher G

2007-08-20

We update Radiation Therapy Oncology Group trial 8911 (USA Intergroup 113), a comparison of chemotherapy plus surgery versus surgery alone for patients with localized esophageal cancer. The relationship between resection type and between tumor response and outcome were also analyzed. The chemotherapy group received preoperative cisplatin plus fluorouracil. Outcome based on the type of resection (R0, R1, R2, or no resection) was evaluated. The main end point was overall survival. Disease-free survival, relapse pattern, the influence of postoperative treatment, and the relationship between response to preoperative chemotherapy and outcome were also evaluated. Two hundred sixteen patients received preoperative chemotherapy, 227 underwent immediate surgery. Fifty-nine percent of surgery only and 63% of chemotherapy plus surgery patients underwent R0 resections (P = .5137). Patients undergoing less than an R0 resection had an ominous prognosis; 32% of patients with R0 resections were alive and free of disease at 5 years, only 5% of patients undergoing an R1 resection survived for longer than 5 years. The median survival rates for patients with R1, R2, or no resections were not significantly different. While, as initially reported, there was no difference in overall survival for patients receiving perioperative chemotherapy compared with the surgery only group, patients with objective tumor regression after preoperative chemotherapy had improved survival. For patients with localized esophageal cancer, whether or not preoperative chemotherapy is administered, only an R0 resection results in substantial long-term survival. Even microscopically positive margins are an ominous prognostic factor. After a R1 resection, postoperative chemoradiotherapy therapy offers the possibility of long-term disease-free survival to a small percentage of patients.

Updating Assessment Styles: Website Development Rather than Report Writing for Project Based Learning Courses

Science.gov (United States)

Brown, Nicola

2017-01-01

While teaching methods tend to be updated frequently, the implementation of new innovative assessment tools is much slower. For example project based learning has become popular as a teaching technique, however, the assessment tends to be via traditional reports. This paper reports on the implementation and evaluation of using website development…

Object Tracking Using Adaptive Covariance Descriptor and Clustering-Based Model Updating for Visual Surveillance

Directory of Open Access Journals (Sweden)

Lei Qin

2014-05-01

Full Text Available We propose a novel approach for tracking an arbitrary object in video sequences for visual surveillance. The first contribution of this work is an automatic feature extraction method that is able to extract compact discriminative features from a feature pool before computing the region covariance descriptor. As the feature extraction method is adaptive to a specific object of interest, we refer to the region covariance descriptor computed using the extracted features as the adaptive covariance descriptor. The second contribution is to propose a weakly supervised method for updating the object appearance model during tracking. The method performs a mean-shift clustering procedure among the tracking result samples accumulated during a period of time and selects a group of reliable samples for updating the object appearance model. As such, the object appearance model is kept up-to-date and is prevented from contamination even in case of tracking mistakes. We conducted comparing experiments on real-world video sequences, which confirmed the effectiveness of the proposed approaches. The tracking system that integrates the adaptive covariance descriptor and the clustering-based model updating method accomplished stable object tracking on challenging video sequences.

Intra-operative neurophysiological mapping and monitoring during brain tumour surgery in children: an update.

Science.gov (United States)

Coppola, Angela; Tramontano, Vincenzo; Basaldella, Federica; Arcaro, Chiara; Squintani, Giovanna; Sala, Francesco

2016-10-01

Over the past decade, the reluctance to operate in eloquent brain areas has been reconsidered in the light of the advent of new peri-operative functional neuroimaging techniques and new evidence from neuro-oncology. To maximise tumour resection while minimising morbidity should be the goal of brain surgery in children as much as it is in adults, and preservation of brain functions is critical in the light of the increased survival and the expectations in terms of quality of life. Intra-operative neurophysiology is the gold standard to localise and preserve brain functions during surgery and is increasingly used in paediatric neurosurgery. Yet, the developing nervous system has peculiar characteristics in terms of anatomical and physiological maturation, and some technical aspects need to be tailored for its use in children, especially in infants. This paper will review the most recent advances in the field of intra-operative neurophysiology (ION) techniques during brain surgery, focussing on those aspects that are relevant to the paediatric neurosurgery practice.

Outpatient-based scalp surgery without shaving and allowing use of shampoo.

Science.gov (United States)

Hwang, Sun-Chul; Kim, Soon-Kwon; Park, Kwan-Woong; Im, Soo-Bin; Shin, Won-Han; Kim, Bum-Tae

2012-02-01

To assess the authors' experience of wound management following scalp mass surgery after introducing a policy of leaving hair unshaved and allowing patients to use shampoo. The authors retrospectively reviewed 93 patients who underwent outpatient-based excision of a scalp or skull mass. Surgical complications, mass depth, and maximal mass size were analyzed. All of the surgeries were performed without shaving around the lesion; the hair was simply parted along the proposed incision, and the parting was maintained using adhesive plasters. Routine antiseptic scalp preparations, skin closure with staples after mass excision, and topical ointment on the day following surgery were used, and use of shampoo was allowed. The staples were removed on postoperative days 7-10. The masses were located in the skin (23 cases), subcutaneously (64 cases), and subgaleally (6 cases). All patients except one had satisfactory wound healing. No infections occurred. Leaving hair unshaved and allowing patients to use shampoo can be applied in wound management after scalp mass surgery. Copyright © 2012 Elsevier Inc. All rights reserved.

[Purity Detection Model Update of Maize Seeds Based on Active Learning].

Science.gov (United States)

Tang, Jin-ya; Huang, Min; Zhu, Qi-bing

2015-08-01

Seed purity reflects the degree of seed varieties in typical consistent characteristics, so it is great important to improve the reliability and accuracy of seed purity detection to guarantee the quality of seeds. Hyperspectral imaging can reflect the internal and external characteristics of seeds at the same time, which has been widely used in nondestructive detection of agricultural products. The essence of nondestructive detection of agricultural products using hyperspectral imaging technique is to establish the mathematical model between the spectral information and the quality of agricultural products. Since the spectral information is easily affected by the sample growth environment, the stability and generalization of model would weaken when the test samples harvested from different origin and year. Active learning algorithm was investigated to add representative samples to expand the sample space for the original model, so as to implement the rapid update of the model's ability. Random selection (RS) and Kennard-Stone algorithm (KS) were performed to compare the model update effect with active learning algorithm. The experimental results indicated that in the division of different proportion of sample set (1:1, 3:1, 4:1), the updated purity detection model for maize seeds from 2010 year which was added 40 samples selected by active learning algorithm from 2011 year increased the prediction accuracy for 2011 new samples from 47%, 33.75%, 49% to 98.89%, 98.33%, 98.33%. For the updated purity detection model of 2011 year, its prediction accuracy for 2010 new samples increased by 50.83%, 54.58%, 53.75% to 94.57%, 94.02%, 94.57% after adding 56 new samples from 2010 year. Meanwhile the effect of model updated by active learning algorithm was better than that of RS and KS. Therefore, the update for purity detection model of maize seeds is feasible by active learning algorithm.

Adaptive Fault Detection for Complex Dynamic Processes Based on JIT Updated Data Set

Directory of Open Access Journals (Sweden)

Jinna Li

2012-01-01

Full Text Available A novel fault detection technique is proposed to explicitly account for the nonlinear, dynamic, and multimodal problems existed in the practical and complex dynamic processes. Just-in-time (JIT detection method and k-nearest neighbor (KNN rule-based statistical process control (SPC approach are integrated to construct a flexible and adaptive detection scheme for the control process with nonlinear, dynamic, and multimodal cases. Mahalanobis distance, representing the correlation among samples, is used to simplify and update the raw data set, which is the first merit in this paper. Based on it, the control limit is computed in terms of both KNN rule and SPC method, such that we can identify whether the current data is normal or not by online approach. Noted that the control limit obtained changes with updating database such that an adaptive fault detection technique that can effectively eliminate the impact of data drift and shift on the performance of detection process is obtained, which is the second merit in this paper. The efficiency of the developed method is demonstrated by the numerical examples and an industrial case.

[Innovation drive is the original motive force of discipline construction: the developing road of Department of Burns and Plastic Surgery in the 309th Hospital of PLA].

Science.gov (United States)

Jia, C Y

2018-03-20

Discipline construction is a systematic project, covering clinic, teaching, scientific research, management, and humanity. Based on the perspective of innovation drive, from the aspects of discipline structure setting, specialized laboratory construction, sub-specialty formation, clinical characteristic and advantage formation, and management concept update, this article summarizes the growth process of Department of Burns and Plastic Surgery in the 309th Hospital of PLA.

Virtual reality based surgery simulation for endoscopic gynaecology.

Science.gov (United States)

Székely, G; Bajka, M; Brechbühler, C; Dual, J; Enzler, R; Haller, U; Hug, J; Hutter, R; Ironmonger, N; Kauer, M; Meier, V; Niederer, P; Rhomberg, A; Schmid, P; Schweitzer, G; Thaler, M; Vuskovic, V; Tröster, G

1999-01-01

Virtual reality (VR) based surgical simulator systems offer very elegant possibilities to both enrich and enhance traditional education in endoscopic surgery. However, while a wide range of VR simulator systems have been proposed and realized in the past few years, most of these systems are far from able to provide a reasonably realistic surgical environment. We explore the basic approaches to the current limits of realism and ultimately seek to extend these based on our description and analysis of the most important components of a VR-based endoscopic simulator. The feasibility of the proposed techniques is demonstrated on a first modular prototype system implementing the basic algorithms for VR-training in gynaecologic laparoscopy.

Metabolic Syndrome Prevalence and Associations in a Bariatric Surgery Cohort from the Longitudinal Assessment of Bariatric Surgery-2 Study

Science.gov (United States)

Selzer, Faith; Smith, Mark D.; Berk, Paul D.; Courcoulas, Anita P.; Inabnet, William B.; King, Wendy C.; Pender, John; Pomp, Alfons; Raum, William J.; Schrope, Beth; Steffen, Kristine J.; Wolfe, Bruce M.; Patterson, Emma J.

2014-01-01

Abstract Background: Metabolic syndrome is associated with higher risk for cardiovascular disease, sleep apnea, and nonalcoholic steatohepatitis, all common conditions in patients referred for bariatric surgery, and it may predict early postoperative complications. The objective of this study was to determine the prevalence of metabolic syndrome, defined using updated National Cholesterol Education Program criteria, in adults undergoing bariatric surgery and compare the prevalence of baseline co-morbid conditions and select operative and 30-day postoperative outcomes by metabolic syndrome status. Methods: Complete metabolic syndrome data were available for 2275 of 2458 participants enrolled in the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), an observational cohort study designed to evaluate long-term safety and efficacy of bariatric surgery in obese adults. Results: The prevalence of metabolic syndrome was 79.9%. Compared to those without metabolic syndrome, those with metabolic syndrome were significantly more likely to be men, to have a higher prevalence of diabetes and prior cardiac events, to have enlarged livers and higher median levels of liver enzymes, a history of sleep apnea, and a longer length of stay after surgery following laparoscopic Roux-en-Y gastric bypass (RYGB) and gastric sleeves but not open RYGB or laparoscopic adjustable gastric banding. Metabolic syndrome status was not significantly related to duration of surgery or rates of composite end points of intraoperative events and 30-day major adverse surgical outcomes. Conclusions: Nearly four in five participants undergoing bariatric surgery presented with metabolic syndrome. Establishing a diagnosis of metabolic syndrome in bariatric surgery patients may identify a high-risk patient profile, but does not in itself confer a higher risk for short-term adverse postsurgery outcomes. PMID:24380645

Fast-track Orthognathic Surgery: An Evidence-based Review

Science.gov (United States)

Otero, Joel Joshi; Detriche, Olivier; Mommaerts, Maurice Yves

2017-01-01

The aim of this study was to establish a fast-track protocol for bimaxillary orthognathic surgery (OGS). Fast-track surgery (FTS) is a multidisciplinary approach where the pre-, intra-, and postoperative management is focusing maximally on a quick patient recovery and early discharge. To enable this, the patients’ presurgical stress and postsurgical discomfort should be maximally reduced. Both referral patterns and expenses within the health-care system are positively influenced by FTS. University hospital-literature review through Medline, Embase, and the Cochrane Library (January 2000–July 2016) using the following words – “fast track, enhanced recovery, multimodal, and perioperative care” – to define a protocol evidence based for OGS, as well as evidenced-based medicine search of every term added to the protocol during the same period. The process has resulted in an OGS protocol that may improve the outcome of the patient through several nonoperative and operative measures such as preoperative patient education and intra/postoperative measures that should improve overall patient satisfaction, decrease morbidity such as postoperative nausea, headache, dizziness, pain, and intubation discomfort, and shorten hospital stay. A literature review allowed us to fine-tune a fast-track protocol for uncomplicated OGS that can be prospectively studied against currently applied ones. PMID:29264281

Approach to intraoperative electromagnetic navigation in orthognathic surgery: A phantom skull based trial.

Science.gov (United States)

Berger, Moritz; Kallus, Sebastian; Nova, Igor; Ristow, Oliver; Eisenmann, Urs; Dickhaus, Hartmut; Kuhle, Reinald; Hoffmann, Jürgen; Seeberger, Robin

2015-11-01

Intraoperative guidance using electromagnetic navigation is an upcoming method in maxillofacial surgery. However, due to their unwieldy structures, especially the line-of-sight problem, optical navigation devices are not used for daily orthognathic surgery. Therefore, orthognathic surgery was simulated on study phantom skulls, evaluating the accuracy and handling of a new electromagnetic tracking system. Le-Fort I osteotomies were performed on 10 plastic skulls. Orthognathic surgical planning was done in the conventional way using plaster models. Accuracy of the gold standard, splint-based model surgery versus an electromagnetic tracking system was evaluated by measuring the actual maxillary deviation using bimaxillary splints and preoperative and postoperative cone beam computer tomography imaging. The distance of five anatomical marker points were compared pre- and postoperatively. The electromagnetic tracking system was significantly more accurate in all measured parameters compared with the gold standard using bimaxillary splints (p orthognathic surgery to 0.3 mm on average. The data of this preliminary study shows a high level of accuracy in surgical orthognathic performance using electromagnetic navigation, and may offer greater precision than the conventional plaster model surgery with bimaxillary splints. This preliminary work shows great potential for the establishment of an intraoperative electromagnetic navigation system for maxillofacial surgery. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

2018 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Focused Update of the Guidelines for the Use of Antiplatelet Therapy.

Science.gov (United States)

Mehta, Shamir R; Bainey, Kevin R; Cantor, Warren J; Lordkipanidzé, Marie; Marquis-Gravel, Guillaume; Robinson, Simon D; Sibbald, Matthew; So, Derek Y; Wong, Graham C; Abunassar, Joseph G; Ackman, Margaret L; Bell, Alan D; Cartier, Raymond; Douketis, James D; Lawler, Patrick R; McMurtry, Michael S; Udell, Jacob A; van Diepen, Sean; Verma, Subodh; Mancini, G B John; Cairns, John A; Tanguay, Jean-François

2018-03-01

Antiplatelet therapy (APT) has become an important tool in the treatment and prevention of atherosclerotic events, particularly those associated with coronary artery disease. A large evidence base has evolved regarding the relationship between APT prescription in various clinical contexts and risk/benefit relationships. The Guidelines Committee of the Canadian Cardiovascular Society and Canadian Association of Interventional Cardiology publishes regular updates of its recommendations, taking into consideration the most recent clinical evidence. The present update to the 2011 and 2013 Canadian Cardiovascular Society APT guidelines incorporates new evidence on how to optimize APT use, particularly in situations in which few to no data were previously available. The recommendations update focuses on the following primary topics: (1) the duration of dual APT (DAPT) in patients who undergo percutaneous coronary intervention (PCI) for acute coronary syndrome and non-acute coronary syndrome indications; (2) management of DAPT in patients who undergo noncardiac surgery; (3) management of DAPT in patients who undergo elective and semiurgent coronary artery bypass graft surgery; (4) when and how to switch between different oral antiplatelet therapies; and (5) management of antiplatelet and anticoagulant therapy in patients who undergo PCI. For PCI patients, we specifically analyze the particular considerations in patients with atrial fibrillation, mechanical or bioprosthetic valves (including transcatheter aortic valve replacement), venous thromboembolic disease, and established left ventricular thrombus or possible left ventricular thrombus with reduced ejection fraction after ST-segment elevation myocardial infarction. In addition to specific recommendations, we provide values and preferences and practical tips to aid the practicing clinician in the day to day use of these important agents. Copyright © 2018. Published by Elsevier Inc.

SWCD: a sliding window and self-regulated learning-based background updating method for change detection in videos

Science.gov (United States)

Işık, Şahin; Özkan, Kemal; Günal, Serkan; Gerek, Ömer Nezih

2018-03-01

Change detection with background subtraction process remains to be an unresolved issue and attracts research interest due to challenges encountered on static and dynamic scenes. The key challenge is about how to update dynamically changing backgrounds from frames with an adaptive and self-regulated feedback mechanism. In order to achieve this, we present an effective change detection algorithm for pixelwise changes. A sliding window approach combined with dynamic control of update parameters is introduced for updating background frames, which we called sliding window-based change detection. Comprehensive experiments on related test videos show that the integrated algorithm yields good objective and subjective performance by overcoming illumination variations, camera jitters, and intermittent object motions. It is argued that the obtained method makes a fair alternative in most types of foreground extraction scenarios; unlike case-specific methods, which normally fail for their nonconsidered scenarios.

Second-generation speed limit map updating applications

DEFF Research Database (Denmark)

Tradisauskas, Nerius; Agerholm, Niels; Juhl, Jens

2011-01-01

Intelligent Speed Adaptation is an Intelligent Transport System developed to significantly improve road safety in helping car drivers maintain appropriate driving behaviour. The system works in connection with the speed limits on the road network. It is thus essential to keep the speed limit map...... used in the Intelligent Speed Adaptation scheme updated. The traditional method of updating speed limit maps on the basis of long time interval observations needed to be replaced by a more efficient speed limit updating tool. In a Danish Intelligent Speed Adaptation trial a web-based tool was therefore...... for map updating should preferably be made on the basis of a commercial map provider, 2 such as Google Maps and that the real challenge is to oblige road authorities to carry out updates....

[Thymus surgery in a general surgery department].

Science.gov (United States)

Mega, Raquel; Coelho, Fátima; Pimentel, Teresa; Ribero, Rui; Matos, Novo de; Araújo, António

2005-01-01

Evaluation of thymectomy cases between 1990-2003, in a General Surgery Department. Evaluation of the therapeutic efficacy in Miastenia Gravis patients. Retrospective study based on evaluation of data from Serviço de Cirurgia, Neurologia and Consult de Neurology processes, between 1990-2003, of 15 patients submitted to total thymectomy. 15 patients, aged 17 to 72, 11 female and 4 male. Miastenia Gravis was the main indication for surgery, for uncontrollable symptoms or suspicion of thymoma. In patients with myasthenia, surgery was accomplish after compensation of symptoms. There weren't post-surgery complications. Pathology were divided in thymic hyperplasia and thymoma. Miastenia patients have there symptoms diminished or stable with reduction or cessation of medical therapy. Miastenia was the most frequent indication for thymectomy. Surgery was good results, with low morbimortality, as long as the protocols are respected.

A 1-year videoconferencing-based psychoeducational group intervention following bariatric surgery: results of a randomized controlled study.

Science.gov (United States)

Wild, Beate; Hünnemeyer, Katharina; Sauer, Helene; Hain, Bernhard; Mack, Isabelle; Schellberg, Dieter; Müller-Stich, Beat Peter; Weiner, Rudolf; Meile, Tobias; Rudofsky, Gottfried; Königsrainer, Alfred; Zipfel, Stephan; Herzog, Wolfgang; Teufel, Martin

2015-01-01

For severely obese patients, bariatric surgery has been recommended as an effective therapy. The Bariataric Surgery and Education (BaSE) study aimed to assess the efficacy of a videoconferencing-based psychoeducational group intervention in patients after bariatric surgery. The BaSE study is a randomized, controlled multicenter clinical trial involving 117 patients undergoing bariatric surgery (mean preoperative body mass index [BMI] 49.9 kg/m(2), SD 6.4). Patients were enrolled between May 2009 and November 2012 and were randomly assigned to receive either conventional postsurgical visits or, in addition, a videoconferencing-based 1-year group program. Primary outcome measures were weight in kilograms, health-related quality of life (HRQOL), and general self-efficacy (GSE). Secondary outcome measures were depression symptoms and eating behavior. 94% of the patients completed the study. Mean weight loss for all patients was 45.9 kg (SD 16.4) 1 year after surgery (mean excess weight loss [EWL] 63%). Intention-to-treat analyses revealed no differences in weight loss, EWL, HRQOL, or self-efficacy between study groups at 1 year after surgery. However, patients with clinically significant depression symptoms (CSD) at baseline assigned to the intervention group (n = 29) had a significantly better HRQOL (P = .03), lower depression scores (P = .02), and a trend for a better EWL (.06) 1 year after surgery compared with the control group (n = 20). We could not prove the efficacy of the group program for the whole study sample. However, results indicate that the intervention is effective for the important subgroup of patients with CSD. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Updating systematic reviews: an international survey.

Directory of Open Access Journals (Sweden)

Chantelle Garritty

Full Text Available BACKGROUND: Systematic reviews (SRs should be up to date to maintain their importance in informing healthcare policy and practice. However, little guidance is available about when and how to update SRs. Moreover, the updating policies and practices of organizations that commission or produce SRs are unclear. METHODOLOGY/PRINCIPAL FINDINGS: The objective was to describe the updating practices and policies of agencies that sponsor or conduct SRs. An Internet-based survey was administered to a purposive non-random sample of 195 healthcare organizations within the international SR community. Survey results were analyzed using descriptive statistics. The completed response rate was 58% (n = 114 from across 26 countries with 70% (75/107 of participants identified as producers of SRs. Among responders, 79% (84/107 characterized the importance of updating as high or very-high and 57% (60/106 of organizations reported to have a formal policy for updating. However, only 29% (35/106 of organizations made reference to a written policy document. Several groups (62/105; 59% reported updating practices as irregular, and over half (53/103 of organizational respondents estimated that more than 50% of their respective SRs were likely out of date. Authors of the original SR (42/106; 40% were most often deemed responsible for ensuring SRs were current. Barriers to updating included resource constraints, reviewer motivation, lack of academic credit, and limited publishing formats. Most respondents (70/100; 70% indicated that they supported centralization of updating efforts across institutions or agencies. Furthermore, 84% (83/99 of respondents indicated they favoured the development of a central registry of SRs, analogous to efforts within the clinical trials community. CONCLUSIONS/SIGNIFICANCE: Most organizations that sponsor and/or carry out SRs consider updating important. Despite this recognition, updating practices are not regular, and many organizations lack

[Present situation and prospect of enhanced recovery after surgery in pancreatic surgery].

Science.gov (United States)

Feng, Mengyu; Zhang, Taiping; Zhao, Yupei

2017-05-25

Enhanced recovery after surgery is a multimodal perioperative strategy according to the evidence-based medicine and multidisciplinary collaboration, aiming to improve the restoration of functional capacity after surgery by reducing surgical stress, optimal control of pain, early oral diet and early mobilization. Compared with other sub-specialty in general surgery, pancreatic surgery is characterized by complex disease, highly difficult procedure and more postoperative complications. Accordingly, pancreatic surgery shares a slow development in enhanced recovery after surgery. In this review, the feasibility, safety, application progress, prospect and controversy of enhanced recovery after surgery in pancreatic surgery are discussed.

Resection of highly language-eloquent brain lesions based purely on rTMS language mapping without awake surgery.

Science.gov (United States)

Ille, Sebastian; Sollmann, Nico; Butenschoen, Vicki M; Meyer, Bernhard; Ringel, Florian; Krieg, Sandro M

2016-12-01

The resection of left-sided perisylvian brain lesions harbours the risk of postoperative language impairment. Therefore the individual patient's language distribution is investigated by intraoperative direct cortical stimulation (DCS) during awake surgery. Yet, not all patients qualify for awake surgery. Non-invasive language mapping by repetitive navigated transcranial magnetic stimulation (rTMS) has frequently shown a high correlation in comparison with the results of DCS language mapping in terms of language-negative brain regions. The present study analyses the extent of resection (EOR) and functional outcome of patients who underwent left-sided perisylvian resection of brain lesions based purely on rTMS language mapping. Four patients with left-sided perisylvian brain lesions (two gliomas WHO III, one glioblastoma, one cavernous angioma) underwent rTMS language mapping prior to surgery. Data from rTMS language mapping and rTMS-based diffusion tensor imaging fibre tracking (DTI-FT) were transferred to the intraoperative neuronavigation system. Preoperatively, 5 days after surgery (POD5), and 3 months after surgery (POM3) clinical follow-up examinations were performed. No patient suffered from a new surgery-related aphasia at POM3. Three patients underwent complete resection immediately, while one patient required a second rTMS-based resection some days later to achieve the final, complete resection. The present study shows for the first time the feasibility of successfully resecting language-eloquent brain lesions based purely on the results of negative language maps provided by rTMS language mapping and rTMS-based DTI-FT. In very select cases, this technique can provide a rescue strategy with an optimal functional outcome and EOR when awake surgery is not feasible.

Motor evoked potential monitoring of the vagus nerve with transcranial electrical stimulation during skull base surgeries.

Science.gov (United States)

Ito, Eiji; Ichikawa, Masahiro; Itakura, Takeshi; Ando, Hitoshi; Matsumoto, Yuka; Oda, Keiko; Sato, Taku; Watanabe, Tadashi; Sakuma, Jun; Saito, Kiyoshi

2013-01-01

Dysphasia is one of the most serious complications of skull base surgeries and results from damage to the brainstem and/or cranial nerves involved in swallowing. Here, the authors propose a method to monitor the function of the vagus nerve using endotracheal tube surface electrodes and transcranial electrical stimulation during skull base surgeries. Fifteen patients with skull base or brainstem tumors were enrolled. The authors used surface electrodes of an endotracheal tube to record compound electromyographic responses from the vocalis muscle. Motor neurons were stimulated using corkscrew electrodes placed subdermally on the scalp at C3 and C4. During surgery, the operator received a warning when the amplitude of the vagal motor evoked potential (MEP) decreased to less than 50% of the control level. After surgery, swallowing function was assessed clinically using grading criteria. In 5 patients, vagal MEP amplitude permanently deteriorated to less than 50% of the control level on the right side when meningiomas were dissected from the pons or basilar artery, or when a schwannoma was dissected from the vagal rootlets. These 5 patients had postoperative dysphagia. At 4 weeks after surgery, 2 patients still had dysphagia. In 2 patients, vagal MEPs of one side transiently disappeared when the tumors were dissected from the brainstem or the vagal rootlets. After surgery, both patients had dysphagia, which recovered in 4 weeks. In 7 patients, MEP amplitude was consistent, maintaining more than 50% of the control level throughout the operative procedures. After surgery all 7 patients were neurologically intact with normal swallowing function. Vagal MEP monitoring with transcranial electrical stimulation and endotracheal tube electrode recording was a safe and effective method to provide continuous real-time information on the integrity of both the supranuclear and infranuclear vagal pathway. This method is useful to prevent intraoperative injury of the brainstem

Update of guidelines for surgical endodontics - the position after ten years.

Science.gov (United States)

Evans, G E; Bishop, K; Renton, T

2012-05-25

This is the first of a series of articles, which will summarise new or updated clinical guidelines produced by the Clinical Standards Committee of the Faculty of Dental Surgery, Royal College of Surgeons of England (FDSRCS). Important developments for the dental profession from a number of clinical guidelines will be presented, commencing with the Guidelines for surgical endodontics. The impact of recent evidence relating to the outcome of surgical endodontics and techniques such as cone beam computed tomography and microsurgical techniques are considered.

EOP Improvement Proposal for SGTR based on The OPR PSA Update

Energy Technology Data Exchange (ETDEWEB)

Park, Jin Hee; Cho, Jae Hyun; Kim, Dong San; Yang, Joon Eon [KAERI, Daejeon (Korea, Republic of)

2016-05-15

This updating process was also focused to enhance the PSA quality and to respect the as built and as operated conditions of target plants. For this purpose, the EOP(Emergency Operating Procedure) and AOP(Abnormal Operating Procedure) of target plant were reviewed in detail and various thermal hydraulic(T/H) analysis were also performed to analyze the realistic PSA accident sequence model. In this paper, the unreasonable point of SGTR (Steam Generator Tube Rupture) EOP based on PSA perspective was identified and the initial proposal for EOP change items from PSA insight was proposed. In this paper, the unreasonable point of SGTR EOP based on PSA perspective was identified and the EOP improvement items are proposed to enhance safety and operator's convenience for the target plant.

Statin use and vitreoretinal surgery: Findings from a Finnish population-based cohort study.

Science.gov (United States)

Loukovaara, Sirpa; Sahanne, Sari; Takala, Annika; Haukka, Jari

2018-01-16

Vitreoretinal (VR) surgery is the third most common intraocular surgery after refractive and cataract surgery. The impact of statin therapy on VR surgery outcomes remains unclear, despite a potentially beneficial effect. We explored the association of preoperative statin therapy and the need for revitrectomy after primary vitrectomy. Our historical, population-based, register-based, VR surgery cohort consisted of 5709 patients operated in a tertiary, academic referral hospital in Finland, during 2008-2014, covering 6.5 years. Subgroup analysis was performed as follows: eyes operated due to (i) rhegmatogenous retinal detachment (RRD), (ii) VR interface diseases (macular pucker/hole), (iii) diabetic maculopathy or proliferative retinopathy, (iv) vitreous haemorrhage, (v) lens subluxation, (vi) vitreous opacities or (vii) other VR indication. The primary end-point event was revitrectomy during a postoperative follow-up period of 1 year due to retinal redetachment, vitreous rehaemorrhage, postoperative endophthalmitis, recurrent pucker or unclosed macular hole. Rhegmatogenous retinal detachment (RRD) was the second most frequent indication of VR surgery, including 1916 patients, with 305 re-operations with rate 0.20 (95% CI 0.18-0.23) per person-year. Statin treatment in time of operation was associated with lower risk of re-operation according to relative scale (incidence rate ratio 0.72, 95% CI 0.53-0.97), but not in absolute scale (incidence rate difference -0.58, 95% CI -4.30 to 3.15 for 100 person-years). No association with statin therapy and vitrectomy outcome was observed in the other VR subgroups. Use of statin treatment was associated with a 28% lower risk of revitrectomy in patients operated due to RRD. Further randomized clinical trials are highly warranted. © 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions

Science.gov (United States)

Rodríguez-Sanjuán, Juan C; Gómez-Ruiz, Marcos; Trugeda-Carrera, Soledad; Manuel-Palazuelos, Carlos; López-Useros, Antonio; Gómez-Fleitas, Manuel

2016-01-01

Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen’s fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated. PMID:26877605

Computer-based endoscopic image-processing technology for endourology and laparoscopic surgery

International Nuclear Information System (INIS)

Igarashi, Tatsuo; Suzuki, Hiroyoshi; Naya, Yukio

2009-01-01

Endourology and laparoscopic surgery are evolving in accordance with developments in instrumentation and progress in surgical technique. Recent advances in computer and image-processing technology have enabled novel images to be created from conventional endoscopic and laparoscopic video images. Such technology harbors the potential to advance endourology and laparoscopic surgery by adding new value and function to the endoscope. The panoramic and three-dimensional images created by computer processing are two outstanding features that can address the shortcomings of conventional endoscopy and laparoscopy, such as narrow field of view, lack of depth cue, and discontinuous information. The wide panoramic images show an anatomical map' of the abdominal cavity and hollow organs with high brightness and resolution, as the images are collected from video images taken in a close-up manner. To assist in laparoscopic surgery, especially in suturing, a three-dimensional movie can be obtained by enhancing movement parallax using a conventional monocular laparoscope. In tubular organs such as the prostatic urethra, reconstruction of three-dimensional structure can be achieved, implying the possibility of a liquid dynamic model for assessing local urethral resistance in urination. Computer-based processing of endoscopic images will establish new tools for endourology and laparoscopic surgery in the near future. (author)

Anaesthetic considerations in children with congenital heart disease undergoing non-cardiac surgery

Directory of Open Access Journals (Sweden)

Jagdish Menghraj Shahani

2012-01-01

Full Text Available The objective of this article is to provide an updated and comprehensive review on current perioperative anaesthetic management of paediatric patients with congenital heart disease (CHD coming for non-cardiac surgery. Search of terms such as "anaesthetic management," "congenital heart disease" and "non-cardiac surgery" was carried out in KKH eLibrary, PubMed, Medline and Google, focussing on significant current randomised control trials, case reports, review articles and editorials. Issues on how to tailor perioperative anaesthetic management on cases with left to right shunt, right to left shunt and complex heart disease are discussed in this article. Furthermore, the author also highlights special considerations such as pulmonary hypertension, neonates with CHD coming for extracardiac surgery and the role of regional anaesthesia in children with CHD undergoing non-cardiac operation.

Quality Assurance of Multiport Image-Guided Minimally Invasive Surgery at the Lateral Skull Base

Directory of Open Access Journals (Sweden)

Maria Nau-Hermes

2014-01-01

Full Text Available For multiport image-guided minimally invasive surgery at the lateral skull base a quality management is necessary to avoid the damage of closely spaced critical neurovascular structures. So far there is no standardized method applicable independently from the surgery. Therefore, we adapt a quality management method, the quality gates (QG, which is well established in, for example, the automotive industry and apply it to multiport image-guided minimally invasive surgery. QG divide a process into different sections. Passing between sections can only be achieved if previously defined requirements are fulfilled which secures the process chain. An interdisciplinary team of otosurgeons, computer scientists, and engineers has worked together to define the quality gates and the corresponding criteria that need to be fulfilled before passing each quality gate. In order to evaluate the defined QG and their criteria, the new surgery method was applied with a first prototype at a human skull cadaver model. We show that the QG method can ensure a safe multiport minimally invasive surgical process at the lateral skull base. Therewith, we present an approach towards the standardization of quality assurance of surgical processes.

Quality assurance of multiport image-guided minimally invasive surgery at the lateral skull base.

Science.gov (United States)

Nau-Hermes, Maria; Schmitt, Robert; Becker, Meike; El-Hakimi, Wissam; Hansen, Stefan; Klenzner, Thomas; Schipper, Jörg

2014-01-01

For multiport image-guided minimally invasive surgery at the lateral skull base a quality management is necessary to avoid the damage of closely spaced critical neurovascular structures. So far there is no standardized method applicable independently from the surgery. Therefore, we adapt a quality management method, the quality gates (QG), which is well established in, for example, the automotive industry and apply it to multiport image-guided minimally invasive surgery. QG divide a process into different sections. Passing between sections can only be achieved if previously defined requirements are fulfilled which secures the process chain. An interdisciplinary team of otosurgeons, computer scientists, and engineers has worked together to define the quality gates and the corresponding criteria that need to be fulfilled before passing each quality gate. In order to evaluate the defined QG and their criteria, the new surgery method was applied with a first prototype at a human skull cadaver model. We show that the QG method can ensure a safe multiport minimally invasive surgical process at the lateral skull base. Therewith, we present an approach towards the standardization of quality assurance of surgical processes.

Application of terrestrial laser scanning to the development and updating of the base map

Science.gov (United States)

Klapa, Przemysław; Mitka, Bartosz

2017-06-01

The base map provides basic information about land to individuals, companies, developers, design engineers, organizations, and government agencies. Its contents include spatial location data for control network points, buildings, land lots, infrastructure facilities, and topographic features. As the primary map of the country, it must be developed in accordance with specific laws and regulations and be continuously updated. The base map is a data source used for the development and updating of derivative maps and other large scale cartographic materials such as thematic or topographic maps. Thanks to the advancement of science and technology, the quality of land surveys carried out by means of terrestrial laser scanning (TLS) matches that of traditional surveying methods in many respects. This paper discusses the potential application of output data from laser scanners (point clouds) to the development and updating of cartographic materials, taking Poland's base map as an example. A few research sites were chosen to present the method and the process of conducting a TLS land survey: a fragment of a residential area, a street, the surroundings of buildings, and an undeveloped area. The entire map that was drawn as a result of the survey was checked by comparing it to a map obtained from PODGiK (pol. Powiatowy Ośrodek Dokumentacji Geodezyjnej i Kartograficznej - Regional Centre for Geodetic and Cartographic Records) and by conducting a field inspection. An accuracy and quality analysis of the conducted fieldwork and deskwork yielded very good results, which provide solid grounds for predicating that cartographic materials based on a TLS point cloud are a reliable source of information about land. The contents of the map that had been created with the use of the obtained point cloud were very accurately located in space (x, y, z). The conducted accuracy analysis and the inspection of the performed works showed that high quality is characteristic of TLS surveys. The

Developing accreditation for community based surgery: the Irish experience.

Science.gov (United States)

Ní Riain, Ailís; Collins, Claire; O'Sullivan, Tony

2018-02-05

Purpose Carrying out minor surgery procedures in the primary care setting is popular with patients, cost effective and delivers at least as good outcomes as those performed in the hospital setting. This paper aims to describe the central role of clinical leadership in developing an accreditation system for general practitioners (GPs) undertaking community-based surgery in the Irish national setting where no mandatory accreditation process currently exists. Design/methodology/approach In all, 24 GPs were recruited to the GP network. Ten pilot standards were developed addressing GPs' experience and training, clinical activity and practice supporting infrastructure and tested, using information and document review, prospective collection of clinical data and a practice inspection visit. Two additional components were incorporated into the project (patient satisfaction survey and self-audit). A multi-modal evaluation was undertaken. A majority of GPs was included at all stages of the project, in line with the principles of action learning. The steering group had a majority of GPs with relevant expertise and representation of all other actors in the minor surgery arena. The GP research network contributed to each stage of the project. The project lead was a GP with minor surgery experience. Quantitative data collected were analysed using Predictive Analytic SoftWare. Krueger's framework analysis approach was used to analyse the qualitative data. Findings A total of 9 GPs achieved all standards at initial review, 14 successfully completed corrective actions and 1 GP did not achieve the required standard. Standards were then amended to reflect findings and a supporting framework was developed. Originality/value The flexibility of the action-learning approach and the clinical leadership design allowed for the development of robust quality standards in a short timeframe.

Is Office-Based Surgery Safe? Comparing Outcomes of 183,914 Aesthetic Surgical Procedures Across Different Types of Accredited Facilities.

Science.gov (United States)

Gupta, Varun; Parikh, Rikesh; Nguyen, Lyly; Afshari, Ashkan; Shack, R Bruce; Grotting, James C; Higdon, K Kye

2017-02-01

There has been a dramatic rise in office-based surgery. However, due to wide variations in regulatory standards, the safety of office-based aesthetic surgery has been questioned. This study compares complication rates of cosmetic surgery performed at office-based surgical suites (OBSS) to ambulatory surgery centers (ASCs) and hospitals. A prospective cohort of patients undergoing cosmetic surgery between 2008 and 2013 were identified from the CosmetAssure database (Birmingham, AL). Patients were grouped by type of accredited facility where the surgery was performed: OBSS, ASC, or hospital. The primary outcome was the incidence of major complication(s) requiring emergency room visit, hospital admission, or reoperation within 30 days postoperatively. Potential risk factors including age, gender, body mass index (BMI), smoking, diabetes, type of procedure, and combined procedures were reviewed. Of the 129,007 patients (183,914 procedures) in the dataset, the majority underwent the procedure at ASCs (57.4%), followed by hospitals (26.7%) and OBSS (15.9%). Patients operated in OBSS were less likely to undergo combined procedures (30.3%) compared to ASCs (31.8%) and hospitals (35.3%, P procedures. Plastic surgeons should continue to triage their patients carefully based on other significant comorbidities that were not measured in this present study. LEVEL OF EVIDENCE 3. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

Predictive factors for cosmetic surgery: a hospital-based investigation.

Science.gov (United States)

Li, Jun; Li, Qian; Zhou, Bei; Gao, Yanli; Ma, Jiehua; Li, Jingyun

2016-01-01

Cosmetic surgery is becoming increasingly popular in China. However, reports on the predictive factors for cosmetic surgery in Chinese individuals are scarce in the literature. We retrospectively analyzed 4550 cosmetic surgeries performed from January 2010 to December 2014 at a single center in China. Data collection included patient demographics and type of cosmetic surgery. Predictive factors were age, sex, marital status, occupational status, educational degree, and having had children. Predictive factors for the three major cosmetic surgeries were determined using a logistic regression analysis. Patients aged 19-34 years accounted for the most popular surgical procedures (76.9 %). The most commonly requested procedures were eye surgery, Botox injection, and nevus removal. Logistic regression analysis showed that higher education level (college, P = 0.01, OR 1.21) was predictive for eye surgery. Age (19-34 years, P = 0.00, OR 33.39; 35-50, P = 0.00, OR 31.34; ≥51, P = 0.00, OR 16.42), female sex (P = 0.00, OR 9.19), employment (service occupations, P = 0.00, OR 2.31; non-service occupations, P = 0.00, OR 1.76), and higher education level (college, P = 0.00, OR 1.39) were independent predictive factors for Botox injection. Married status (P = 0.00, OR 1.57), employment (non-service occupations, P = 0.00, OR 1.50), higher education level (masters, P = 0.00, OR 6.61), and having children (P = 0.00, OR 1.45) were independent predictive factors for nevus removal. The principal three cosmetic surgeries (eye surgery, Botox injection, and nevus removal) were associated with multiple variables. Patients employed in non-service occupations were more inclined to undergo Botox injection and nevus removal. Cohort study, Level III.

Exercise-based cardiac rehabilitation for adults after Heart valve surgery (protocol)

DEFF Research Database (Denmark)

Lærum Sibilitz, Kristine; Berg, Selina Kikkenborg; Tang, Lars Hermann

2013-01-01

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the benefits and harms of exercise-based intervention programmes (exercise-based interventions alone or in combination with psycho-educational components), compared to no intervention, or treatment...... as usual, in adults who have had heart valve surgery. In this review we will focus on programmes that include an exercise-based intervention with, or without, another rehabilitation component (such as a psycho-educational component)....

Student perceptions of a simulation-based flipped classroom for the surgery clerkship: A mixed-methods study.

Science.gov (United States)

Liebert, Cara A; Mazer, Laura; Bereknyei Merrell, Sylvia; Lin, Dana T; Lau, James N

2016-09-01

The flipped classroom, a blended learning paradigm that uses pre-session online videos reinforced with interactive sessions, has been proposed as an alternative to traditional lectures. This article investigates medical students' perceptions of a simulation-based, flipped classroom for the surgery clerkship and suggests best practices for implementation in this setting. A prospective cohort of students (n = 89), who were enrolled in the surgery clerkship during a 1-year period, was taught via a simulation-based, flipped classroom approach. Students completed an anonymous, end-of-clerkship survey regarding their perceptions of the curriculum. Quantitative analysis of Likert responses and qualitative analysis of narrative responses were performed. Students' perceptions of the curriculum were positive, with 90% rating it excellent or outstanding. The majority reported the curriculum should be continued (95%) and applied to other clerkships (84%). The component received most favorably by the students was the simulation-based skill sessions. Students rated the effectiveness of the Khan Academy-style videos the highest compared with other video formats (P flipped classroom in the surgery clerkship were overwhelmingly positive. The flipped classroom approach can be applied successfully in a surgery clerkship setting and may offer additional benefits compared with traditional lecture-based curricula. Copyright © 2016 Elsevier Inc. All rights reserved.

Sequence History Update Tool

Science.gov (United States)

Khanampompan, Teerapat; Gladden, Roy; Fisher, Forest; DelGuercio, Chris

2008-01-01

The Sequence History Update Tool performs Web-based sequence statistics archiving for Mars Reconnaissance Orbiter (MRO). Using a single UNIX command, the software takes advantage of sequencing conventions to automatically extract the needed statistics from multiple files. This information is then used to populate a PHP database, which is then seamlessly formatted into a dynamic Web page. This tool replaces a previous tedious and error-prone process of manually editing HTML code to construct a Web-based table. Because the tool manages all of the statistics gathering and file delivery to and from multiple data sources spread across multiple servers, there is also a considerable time and effort savings. With the use of The Sequence History Update Tool what previously took minutes is now done in less than 30 seconds, and now provides a more accurate archival record of the sequence commanding for MRO.

Robotic-assisted laparoendoscopic single-site surgery (R-LESS) in urology: an evidence-based analysis.

Science.gov (United States)

Barret, E; Sanchez-Salas, R; Ercolani, M; Forgues, A; Rozet, F; Galiano, M; Cathelineau, X

2011-06-01

The objective of this manuscript is to provide an evidence-based analysis of the current status and future perspectives of robotic laparoendoscopic single-site surgery (R-LESS). A PubMed search has been performed for all relevant urological literature regarding natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). All clinical and investigative reports for robotic LESS and NOTES procedures in the urological literature have been considered. A significant number of clinical urological procedures have been successfully completed utilizing R-LESS procedures. The available experience is limited to referral centers, where the case volume is sufficient to help overcome the challenges and learning curve of LESS surgery. The robotic interface remains the best fit for LESS procedures but its mode of use continues to evolve in attempts to improve surgical technique. We stand today at the dawn of R-LESS surgery, but this approach may well become the standard of care in the near future. Further technological development is needed to allow widespread adoption of the technique.

Improving the accuracy of brain tumor surgery via Raman-based technology.

Science.gov (United States)

Hollon, Todd; Lewis, Spencer; Freudiger, Christian W; Sunney Xie, X; Orringer, Daniel A

2016-03-01

Despite advances in the surgical management of brain tumors, achieving optimal surgical results and identification of tumor remains a challenge. Raman spectroscopy, a laser-based technique that can be used to nondestructively differentiate molecules based on the inelastic scattering of light, is being applied toward improving the accuracy of brain tumor surgery. Here, the authors systematically review the application of Raman spectroscopy for guidance during brain tumor surgery. Raman spectroscopy can differentiate normal brain from necrotic and vital glioma tissue in human specimens based on chemical differences, and has recently been shown to differentiate tumor-infiltrated tissues from noninfiltrated tissues during surgery. Raman spectroscopy also forms the basis for coherent Raman scattering (CRS) microscopy, a technique that amplifies spontaneous Raman signals by 10,000-fold, enabling real-time histological imaging without the need for tissue processing, sectioning, or staining. The authors review the relevant basic and translational studies on CRS microscopy as a means of providing real-time intraoperative guidance. Recent studies have demonstrated how CRS can be used to differentiate tumor-infiltrated tissues from noninfiltrated tissues and that it has excellent agreement with traditional histology. Under simulated operative conditions, CRS has been shown to identify tumor margins that would be undetectable using standard bright-field microscopy. In addition, CRS microscopy has been shown to detect tumor in human surgical specimens with near-perfect agreement to standard H & E microscopy. The authors suggest that as the intraoperative application and instrumentation for Raman spectroscopy and imaging matures, it will become an essential component in the neurosurgical armamentarium for identifying residual tumor and improving the surgical management of brain tumors.

Web-based tailored intervention for preparation of parents and children for outpatient surgery (WebTIPS): development.

Science.gov (United States)

Kain, Zeev N; Fortier, Michelle A; Chorney, Jill MacLaren; Mayes, Linda

2015-04-01

As a result of cost-containment efforts, preparation programs for outpatient surgery are currently not available to the majority of children and parents. The recent dramatic growth in the Internet presents a unique opportunity to transform how children and their parents are prepared for surgery. In this article, we describe the development of a Web-based Tailored Intervention for Preparation of parents and children undergoing Surgery (WebTIPS). A multidisciplinary taskforce agreed that a Web-based tailored intervention consisting of intake, matrix, and output modules was the preferred approach. Next, the content of the various intake variables, the matrix logic, and the output content was developed. The output product has a parent component and a child component and is described in http://surgerywebtips.com/about.php. The child component makes use of preparation strategies such as information provision, modeling, play, and coping skills training. The parent component of WebTIPS includes strategies such as information provision, coping skills training, and relaxation and distraction techniques. A reputable animation and Web design company developed a secured Web-based product based on the above description. In this article, we describe the development of a Web-based tailored preoperative preparation program that can be accessed by children and parents multiple times before and after surgery. A follow-up article in this issue of Anesthesia & Analgesia describes formative evaluation and preliminary efficacy testing of this Web-based tailored preoperative preparation program.

Use of computer-based clinical examination to assess medical students in surgery.

Science.gov (United States)

El Shallaly, Gamal E H A; Mekki, Abdelrahman M

2012-01-01

To improve the viewing of the video-projected structured clinical examination (ViPSCE), we developed a computerized version; the computer-based clinical examination (CCE). This was used to assess medical students' higher knowledge and problem solving skills in surgery. We present how we did this, test score descriptive statistics, and the students' evaluation of the CCE. A CCE in surgery was administered to assess a class of 43 final year medical students at the end of their surgical clerkship. Like the ViPSCE, the exam was delivered as a slide show, using a PowerPoint computer program. However, instead of projecting it onto a screen, each student used a computer. There were 20 slides containing either still photos or short video clips of clinical situations in surgery. The students answered by hand writing on the exam papers. At the end, they completed evaluation forms. The exam papers were corrected manually. Test score descriptive statistics were calculated and correlated with the students' scores in other exams in surgery. Administration of the CCE was straightforward. The test scores were normally distributed (mean = median = 4.9). They correlated significantly with the total scores obtained by the students in surgery (r = 0.68), and with each of the other exam modalities in surgery, such as the multiple choice and structured essay questions. Acceptability of the CCE to the students was high and they recommended the use of the CCE in other departments. CCE is feasible and popular with students. It inherits the validity and reliability of the ViPSCE with the added advantage of improving the viewing of the slides.

Tracking Real-Time Changes in Working Memory Updating and Gating with the Event-Based Eye-Blink Rate

NARCIS (Netherlands)

Rac-Lubashevsky, R.; Slagter, H.A.; Kessler, Y.

2017-01-01

Effective working memory (WM) functioning depends on the gating process that regulates the balance between maintenance and updating of WM. The present study used the event-based eye-blink rate (ebEBR), which presumably reflects phasic striatal dopamine activity, to examine how the cognitive

Modified three-dimensional skull base model with artificial dura mater, cranial nerves, and venous sinuses for training in skull base surgery: technical note.

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Mori, Kentaro; Yamamoto, Takuji; Oyama, Kazutaka; Ueno, Hideaki; Nakao, Yasuaki; Honma, Keiichirou

2008-12-01

Experience with dissection of the cavernous sinus and the temporal bone is essential for training in skull base surgery, but the opportunities for cadaver dissection are very limited. A modification of a commercially available prototype three-dimensional (3D) skull base model, made by a selective laser sintering method and incorporating surface details and inner bony structures such as the inner ear structures and air cells, is proposed to include artificial dura mater, cranial nerves, venous sinuses, and the internal carotid artery for such surgical training. The transpetrosal approach and epidural cavernous sinus surgery (Dolenc's technique) were performed on this modified model using a high speed drill or ultrasonic bone curette under an operating microscope. The model could be dissected in almost the same way as a real cadaver. The modified 3D skull base model provides a good educational tool for training in skull base surgery.

Virtual surgical planning in endoscopic skull base surgery.

Science.gov (United States)

Haerle, Stephan K; Daly, Michael J; Chan, Harley H L; Vescan, Allan; Kucharczyk, Walter; Irish, Jonathan C

2013-12-01

Skull base surgery (SBS) involves operative tasks in close proximity to critical structures in a complex three-dimensional (3D) anatomy. The aim was to investigate the value of virtual planning (VP) based on preoperative magnetic resonance imaging (MRI) for surgical planning in SBS and to compare the effects of virtual planning with 3D contours between the expert and the surgeon in training. Retrospective analysis. Twelve patients with manually segmented anatomical structures based on preoperative MRI were evaluated by eight surgeons in a randomized order using a validated National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire. Multivariate analysis revealed significant reduction of workload when using VP (PNASA-TLX differences (P.05). Preoperative anatomical segmentation with virtual surgical planning using contours in endoscopic SBS significantly reduces the workload for the expert and the surgeon in training. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Imaging studies for failed back surgery syndrome

International Nuclear Information System (INIS)

Cosnard, G.; Cordoliani, Y.S.; Sarrazin, J.L.; Soulie, D.

1995-01-01

In patients with failed back surgery syndrome, magnetic resonance imaging (MRI) can be the best first-line imaging study because it simplifies the diagnosis. This update is based on over 600 cases. MRI shows the scar tissue at the surgical site, persistent evidence of disk herniation for several weeks after surgery, and evidence of local and regional edema in one-fourth of cases. The edema is most marked between two months and two years after the operation and can misleadingly suggest discitis. MRI is the best investigation for detecting recurrent herniation at the same vertebral level or another level. Herniated disk material is seen as a mass that does not enhance after gadolinium, in contrast to the vascularized scar tissue. Free fragments are often clearly visible within the scar tissue. Fragments that migrate to the epidural space can give rise to granulomatous reactions. Scar tissue can be seen in the epidural space and within the disk; it can show enhancement after gadolinium for several years. The scar can be atrophic or hypertrophic and can encase or impinge on the dural sac and nerve roots. Pathological fibrosis cannot be differentiated from ordinary scar tissue. Arachnoiditis causing adherence of the nerve roots to the dura mater or to each other occurs in 5 % to 10 % of cases. Nerve root enhancement after gadolinium is seen in three-fourths of cases. Bone lesions are common, especially some time after surgery; they are usually accompanied with other lesions. Hematomas are seen in less than 10 % of cases. Infections are similarly rare (0.25 % each for discitis and epiduritis). The diagnosis of discitis is difficult and requires percutaneous biopsy of the disk, especially when MRI shows fluid within the disk, with decreased signal intensity on T2 images, and non enhancement after intravenous gadolinium. (authors). 19 refs., 7 figs

Interdisciplinary consensus on diagnosis and treatment of testicular germ cell tumors. Results of an update conference based on evidence-based medicine (EBM); Interdisziplinaerer Konsensus zur Diagnostik und Therapie von Hodentumoren. Ergebnisse einer Update-Konferenz auf Grundlage evidenzbasierter Medizin (EBM)

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Souchon, R. [Deutsche Gesellschaft fuer Radioonkologie (DEGRO) (Germany); Arbeitsgemeinschaft Radiologische Onkologie (ARO), Strahlenklinik AKH Hagen (Germany); Krege, S. [Deutsche Gesellschaft fuer Urologie (DGU) (Germany); Essen Univ. (Gesamthochschule) (Germany). Klinik und Poliklinik fuer Urologie; Schmoll, H.J. [Arbeitsgemeinschaft Internistische Onkologie (AIO), Zentrum fuer innere Medizin IV der Martin-Luther-Univ. Halle-Wittenberg (Germany); Albers, P. [Bonn Univ. (Germany). Urologische Klinik; Beyer, J. [Marburg Univ. (Germany). Medizinisches Zentrum fuer Innere Medizin; Bokemeyer, C. [Tuebingen Univ. (Germany). Abt. fuer Innere Medizin 2; Classen, J. [Tuebingen Univ. (Germany). Medizinisches Strahleninstitut und Roentgenabteilung; Dieckmann, K.P. [Albertinen-Krankenhaus, Hamburg (Germany). Urologische Abt.; Hartmann, M. [Bundeswehrkrankenhaus, Hamburg (Germany). Urologische Abt.; Heidenreich, A. [Marburg Univ. (Germany). Urologische Klinik; Hoeltl, W. [Kaiser-Franz-Josef-Spital Wien (Austria). Urologische Klinik; Kliesch, S. [Muenster Univ. (Germany). Klinik fuer Urologie; Koehrmann, K.U. [Urologische Klinik des Klinikums der Stadt Mannheim (Germany); Kuczyk, M. [Medizinische Hochschule Hannover (Germany). Klinik fuer Urologie; Schmidberger, H. [Goettingen Univ. (Germany). Klinik fuer Strahlentherapie und Radioonkologie; Weinknecht, S. [Krankenhaus am Urban Berlin (Germany). Urologische Abt.; Winter, E. [Klinikum Schwerin (Germany). Urologische Klinik; Wittekind, C. [Leipzig Univ. (Germany). Inst. fuer Pathologie; Bamberg, M. [Tuebingen Univ. (Germany). Abt. fuer Strahlentherapie

2000-09-01

An 'Interdisciplinary Update Consensus Statement' summarizes and defines the diagnostic and therapeutic standards according to the current scientific practices in testicular cancer. For 21 separate areas scientifically based decision criteria are suggested. For treatment areas where more than one option exist without a consensus being reached for a preferred strategy, such as in seminoma in clinical Stage I or in non-seminoma Stages CS I or CS IIA/B, all acceptable alternative strategies with their respecitve advantages and disadvantages are presented. This 'Interdisciplinary Update Consensus' was presented at the 24th National Congress of the German Cancer Society on March 21st and subsequently evaluated and approved by the various German scientific medical societies. (orig.) [German] Der zu 21 Themenkomplexen anhand wissenschaftlich begruendeter Entscheidungskriterien erarbeitete 'Interdisziplinaere Update-Konsensus' praezisiert und definiert diagnostische und therapeutische Standards entsprechend dem aktuellen Wissensstand ueber die Tumorentitaet. Fuer Therapiesituationen, bei denen mehrere Optionen bestehen und kein Konsens ueber die favorisierte Strategie erzielt wurde wie beim Seminom im klinischen Stadium I oder beim Nichtseminom in den Stadien CS I bzw. CS IIA/B, wurden jeweilige Alternativen mit deren Vor- und Nachteilen dargestellt. Der 'Interdisziplinaere Update-Konsensus' wurde beim 24. Deutschen Krebskongress am 21.3.2000 vorgestellt, nachfolgend von den daran beteiligten wissenschaftlichen Fachgesellschaften geprueft und gebilligt. (orig.)

Evaluating Non-In-Place Update Techniques for Flash-Based Transaction Processing Systems

Science.gov (United States)

Wang, Yongkun; Goda, Kazuo; Kitsuregawa, Masaru

Recently, flash memory is emerging as the storage device. With price sliding fast, the cost per capacity is approaching to that of SATA disk drives. So far flash memory has been widely deployed in consumer electronics even partly in mobile computing environments. For enterprise systems, the deployment has been studied by many researchers and developers. In terms of the access performance characteristics, flash memory is quite different from disk drives. Without the mechanical components, flash memory has very high random read performance, whereas it has a limited random write performance because of the erase-before-write design. The random write performance of flash memory is comparable with or even worse than that of disk drives. Due to such a performance asymmetry, naive deployment to enterprise systems may not exploit the potential performance of flash memory at full blast. This paper studies the effectiveness of using non-in-place-update (NIPU) techniques through the IO path of flash-based transaction processing systems. Our deliberate experiments using both open-source DBMS and commercial DBMS validated the potential benefits; x3.0 to x6.6 performance improvement was confirmed by incorporating non-in-place-update techniques into file system without any modification of applications or storage devices.

Collinearity analysis of Brassica A and C genomes based on an updated inferred unigene order

Directory of Open Access Journals (Sweden)

Ian Bancroft

2015-06-01

Full Text Available This data article includes SNP scoring across lines of the Brassica napus TNDH population based on Illumina sequencing of mRNA, expanded to 75 lines. The 21, 323 mapped markers defined 887 recombination bins, representing an updated genetic linkage map for the species. Based on this new map, 5 genome sequence scaffolds were split and the order and orientation of scaffolds updated to establish a new pseudomolecule specification. The order of unigenes and SNP array probes within these pseudomolecules was determined. Unigenes were assessed for sequence similarity to the A and C genomes. The 57, 246 that mapped to both enabled the collinearity of the A and C genomes to be illustrated graphically. Although the great majority was in collinear positions, some were not. Analyses of 60 such instances are presented, suggesting that the breakdown in collinearity was largely due to either the absence of the homoeologue on one genome (resulting in sequence match to a paralogue or multiple similar sequences being present. The mRNAseq datasets for the TNDH lines are available from the SRA repository (ERA283648; the remaining datasets are supplied with this article.

Out of the shadows and 6000 reasons to celebrate: An update from FIGO's fistula surgery training initiative.

Science.gov (United States)

Slinger, Gillian; Trautvetter, Lilli; Browning, Andrew; Rane, Ajay

2018-06-01

Obstetric fistula is a devastating childbirth injury caused by unrelieved obstructed labor. Obstetric fistula leads to chronic incontinence and, in most cases, significant physical and emotional suffering. The condition continues to blight the lives of 1-2 million women in low-resource settings, with 50 000-100 000 new cases each year adding to the backlog. A trained, skilled fistula surgeon is essential to repair an obstetric fistula; however, owing to a global shortage of these surgeons, few women are able to receive life-restoring treatment. In 2011, to address the treatment gap, FIGO and partners released the Global Competency-Based Fistula Surgery Training Manual, the first standardized curriculum to train fistula surgeons. To increase the number of fistula surgeons, the FIGO Fistula Surgery Training Initiative was launched in 2012, and FIGO Fellows started to enter the program to train as fistula surgeons. Following a funding boost in 2014, the initiative has grown considerably. With 52 fellows involved and a new Expert Advisory Group in place, the program is achieving major milestones, with a record-breaking number of fistula repairs performed by FIGO Fellows in 2017, bringing the total number of repairs since the start of the project to more than 6000. © 2018 International Federation of Gynecology and Obstetrics.

[Local recurrence based on size after conservative surgery in breast cancer stage T1-T2. A population-based study].

Science.gov (United States)

Martínez-Ramos, David; Fortea-Sanchis, Carlos; Escrig-Sos, Javier; Prats-de Puig, Miguel; Queralt-Martín, Raquel; Salvador-Sanchis, José Luís

2014-01-01

Conservative surgery can be regarded as the standard treatment for most early stage breast tumors. However, a minority of patients treated with conservative surgery will present local or locoregional recurrence. Therefore, it is of interest to evaluate the possible factors associated with this recurrence. A population-based retrospective study using data from the Tumor Registry of Castellón (Valencia, Spain) of patients operated on for primary nonmetastatic breast cancer between January 2000 and December 2008 was designed. Kaplan-Meier curves and log-rank test to estimate 5-year local recurrence were used. Two groups of patients were defined, one with conservative surgery and another with nonconservative surgery. Cox multivariate analysis was conducted. The total number of patients was 410. Average local recurrence was 6.8%. In univariate analysis, only tumor size and lymph node involvement showed significant differences. On multivariate analysis, independent prognostic factors were conservative surgery (hazard ratio [HR] 4.62; 95% confidence interval [CI]: 1.12-16.82), number of positive lymph nodes (HR 1.07; 95% CI: 1.01-1.17) and tumor size (in mm) (HR 1.02; 95% CI: 1.01-1.06). Local recurrence after breast-conserving surgery is higher in tumors >2 cm. Although tumor size should not be a contraindication for conservative surgery, it should be a risk factor to be considered.

A Commentary on "Updating the Duplex Design for Test-Based Accountability in the Twenty-First Century"

Science.gov (United States)

Brandt, Steffen

2010-01-01

This article presents the author's commentary on "Updating the Duplex Design for Test-Based Accountability in the Twenty-First Century," in which Isaac I. Bejar and E. Aurora Graf propose the application of a test design--the duplex design (which was proposed in 1988 by Bock and Mislevy) for application in current accountability assessments.…

[Inpatient Salivary Gland Surgery in Germany: A DRG-Based Nationwide Analysis, 2007-2011].

Science.gov (United States)

Jensen, J E; Schlattmann, P; Guntinas-Lichius, O

2016-09-01

This is the first population-based analysis of inpatient salivary gland surgery across Germany. Nationwide Diagnosis-Related Groups (DRG) statistics for 2007 to 2011 were analyzed regarding indications for salivary gland surgery based on ICD-10 codes. Age specific surgery rates were calculated for both sexes. Inpatient salivary gland surgical rates in 2007-2011 amounted for incisions (OPS [Classification of Operations and Procedures] code 5-260) 1.43 per 100 000 population, for excisions (5-261) 2.06 per 100 000, for salivary gland resections (5-262) 2.06 per 100 000, and for external incisions (5-270) 0.43 per 100 000. Regarding the mentioned four OPS codes, the surgical rates for benign tumors accounted to 10.08 per 100 000, for sialadenitis (without sialoliths) to 4.00 per 100 000, for malignant tumors to 3.90 per 100 000, and for sialolithiasis to 2.09 per 100 000. The increase of surgical rates from 2007 to 2011 was significant for malignant and benign tumors as well as for salivary stones. The surgical rates were highest for patients>60 years. Especially surgery for malignant tumors was more frequent than expected. In spite of the introduction of minimal invasive technique the rates for salivary gland resections in case of sialadenitis or sialolithiasis still seem to be high. © Georg Thieme Verlag KG Stuttgart · New York.

Patient Satisfaction With an Early Smartphone-Based Cosmetic Surgery Postoperative Follow-Up.

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Pozza, Edoardo Dalla; D'Souza, Gehaan F; DeLeonibus, Anthony; Fabiani, Brianna; Gharb, Bahar Bassiri; Zins, James E

2017-12-13

While prevalent in everyday life, smartphones are also finding increasing use as a medical care adjunct. The use of smartphone technology as a postoperative cosmetic surgery adjunct for care has received little attention in the literature. The purpose of this effort was to assess the potential efficacy of a smartphone-based cosmetic surgery early postoperative follow-up program. Specifically, could smartphone photography provided by the patient to the plastic surgeon in the first few days after surgery allay patient's concerns, improve the postoperative experience and, possibly, detect early complications? From August 2015 to March 2016 a smartphone-based postoperative protocol was established for patients undergoing cosmetic procedures. At the time of discharge, the plastic surgeon sent a text to the patient with instructions for the patient to forward a postoperative photograph of the operated area within 48 to 72 hours. The plastic surgeon then made a return call/text that same day to review the patient's progress. A postoperative questionnaire evaluated the patients' postoperative experience and satisfaction with the program. A total of 57 patients were included in the study. Fifty-two patients responded to the survey. A total of 50 (96.2%) patients reported that the process improved the quality of their postoperative experience. The protocol allowed to detect early complications in 3 cases. The physician was able to address and treat the complications the following day prior to the scheduled clinic follow up. The smartphone can be effectively utilized by the surgeon to both enhance the patient's postoperative experience and alert the surgeon to early postoperative problems. 4. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study

Science.gov (United States)

Li, Liang; Yang, Jian; Chu, Yakui; Wu, Wenbo; Xue, Jin; Liang, Ping; Chen, Lei

2016-01-01

Objective To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery. Materials and Methods In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems. Results The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D) virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons. Conclusion The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon’s skills and knowledge, not as a substitute. PMID:26757365

A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study.

Directory of Open Access Journals (Sweden)

Liang Li

Full Text Available To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery.In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems.The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons.The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon's skills and knowledge, not as a substitute.

Cloud-Based Service Information System for Evaluating Quality of Life after Breast Cancer Surgery.

Directory of Open Access Journals (Sweden)

Hao-Yun Kao

Full Text Available Although recent studies have improved understanding of quality of life (QOL outcomes of breast conserving surgery, few have used longitudinal data for more than two time points, and few have examined predictors of QOL over two years. Additionally, the longitudinal data analyses in such studies rarely apply the appropriate statistical methodology to control for censoring and inter-correlations arising from repeated measures obtained from the same patient pool. This study evaluated an internet-based system for measuring longitudinal changes in QOL and developed a cloud-based system for managing patients after breast conserving surgery.This prospective study analyzed 657 breast cancer patients treated at three tertiary academic hospitals. Related hospital personnel such as surgeons and other healthcare professionals were also interviewed to determine the requirements for an effective cloud-based system for surveying QOL in breast cancer patients. All patients completed the SF-36, Quality of Life Questionnaire (QLQ-C30 and its supplementary breast cancer measure (QLQ-BR23 at baseline, 6 months, 1 year, and 2 years postoperatively. The 95% confidence intervals for differences in responsiveness estimates were derived by bootstrap estimation. Scores derived by these instruments were interpreted by generalized estimating equation before and after surgery.All breast cancer surgery patients had significantly improved QLQ-C30 and QLQ-BR23 subscale scores throughout the 2-year follow-up period (p<0.05. During the study period, QOL generally had a negative association with advanced age, high Charlson comorbidity index score, tumor stage III or IV, previous chemotherapy, and long post-operative LOS. Conversely, QOL was positively associated with previous radiotherapy and hormone therapy. Additionally, patients with high scores for preoperative QOL tended to have high scores for QLQ-C30, QLQ-BR23 and SF-36 subscales. Based on the results of usability testing

Bariatric Surgery and Endoluminal Procedures: IFSO Worldwide Survey 2014.

Science.gov (United States)

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

2017-09-01

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

[Orthopedic and trauma surgery in the German DRG system 2008].

Science.gov (United States)

Franz, D; Kaufmann, M; Siebert, C H; Windolf, J; Roeder, N

2008-04-01

The German DRG (diagnosis-related groups) system has been modified and updated into version 2008. For orthopedic and trauma surgery significant changes concerning coding of diagnoses, medical procedures and the DRG structure were made. The modified version has been analyzed in order to ascertain whether the DRG system is suitably qualified to fulfill the demands of the reimbursement system or whether further improvements are necessary. Analysis of the severity of relevant side-effect diagnoses, medical procedures and G-DRGs in the versions 2007 and 2008 was carried out based on the publications of the German DRG institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). Changes for 2008 focused on the development of DRG structure, DRG validation and codes for medical procedures. The outcome of these changes for German hospitals may vary depending on the range of activities. G-DRG system has become even more complex and the new regulations have also resulted in new problems associated with complications.. High demands are made on correct and complete coding of complex orthopedic and trauma surgery cases. Quality of case allocation within the G-DRG system has been improved. Nevertheless, further improvements of the G-DRG system are necessary, especially for cases with severe injuries.

Effect of asynchronous updating on the stability of cellular automata

International Nuclear Information System (INIS)

Baetens, J.M.; Van der Weeën, P.; De Baets, B.

2012-01-01

Highlights: ► An upper bound on the Lyapunov exponent of asynchronously updated CA is established. ► The employed update method has repercussions on the stability of CAs. ► A decision on the employed update method should be taken with care. ► Substantial discrepancies arise between synchronously and asynchronously updated CA. ► Discrepancies between different asynchronous update schemes are less pronounced. - Abstract: Although cellular automata (CAs) were conceptualized as utter discrete mathematical models in which the states of all their spatial entities are updated simultaneously at every consecutive time step, i.e. synchronously, various CA-based models that rely on so-called asynchronous update methods have been constructed in order to overcome the limitations that are tied up with the classical way of evolving CAs. So far, only a few researchers have addressed the consequences of this way of updating on the evolved spatio-temporal patterns, and the reachable stationary states. In this paper, we exploit Lyapunov exponents to determine to what extent the stability of the rules within a family of totalistic CAs is affected by the underlying update method. For that purpose, we derive an upper bound on the maximum Lyapunov exponent of asynchronously iterated CAs, and show its validity, after which we present a comparative study between the Lyapunov exponents obtained for five different update methods, namely one synchronous method and four well-established asynchronous methods. It is found that the stability of CAs is seriously affected if one of the latter methods is employed, whereas the discrepancies arising between the different asynchronous methods are far less pronounced and, finally, we discuss the repercussions of our findings on the development of CA-based models.

Aligning In-Service Training Examinations in Plastic Surgery and Orthopaedic Surgery With Competency-Based Education.

Science.gov (United States)

Ganesh Kumar, Nishant; Benvenuti, Michael A; Drolet, Brian C

2017-10-01

In-service training examinations (ITEs) are used to assess residents across specialties. However, it is not clear how they are integrated with the Accreditation Council for Graduate Medical Education Milestones and competencies. This study explored the distribution of specialty-specific milestones and competencies in ITEs for plastic surgery and orthopaedic surgery. In-service training examinations were publicly available for plastic surgery (PSITE) and orthopaedics (OITE). Questions on the PSITE for 2014-2016 and the OITE for 2013-2015 were mapped to the specialty-specific milestones and the 6 competencies. There was an uneven distribution of milestones and competencies in ITE questions. Nine of the 36 Plastic Surgery Milestones represented 52% (341 of 650) of questions, and 3 were not included in the ITE. Of 41 Orthopaedic Surgery Milestones, 7 represented 51% (201 of 394) of questions, and 5 had no representation on the ITE. Among the competencies, patient care was the most common (PSITE = 62% [403 of 650]; OITE = 59% [233 of 394]), followed by medical knowledge (PSITE = 34% [222 of 650]; OITE = 31% [124 of 394]). Distribution of the remaining competencies differed between the 2 specialties (PSITE = 4% [25 of 650]; OITE = 9% [37 of 394]). The ITEs tested slightly more than half of the milestones for the 2 specialties, and focused predominantly on patient care and medical knowledge competencies.

Heart failure - surgeries and devices

Science.gov (United States)

... surgery; HF - surgery; Intra-aortic balloon pumps - heart failure; IABP - heart failure; Catheter based assist devices - heart failure ... problem may cause heart failure or make heart failure worse. Heart valve surgery may be needed to repair or ...

The Movement Disorder Society Evidence-Based Medicine Review Update: Treatments for the motor symptoms of Parkinson's disease.

Science.gov (United States)

Fox, Susan H; Katzenschlager, Regina; Lim, Shen-Yang; Ravina, Bernard; Seppi, Klaus; Coelho, Miguel; Poewe, Werner; Rascol, Olivier; Goetz, Christopher G; Sampaio, Cristina

2011-10-01

The objective was to update previous evidence-based medicine reviews of treatments for motor symptoms of Parkinson's disease published between 2002 and 2005. Level I (randomized, controlled trial) reports of pharmacological, surgical, and nonpharmacological interventions for the motor symptoms of Parkinson's disease between January 2004 (2001 for nonpharmacological) and December 2010 were reviewed. Criteria for inclusion, clinical indications, ranking, efficacy conclusions, safety, and implications for clinical practice followed the original program outline and adhered to evidence-based medicine methodology. Sixty-eight new studies qualified for review. Piribedil, pramipexole, pramipexole extended release, ropinirole, rotigotine, cabergoline, and pergolide were all efficacious as symptomatic monotherapy; ropinirole prolonged release was likely efficacious. All were efficacious as a symptomatic adjunct except pramipexole extended release, for which there is insufficient evidence. For prevention/delay of motor fluctuations, pramipexole and cabergoline were efficacious, and for prevention/delay of dyskinesia, pramipexole, ropinirole, ropinirole prolonged release, and cabergoline were all efficacious, whereas pergolide was likely efficacious. Duodenal infusion of levodopa was likely efficacious in the treatment of motor complications, but the practice implication is investigational. Entacapone was nonefficacious as a symptomatic adjunct to levodopa in nonfluctuating patients and nonefficacious in the prevention/delay of motor complications. Rasagiline conclusions were revised to efficacious as a symptomatic adjunct, and as treatment for motor fluctuations. Clozapine was efficacious in dyskinesia, but because of safety issues, the practice implication is possibly useful. Bilateral subthalamic nucleus deep brain stimulation, bilateral globus pallidus stimulation, and unilateral pallidotomy were updated to efficacious for motor complications. Physical therapy was revised

A Multidisciplinary Approach on the Perioperative Antithrombotic Management of Patients With Coronary Stents Undergoing Surgery: Surgery After Stenting 2.

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Rossini, Roberta; Tarantini, Giuseppe; Musumeci, Giuseppe; Masiero, Giulia; Barbato, Emanuele; Calabrò, Paolo; Capodanno, Davide; Leonardi, Sergio; Lettino, Maddalena; Limbruno, Ugo; Menozzi, Alberto; Marchese, U O Alfredo; Saia, Francesco; Valgimigli, Marco; Ageno, Walter; Falanga, Anna; Corcione, Antonio; Locatelli, Alessandro; Montorsi, Marco; Piazza, Diego; Stella, Andrea; Bozzani, Antonio; Parolari, Alessandro; Carone, Roberto; Angiolillo, Dominick J

2018-03-12

Perioperative management of antithrombotic therapy in patients treated with coronary stents undergoing surgery remains poorly defined. Importantly, surgery represents a common reason for premature treatment discontinuation, which is associated with an increased risk in mortality and major adverse cardiac events. However, maintaining antithrombotic therapy to minimize the incidence of perioperative ischemic complications may increase the risk of bleeding complications. Although guidelines provide some recommendations with respect to the perioperative management of antithrombotic therapy, these have been largely developed according to the thrombotic risk of the patient and a definition of the hemorrhagic risk specific to each surgical procedure, key to defining the trade-off between ischemia and bleeding, is not provided. These observations underscore the need for a multidisciplinary collaboration among cardiologists, anesthesiologists, hematologists and surgeons to reach this goal. The present document is an update on practical recommendations for standardizing management of antithrombotic therapy management in patients treated with coronary stents (Surgery After Stenting 2) in various types of surgery according to the predicted individual risk of thrombotic complications against the anticipated risk of surgical bleeding complications. Cardiologists defined the thrombotic risk using a "combined ischemic risk" approach, while surgeons classified surgeries according to their inherent hemorrhagic risk. Finally, a multidisciplinary agreement on the most appropriate antithrombotic treatment regimen in the perioperative phase was reached for each surgical procedure. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

[Surgery for pancreatic cancer: Evidence-based surgical strategies].

Science.gov (United States)

Sánchez Cabús, Santiago; Fernández-Cruz, Laureano

2015-01-01

Pancreatic cancer surgery represents a challenge for surgeons due to its technical complexity, the potential complications that may appear, and ultimately because of its poor survival. The aim of this article is to summarize the scientific evidence regarding the surgical treatment of pancreatic cancer in order to help surgeons in the decision making process in the management of these patients .Here we will review such fundamental issues as the need for a biopsy before surgery, the type of pancreatic anastomosis leading to better results, and the need for placement of drains after pancreatic surgery will be discussed. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Research on Topographic Map Updating

Directory of Open Access Journals (Sweden)

Ivana Javorović

2013-04-01

Full Text Available The investigation of interpretability of panchromatic satellite image IRS-1C integrated with multispectral Landsat TM image with the purpose of updating the topographic map sheet at the scale of 1:25 000 has been described. The geocoding of source map was based on trigonometric points of the map sheet. Satellite images were geocoded using control points selected from the map. The contents of map have been vectorized and topographic database designed. The digital image processing improved the interpretability of images. Then, the vectorization of new contents was made. The change detection of the forest and water area was defined by using unsupervised classification of spatial and spectral merged images. Verification of the results was made using corresponding aerial photographs. Although this methodology could not insure the complete updating of topographic map at the scale of 1:25 000, the database has been updated with huge amount of data. Erdas Imagine 8.3. software was used. 

A short-term operating room surgery scheduling problem integrating multiple nurses roster constraints.

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Xiang, Wei; Yin, Jiao; Lim, Gino

2015-02-01

Operating room (OR) surgery scheduling determines the individual surgery's operation start time and assigns the required resources to each surgery over a schedule period, considering several constraints related to a complete surgery flow and the multiple resources involved. This task plays a decisive role in providing timely treatments for the patients while balancing hospital resource utilization. The originality of the present study is to integrate the surgery scheduling problem with real-life nurse roster constraints such as their role, specialty, qualification and availability. This article proposes a mathematical model and an ant colony optimization (ACO) approach to efficiently solve such surgery scheduling problems. A modified ACO algorithm with a two-level ant graph model is developed to solve such combinatorial optimization problems because of its computational complexity. The outer ant graph represents surgeries, while the inner graph is a dynamic resource graph. Three types of pheromones, i.e. sequence-related, surgery-related, and resource-related pheromone, fitting for a two-level model are defined. The iteration-best and feasible update strategy and local pheromone update rules are adopted to emphasize the information related to the good solution in makespan, and the balanced utilization of resources as well. The performance of the proposed ACO algorithm is then evaluated using the test cases from (1) the published literature data with complete nurse roster constraints, and 2) the real data collected from a hospital in China. The scheduling results using the proposed ACO approach are compared with the test case from both the literature and the real life hospital scheduling. Comparison results with the literature shows that the proposed ACO approach has (1) an 1.5-h reduction in end time; (2) a reduction in variation of resources' working time, i.e. 25% for ORs, 50% for nurses in shift 1 and 86% for nurses in shift 2; (3) an 0.25h reduction in

Sub-Tenon's anaesthesia versus topical anaesthesia for cataract surgery.

Science.gov (United States)

Guay, Joanne; Sales, Karl

2015-08-27

Local anaesthesia for cataract surgery can be provided by sub-Tenon's or topical anaesthesia. Both techniques offer possible advantages. This review, which originally was published in 2007 and was updated in 2014, was undertaken to compare these two anaesthetic techniques. Our objectives were to compare the effectiveness of topical anaesthesia (with or without intracameral local anaesthetic) versus sub-Tenon's anaesthesia in providing pain relief during cataract surgery. We reviewed pain during administration of anaesthesia, postoperative pain, surgical satisfaction with operating conditions and patient satisfaction with pain relief provided, and we looked at associated complications. We searched the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE (last search in November 2014) and the reference lists of published articles. We looked for conferences abstracts and trials in progress and placed no constraints on language or publication status. We included all randomized studies that compared sub-Tenon's anaesthesia versus topical anaesthesia for cataract surgery. We assessed trial quality and extracted data in the format allowing maximal data inclusion. We included eight studies in this updated review but could retain in the analysis only seven studies on 742 operated eyes of 617 participants. Two cross-over trials included 125 participants, and five parallel trials included 492 participants. These studies were published between 1997 and 2005. The mean age of participants varied from 71.5 years to 83.5 years. The female proportion of participants varied from 54% to 76%. Compared with sub-Tenon's anaesthesia, topical anaesthesia (with or without intracameral injection) for cataract surgery increases intraoperative pain but decreases postoperative pain at 24 hours. The amplitude of the effect (equivalent to 1.1 on a score from 0 to 10 for intraoperative pain, and to 0.2 on the same scale for postoperative pain at 24 hours), although statistically

A novel cadaver-based educational program in general surgery training.

Science.gov (United States)

Lewis, Catherine E; Peacock, Warwick J; Tillou, Areti; Hines, O Joe; Hiatt, Jonathan R

2012-01-01

To describe the development of a cadaver-based educational program and report our residents' assessment of the new program. An anatomy-based educational program was developed using fresh frozen cadavers to teach surgical anatomy and operative skills to general surgery (GS) trainees. Residents were asked to complete a voluntary, anonymous survey evaluating perceptions of the program (6 questions formulated on a 5-point Likert scale) and comparing cadaver sessions to other types of learning (4 rank order questions). Large university teaching hospital. Medical students, residents, and faculty members were participants in the cadaver programs. Only GS residents were asked to complete the survey. Since its implementation, 150 residents of all levels participated in 13 sessions. A total of 40 surveys were returned for a response rate of 89%. Overall, respondents held a positive view of the cadaver sessions and believed them to be useful for learning anatomy (94% agree or strongly agree), learning the steps of an operation (76% agree or strongly agree), and increasing confidence in doing an operation (53% agree or strongly agree). Trainees wanted to have more sessions (87% agree or strongly agree), and believed they would spend free time in the cadaver laboratory (58% agree or strongly agree). Compared with other learning modalities, cadaver sessions were ranked first for learning surgical anatomy, followed by textbooks, simulators, web sites, animate laboratories, and lectures. Respondents also ranked cadaver sessions first for increasing confidence in performing a procedure and for learning the steps of an operation. Cost of cadavers represented the major expense of the program. Fresh cadaver dissections represent a solution to the challenges of efficient, safe, and effective general surgery education. Residents have a positive attitude toward these teaching sessions and found them to be more effective than other learning modalities. Copyright © 2012 Association of

An Innovate Robotic Endoscope Guidance System for Transnasal Sinus and Skull Base Surgery: Proof of Concept.

Science.gov (United States)

Friedrich, D T; Sommer, F; Scheithauer, M O; Greve, J; Hoffmann, T K; Schuler, P J

2017-12-01

Objective  Advanced transnasal sinus and skull base surgery remains a challenging discipline for head and neck surgeons. Restricted access and space for instrumentation can impede advanced interventions. Thus, we present the combination of an innovative robotic endoscope guidance system and a specific endoscope with adjustable viewing angle to facilitate transnasal surgery in a human cadaver model. Materials and Methods  The applicability of the robotic endoscope guidance system with custom foot pedal controller was tested for advanced transnasal surgery on a fresh frozen human cadaver head. Visualization was enabled using a commercially available endoscope with adjustable viewing angle (15-90 degrees). Results  Visualization and instrumentation of all paranasal sinuses, including the anterior and middle skull base, were feasible with the presented setup. Controlling the robotic endoscope guidance system was effectively precise, and the adjustable endoscope lens extended the view in the surgical field without the common change of fixed viewing angle endoscopes. Conclusion  The combination of a robotic endoscope guidance system and an advanced endoscope with adjustable viewing angle enables bimanual surgery in transnasal interventions of the paranasal sinuses and the anterior skull base in a human cadaver model. The adjustable lens allows for the abandonment of fixed-angle endoscopes, saving time and resources, without reducing the quality of imaging.

Co-operation and Phase Behavior under the Mixed Updating Rules

International Nuclear Information System (INIS)

Zhang Wen; Li Yao-Sheng; Xu Chen

2015-01-01

We present a model by considering two updating rules when the agents play prisoner's dilemma on a square lattice. Agents can update their strategies by referencing one of his neighbors of higher payoffs under the imitation updating rule or directly replaced by one of his neighbors according to the death-birth updating rule. The frequency of co-operation is related to the probability q of occurrence of the imitation updating or the death-birth updating and the game parameter b. The death-birth updating rule favors the co-operation while the imitation updating rule favors the defection on the lattice, although both rules suppress the co-operation in the well-mixed population. Therefore a totally co-operative state may emerge when the death-birth updating is involved in the evolution when b is relatively small. We also obtain a phase diagram on the q-b plane. There are three phases on the plane with two pure phases of a totally co-operative state and a totally defective state and a mixing phase of mixed strategies. Based on the pair approximation, we theoretically analyze the phase behavior and obtain a quantitative agreement with the simulation results. (paper)

Sum of the Magnitude for Hard Decision Decoding Algorithm Based on Loop Update Detection

Science.gov (United States)

Meng, Jiahui; Zhao, Danfeng; Tian, Hai; Zhang, Liang

2018-01-01

In order to improve the performance of non-binary low-density parity check codes (LDPC) hard decision decoding algorithm and to reduce the complexity of decoding, a sum of the magnitude for hard decision decoding algorithm based on loop update detection is proposed. This will also ensure the reliability, stability and high transmission rate of 5G mobile communication. The algorithm is based on the hard decision decoding algorithm (HDA) and uses the soft information from the channel to calculate the reliability, while the sum of the variable nodes’ (VN) magnitude is excluded for computing the reliability of the parity checks. At the same time, the reliability information of the variable node is considered and the loop update detection algorithm is introduced. The bit corresponding to the error code word is flipped multiple times, before this is searched in the order of most likely error probability to finally find the correct code word. Simulation results show that the performance of one of the improved schemes is better than the weighted symbol flipping (WSF) algorithm under different hexadecimal numbers by about 2.2 dB and 2.35 dB at the bit error rate (BER) of 10−5 over an additive white Gaussian noise (AWGN) channel, respectively. Furthermore, the average number of decoding iterations is significantly reduced. PMID:29342963

Sum of the Magnitude for Hard Decision Decoding Algorithm Based on Loop Update Detection.

Science.gov (United States)

Meng, Jiahui; Zhao, Danfeng; Tian, Hai; Zhang, Liang

2018-01-15

In order to improve the performance of non-binary low-density parity check codes (LDPC) hard decision decoding algorithm and to reduce the complexity of decoding, a sum of the magnitude for hard decision decoding algorithm based on loop update detection is proposed. This will also ensure the reliability, stability and high transmission rate of 5G mobile communication. The algorithm is based on the hard decision decoding algorithm (HDA) and uses the soft information from the channel to calculate the reliability, while the sum of the variable nodes' (VN) magnitude is excluded for computing the reliability of the parity checks. At the same time, the reliability information of the variable node is considered and the loop update detection algorithm is introduced. The bit corresponding to the error code word is flipped multiple times, before this is searched in the order of most likely error probability to finally find the correct code word. Simulation results show that the performance of one of the improved schemes is better than the weighted symbol flipping (WSF) algorithm under different hexadecimal numbers by about 2.2 dB and 2.35 dB at the bit error rate (BER) of 10 -5 over an additive white Gaussian noise (AWGN) channel, respectively. Furthermore, the average number of decoding iterations is significantly reduced.

Sum of the Magnitude for Hard Decision Decoding Algorithm Based on Loop Update Detection

Directory of Open Access Journals (Sweden)

Jiahui Meng

2018-01-01

Full Text Available In order to improve the performance of non-binary low-density parity check codes (LDPC hard decision decoding algorithm and to reduce the complexity of decoding, a sum of the magnitude for hard decision decoding algorithm based on loop update detection is proposed. This will also ensure the reliability, stability and high transmission rate of 5G mobile communication. The algorithm is based on the hard decision decoding algorithm (HDA and uses the soft information from the channel to calculate the reliability, while the sum of the variable nodes’ (VN magnitude is excluded for computing the reliability of the parity checks. At the same time, the reliability information of the variable node is considered and the loop update detection algorithm is introduced. The bit corresponding to the error code word is flipped multiple times, before this is searched in the order of most likely error probability to finally find the correct code word. Simulation results show that the performance of one of the improved schemes is better than the weighted symbol flipping (WSF algorithm under different hexadecimal numbers by about 2.2 dB and 2.35 dB at the bit error rate (BER of 10−5 over an additive white Gaussian noise (AWGN channel, respectively. Furthermore, the average number of decoding iterations is significantly reduced.

A Methodology to Detect and Update Active Deformation Areas Based on Sentinel-1 SAR Images

Directory of Open Access Journals (Sweden)

Anna Barra

2017-09-01

Full Text Available This work is focused on deformation activity mapping and monitoring using Sentinel-1 (S-1 data and the DInSAR (Differential Interferometric Synthetic Aperture Radar technique. The main goal is to present a procedure to periodically update and assess the geohazard activity (volcanic activity, landslides and ground-subsidence of a given area by exploiting the wide area coverage and the high coherence and temporal sampling (revisit time up to six days provided by the S-1 satellites. The main products of the procedure are two updatable maps: the deformation activity map and the active deformation areas map. These maps present two different levels of information aimed at different levels of geohazard risk management, from a very simplified level of information to the classical deformation map based on SAR interferometry. The methodology has been successfully applied to La Gomera, Tenerife and Gran Canaria Islands (Canary Island archipelago. The main obtained results are discussed.

Application of Real Time Models Updating in ABO Central Field

International Nuclear Information System (INIS)

Heikal, S.; Adewale, D.; Doghmi, A.; Augustine, U.

2003-01-01

ABO central field is the first deep offshore oil production in Nigeria located in OML 125 (ex-OPL316). The field was developed in a water depth of between 500 and 800 meters. Deep-water development requires much faster data handling and model updates in order to make the best possible technical decision. This required an easy way to incorporate the latest information and dynamic update of the reservoir model enabling real time reservoir management. The paper aims at discussing the benefits of real time static and dynamic model update and illustrates with a horizontal well example how this update was beneficial prior and during the drilling operation minimizing the project CAPEX Prior to drilling, a 3D geological model was built based on seismic and offset wells' data. The geological model was updated twice, once after the pilot hole drilling and then after reaching the landing point and prior drilling the horizontal section .Forward modeling ws made was well using the along the planned trajectory. During the drilling process both geo- steering and LWD data were loaded in real time to the 3D modeling software. The data was analyzed and compared with the predicted model. The location of markers was changed as drilling progressed and the entire 3D Geological model was rapidly updated. The target zones were revaluated in the light of the new model updates. Recommendations were communicated to the field, and the well trajectory was modified to take into account the new information. The combination of speed, flexibility and update-ability of the 3D modeling software enabled continues geological model update on which the asset team based their trajectory modification decisions throughout the drilling phase. The well was geo-steered through 7 meters thickness of sand. After the drilling, the testing showed excellent results with a productivity and fluid properties data were used to update the dynamic model reviewing the well production plateau providing optimum reservoir

Trigeminal complications arising after surgery of cranial base meningiomas.

Science.gov (United States)

Westerlund, Ulf; Linderoth, Bengt; Mathiesen, Tiit

2012-04-01

Chronic severe facial pain is a feared sequel of cranial base surgery. This study explores the symptomatology, incidence and impact on the individual of postoperative de novo trigeminal nerve affection as well as the recovery potential. Out of 231 patients operated for cranial base meningiomas at the Karolinska University Hospital during 7 years, 25 complained of de novo trigeminal symptoms at clinical follow-up 3 months after surgery. Six were later lost to follow-up leaving 19 participants in the study, which was conducted using a questionnaire and a structured telephone interview. All patients complained of facial numbness, affecting the V1 branch in 10/19 patients (53%), the V2 branch in 18/19 (95%) and the V3 branch in 9/19 (47%). Surprisingly, only three (16%) suffered from trigeminal pain, which could be adequately managed by pharmacotherapy. However, five patients (26%) demonstrated ocular dysaesthetic problems. Twelve (63%) described their handicap to be mild, while seven (37%) had daily or severe symptoms. Five patients (26%) reported no improvement over time, while nine (47%) showed improvement and four (21%) stated good recovery. Only one patient (5%) claimed complete symptom remission. In the present study, 11% of the patients presented with a de novo postoperative affection of the trigeminal nerve after removal of a cranial base meningioma; 37% of these reported daily/severe symptoms. Only 26% showed good recovery, observed in patients without tumour infiltration of the nerve or intraoperative nerve damage. In spite of frequent complaints of numbness, pain was uncommon (16%) and often manageable by pharmacotherapy, while ocular symptoms turned out to be more frequent and more disabling than expected.

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

Science.gov (United States)

Hauck, Randy M; Nogan, Stephen

2013-01-01

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

An Updating System for the Gridded Population Database of China Based on Remote Sensing, GIS and Spatial Database Technologies

Directory of Open Access Journals (Sweden)

Xiaohuan Yang

2009-02-01

Full Text Available The spatial distribution of population is closely related to land use and land cover (LULC patterns on both regional and global scales. Population can be redistributed onto geo-referenced square grids according to this relation. In the past decades, various approaches to monitoring LULC using remote sensing and Geographic Information Systems (GIS have been developed, which makes it possible for efficient updating of geo-referenced population data. A Spatial Population Updating System (SPUS is developed for updating the gridded population database of China based on remote sensing, GIS and spatial database technologies, with a spatial resolution of 1 km by 1 km. The SPUS can process standard Moderate Resolution Imaging Spectroradiometer (MODIS L1B data integrated with a Pattern Decomposition Method (PDM and an LULC-Conversion Model to obtain patterns of land use and land cover, and provide input parameters for a Population Spatialization Model (PSM. The PSM embedded in SPUS is used for generating 1 km by 1 km gridded population data in each population distribution region based on natural and socio-economic variables. Validation results from finer township-level census data of Yishui County suggest that the gridded population database produced by the SPUS is reliable.

An Updating System for the Gridded Population Database of China Based on Remote Sensing, GIS and Spatial Database Technologies

Science.gov (United States)

Yang, Xiaohuan; Huang, Yaohuan; Dong, Pinliang; Jiang, Dong; Liu, Honghui

2009-01-01

The spatial distribution of population is closely related to land use and land cover (LULC) patterns on both regional and global scales. Population can be redistributed onto geo-referenced square grids according to this relation. In the past decades, various approaches to monitoring LULC using remote sensing and Geographic Information Systems (GIS) have been developed, which makes it possible for efficient updating of geo-referenced population data. A Spatial Population Updating System (SPUS) is developed for updating the gridded population database of China based on remote sensing, GIS and spatial database technologies, with a spatial resolution of 1 km by 1 km. The SPUS can process standard Moderate Resolution Imaging Spectroradiometer (MODIS L1B) data integrated with a Pattern Decomposition Method (PDM) and an LULC-Conversion Model to obtain patterns of land use and land cover, and provide input parameters for a Population Spatialization Model (PSM). The PSM embedded in SPUS is used for generating 1 km by 1 km gridded population data in each population distribution region based on natural and socio-economic variables. Validation results from finer township-level census data of Yishui County suggest that the gridded population database produced by the SPUS is reliable. PMID:22399959

State energy-price system: 1981 update

Energy Technology Data Exchange (ETDEWEB)

Fang, J.M.; Imhoff, K.L.; Hood, L.J.

1983-08-01

This report updates the State Energy Price Data System (STEPS) to include state-level energy prices by fuel and by end-use sectors for 1981. Both physical unit prices and Btu prices are presented. Basic documentation of the data base remains generally the same as in the original report: State Energy Price System; Volume 1: Overview and Technical Documentation (DOE/NBB-0029 Volume 1 of 2, November 1982). The present report documents only the changes in procedures necessitated by the update to 1981 and the corrections to the basic documentation.

Consensus-based training and assessment model for general surgery.

Science.gov (United States)

Szasz, P; Louridas, M; de Montbrun, S; Harris, K A; Grantcharov, T P

2016-05-01

Surgical education is becoming competency-based with the implementation of in-training milestones. Training guidelines should reflect these changes and determine the specific procedures for such milestone assessments. This study aimed to develop a consensus view regarding operative procedures and tasks considered appropriate for junior and senior trainees, and the procedures that can be used as technical milestone assessments for trainee progression in general surgery. A Delphi process was followed where questionnaires were distributed to all 17 Canadian general surgery programme directors. Items were ranked on a 5-point Likert scale, with consensus defined as Cronbach's α of at least 0·70. Items rated 4 or above on the 5-point Likert scale by 80 per cent of the programme directors were included in the models. Two Delphi rounds were completed, with 14 programme directors taking part in round one and 11 in round two. The overall consensus was high (Cronbach's α = 0·98). The training model included 101 unique procedures and tasks, 24 specific to junior trainees, 68 specific to senior trainees, and nine appropriate to all. The assessment model included four procedures. A system of operative procedures and tasks for junior- and senior-level trainees has been developed along with an assessment model for trainee progression. These can be used as milestones in competency-based assessments. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

Sinonasal outcomes following endoscopic anterior skull base surgery with nasoseptal flap reconstruction: a prospective study.

Science.gov (United States)

Hanson, M; Patel, P M; Betz, C; Olson, S; Panizza, B; Wallwork, B

2015-07-01

To assess nasal morbidity resulting from nasoseptal flap use in the repair of skull base defects in endoscopic anterior skull base surgery. Thirty-six patients awaiting endoscopic anterior skull base surgery were prospectively recruited. A nasoseptal flap was used for reconstruction in all cases. Patients were assessed pre-operatively and 90 days post-operatively via the Sino-Nasal Outcome Test 20 questionnaire and visual analogue scales for nasal obstruction, pain, secretions and smell; endoscopic examination findings and mucociliary clearance times were also recorded. Sino-Nasal Outcome Test 20 questionnaire data and visual analogue scale scores for pain, smell and secretions showed no significant differences between pre- and post-operative outcomes, with visual analogue scale scores for nasal obstruction actually showing a significant improvement (p = 0.0007). A significant deterioration for both flap and non-flap sides was demonstrated post-operatively on endoscopic examination (p = 0.002 and p = 0.02 respectively). Whilst elevation of a nasoseptal flap in endoscopic surgery of the anterior skull base engendered significant clinical deterioration on examination post-operatively, quality of life outcomes showed that no such deterioration was subjectively experienced by the patient. In fact, there was significant nasal airway improvement following nasoseptal flap reconstruction.

Readability Assessment of Internet-Based Patient Education Materials Related to Parathyroid Surgery.

Science.gov (United States)

Patel, Chirag R; Sanghvi, Saurin; Cherla, Deepa V; Baredes, Soly; Eloy, Jean Anderson

2015-07-01

Patient education is critical in obtaining informed consent and reducing preoperative anxiety. Written patient education material (PEM) can supplement verbal communication to improve understanding and satisfaction. Published guidelines recommend that health information be presented at or below a sixth-grade reading level to facilitate comprehension. We investigate the grade level of online PEMs regarding parathyroid surgery. A popular internet search engine was used to identify PEM discussing parathyroid surgery. Four formulas were used to calculate readability scores: Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Gunning Frequency of Gobbledygook (GFOG), and Simple Measure of Gobbledygook (SMOG). Thirty web-based articles discussing parathyroid surgery were identified. The average FRE score was 42.8 (±1 standard deviation [SD] 16.3; 95% confidence interval [CI], 36.6-48.8; range, 6.1-71.3). The average FKGL score was 11.7 (±1 SD 3.3; 95% CI, 10.5-12.9; range, 6.1-19.0). The SMOG scores averaged 14.2 (±1 SD 2.6; 95% CI, 13.2-15.2; range, 10.7-21.9), and the GFOG scores averaged 15.0 (±1 SD 3.5; 95% CI, 13.7-16.3; range, 10.6-24.8). Online PEM on parathyroid surgery is written above the recommended sixth-grade reading level. Improving readability of PEM may promote better health education and compliance. © The Author(s) 2015.

Evolution of ERP Systems in the Cloud: A Study on System Updates

Directory of Open Access Journals (Sweden)

Elise Bjelland

2018-06-01

Full Text Available Cloud-based enterprise resource planning (ERP systems emerged around the new millennium, and since then there has been a lack of research regarding the evolution and update processes of these systems. From the users’ perspective, updates in a traditional on-premise ERP system are carried at their own request; while cloud-based ERPs are compulsory updated. Through an established ERP lifecycle framework, this study investigates how the process of updates is conducted in a cloud ERP context, from both the users’ and vendors’ perspectives. A multiple case study was conducted in Norway at 10 client organizations, as well as a cloud ERP vendor. Our main findings suggest that the vendor and the users view the process of updates differently. The main challenges with the process of updates from the users’ perspective are the size and date of the updates, lack of information and communication during the process, and extinction of certain functionalities. Yet, the main advantages are that all system users will always have the same version of the system, users do not need to spend time on updating the system and paying attention to the ERP market, which leads to more focus on their core competences instead.

A novel protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery under cardiopulmonary bypass.

Science.gov (United States)

Odaka, Mizuho; Minakata, Kenji; Toyokuni, Hideaki; Yamazaki, Kazuhiro; Yonezawa, Atsushi; Sakata, Ryuzo; Matsubara, Kazuo

2015-08-01

This study aimed to develop and assess the effectiveness of a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery. We established a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery. This novel protocol was assessed by comparing patients undergoing open heart surgery before (control group; n = 30) and after its implementation (protocol group; n = 31) at Kyoto University Hospital between July 2012 and January 2013. Surgical site infections (SSIs) were observed in 4 control group patients (13.3 %), whereas no SSIs were observed in the protocol group patients (P open heart surgery.

3D force control for robotic-assisted beating heart surgery based on viscoelastic tissue model.

Science.gov (United States)

Liu, Chao; Moreira, Pedro; Zemiti, Nabil; Poignet, Philippe

2011-01-01

Current cardiac surgery faces the challenging problem of heart beating motion even with the help of mechanical stabilizer which makes delicate operation on the heart surface difficult. Motion compensation methods for robotic-assisted beating heart surgery have been proposed recently in literature, but research on force control for such kind of surgery has hardly been reported. Moreover, the viscoelasticity property of the interaction between organ tissue and robotic instrument further complicates the force control design which is much easier in other applications by assuming the interaction model to be elastic (industry, stiff object manipulation, etc.). In this work, we present a three-dimensional force control method for robotic-assisted beating heart surgery taking into consideration of the viscoelastic interaction property. Performance studies based on our D2M2 robot and 3D heart beating motion information obtained through Da Vinci™ system are provided.

A study of an assisting robot for mandible plastic surgery based on augmented reality.

Science.gov (United States)

Shi, Yunyong; Lin, Li; Zhou, Chaozheng; Zhu, Ming; Xie, Le; Chai, Gang

2017-02-01

Mandible plastic surgery plays an important role in conventional plastic surgery. However, its success depends on the experience of the surgeons. In order to improve the effectiveness of the surgery and release the burden of surgeons, a mandible plastic surgery assisting robot, based on an augmented reality technique, was developed. Augmented reality assists surgeons to realize positioning. Fuzzy control theory was used for the control of the motor. During the process of bone drilling, both the drill bit position and the force were measured by a force sensor which was used to estimate the position of the drilling procedure. An animal experiment was performed to verify the effectiveness of the robotic system. The position error was 1.07 ± 0.27 mm and the angle error was 5.59 ± 3.15°. The results show that the system provides a sufficient accuracy with which a precise drilling procedure can be performed. In addition, under the supervision's feedback of the sensor, an adequate safety level can be achieved for the robotic system. The system realizes accurate positioning and automatic drilling to solve the problems encountered in the drilling procedure, providing a method for future plastic surgery.

A VidEo-Based Intelligent Recognition and Decision System for the Phacoemulsification Cataract Surgery

Directory of Open Access Journals (Sweden)

Shu Tian

2015-01-01

Full Text Available The phacoemulsification surgery is one of the most advanced surgeries to treat cataract. However, the conventional surgeries are always with low automatic level of operation and over reliance on the ability of surgeons. Alternatively, one imaginative scene is to use video processing and pattern recognition technologies to automatically detect the cataract grade and intelligently control the release of the ultrasonic energy while operating. Unlike cataract grading in the diagnosis system with static images, complicated background, unexpected noise, and varied information are always introduced in dynamic videos of the surgery. Here we develop a VidEo-Based Intelligent Recognitionand Decision (VEBIRD system, which breaks new ground by providing a generic framework for automatically tracking the operation process and classifying the cataract grade in microscope videos of the phacoemulsification cataract surgery. VEBIRD comprises a robust eye (iris detector with randomized Hough transform to precisely locate the eye in the noise background, an effective probe tracker with Tracking-Learning-Detection to thereafter track the operation probe in the dynamic process, and an intelligent decider with discriminative learning to finally recognize the cataract grade in the complicated video. Experiments with a variety of real microscope videos of phacoemulsification verify VEBIRD’s effectiveness.

Analgesic efficacy of ultrasound guided versus landmark-based bilateral superficial cervical plexus block for thyroid surgery

Directory of Open Access Journals (Sweden)

Rasha M. Hassan

2017-10-01

Full Text Available Background: The use of bilateral superficial cervical plexus block (BSCPB to provide analgesia for thyroid operations remains debatable. This study was done to assess the analgesic efficacy and safety of ultrasound (US guided or landmark-based BSCPB, performed under general anesthesia, compared to systemic narcotics in thyroid surgery. Patients and methods: A total of 69 patients ASA I and II scheduled for thyroid surgery were randomly assigned into three groups (23 patients each: Group (US received US guided BSCPB. Group (LM received landmark-based BSCPB. In both groups, the block was performed under general anesthesia and before surgery using 0.5% bupivacaine 12 ml on each side. Group (C who didn’t receive any block. We measured intra-operative hemodynamics and fentanyl requirements. We also measured postoperative analgesia within 24 h of surgery as regard: pethidine consumption, visual analogue scale (VAS pain scores and time to first rescue analgesic demand. Postoperative nausea and vomiting (PONV and other adverse events were noted as well. Results: There was a significant reduction in systolic blood pressure (SBP and heart rate (HR in groups US and LM compared with group C. Intra-operative fentanyl requirements were significantly increased in group C compared to groups US and LM. Time to first analgesic request was significantly longer in groups US and LM than in group C. Postoperative pethidine consumption and VAS scores, measured during the first postoperative day, were significantly higher in group C than groups US and LM. No significant difference was noted between the three groups regarding PONV. No other adverse events were recorded. No significant differences were noted between groups US and LM. Conclusion: BSCPB (US guided or landmark-based, performed under general anesthesia, effectively decreased peri-operative analgesic requirements in thyroid operations. However, there was no significant difference in analgesic efficacy or

Robot Visual Tracking via Incremental Self-Updating of Appearance Model

Directory of Open Access Journals (Sweden)

Danpei Zhao

2013-09-01

Full Text Available This paper proposes a target tracking method called Incremental Self-Updating Visual Tracking for robot platforms. Our tracker treats the tracking problem as a binary classification: the target and the background. The greyscale, HOG and LBP features are used in this work to represent the target and are integrated into a particle filter framework. To track the target over long time sequences, the tracker has to update its model to follow the most recent target. In order to deal with the problems of calculation waste and lack of model-updating strategy with the traditional methods, an intelligent and effective online self-updating strategy is devised to choose the optimal update opportunity. The strategy of updating the appearance model can be achieved based on the change in the discriminative capability between the current frame and the previous updated frame. By adjusting the update step adaptively, severe waste of calculation time for needless updates can be avoided while keeping the stability of the model. Moreover, the appearance model can be kept away from serious drift problems when the target undergoes temporary occlusion. The experimental results show that the proposed tracker can achieve robust and efficient performance in several benchmark-challenging video sequences with various complex environment changes in posture, scale, illumination and occlusion.

Regional anesthesia procedures for shoulder and upper arm surgery upper extremity update--2005 to present.

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Sripada, Ramprasad; Bowens, Clifford

2012-01-01

This review of the literature since 2005 assesses developments of RA techniques commonly used for shoulder surgery, and their effectiveness for postoperative analgesia. Advantages of regional techniques include site-specific anesthesia and decreased postoperative opioid use. For shoulder surgeries, the ISB provides effective analgesia with minimal complications, whereas the impacts of IA single-injections remain unclear. When combined with GA, ISB can be used in lower volumes and reducing the complications for shoulder and proximal upper extremity. USG ISB and SCB are both effective and safe for shoulder surgery with a low incidence of complications, especially PONS.53 When compared with intravenous patient-controlled opioid analgesia, a perineural LA infusion using a disposable pump with patient-controlled LA bolus function has led to better pain relief and functional recovery while decreasing the need for rescue analgesics and the number of adverse events after ambulatory orthopedic surgery. The most remarkable advance in RA in the past 5 years is the increased usage of USG. Although there are no large-scale prospective studies to show the safety, efficacy, and success and complication rates for USG blocks, USG RA theoretically could have less risk for neurologic symptoms, except for those induced by LA (less likely perineurally, much more likely intraneurally). The next "quantum leap" lies in reducing LA concentrations and augmenting anesthetic-analgesic effects with perineural additives (including clonidine, buprenorphine, and likely low-dose dexamethasone). Since 2005, perineural catheters have been an analgesic option that offers improved pain relief among other benefits, and are now being used at home. It is clear that patients benefit greatly from a single injection and continuous nerve block for postoperative pain management,but the financial and logistical aspects need to be resolved, not to mention the phrenic hemiparesis coin toss. Whether combined

Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery

DEFF Research Database (Denmark)

Bertelsen, Claus Anders; Neuenschwander, Anders Ulrich; Jansen, Jens Erik

2015-01-01

BACKGROUND: Application of the principles of total mesorectal excision to colon cancer by undertaking complete mesocolic excision (CME) has been proposed to improve oncological outcomes. We aimed to investigate whether implementation of CME improved disease-free survival compared with conventional...... consisted of patients who underwent CME surgery in a centre validated to perform such surgery; the control group consisted of patients undergoing conventional colon resection in three other hospitals. Data were collected from the Danish Colorectal Cancer Group (DCCG) database and medical charts. Patients...... updated by the National Central Office of Civil Registration. FINDINGS: The CME group consisted of 364 patients and the non-CME group consisted of 1031 patients. For all patients, 4-year disease-free survival was 85.8% (95% CI 81.4-90.1) after CME and 75.9% (72.2-79.7) after non-CME surgery (log-rank p=0...

a Bottom-Up Geosptial Data Update Mechanism for Spatial Data Infrastructure Updating

Science.gov (United States)

Tian, W.; Zhu, X.; Liu, Y.

2012-08-01

Currently, the top-down spatial data update mechanism has made a big progress and it is wildly applied in many SDI (spatial data infrastructure). However, this mechanism still has some issues. For example, the update schedule is limited by the professional department's project, usually which is too long for the end-user; the data form collection to public cost too much time and energy for professional department; the details of geospatial information does not provide sufficient attribute, etc. Thus, how to deal with the problems has become the effective shortcut. Emerging Internet technology, 3S technique and geographic information knowledge which is popular in the public promote the booming development of geoscience in volunteered geospatial information. Volunteered geospatial information is the current "hotspot", which attracts many researchers to study its data quality and credibility, accuracy, sustainability, social benefit, application and so on. In addition to this, a few scholars also pay attention to the value of VGI to support the SDI updating. And on that basis, this paper presents a bottom-up update mechanism form VGI to SDI, which includes the processes of match homonymous elements between VGI and SDI vector data , change data detection, SDI spatial database update and new data product publication to end-users. Then, the proposed updating cycle is deeply discussed about the feasibility of which can detect the changed elements in time and shorten the update period, provide more accurate geometry and attribute data for spatial data infrastructure and support update propagation.

Structuring polymers for delivery of DNA-based therapeutics: updated insights.

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Gupta, Madhu; Tiwari, Shailja; Vyas, Suresh

2012-01-01

Gene therapy offers greater opportunities for treating numerous incurable diseases from genetic disorders, infections, and cancer. However, development of appropriate delivery systems could be one of the most important factors to overcome numerous biological barriers for delivery of various therapeutic molecules. A number of nonviral polymer-mediated vectors have been developed for DNA delivery and offer the potential to surmount the associated problems of their viral counterpart. To address the concerns associated with safety issues, a wide range of polymeric vectors are available and have been utilized successfully to deliver their therapeutics in vivo. Today's research is mainly focused on the various natural or synthetic polymer-based delivery carriers that protect the DNA molecule from degradation, which offer specific targeting to the desired cells after systemic administration, have transfection efficiencies equivalent to virus-mediated gene delivery, and have long-term gene expression through sustained-release mechanisms. This review explores an updated overview of different nonviral polymeric delivery system for delivery of DNA-based therapeutics. These polymeric carriers have been evaluated in vitro and in vivo and are being utilized in various stages of clinical evaluation. Continued research and understanding of the principles of polymer-based gene delivery systems will enable us to develop new and efficient delivery systems for the delivery of DNA-based therapeutics to achieve the goal of efficacious and specific gene therapy for a vast array of clinical disorders as the therapeutic solutions of tomorrow.

Working Memory Updating Latency Reflects the Cost of Switching between Maintenance and Updating Modes of Operation

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Kessler, Yoav; Oberauer, Klaus

2014-01-01

Updating and maintenance of information are 2 conflicting demands on working memory (WM). We examined the time required to update WM (updating latency) as a function of the sequence of updated and not-updated items within a list. Participants held a list of items in WM and updated a variable subset of them in each trial. Four experiments that vary…

Technical aspects of pediatric epilepsy surgery: Report of a multicenter, multinational web-based survey by the ILAE Task Force on Pediatric Epilepsy Surgery.

Science.gov (United States)

Cukiert, Arthur; Rydenhag, Bertil; Harkness, William; Cross, J Helen; Gaillard, William D

2016-02-01

Surgical techniques may vary extensively between centers. We report on a web-based survey aimed at evaluating the current technical approaches in different centers around the world performing epilepsy surgery in children. The intention of the survey was to establish technical standards. A request was made to 88 centers to complete a web-based survey comprising 51 questions. There were 14 questions related to general issues, 13 questions investigating the different technical aspects for children undergoing epilepsy surgery, and 24 questions investigating surgical strategies in pediatric epilepsy surgery. Fifty-two centers covering a wide geographic representation completed the questionnaire. The median number of resective procedures per center per year was 47. Some important technical practices appeared (>80% of the responses) such as the use of prophylactic antibiotics (98%), the use of high-speed drills for bone opening (88%), nonresorbable material for bone flap closure (85%), head fixation (90%), use of the surgical microscope (100%), and of free bone flaps. Other questions, such as the use of drains, electrocorticography (ECoG) and preoperative withdrawal of valproate, led to mixed, inconclusive results. Complications were noted in 3.8% of the patients submitted to cortical resection, 9.9% hemispheric surgery, 5% callosotomy, 1.8% depth electrode implantation, 5.9% subdural grids implantation, 11.9% hypothalamic hamartoma resection, 0.9% vagus nerve stimulation (VNS), and 0.5% deep brain stimulation. There were no major differences across regions or countries in any of the subitems above. The present data offer the first overview of the technical aspects of pediatric epilepsy surgery worldwide. Surprisingly, there seem to be more similarities than differences. That aside many of the evaluated issues should be examined by adequately designed multicenter randomized controlled trials (RCTs). Further knowledge on these technical issues might lead to increased

FRMAC Updates

International Nuclear Information System (INIS)

Mueller, P.

1995-01-01

This talks describes updates in the following updates in FRMAC publications concerning radiation emergencies: Monitoring and Analysis Manual; Evaluation and Assessment Manual; Handshake Series (Biannual) including exercises participated in; environmental Data and Instrument Transmission System (EDITS); Plume in a Box with all radiological data stored onto a hand-held computer; and courses given

Craniofacial Surgery Fellowship Websites.

Science.gov (United States)

Silvestre, Jason; Agarwal, Divyansh; Taylor, Jesse A

2016-06-01

Applicants for craniofacial surgery fellowships utilize Internet-based resources like the San Francisco (SF) Match to manage applications. The purpose of this study was to evaluate the accessibility and content of craniofacial surgery fellowship websites (CSFWs). A list of available craniofacial surgery fellowships was compiled from directories of the American Society of Craniofacial Surgery (ACSFS) and SF Match. Accessibility of CSFWs was assessed via links from these directories and a Google search. Craniofacial surgery fellowship websites were evaluated on education and recruitment content and compared via program characteristics. Twenty-four of the 28 US-based craniofacial surgery fellowship programs had a CSFW (86%). The ACSFS and SF Match databases had limited CSFW accessibility, but a Google search revealed most CSFWs had the top search result (76%). In total, CSFWs provided an average of 39% of education and recruitment variables. While most programs provided fellowship program descriptions (96%), application links (96%), and faculty listings (83%), relatively few provided rotation schedules (13%), fellow selection process information (13%), or interview dates (8%). CSFW content did not vary by program location, faculty size, accreditation status, or institutional affiliations (P > 0.05). Craniofacial surgery fellowships often lack readily accessible websites from national program lists and have limited information for interested applicants. The consistent lack of online information across programs suggests future opportunities exist to improve these educational resources.

Endoscopic Endonasal Anterior Skull Base Surgery: A Systematic Review of Complications During the Past 65 Years.

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Borg, Anouk; Kirkman, Matthew A; Choi, David

2016-11-01

Endoscopic skull base surgery is becoming more popular as an approach to the anterior skull base for tumors and cerebrospinal fluid (CSF) fistulae. It offers the advantages of better cosmesis and improved quality of life after surgery. We reviewed the complication rates reported in the literature. A literature search was performed in the electronic database Ovid MEDLINE (1950 to August 25, 2015) with the search item "([Anterior] AND Skull base surgery) AND endoscopic." We identified 82 relevant studies that included 7460 cases. An average overall complication rate of 17.1% (range 0%-68.0%) and a mortality rate of 0.4% (0%-10.0%) were demonstrated in a total of 82 studies that included 7460 cases. The average CSF leak rate for all studies was 8.9% (0%-40.0%) with meningiomas and clival lesions having the greatest CSF leak rates. The most frequent benign pathology encountered was pituitary adenomas (n = 3720, 49.8% of all cases) and the most frequent malignant tumor was esthesioneuroblastoma (n = 120, 1.6% of all cases). Studies that included only CSF fistula repairs had a lower average total complication rate (12.9%) but a greater rate of meningitis compared with studies that reported mixed pathology (2.4% vs. 1.3%). A trend towards a lower total complication rate with increasing study size was observed. The endoscopic approach is an increasingly accepted technique for anterior skull base tumor surgery and is associated with acceptable complication rates. Increasing experience with this technique can decrease rates of complications. Copyright © 2016 Elsevier Inc. All rights reserved.

[Preoperative evaluation of surgery for intractable aspiration based on the prognostic nutritional index].

Science.gov (United States)

Uchida, Masaya; Hashimoto, Keiko; Mukudai, Shigeyuki; Ushijima, Chihisa; Dejima, Kenji

2014-12-01

Because there is no absolute indicator of the nutritional status and prognosis in patients with severe aspiration problems, it is quite difficult to arrive at a true long-time prognosis. By performing surgery for intractable aspiration on such patients, both the prognosis and QOL of the patients could be expected to improve. In our department, we have experienced patients dying within 6 months after surgery. In these cases, the patient's preoperative nutritional status was not good. Therefore, we consider that, when we adopt this procedure, there should be some indicators we should use which could have an effect on the prognosis of such nutritionally-challenged patients. In patients who underwent surgery for intractable aspiration; we examined the relationship between their survival and the prognostic nutritional index (PNI) which is an indicator of the risk of complications such as post-operative events in the surgical field. We investigated the relationship between the prognosis and the postoperative indicators of each of the following: WBC, CRP, serum albumin level, and PNI. Out of a total of 31 cases, the average O-PNI of eight cases in which death occurred was 29.45, and the average of six cases in which death occurred within 6 months after surgery was 28.26. The average O-PNI of the survivors was 36.01. A significant association was noted between the early postoperative deaths and some of the four indicators namely that serum albumin level and O-PNI. Based on the ROC curve, the O-PNI offered higher precision than the albumin level. The cut-off value of the O-PNI value for early postoperative mortality rate was 32. The early postoperative mortality rate was 44.4% in patients with less than 32 O-PNI in the preoperative examination, but if it were O-PNI 32 or more, the early postoperative mortality rate was 9.1%, significantly lower. Therefore, O-PNI could be useful as one of the prognostic evaluation factors in the case of preoperative surgery for intractable

An update on synthetic dyes adsorption onto clay based minerals: A state-of-art review

CSIR Research Space (South Africa)

Ngulube, T

2017-04-01

Full Text Available of Environmental Management An update on synthetic dyes adsorption onto clay based minerals: A state- of-art review Tholiso Ngulube a,*, Jabulani Ray Gumbo b, Vhahangwele Masindi c,d, Arjun Maity e a Department of Ecology and Resources Management..., University of Venda, Private Bag X5050, Thohoyandou, 0950, Limpopo, South Africa b Department of Hydrology and Water Resources, School of Environmental Sciences, University of Venda, Private Bag X5050, Thohoyandou, 0950, Limpopo, South Africa c Council...

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Towards Dynamic Updates in Service Composition

Directory of Open Access Journals (Sweden)

Mario Bravetti

2015-12-01

Full Text Available We survey our results about verification of adaptable processes. We present adaptable processes as a way of overcoming the limitations that process calculi have for describing patterns of dynamic process evolution. Such patterns rely on direct ways of controlling the behavior and location of running processes, and so they are at the heart of the adaptation capabilities present in many modern concurrent systems. Adaptable processes have named scopes and are sensible to actions of dynamic update at runtime; this allows to express dynamic and static topologies of adaptable processes as well as different evolvability patterns for concurrent processes. We introduce a core calculus of adaptable processes and consider verification problems for them: first based on specific properties related to error occurrence, that we call bounded and eventual adaptation, and then by considering a simple yet expressive temporal logic over adaptable processes. We provide (undecidability results of such verification problems over adaptable processes considering the spectrum of topologies/evolvability patterns introduced. We then consider distributed adaptability, where a process can update part of a protocol by performing dynamic distributed updates over a set of protocol participants. Dynamic updates in this context are presented as an extension of our work on choreographies and behavioural contracts in multiparty interactions. We show how update mechanisms considered for adaptable processes can be used to extend the theory of choreography and orchestration/contracts, allowing them to be modified at run-time by internal (self-adaptation or external intervention.

The distance effect in numerical memory-updating tasks.

Science.gov (United States)

Lendínez, Cristina; Pelegrina, Santiago; Lechuga, Teresa

2011-05-01

Two experiments examined the role of numerical distance in updating numerical information in working memory. In the first experiment, participants had to memorize a new number only when it was smaller than a previously memorized number. In the second experiment, updating was based on an external signal, which removed the need to perform any numerical comparison. In both experiments, distance between the memorized number and the new one was manipulated. The results showed that smaller distances between the new and the old information led to shorter updating times. This graded facilitation suggests that the process by which information is substituted in the focus of attention involves maintaining the shared features between the new and the old number activated and selecting other new features to be activated. Thus, the updating cost may be related to amount of new features to be activated in the focus of attention.

Inter-firm Networks, Organizational Learning and Knowledge Updating: An Empirical Study

Science.gov (United States)

Zhang, Su-rong; Wang, Wen-ping

In the era of knowledge-based economy which information technology develops rapidly, the rate of knowledge updating has become a critical factor for enterprises to gaining competitive advantage .We build an interactional theoretical model among inter-firm networks, organizational learning and knowledge updating thereby and demonstrate it with empirical study at last. The result shows that inter-firm networks and organizational learning is the source of knowledge updating.

Dynamic model updating based on strain mode shape and natural frequency using hybrid pattern search technique

Science.gov (United States)

Guo, Ning; Yang, Zhichun; Wang, Le; Ouyang, Yan; Zhang, Xinping

2018-05-01

Aiming at providing a precise dynamic structural finite element (FE) model for dynamic strength evaluation in addition to dynamic analysis. A dynamic FE model updating method is presented to correct the uncertain parameters of the FE model of a structure using strain mode shapes and natural frequencies. The strain mode shape, which is sensitive to local changes in structure, is used instead of the displacement mode for enhancing model updating. The coordinate strain modal assurance criterion is developed to evaluate the correlation level at each coordinate over the experimental and the analytical strain mode shapes. Moreover, the natural frequencies which provide the global information of the structure are used to guarantee the accuracy of modal properties of the global model. Then, the weighted summation of the natural frequency residual and the coordinate strain modal assurance criterion residual is used as the objective function in the proposed dynamic FE model updating procedure. The hybrid genetic/pattern-search optimization algorithm is adopted to perform the dynamic FE model updating procedure. Numerical simulation and model updating experiment for a clamped-clamped beam are performed to validate the feasibility and effectiveness of the present method. The results show that the proposed method can be used to update the uncertain parameters with good robustness. And the updated dynamic FE model of the beam structure, which can correctly predict both the natural frequencies and the local dynamic strains, is reliable for the following dynamic analysis and dynamic strength evaluation.

Ursodeoxycholic Acid in the Prevention of Gallstone Formation After Bariatric Surgery: an Updated Systematic Review and Meta-analysis.

Science.gov (United States)

Magouliotis, Dimitrios E; Tasiopoulou, Vasiliki S; Svokos, Alexis A; Svokos, Konstantina A; Chatedaki, Christina; Sioka, Eleni; Zacharoulis, Dimitris

2017-11-01

We aim to review the available literature on obese patients treated with ursodeoxycholic acid (UDCA) in order to prevent gallstone formation after bariatric surgery. A systematic literature search was performed in PubMed, Cochrane library, and Scopus databases, in accordance with the PRISMA guidelines. Eight studies met the inclusion criteria incorporating 1355 patients. Random-effects meta-analysis showed a lower incidence of gallstone formation in patients taking UDCA. Subgroup analysis reported fewer cases of gallstone disease in the UDCA group in relation to different bariatric procedures, doses of administered UDCA, and time from bariatric surgery. Adverse events were similar in both groups. Fewer patients required cholecystectomy in UDCA group. No deaths were reported. The administration of UDCA after bariatric surgery seems to prevent gallstone formation.

Antibiotic susceptibility, heteroresistance, and updated treatment strategies in Helicobacter pylori infection

Directory of Open Access Journals (Sweden)

Mascellino MT

2017-07-01

Full Text Available Maria Teresa Mascellino,1 Barbara Porowska,2 Massimiliano De Angelis,1 Alessandra Oliva1 1Department of Public Health and Infectious Diseases, 2Department of Cardio-Thoracic, Vascular, General Surgery and of Organ Transplants, Policlinico Umberto I, Rome, Italy Abstract: In this review, we discuss the problem of antibiotic resistance, heteroresistance, the utility of cultures and antibiotic susceptibility tests in Helicobacter pylori (Hp eradication, as well as the updated treatment strategies for this infection. The prevalence of antibiotic resistance is increasing all over the world, especially for metronidazole and clarithromycin, because of their heavy use in some geographical areas. Heteroresistance (simultaneous presence of both susceptible and resistant strains in different sites of a single stomach is another important issue, as an isolate could be mistakenly considered susceptible if a single biopsy is used for antimicrobial tests. We also examined literature data regarding eradication success rates of culture-guided and empiric therapies. The empiric therapy and the one based on susceptibility testing, in Hp eradication, may depend on several factors such as concomitant diseases, the number of previous antibiotic treatments, differences in bacterial virulence in individuals with positive or negative cultures, together with local antibiotic resistance patterns in real-world settings. Updated treatment strategies in Hp infection presented in the guidelines of the Toronto Consensus Group (2016 are reported. These suggest to prolong eradication therapy up to 14 days, replacing the old triple therapy with a quadruple therapy based on proton pump inhibitor (PPI, bismuth, metronidazole, and tetracycline for most of the patients, or as an alternative quadruple therapy without bismuth, based on the use of PPI, amoxicillin, metronidazole, and clarithromycin. The new drug vonoprazan, a first-in-class potassium-competitive acid blocker recently

Design-Based Comparison of Spine Surgery Simulators: Optimizing Educational Features of Surgical Simulators.

Science.gov (United States)

Ryu, Won Hyung A; Mostafa, Ahmed E; Dharampal, Navjit; Sharlin, Ehud; Kopp, Gail; Jacobs, W Bradley; Hurlbert, R John; Chan, Sonny; Sutherland, Garnette R

2017-10-01

Simulation-based education has made its entry into surgical residency training, particularly as an adjunct to hands-on clinical experience. However, one of the ongoing challenges to wide adoption is the capacity of simulators to incorporate educational features required for effective learning. The aim of this study was to identify strengths and limitations of spine simulators to characterize design elements that are essential in enhancing resident education. We performed a mixed qualitative and quantitative cohort study with a focused survey and interviews of stakeholders in spine surgery pertaining to their experiences on 3 spine simulators. Ten participants were recruited spanning all levels of training and expertise until qualitative analysis reached saturation of themes. Participants were asked to perform lumbar pedicle screw insertion on 3 simulators. Afterward, a 10-item survey was administrated and a focused interview was conducted to explore topics pertaining to the design features of the simulators. Overall impressions of the simulators were positive with regards to their educational benefit, but our qualitative analysis revealed differing strengths and limitations. Main design strengths of the computer-based simulators were incorporation of procedural guidance and provision of performance feedback. The synthetic model excelled in achieving more realistic haptic feedback and incorporating use of actual surgical tools. Stakeholders from trainees to experts acknowledge the growing role of simulation-based education in spine surgery. However, different simulation modalities have varying design elements that augment learning in distinct ways. Characterization of these design characteristics will allow for standardization of simulation curricula in spinal surgery, optimizing educational benefit. Copyright © 2017 Elsevier Inc. All rights reserved.

A Provenance Tracking Model for Data Updates

Directory of Open Access Journals (Sweden)

Gabriel Ciobanu

2012-08-01

Full Text Available For data-centric systems, provenance tracking is particularly important when the system is open and decentralised, such as the Web of Linked Data. In this paper, a concise but expressive calculus which models data updates is presented. The calculus is used to provide an operational semantics for a system where data and updates interact concurrently. The operational semantics of the calculus also tracks the provenance of data with respect to updates. This provides a new formal semantics extending provenance diagrams which takes into account the execution of processes in a concurrent setting. Moreover, a sound and complete model for the calculus based on ideals of series-parallel DAGs is provided. The notion of provenance introduced can be used as a subjective indicator of the quality of data in concurrent interacting systems.

"iBIM"--internet-based interactive modules: an easy and interesting learning tool for general surgery residents.

Science.gov (United States)

Azer, Nader; Shi, Xinzhe; de Gara, Chris; Karmali, Shahzeer; Birch, Daniel W

2014-04-01

The increased use of information technology supports a resident- centred educational approach that promotes autonomy, flexibility and time management and helps residents to assess their competence, promoting self-awareness. We established a web-based e-learning tool to introduce general surgery residents to bariatric surgery and evaluate them to determine the most appropriate implementation strategy for Internet-based interactive modules (iBIM) in surgical teaching. Usernames and passwords were assigned to general surgery residents at the University of Alberta. They were directed to the Obesity101 website and prompted to complete a multiple-choice precourse test. Afterwards, they were able to access the interactive modules. Residents could review the course material as often as they wanted before completing a multiple-choice postcourse test and exit survey. We used paired t tests to assess the difference between pre- and postcourse scores. Out of 34 residents who agreed to participate in the project, 12 completed the project (35.3%). For these 12 residents, the precourse mean score was 50 ± 17.3 and the postcourse mean score was 67 ± 14 (p = 0.020). Most residents who participated in this study recommended using the iBIMs as a study tool for bariatric surgery. Course evaluation scores suggest this novel approach was successful in transferring knowledge to surgical trainees. Further development of this tool and assessment of implementation strategies will determine how iBIM in bariatric surgery may be integrated into the curriculum.

Quality of Life After Cardiac Surgery Based on the Minimal Clinically Important Difference Concept.

Science.gov (United States)

Grand, Nathalie; Bouchet, Jean Baptiste; Zufferey, Paul; Beraud, Anne Marie; Awad, Sahar; Sandri, Fabricio; Campisi, Salvator; Fuzellier, Jean François; Molliex, Serge; Vola, Marco; Morel, Jerome

2018-03-23

Health-related quality of life (HRQOL) is an increasingly important issue in assessing the consequences of any surgical or medical intervention. Our study aimed to evaluate change in HRQOL 6 months after elective cardiac surgery and to identify specific predictors of poor HRQOL. In this prospective, single-center study, HRQOL was evaluated before and 6 months after surgery using the SF-36 questionnaire and its two components: the physical component summary (PCS) and the mental component summary (MCS). We distinguished patients with worsening of HRQOL according to the minimal clinically important difference. All consecutive adult patients undergoing cardiac surgery were included. 326 patients completed the preoperative and postoperative SF-36 questionnaires and 24 patients died before completing follow-up questionnaires. Based on the definition used, clinically significant deterioration of HRQOL was observed in 93 patients (26.6%) for PCS and 99 patients (28.2%) for MCS. Renal replacement for acute renal failure and mechanical ventilation for longer than 48 hours were independent risk factors for PCS and MCS worsening or death. Although our study showed overall improvement of QOL after cardiac surgery, over a quarter of the patients manifested deterioration of HRQOL at 6 months post-surgery. The findings from this study should help clinicians to inform patients about their likely postoperative functional status and quality of life. Copyright © 2018. Published by Elsevier Inc.

A clinical pilot study of a modular video-CT augmentation system for image-guided skull base surgery

Science.gov (United States)

Liu, Wen P.; Mirota, Daniel J.; Uneri, Ali; Otake, Yoshito; Hager, Gregory; Reh, Douglas D.; Ishii, Masaru; Gallia, Gary L.; Siewerdsen, Jeffrey H.

2012-02-01

Augmentation of endoscopic video with preoperative or intraoperative image data [e.g., planning data and/or anatomical segmentations defined in computed tomography (CT) and magnetic resonance (MR)], can improve navigation, spatial orientation, confidence, and tissue resection in skull base surgery, especially with respect to critical neurovascular structures that may be difficult to visualize in the video scene. This paper presents the engineering and evaluation of a video augmentation system for endoscopic skull base surgery translated to use in a clinical study. Extension of previous research yielded a practical system with a modular design that can be applied to other endoscopic surgeries, including orthopedic, abdominal, and thoracic procedures. A clinical pilot study is underway to assess feasibility and benefit to surgical performance by overlaying CT or MR planning data in realtime, high-definition endoscopic video. Preoperative planning included segmentation of the carotid arteries, optic nerves, and surgical target volume (e.g., tumor). An automated camera calibration process was developed that demonstrates mean re-projection accuracy (0.7+/-0.3) pixels and mean target registration error of (2.3+/-1.5) mm. An IRB-approved clinical study involving fifteen patients undergoing skull base tumor surgery is underway in which each surgery includes the experimental video-CT system deployed in parallel to the standard-of-care (unaugmented) video display. Questionnaires distributed to one neurosurgeon and two otolaryngologists are used to assess primary outcome measures regarding the benefit to surgical confidence in localizing critical structures and targets by means of video overlay during surgical approach, resection, and reconstruction.

Computing Cost Price for Cataract Surgery by Activity Based Costing (ABC Method at Hazrat-E-Zahra Hospital, Isfahan University of Medical Sciences, 2014

Directory of Open Access Journals (Sweden)

Masuod Ferdosi

2016-10-01

Full Text Available Background: Hospital managers need to have accurate information about actual costs to make efficient and effective decisions. In activity based costing method, first, activities are recognized and then direct and indirect costs are computed based on allocation methods. The aim of this study was to compute the cost price for cataract surgery by Activity Based Costing (ABC method at Hazrat-e-Zahra Hospital, Isfahan University of Medical Sciences. Methods: This was a cross- sectional study for computing the costs of cataract surgery by activity based costing technique in Hazrat-e-Zahra Hospital in Isfahan University of Medical Sciences, 2014. Data were collected through interview and direct observation and analyzed by Excel software. Results: According to the results of this study, total cost in cataract surgery was 8,368,978 Rials. Personnel cost included 62.2% (5,213,574 Rials of total cost of cataract surgery that is the highest share of surgery costs. The cost of consumables was 7.57% (1,992,852 Rials of surgery costs. Conclusion: Based on the results, there was different between cost price of the services and public Tariff which appears as hazards or financial crises to the hospital. Therefore, it is recommended to use the right methods to compute the costs relating to Activity Based Costing. Cost price of cataract surgery can be reduced by strategies such as decreasing the cost of consumables.

Update History of This Database - GenLibi | LSDB Archive [Life Science Database Archive metadata

Lifescience Database Archive (English)

Full Text Available switchLanguage; BLAST Search Image Search Home About Archive Update History Data ...List Contact us GenLibi Update History of This Database Date Update contents 2014/03/25 GenLibi English archi...base Description Download License Update History of This Database Site Policy | Contact Us Update History of This Database - GenLibi | LSDB Archive ... ...ve site is opened. 2007/03/01 GenLibi ( http://gene.biosciencedbc.jp/ ) is opened. About This Database Data

Current status of cardiovascular surgery in Japan 2013 and 2014: A report based on the Japan Cardiovascular Surgery Database. 2: Congenital heart surgery.

Science.gov (United States)

Hirata, Yasutaka; Hirahara, Norimichi; Murakami, Arata; Motomura, Noboru; Miyata, Hiroaki; Takamoto, Shinichi

2018-01-01

We analyzed the mortality and morbidity of congenital heart surgery in Japan using the Japan Cardiovascular Surgery Database (JCVSD). Data regarding congenital heart surgery performed between January 2013 and December 2014 were obtained from JCVSD. The 20 most frequent procedures were selected and the mortality rates and major morbidities were analyzed. The mortality rates of atrial septal defect repair and ventricular septal defect repair were less than 1%, and the mortality rates of tetralogy of Fallot repair, complete atrioventricular septal defect repair, bidirectional Glenn, and total cavopulmonary connection were less than 2%. The mortality rates of the Norwood procedure and total anomalous pulmonary venous connection repair were more than 10%. The rates of unplanned reoperation, pacemaker implantation, chylothorax, deep sternal infection, phrenic nerve injury, and neurological deficit were shown for each procedure. Using JCVSD, the national data for congenital heart surgery, including postoperative complications, were analyzed. Further improvements of the database and feedback for clinical practice are required.

Using Multi-Viewpoint Contracts for Negotiation of Embedded Software Updates

Directory of Open Access Journals (Sweden)

Sönke Holthusen

2016-05-01

Full Text Available In this paper we address the issue of change after deployment in safety-critical embedded system applications. Our goal is to substitute lab-based verification with in-field formal analysis to determine whether an update may be safely applied. This is challenging because it requires an automated process able to handle multiple viewpoints such as functional correctness, timing, etc. For this purpose, we propose an original methodology for contract-based negotiation of software updates. The use of contracts allows us to cleanly split the verification effort between the lab and the field. In addition, we show how to rely on existing viewpoint-specific methods for update negotiation. We illustrate our approach on a concrete example inspired by the automotive domain.

Enhanced Recovery After Surgery: The Plastic Surgery Paradigm Shift.

Science.gov (United States)

Bartlett, Erica L; Zavlin, Dmitry; Friedman, Jeffrey D; Abdollahi, Aariane; Rappaport, Norman H

2017-12-14

With a focus on providing high quality care and reducing facility based expenses there has been an evolution in perioperative care by way of enhanced recovery after surgery (ERAS). ERAS allows for a multidisciplinary and multimodal approach to perioperative care which not only expedites recovery but maximizes patient outcomes. This paradigm shift has been generally accepted by most surgical specialties, including plastic surgery. The goal of this study was to evaluate the impact of ERAS on outcomes in cosmetic plastic surgery. A prospective study consisting of phone call questionnaires was designed where patients from two senior plastic surgeons (N.H.R. and J.D.F.) were followed. The treatment group (n = 10) followed an ERAS protocol while the control group (n = 12) followed the traditional recovery after surgery which included narcotic usage. Patients were contacted on postoperative days (POD) 0 through 7+ and surveyed about a number of outcomes measures. The ERAS group demonstrated a significant reduction in postoperative pain on POD 0, 1, 2, and 3 (all P plastic surgery. The utility lies in the ability to expedite patient's recovery while still providing quality care. This study showed a reduction in postoperative complaints by avoiding narcotics without an increase in complications. Our findings signify the importance of ERAS protocols within cosmetic plastic surgery. 4. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Updating the Nomographical Diagrams for Dimensioning the Beams

OpenAIRE

Pop Maria T.

2015-01-01

In order to reduce the time period needed for structures design it is strongly recommended to use nomographical diagrams. The base for formation and updating the nomographical diagrams, stands on the charts presented by different technical publications. The updated charts use the same algorithm and calculation elements as the former diagrams in accordance to the latest prescriptions and European standards. The result consists in a chart, having the same properties, similar with the nomogragra...

Deductive Updating Is Not Bayesian

Science.gov (United States)

Markovits, Henry; Brisson, Janie; de Chantal, Pier-Luc

2015-01-01

One of the major debates concerning the nature of inferential reasoning is between counterexample-based theories such as mental model theory and probabilistic theories. This study looks at conclusion updating after the addition of statistical information to examine the hypothesis that deductive reasoning cannot be explained by probabilistic…

Memory updating and mental arithmetic

Directory of Open Access Journals (Sweden)

Cheng-Ching eHan

2016-02-01

Full Text Available Is domain-general memory updating ability predictive of calculation skills or are such skills better predicted by the capacity for updating specifically numerical information? Here, we used multidigit mental multiplication (MMM as a measure for calculating skill as this operation requires the accurate maintenance and updating of information in addition to skills needed for arithmetic more generally. In Experiment 1, we found that only individual differences with regard to a task updating numerical information following addition (MUcalc could predict the performance of MMM, perhaps owing to common elements between the task and MMM. In Experiment 2, new updating tasks were designed to clarify this: a spatial updating task with no numbers, a numerical task with no calculation, and a word task. The results showed that both MUcalc and the spatial task were able to predict the performance of MMM but only with the more difficult problems, while other updating tasks did not predict performance. It is concluded that relevant processes involved in updating the contents of working memory support mental arithmetic in adults.

Pseudodynamic systems approach based on a quadratic approximation of update equations for diffuse optical tomography.

Science.gov (United States)

Biswas, Samir Kumar; Kanhirodan, Rajan; Vasu, Ram Mohan; Roy, Debasish

2011-08-01

We explore a pseudodynamic form of the quadratic parameter update equation for diffuse optical tomographic reconstruction from noisy data. A few explicit and implicit strategies for obtaining the parameter updates via a semianalytical integration of the pseudodynamic equations are proposed. Despite the ill-posedness of the inverse problem associated with diffuse optical tomography, adoption of the quadratic update scheme combined with the pseudotime integration appears not only to yield higher convergence, but also a muted sensitivity to the regularization parameters, which include the pseudotime step size for integration. These observations are validated through reconstructions with both numerically generated and experimentally acquired data.

Management of sports injuries of the foot and ankle: An update.

Science.gov (United States)

Hong, C C; Pearce, C J; Ballal, M S; Calder, J D F

2016-10-01

Injuries to the foot in athletes are often subtle and can lead to a substantial loss of function if not diagnosed and treated appropriately. For these injuries in general, even after a diagnosis is made, treatment options are controversial and become even more so in high level athletes where limiting the time away from training and competition is a significant consideration. In this review, we cover some of the common and important sporting injuries affecting the foot including updates on their management and outcomes. Cite this article: Bone Joint J 2016;98-B:1299-1311. ©2016 The British Editorial Society of Bone & Joint Surgery.

Online and smartphone based cognitive behavioral therapy for bariatric surgery patients: Initial pilot study.

Science.gov (United States)

Zhang, Melvyn W B; Ho, Roger C M; Cassin, Stephanie E; Hawa, Raed; Sockalingam, Sanjeev

2015-01-01

The respective rates of obesity in Canada and the United states are estimated to be 24.1% and 34.1%. Due to the increased incidence of obesity, Bariatric surgery has been recognized as one of the treatment options. Despite the success of Bariatric surgery, studies have proposed that it has neglected the contributions of other factors, such as psychological factors in the causation as well as the maintenance of obesity amongst individuals. Cognitive behavioral therapy (CBT) is largely a psychosocial intervention that has been shown to be efficacious, as studies have demonstrated that even brief CBT interventions could help in the reduction of binge eating and maintenance of weight loss. Previously identified problems with regards to the integration and the provision of such interventions include that of geographical barriers. In order to overcome the geographical barriers, telephone-based CBT has been conceptualized. Over the past decade, there has been massive advancement and development in Internet, Web-based and smartphone technologies, but there is still a paucity of applications in this area. Our current research objective is to determine if bariatric surgery patients will be receptive towards an online and smartphone based CBT intervention. The Bariatric Surgery Online CBT portal and Smartphone companion application was developed between July 2013 and December 2013. A low-cost methodology of developing the online portal was adopted. In terms of development, 4 core development phases were adopted. These included that of: a) Formulation of users' requirements, b) System design and development, c) System evaluation and d) System deployment and pilot application. The bariatric surgery workgroup from the Toronto Western Hospital helped with the recruitment of the subjects from the outpatient specialist service. Links to the web-portal was provided to each of the participants recruited. Since the inception of the online portal to date, in terms of usage rates, there

Efficacy and Safety of Adjuvant Proton Therapy Combined With Surgery for Chondrosarcoma of the Skull Base: A Retrospective, Population-Based Study

Energy Technology Data Exchange (ETDEWEB)

Feuvret, Loïc, E-mail: loic.feuvret@psl.aphp.fr [Department of Radiation Oncology, Groupe Hospitalier La Pitié-Salpêtrière–Charles Foix (Assistance Publique–Hôpitaux de Paris), Paris (France); Department of Radiation Oncology, Institut Curie–Centre de protonthérapie d' Orsay (CPO), Orsay (France); Bracci, Stefano [Institute of Radiation Oncology, Sapienza University, Sant' Andrea Hospital, Rome (Italy); Calugaru, Valentin [Department of Radiation Oncology, Institut Curie–Centre de protonthérapie d' Orsay (CPO), Orsay (France); Bolle, Stéphanie [Department of Radiation Oncology, Gustave Roussy, Villejuif (France); Mammar, Hamid; De Marzi, Ludovic [Department of Radiation Oncology, Institut Curie–Centre de protonthérapie d' Orsay (CPO), Orsay (France); Bresson, Damien [Department of Neurosurgery, Hôpital Lariboisière (Assistance Publique–Hôpitaux de Paris), Paris (France); Habrand, Jean-Louis [Department of Radiation Oncology, Centre François Baclesse, Caen (France); Mazeron, Jean-Jacques [Department of Radiation Oncology, Groupe Hospitalier La Pitié-Salpêtrière–Charles Foix (Assistance Publique–Hôpitaux de Paris), Paris (France); Dendale, Rémi [Department of Radiation Oncology, Institut Curie–Centre de protonthérapie d' Orsay (CPO), Orsay (France); and others

2016-05-01

Purpose: Chondrosarcoma is a rare malignant tumor of the cartilage affecting young adults. Surgery, followed by charged-particle irradiation, is considered the reference standard for the treatment of patients with grade I to II skull base chondrosarcoma. The present study was conducted to assess the effect of the quality of surgery and radiation therapy parameters on local control (LC) and overall survival (OS). Methods and Materials: From 1996 to 2013, 159 patients (median age 40 years, range 12-83) were treated with either protons alone or a combination of protons and photons. The median total dose delivered was 70.2 Gy (relative biologic effectiveness [RBE]; range 67-71). Debulking and biopsy were performed in 133 and 13 patients, respectively. Results: With a median follow-up of 77 months (range 2-214), 5 tumors relapsed based on the initial gross tumor volume. The 5- and 10-year LC rates were 96.4% and 93.5%, respectively, and the 5- and 10-year OS rates were 94.9% and 87%, respectively. A total of 16 patients died (13 of intercurrent disease, 3 of disease progression). On multivariate analysis, age <40 years and primary disease status were independent favorable prognostic factors for progression-free survival and OS, and local tumor control was an independent favorable predictor of OS. In contrast, the extent of surgery, dosimetric parameters, and adjacent organs at risk were not prognostic factors for LC or OS. Conclusions: Systematic high-dose postoperative proton therapy for skull base chondrosarcoma can achieve a high LC rate with a low toxicity profile. Maximal safe surgery, followed by high-dose conformal proton therapy, is therefore recommended.

Update History of This Database - AcEST | LSDB Archive [Life Science Database Archive metadata

Lifescience Database Archive (English)

Full Text Available switchLanguage; BLAST Search Image Search Home About Archive Update History Data ...List Contact us AcEST Update History of This Database Date Update contents 2013/01/10 Errors found on AcEST ...s Database Database Description Download License Update History of This Data...base Site Policy | Contact Us Update History of This Database - AcEST | LSDB Archive ... ...Conting data have been correceted. For details, please refer to the following page. Data correction 2010/03/29 AcEST English archi

Feasibility of Smartphone-Based Education Modules and Ecological Momentary Assessment/Intervention in Pre-bariatric Surgery Patients.

Science.gov (United States)

Mundi, Manpreet S; Lorentz, Paul A; Grothe, Karen; Kellogg, Todd A; Collazo-Clavell, Maria L

2015-10-01

Bariatric surgery is the most effective means of long-term weight loss. Knowledge gaps and lack of engagement in pre-operative patients can result in suboptimal outcome after surgery. Mobile technology, utilizing ecological momentary assessment (EMA)/intervention (EMI), has shown tremendous promise in changing behaviors. The primary objective of the study is to assess feasibility of using smartphone app with EMA/EMI functionality to prepare patients for bariatric surgery. Subjects seeking primary bariatric surgery were provided a smartphone app containing video-based education modules with linked assessments to evaluate mastery of topic. Subjects received algorithmic EMA text messages soliciting a response regarding lifestyle behavior. Upon answering, subjects received tailored EMI text messaging supporting healthy lifestyle. Thirty subjects (27 female and 3 male), with age of 41.3 ± 11.4 years and BMI of 46.3 ± 7.4 kg/m(2) were enrolled. Twenty subjects completed the study. Ten subjects withdrew. On average, seven out of nine education modules were completed (70.9 ± 27.3%), and 37.8/123 EMA were answered (30.7 ± 21.7%), with response time of 17.4 ± 4.4 min. Subjects reported high satisfaction with the app. Many felt that the app fit into their routine "somewhat easily" or "very easily" (n = 12), had "perfect" amount of EMA messages (n = 8), and was very helpful in preparing for surgery (n = 7). This study is the first to reveal the feasibility of using a smartphone app in the education and engagement of patients prior to bariatric surgery. The app was well-received based on subject satisfaction scores and revealed trends toward positive behavior change and increased weight loss. Randomized trials are necessary to delineate true efficacy.

Receiver Operating Characteristic Curve-Based Prediction Model for Periodontal Disease Updated With the Calibrated Community Periodontal Index.

Science.gov (United States)

Su, Chiu-Wen; Yen, Amy Ming-Fang; Lai, Hongmin; Chen, Hsiu-Hsi; Chen, Sam Li-Sheng

2017-12-01

The accuracy of a prediction model for periodontal disease using the community periodontal index (CPI) has been undertaken by using an area under a receiver operating characteristics (AUROC) curve. How the uncalibrated CPI, as measured by general dentists trained by periodontists in a large epidemiologic study, and affects the performance in a prediction model, has not been researched yet. A two-stage design was conducted by first proposing a validation study to calibrate CPI between a senior periodontal specialist and trained general dentists who measured CPIs in the main study of a nationwide survey. A Bayesian hierarchical logistic regression model was applied to estimate the non-updated and updated clinical weights used for building up risk scores. How the calibrated CPI affected performance of the updated prediction model was quantified by comparing AUROC curves between the original and updated models. Estimates regarding calibration of CPI obtained from the validation study were 66% and 85% for sensitivity and specificity, respectively. After updating, clinical weights of each predictor were inflated, and the risk score for the highest risk category was elevated from 434 to 630. Such an update improved the AUROC performance of the two corresponding prediction models from 62.6% (95% confidence interval [CI]: 61.7% to 63.6%) for the non-updated model to 68.9% (95% CI: 68.0% to 69.6%) for the updated one, reaching a statistically significant difference (P prediction model was demonstrated for periodontal disease as measured by the calibrated CPI derived from a large epidemiologic survey.

Thread-Level Parallel Indexing of Update Intensive Moving-Object Workloads

DEFF Research Database (Denmark)

Sidlauskas, Darius; Ross, Kenneth A.; Jensen, Christian S.

2011-01-01

as well as contain queries. The non-trivial challenge addressed is that of avoiding contention between long-running queries and frequent updates. Specifically, the paper proposes a grid-based indexing technique. A static grid indexes a near up-to-date snapshot of the data to support queries, while a live......Modern processors consist of multiple cores that each support parallel processing by multiple physical threads, and they offer ample main-memory storage. This paper studies the use of such processors for the processing of update-intensive moving-object workloads that contain very frequent updates...

Transsphenoidal Approach in Endoscopic Endonasal Surgery for Skull Base Lesions: What Radiologists and Surgeons Need to Know.

Science.gov (United States)

García-Garrigós, Elena; Arenas-Jiménez, Juan José; Monjas-Cánovas, Irene; Abarca-Olivas, Javier; Cortés-Vela, Jesús Julián; De La Hoz-Rosa, Javier; Guirau-Rubio, Maria Dolores

2015-01-01

In the last 2 decades, endoscopic endonasal transsphenoidal surgery has become the most popular choice of neurosurgeons and otolaryngologists to treat lesions of the skull base, with minimal invasiveness, lower incidence of complications, and lower morbidity and mortality rates compared with traditional approaches. The transsphenoidal route is the surgical approach of choice for most sellar tumors because of the relationship of the sphenoid bone to the nasal cavity below and the pituitary gland above. More recently, extended approaches have expanded the indications for transsphenoidal surgery by using different corridors leading to specific target areas, from the crista galli to the spinomedullary junction. Computer-assisted surgery is an evolving technology that allows real-time anatomic navigation during endoscopic surgery by linking preoperative triplanar radiologic images and intraoperative endoscopic views, thus helping the surgeon avoid damage to vital structures. Preoperative computed tomography is the preferred modality to show bone landmarks and vascular structures. Radiologists play an important role in surgical planning by reporting extension of sphenoid pneumatization, recesses and septations of the sinus, and other relevant anatomic variants. Radiologists should understand the relationships of the sphenoid bone and skull base structures, anatomic variants, and image-guided neuronavigation techniques to prevent surgical complications and allow effective treatment of skull base lesions with the endoscopic endonasal transsphenoidal approach. ©RSNA, 2015.

2016 updated MASCC/ESMO consensus recommendations

DEFF Research Database (Denmark)

Ruhlmann, Christina H.; Jahn, Franziska; Jordan, Karin

2017-01-01

Purpose: Radiotherapy-induced nausea and vomiting (RINV) are distressing symptoms. Evidence-based guidelines should facilitate the prescription of the best possible antiemetic prophylaxis. As part of the MASCC/ESMO Antiemetic Guidelines Update 2016, a thorough review of the literature concerning ...

Cirurgia para controle de danos: estado atual Damage control surgery: an update

Directory of Open Access Journals (Sweden)

Rodrigo Camargo Leão Edelmuth

2013-04-01

Full Text Available A cirurgia de controle de danos é um conceito amplamente aceito atualmente entre os especialistas em trauma abdominal quando se trata de doentes gravemente traumatizados. Nestes pacientes a morte decorre, na maioria das vezes, da instalação da tríade letal (hipotermia, coagulopatia e acidose e não da incapacidade de reparar as graves lesões presentes. Nesta revisão, os autores abordam a tríade letal, em suas três fases, e enfatizam as medidas adotadas para preveni-las. Além de discutirem a indicação e o emprego da cirurgia para o controle de danos em seus vários estágios. A restauração dos padrões fisiológicos do doente na UTI, para que o mesmo possa ser submetido à operação definitiva e ao fechamento da cavidade abdominal, outro desafio no paciente traumatizado grave, também é discutida.The damage control surgery is a widely accepted concept today among abdominal trauma specialists when it comes to the severely traumatized. In these patients, the death is due, in most cases, to the installation of the lethal triad (hypothermia, coagulopathy and acidosis and not the inability to repair the serious initial damage. In this review, the authors address the lethal triad in its three phases and emphasize the measures taken to prevent them, as well as discussing the indication and employment of damage control surgery in its various stages. Restoring the physiological status of the patient in the ICU, so that he/she can be submitted to final operation and closure of the abdominal cavity, another challenge in severe trauma patients, is also discussed.

Intraoperative Magnetic Resonance Imaging in Skull Base Surgery: A Review of 71 Consecutive Cases.

Science.gov (United States)

Ashour, Ramsey; Reintjes, Stephen; Park, Michael S; Sivakanthan, Sananthan; van Loveren, Harry; Agazzi, Siviero

2016-09-01

Although intraoperative magnetic resonance imaging (iMRI) increasingly is used during glioma resection, its role in skull base surgery has not been well documented. In this study, we evaluate our experience with iMRI for skull base surgery. Medical records were reviewed retrospectively on all neurosurgical cases performed at our institution in the IMRIS iMRI suite between April 2014 and July 2015. During the study period, the iMRI suite was used for 71 skull base tumors. iMRI was performed in 23 of 71 cases. Additional tumor resection was pursued after scanning in 7 of 23 patients. There was a significant difference in procedure length between the scanned versus nonscanned groups, and this was likely attributable to a greater proportion of petroclival meningiomas in the scanned group. Further analyses revealed significant increases in procedure length for the following scanned subgroups: anterolateral approach, anterolateral and petroclival lesion locations, and meningiomas. The rate of non-neurologic complications was significantly greater in the scanned group, particularly for patients with tumors >3 cm. Despite the unique challenges associated with skull base tumor surgery, iMRI can be safely obtained while adding a modest although not prohibitive amount of time to the procedure. The immediate evidence of residual tumor with a patient still in position to have additional resection may influence the surgeon to alter the surgical plan and attempt further resection in a critical area. Copyright © 2016 Elsevier Inc. All rights reserved.

The risk of disabling, surgery and reoperation in Crohn's disease - A decision tree-based approach to prognosis.

Science.gov (United States)

Dias, Cláudia Camila; Pereira Rodrigues, Pedro; Fernandes, Samuel; Portela, Francisco; Ministro, Paula; Martins, Diana; Sousa, Paula; Lago, Paula; Rosa, Isadora; Correia, Luis; Moura Santos, Paula; Magro, Fernando

2017-01-01

Crohn's disease (CD) is a chronic inflammatory bowel disease known to carry a high risk of disabling and many times requiring surgical interventions. This article describes a decision-tree based approach that defines the CD patients' risk or undergoing disabling events, surgical interventions and reoperations, based on clinical and demographic variables. This multicentric study involved 1547 CD patients retrospectively enrolled and divided into two cohorts: a derivation one (80%) and a validation one (20%). Decision trees were built upon applying the CHAIRT algorithm for the selection of variables. Three-level decision trees were built for the risk of disabling and reoperation, whereas the risk of surgery was described in a two-level one. A receiver operating characteristic (ROC) analysis was performed, and the area under the curves (AUC) Was higher than 70% for all outcomes. The defined risk cut-off values show usefulness for the assessed outcomes: risk levels above 75% for disabling had an odds test positivity of 4.06 [3.50-4.71], whereas risk levels below 34% and 19% excluded surgery and reoperation with an odds test negativity of 0.15 [0.09-0.25] and 0.50 [0.24-1.01], respectively. Overall, patients with B2 or B3 phenotype had a higher proportion of disabling disease and surgery, while patients with later introduction of pharmacological therapeutic (1 months after initial surgery) had a higher proportion of reoperation. The decision-tree based approach used in this study, with demographic and clinical variables, has shown to be a valid and useful approach to depict such risks of disabling, surgery and reoperation.

Multicore-Optimized Wavefront Diamond Blocking for Optimizing Stencil Updates

KAUST Repository

Malas, T.

2015-07-02

The importance of stencil-based algorithms in computational science has focused attention on optimized parallel implementations for multilevel cache-based processors. Temporal blocking schemes leverage the large bandwidth and low latency of caches to accelerate stencil updates and approach theoretical peak performance. A key ingredient is the reduction of data traffic across slow data paths, especially the main memory interface. In this work we combine the ideas of multicore wavefront temporal blocking and diamond tiling to arrive at stencil update schemes that show large reductions in memory pressure compared to existing approaches. The resulting schemes show performance advantages in bandwidth-starved situations, which are exacerbated by the high bytes per lattice update case of variable coefficients. Our thread groups concept provides a controllable trade-off between concurrency and memory usage, shifting the pressure between the memory interface and the CPU. We present performance results on a contemporary Intel processor.

Multicore-Optimized Wavefront Diamond Blocking for Optimizing Stencil Updates

KAUST Repository

Malas, T.; Hager, G.; Ltaief, Hatem; Stengel, H.; Wellein, G.; Keyes, David E.

2015-01-01

The importance of stencil-based algorithms in computational science has focused attention on optimized parallel implementations for multilevel cache-based processors. Temporal blocking schemes leverage the large bandwidth and low latency of caches to accelerate stencil updates and approach theoretical peak performance. A key ingredient is the reduction of data traffic across slow data paths, especially the main memory interface. In this work we combine the ideas of multicore wavefront temporal blocking and diamond tiling to arrive at stencil update schemes that show large reductions in memory pressure compared to existing approaches. The resulting schemes show performance advantages in bandwidth-starved situations, which are exacerbated by the high bytes per lattice update case of variable coefficients. Our thread groups concept provides a controllable trade-off between concurrency and memory usage, shifting the pressure between the memory interface and the CPU. We present performance results on a contemporary Intel processor.

WIMS Library updating

Energy Technology Data Exchange (ETDEWEB)

Ravnik, M; Trkov, A [Inst. Jozef Stefan, Ljubljana (Slovenia); Holubar, A [Ustav Jaderneho Vyzkumu CSKAE, Rez (Serbia and Montenegro)

1992-07-01

At the end of 1990 the WIMS Library Update Project (WLUP) has been initiated at the International Atomic Energy Agency. The project was organized as an international research project, coordinated at the J. Stefan Institute. Up to now, 22 laboratories from 19 countries joined the project. Phase 1 of the project, which included WIMS input optimization for five experimental benchmark lattices, has been completed. The work presented in this paper describes also the results of Phase 2 of the Project, in which the cross sections based on ENDF/B-IV evaluated nuclear data library have been processed. (author) [Slovenian] Konec 1990 se je na Mednarodni agenciji za atomsko energijo zacel projekt obnove knjiznice presekov programa WIMS (WIMS Library Updating Project, WLUP). V projektu sodeluje 22 laboratorijev iz 19 drzav, koordiniramo pa ga na Institutu Jozef Stefan. Doslej je koncana faza 1 tega projekta, ki obsega optimizacijo vhodnega modela programa WIMS za pet eksperimentalnih testnih problemov. Podani so tudi rezultati faze 2, v kateri so se procesirali preseki na osnovi ENDF/B-IV datoteke. (author)

A review of virtual reality based training simulators for orthopaedic surgery

OpenAIRE

Vaughan, Neil; Dubey, Venketesh N.; Wainwright, Tom; Middleton, Robert

2015-01-01

This review presents current virtual reality based training simulators for hip, knee and other orthopaedic surgery, including elective and trauma surgical procedures. There have not been any reviews focussing on hip and knee orthopaedic simulators. A comparison of existing simulator features is provided to identify what is missing and what is required to improve upon current simulators. In total 11 total hip replacement pre-operative planning tools were analysed, plus 9 hip trauma fracture tr...

Nevada Nuclear Waste Storage Investigations, January-June 1987: An update

International Nuclear Information System (INIS)

Tamura, A.T.; Lorenz, J.J.

1988-03-01

This update contains information on the Nevada Nuclear Waste Storage Investigations (NNWSI) that was added to the DOE Energy Data Base during the first six months of 1987. The update is categorized by principal NNWSI Project participating organization, and items are arranged in chronological order. Participant-sponsored subcontractor reports, papers, and articles are included in the sponsoring organization's list. The publication following this update will be a supplement to the first bibliography (DOE/TIC-3406) and will include all information retrieved from January 1, 1986, to December 31, 1987. It will be a cumulation of all updates for this two-year interval and will include indexing for: Corporate Author, Personal Author, Subject, Contract Number, Report Number, Order Number Correlation, and Key Word in Context

A review of illicit psychoactive drug use in elective surgery patients: Detection, effects, and policy.

Science.gov (United States)

Selvaggi, Gennaro; Spagnolo, Antonio G; Elander, Anna

2017-12-01

Limited information is present in literature regarding detection of illicit drug users visiting physicians when planning elective surgery; also, there is no update manuscript that is illustrating the effects of illicit drugs use that require reconstructive surgery interventions. Aims of this manuscript are: 1) to summarize existing knowledge, and give surgeons information how to detect patients who might possible use illicit drugs; 2) to review the effects of illicit drug use that specifically require reconstructive surgery interventions; 3) to assess on existing policies on asymptomatic illicit drug users when planning elective surgery. Studies were identified by searching systematically in the electronic databases PubMed, Medline, The Cochrane Library and SveMed+. Because of the nature of research questions to be investigated (drug policy and surgery), a "systematic review" was not possible. In spite of some existing policies to detect illicit drug use in specific situations such as workplaces or acute trauma patients, there is a lack of data and lack of information, and subsequently no policy has ever been made, for detection and management of illicit drug use asymptomatic patients requesting or referred for plastic surgery interventions. This manuscript poses questions for further ethical evaluations and future policy. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Selection of Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer: ASCO Clinical Practice Guideline Focused Update.

Science.gov (United States)

Denduluri, Neelima; Chavez-MacGregor, Mariana; Telli, Melinda L; Eisen, Andrea; Graff, Stephanie L; Hassett, Michael J; Holloway, Jamie N; Hurria, Arti; King, Tari A; Lyman, Gary H; Partridge, Ann H; Somerfield, Mark R; Trudeau, Maureen E; Wolff, Antonio C; Giordano, Sharon H

2018-05-22

Purpose To update key recommendations of the ASCO guideline adaptation of the Cancer Care Ontario guideline on the selection of optimal adjuvant chemotherapy regimens for early breast cancer and adjuvant targeted therapy for breast cancer. Methods An Expert Panel conducted targeted systematic literature reviews guided by a signals approach to identify new, potentially practice-changing data that might translate to revised practice recommendations. Results The Expert Panel reviewed phase III trials that evaluated adjuvant capecitabine after completion of standard preoperative anthracycline- and taxane-based combination chemotherapy by patients with early-stage breast cancer HER2-negative breast cancer with residual invasive disease at surgery; the addition of 1 year of adjuvant pertuzumab to combination chemotherapy and trastuzumab for patients with early-stage, HER2-positive breast cancer; and the use of neratinib as extended adjuvant therapy for patients after combination chemotherapy and trastuzumab-based adjuvant therapy with early-stage, HER2-positive breast cancer. Recommendations Patients with early-stage HER2-negative breast cancer with pathologic, invasive residual disease at surgery following standard anthracycline- and taxane-based preoperative therapy may be offered up to six to eight cycles of adjuvant capecitabine. Clinicians may add 1 year of adjuvant pertuzumab to trastuzumab-based combination chemotherapy in patients with high-risk, early-stage, HER2-positive breast cancer. Clinicians may use extended adjuvant therapy with neratinib to follow trastuzumab in patients with early-stage, HER2-positive breast cancer. Neratinib causes substantial diarrhea, and diarrhea prophylaxis must be used. Additional information can be found at www.asco.org/breast-cancer-guidelines .

Implementation of Enhanced Recovery After Surgery: a strategy to transform surgical care across a health system.

Science.gov (United States)

Gramlich, Leah M; Sheppard, Caroline E; Wasylak, Tracy; Gilmour, Loreen E; Ljungqvist, Olle; Basualdo-Hammond, Carlota; Nelson, Gregg

2017-05-19

Enhanced Recovery After Surgery (ERAS) programs have been shown to have a positive impact on outcome. The ERAS care system includes an evidence-based guideline, an implementation program, and an interactive audit system to support practice change. The purpose of this study is to describe the use of the Theoretic Domains Framework (TDF) in changing surgical care and application of the Quality Enhancement Research Initiative (QUERI) model to analyze end-to-end implementation of ERAS in colorectal surgery across multiple sites within a single health system. The ultimate intent of this work is to allow for the development of a model for spread, scale, and sustainability of ERAS in Alberta Health Services (AHS). ERAS for colorectal surgery was implemented at two sites and then spread to four additional sites. The ERAS Interactive Audit System (EIAS) was used to assess compliance with the guidelines, length of stay, readmissions, and complications. Data sources informing knowledge translation included surveys, focus groups, interviews, and other qualitative data sources such as minutes and status updates. The QUERI model and TDF were used to thematically analyze 189 documents with 2188 quotes meeting the inclusion criteria. Data sources were analyzed for barriers or enablers, organized into a framework that included individual to organization impact, and areas of focus for guideline implementation. Compliance with the evidence-based guidelines for ERAS in colorectal surgery at baseline was 40%. Post implementation compliance, consistent with adoption of best practice, improved to 65%. Barriers and enablers were categorized as clinical practice (22%), individual provider (26%), organization (19%), external environment (7%), and patients (25%). In the Alberta context, 26% of barriers and enablers to ERAS implementation occurred at the site and unit levels, with a provider focus 26% of the time, a patient focus 26% of the time, and a system focus 22% of the time. Using the

Endoscopic vision-based tracking of multiple surgical instruments during robot-assisted surgery.

Science.gov (United States)

Ryu, Jiwon; Choi, Jaesoon; Kim, Hee Chan

2013-01-01

Robot-assisted minimally invasive surgery is effective for operations in limited space. Enhancing safety based on automatic tracking of surgical instrument position to prevent inadvertent harmful events such as tissue perforation or instrument collisions could be a meaningful augmentation to current robotic surgical systems. A vision-based instrument tracking scheme as a core algorithm to implement such functions was developed in this study. An automatic tracking scheme is proposed as a chain of computer vision techniques, including classification of metallic properties using k-means clustering and instrument movement tracking using similarity measures, Euclidean distance calculations, and a Kalman filter algorithm. The implemented system showed satisfactory performance in tests using actual robot-assisted surgery videos. Trajectory comparisons of automatically detected data and ground truth data obtained by manually locating the center of mass of each instrument were used to quantitatively validate the system. Instruments and collisions could be well tracked through the proposed methods. The developed collision warning system could provide valuable information to clinicians for safer procedures. © 2012, Copyright the Authors. Artificial Organs © 2012, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

rSNPBase 3.0: an updated database of SNP-related regulatory elements, element-gene pairs and SNP-based gene regulatory networks.

Science.gov (United States)

Guo, Liyuan; Wang, Jing

2018-01-04

Here, we present the updated rSNPBase 3.0 database (http://rsnp3.psych.ac.cn), which provides human SNP-related regulatory elements, element-gene pairs and SNP-based regulatory networks. This database is the updated version of the SNP regulatory annotation database rSNPBase and rVarBase. In comparison to the last two versions, there are both structural and data adjustments in rSNPBase 3.0: (i) The most significant new feature is the expansion of analysis scope from SNP-related regulatory elements to include regulatory element-target gene pairs (E-G pairs), therefore it can provide SNP-based gene regulatory networks. (ii) Web function was modified according to data content and a new network search module is provided in the rSNPBase 3.0 in addition to the previous regulatory SNP (rSNP) search module. The two search modules support data query for detailed information (related-elements, element-gene pairs, and other extended annotations) on specific SNPs and SNP-related graphic networks constructed by interacting transcription factors (TFs), miRNAs and genes. (3) The type of regulatory elements was modified and enriched. To our best knowledge, the updated rSNPBase 3.0 is the first data tool supports SNP functional analysis from a regulatory network prospective, it will provide both a comprehensive understanding and concrete guidance for SNP-related regulatory studies. © The Author(s) 2017. Published by Oxford University Press on behalf of Nucleic Acids Research.

A review of virtual reality based training simulators for orthopaedic surgery.

Science.gov (United States)

Vaughan, Neil; Dubey, Venketesh N; Wainwright, Thomas W; Middleton, Robert G

2016-02-01

This review presents current virtual reality based training simulators for hip, knee and other orthopaedic surgery, including elective and trauma surgical procedures. There have not been any reviews focussing on hip and knee orthopaedic simulators. A comparison of existing simulator features is provided to identify what is missing and what is required to improve upon current simulators. In total 11 hip replacements pre-operative planning tools were analysed, plus 9 hip trauma fracture training simulators. Additionally 9 knee arthroscopy simulators and 8 other orthopaedic simulators were included for comparison. The findings are that for orthopaedic surgery simulators in general, there is increasing use of patient-specific virtual models which reduce the learning curve. Modelling is also being used for patient-specific implant design and manufacture. Simulators are being increasingly validated for assessment as well as training. There are very few training simulators available for hip replacement, yet more advanced virtual reality is being used for other procedures such as hip trauma and drilling. Training simulators for hip replacement and orthopaedic surgery in general lag behind other surgical procedures for which virtual reality has become more common. Further developments are required to bring hip replacement training simulation up to date with other procedures. This suggests there is a gap in the market for a new high fidelity hip replacement and resurfacing training simulator. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

UPDATING UNDER RISK CONDITION

Directory of Open Access Journals (Sweden)

VĂDUVA CECILIA ELENA

2018-02-01

Full Text Available The foundation for future firm development is investment. Agents have a risk aversion requiring higher returns as the risks associated with the project will be greater. The investment decision determines the market firm's affirmation, increasing the market share, dominating the market. Making an investment at a certain point will determine certain cash flows throughout the life of the project, and a residual value can be obtained when it is taken out of service. The flows and payments for the investment project can be more easily tracked if we are proposing a constant update rate. We will be able to analyze, based on various factors, three techniques for determining the discount rate for investment projects: the opportunity cost, the risk-free rate, and a series of risk premiums, the weighted average cost of capital. People without financial training make value judgments for investment projects based on other market opportunities, comparing the returns that any investment offers to other pay options. An investor has a sum of money he wants to make - if he does not invest in a project, he will invest in another, that will bring him a certain amount of money, choosing the most advantageous project by comparison. All projects are characterized by identical risks, and the agents are considered indifferent to the risks. The answer given by financial theory and practice to the disadvantage of rates in the opportunity cost category is the discount rate calculated as a sum of the risk-free rate and a risk premium, defining the risk as a factor whose action may cause a possible decrease in cash of the available flows. Higher objectivity is presented by the opportunity cost update rates of update because it refers to known variables but cannot be perfectly matched to the performance of the investment process.

Art and Plastic Surgery.

Science.gov (United States)

Fernandes, Julio Wilson; Metka, Susanne

2016-04-01

The roots of science and art of plastic surgery are very antique. Anatomy, drawing, painting, and sculpting have been very important to the surgery and medicine development over the centuries. Artistic skills besides shape, volume, and lines perception can be a practical aid to the plastic surgeons' daily work. An overview about the interactions between art and plastic surgery is presented, with a few applications to rhinoplasty, cleft lip, and other reconstructive plastic surgeries. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Development and implementation of a clinical pathway approach to simulation-based training for foregut surgery.

Science.gov (United States)

Miyasaka, Kiyoyuki W; Buchholz, Joseph; LaMarra, Denise; Karakousis, Giorgos C; Aggarwal, Rajesh

2015-01-01

Contemporary demands on resident education call for integration of simulation. We designed and implemented a simulation-based curriculum for Post Graduate Year 1 surgery residents to teach technical and nontechnical skills within a clinical pathway approach for a foregut surgery patient, from outpatient visit through surgery and postoperative follow-up. The 3-day curriculum for groups of 6 residents comprises a combination of standardized patient encounters, didactic sessions, and hands-on training. The curriculum is underpinned by a summative simulation "pathway" repeated on days 1 and 3. The "pathway" is a series of simulated preoperative, intraoperative, and postoperative encounters in following up a single patient through a disease process. The resident sees a standardized patient in the clinic presenting with distal gastric cancer and then enters an operating room to perform a gastrojejunostomy on a porcine tissue model. Finally, the resident engages in a simulated postoperative visit. All encounters are rated by faculty members and the residents themselves, using standardized assessment forms endorsed by the American Board of Surgery. A total of 18 first-year residents underwent this curriculum. Faculty ratings of overall operative performance significantly improved following the 3-day module. Ratings of preoperative and postoperative performance were not significantly changed in 3 days. Resident self-ratings significantly improved for all encounters assessed, as did reported confidence in meeting the defined learning objectives. Conventional surgical simulation training focuses on technical skills in isolation. Our novel "pathway" curriculum targets an important gap in training methodologies by placing both technical and nontechnical skills in their clinical context as part of managing a surgical patient. Results indicate consistent improvements in assessments of performance as well as confidence and support its continued usage to educate surgery residents

Feasibility of using administrative data for identifying medical reasons to delay hip fracture surgery: a Canadian database study.

Science.gov (United States)

Guy, Pierre; Sheehan, Katie J; Morin, Suzanne N; Waddell, James; Dunbar, Michael; Harvey, Edward; Sirett, Susan; Sobolev, Boris; Kuramoto, Lisa; Tang, Michael

2017-10-05

Failure to account for medically necessary delays may lead to an underestimation of early surgery benefits. This study investigated the feasibility of using administrative data to identify the National Institute for Health and Care Excellence (NICE) 124 guideline list of conditions that appropriately delay hip fracture surgery. We assembled a list of diagnosis and procedure codes to reflect the NICE 124 conditions. The list was reviewed and updated by an advanced clinical coder. The list was refined by five clinical experts. We then screened Canadian Institute for Health Information discharge abstracts for 153 918 patients surgically treated for a non-pathological first hip fracture between 1 January 2004 and 31 December 2012 for diagnosis codes present on admission and procedure codes that antedated hip fracture surgery. We classified abstracts as having medical reasons for delaying surgery based on the presence of these codes. In total, 10 237 (6.7%; 95% CI 6.5% to 6.8%) patients had diagnostic and procedure codes indicating medical reasons for delay. The most common reasons for medical delay were exacerbation of a chronic chest condition (35.9%) and acute chest infection (23.2%). The proportion of patients with reasons for medical delays increased with time from admission to surgery: 3.9% (95% CI 3.6% to 4.1%) for same day surgery; 4.7% (95% CI 4.5% to 4.8%) for surgery 1 day after admission; 7.1% (95% CI 6.9% to 7.4%) for surgery 2 days after admission; and 15.5% (95% CI 15.1% to 16.0%) for surgery more than 2 days after admission. The trend was seen for admissions on weekday working hours, weekday after hours and on weekends. Administrative data can be considered to identify conditions that appropriately delay hip fracture surgery. Accounting for medically necessary delays can improve estimates of the effectiveness of early surgery. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights

[Neurophysiological identification of the cranial nerves in endoscopic endonasal surgery of skull base tumors].

Science.gov (United States)

Shkarubo, A N; Ogurtsova, A A; Moshchev, D A; Lubnin, A Yu; Andreev, D N; Koval', K V; Chernov, I V

2016-01-01

Intraoperative identification of the cranial nerves is a useful technique in removal of skull base tumors through the endoscopic endonasal approach. Searching through the scientific literature found one pilot study on the use of triggered electromyography (t-EMG) for identification of the VIth nerve in endonasal endoscopic surgery of skull base tumors (D. San-Juan, et al, 2014). The study objective was to prevent iatrogenic injuries to the cranial nerves without reducing the completeness of tumor tissue resection. In 2014, 5 patients were operated on using the endoscopic endonasal approach. Surgeries were performed for large skull base chordomas (2 cases) and trigeminal nerve neurinomas located in the cavernous sinus (3). Intraoperatively, identification of the cranial nerves was performed by triggered electromyography using a bipolar electrode (except 1 case of chordoma where a monopolar electrode was used). Evaluation of the functional activity of the cranial nerves was carried out both preoperatively and postoperatively. Tumor resection was total in 4 out of 5 cases and subtotal (chordoma) in 1 case. Intraoperatively, the IIIrd (2 patients), Vth (2), and VIth (4) cranial nerves were identified. No deterioration in the function of the intraoperatively identified nerves was observed in the postoperative period. In one case, no responses from the VIth nerve on the right (in the cavernous sinus region) were intraoperatively obtained, and deep paresis (up to plegia) of the nerve-innervated muscles developed in the postoperative period. The nerve function was not impaired before surgery. The t-EMG technique is promising and requires further research.

The Contemporary Incidence and Sequelae of Rhabdomyolysis Following Extirpative Renal Surgery: A Population Based Analysis.

Science.gov (United States)

Gelpi-Hammerschmidt, Francisco; Tinay, Ilker; Allard, Christopher B; Su, Li-Ming; Preston, Mark A; Trinh, Quoc-Dien; Kibel, Adam S; Wang, Ye; Chung, Benjamin I; Chang, Steven L

2016-02-01

We evaluate the contemporary incidence and consequences of postoperative rhabdomyolysis after extirpative renal surgery. We conducted a population based, retrospective cohort study of patients who underwent extirpative renal surgery with a diagnosis of a renal mass or renal cell carcinoma in the United States between 2004 and 2013. Regression analysis was performed to evaluate 90-day mortality (Clavien grade V), nonfatal major complications (Clavien grade III-IV), hospital readmission rates, direct costs and length of stay. The final weighted cohort included 310,880 open, 174,283 laparoscopic and 69,880 robotic extirpative renal surgery cases during the 10-year study period, with 745 (0.001%) experiencing postoperative rhabdomyolysis. The presence of postoperative rhabdomyolysis led to a significantly higher incidence of 90-day nonfatal major complications (34.7% vs 7.3%, p rhabdomyolysis (incidence risk ratio 1.83, 95% CI 1.56-2.15, p rhabdomyolysis (vs laparoscopic approach, OR 2.43, p rhabdomyolysis (p rhabdomyolysis developing. Our study confirms that postoperative rhabdomyolysis is an uncommon complication among patients undergoing extirpative renal surgery, but has a potentially detrimental impact on surgical morbidity, mortality and costs. Male gender, comorbidities, obesity, prolonged surgery (more than 5 hours) and a robotic approach appear to place patients at higher risk for postoperative rhabdomyolysis. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Patients' perceptions of waiting for bariatric surgery: a qualitative study.

Science.gov (United States)

Gregory, Deborah M; Temple Newhook, Julia; Twells, Laurie K

2013-10-18

In Canada waiting lists for bariatric surgery are common, with wait times on average > 5 years. The meaning of waiting for bariatric surgery from the patients' perspective must be understood if health care providers are to act as facilitators in promoting satisfaction with care and quality care outcomes. The aims of this study were to explore patients' perceptions of waiting for bariatric surgery, the meaning and experience of waiting, the psychosocial and behavioral impact of waiting for treatment and identify health care provider and health system supportive measures that could potentially improve the waiting experience. Twenty-one women and six men engaged in in-depth interviews that were digitally recorded, transcribed verbatim and analysed using a grounded theory approach to data collection and analysis between June 2011 and April 2012. The data were subjected to re-analysis to identify perceived health care provider and health system barriers to accessing bariatric surgery. Thematic analysis identified inequity as a barrier to accessing bariatric surgery. Three areas of perceived inequity were identified from participants' accounts: socioeconomic inequity, regional inequity, and inequity related to waitlist prioritization. Although excited about their acceptance as candidates for surgery, the waiting period was described as stressful, anxiety provoking, and frustrating. Anger was expressed towards the health care system for the long waiting times. Participants identified the importance of health care provider and health system supports during the waiting period. Recommendations on how to improve the waiting experience included periodic updates from the surgeon's office about their position on the wait list; a counselor who specializes in helping people going through this surgery, dietitian support and further information on what to expect after surgery, among others. Patients' perceptions of accessing and waiting for bariatric surgery are shaped by perceived

Bayesian updating of reliability of civil infrastructure facilities based on condition-state data and fault-tree model

International Nuclear Information System (INIS)

Ching Jianye; Leu, S.-S.

2009-01-01

This paper considers a difficult but practical circumstance of civil infrastructure management-deterioration/failure data of the infrastructure system are absent while only condition-state data of its components are available. The goal is to develop a framework for estimating time-varying reliabilities of civil infrastructure facilities under such a circumstance. A novel method of analyzing time-varying condition-state data that only reports operational/non-operational status of the components is proposed to update the reliabilities of civil infrastructure facilities. The proposed method assumes that the degradation arrivals can be modeled as a Poisson process with unknown time-varying arrival rate and damage impact and that the target system can be represented as a fault-tree model. To accommodate large uncertainties, a Bayesian algorithm is proposed, and the reliability of the infrastructure system can be quickly updated based on the condition-state data. Use of the new method is demonstrated with a real-world example of hydraulic spillway gate system.

Cardiovascular Update: Risk, Guidelines, and Recommendations.

Science.gov (United States)

Pearson, Tamera

2015-09-01

This article provides an update of the current status of cardiovascular disease (CVD) in the United States, including a brief review of the underlying pathophysiology and epidemiology. This article presents a discussion of the latest American Heart Association guidelines that introduce the concept of promoting ideal cardiovascular health, defined by seven identified metrics. Specific CVD risk factors and utilization of the 10-year CVD event prediction calculator are discussed. In addition, current management recommendations of health-related conditions that increase risk for CVD, such as hypertension and hypercholesterolemia, are provided. Finally, a discussion of detailed evidence-based lifestyle recommendations to promote cardiovascular health and reduce CVD risks concludes the update. © 2015 The Author(s).

Physician Bayesian updating from personal beliefs about the base rate and likelihood ratio.

Science.gov (United States)

Rottman, Benjamin Margolin

2017-02-01

Whether humans can accurately make decisions in line with Bayes' rule has been one of the most important yet contentious topics in cognitive psychology. Though a number of paradigms have been used for studying Bayesian updating, rarely have subjects been allowed to use their own preexisting beliefs about the prior and the likelihood. A study is reported in which physicians judged the posttest probability of a diagnosis for a patient vignette after receiving a test result, and the physicians' posttest judgments were compared to the normative posttest calculated from their own beliefs in the sensitivity and false positive rate of the test (likelihood ratio) and prior probability of the diagnosis. On the one hand, the posttest judgments were strongly related to the physicians' beliefs about both the prior probability as well as the likelihood ratio, and the priors were used considerably more strongly than in previous research. On the other hand, both the prior and the likelihoods were still not used quite as much as they should have been, and there was evidence of other nonnormative aspects to the updating, such as updating independent of the likelihood beliefs. By focusing on how physicians use their own prior beliefs for Bayesian updating, this study provides insight into how well experts perform probabilistic inference in settings in which they rely upon their own prior beliefs rather than experimenter-provided cues. It suggests that there is reason to be optimistic about experts' abilities, but that there is still considerable need for improvement.

A National Needs Assessment to Identify Technical Procedures in Vascular Surgery for Simulation Based Training.

Science.gov (United States)

Nayahangan, L J; Konge, L; Schroeder, T V; Paltved, C; Lindorff-Larsen, K G; Nielsen, B U; Eiberg, J P

2017-04-01

Practical skills training in vascular surgery is facing challenges because of an increased number of endovascular procedures and fewer open procedures, as well as a move away from the traditional principle of "learning by doing." This change has established simulation as a cornerstone in providing trainees with the necessary skills and competences. However, the development of simulation based programs often evolves based on available resources and equipment, reflecting convenience rather than a systematic educational plan. The objective of the present study was to perform a national needs assessment to identify the technical procedures that should be integrated in a simulation based curriculum. A national needs assessment using a Delphi process was initiated by engaging 33 predefined key persons in vascular surgery. Round 1 was a brainstorming phase to identify technical procedures that vascular surgeons should learn. Round 2 was a survey that used a needs assessment formula to explore the frequency of procedures, the number of surgeons performing each procedure, risk and/or discomfort, and feasibility for simulation based training. Round 3 involved elimination and ranking of procedures. The response rate for round 1 was 70%, with 36 procedures identified. Round 2 had a 76% response rate and resulted in a preliminary prioritised list after exploring the need for simulation based training. Round 3 had an 85% response rate; 17 procedures were eliminated, resulting in a final prioritised list of 19 technical procedures. A national needs assessment using a standardised Delphi method identified a list of procedures that are highly suitable and may provide the basis for future simulation based training programs for vascular surgeons in training. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Neurophysiological Identification of Cranial Nerves During Endoscopic Endonasal Surgery of Skull Base Tumors: Pilot Study Technical Report.

Science.gov (United States)

Shkarubo, Alexey Nikolaevich; Chernov, Ilia Valerievich; Ogurtsova, Anna Anatolievna; Moshchev, Dmitry Aleksandrovich; Lubnin, Andrew Jurievich; Andreev, Dmitry Nicolaevich; Koval, Konstantin Vladimirovich

2017-02-01

Intraoperative identification of cranial nerves is crucial for safe surgery of skull base tumors. Currently, only a small number of published papers describe the technique of trigger electromyography (t-EMG) in endoscopic endonasal removal of such tumors. To assess the effectiveness of t-EMG in preventing intraoperative cranial nerve damage in endoscopic endonasal surgery of skull base tumors. Nine patients were operated on using the endoscopic endonasal approach within a 1-year period. The tumors included large skull base chordomas and trigeminal neurinomas localized in the cavernous sinus. During the surgical process, cranial nerve identification was carried out using monopolar and bipolar t-EMG methods. Assessment of cranial nerve functional activity was conducted both before and after tumor removal. We mapped 17 nerves in 9 patients. Third, fifth, and sixth cranial nerves were identified intraoperatively. There were no cases of postoperative functional impairment of the mapped cranial nerves. In one case we were unable to get an intraoperative response from the fourth cranial nerve and observed its postoperative transient plegia (the function was normal before surgery). t-EMG allows surgeons to control the safety of cranial nerves both during and after skull base tumor removal. Copyright © 2016 Elsevier Inc. All rights reserved.

Update History of This Database - Arabidopsis Phenome Database | LSDB Archive [Life Science Database Archive metadata

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Full Text Available List Contact us Arabidopsis Phenome Database Update History of This Database Date Update contents 2017/02/27 Arabidopsis Phenome Data...base English archive site is opened. - Arabidopsis Phenome Database (http://jphenom...e.info/?page_id=95) is opened. About This Database Database Description Download License Update History of This Database... Site Policy | Contact Us Update History of This Database - Arabidopsis Phenome Database | LSDB Archive ...

Application and study of conjunctival sac disinfectants in ophthalmic surgeries

Directory of Open Access Journals (Sweden)

Yan-Fei Luo

2016-01-01

Full Text Available Postoperative endophthalmitis is the most serious complications of ophthalmic surgeries. Conjunctival sac disinfection is currently recognized as an effectively important way to reduce the risk of endophthalmitis. At present, there are some disinfectants has been used in clinic or in the researches:mercury agent, gentamicin, povidone iodine and acid electrolytic water. All kinds of disinfectants play the role of disinfection by different ways. Povidone iodine is the most widely used conjunctival sac disinfectant. Mercurial and gentamicin have been rarely used because they pollute the environment, are easy to cause drug resistant bacteria, localized side reactions and so on. The acid electrolyte water is not used in clinic at present. With the popularization and development of the ophthalmic surgeries, the ophthalmologists have become more and more concerned about the postoperative eye comfort, the research and application of conjunctival sac disinfectant in the future will continue to be updated and developed.

Tetraplegia Management Update.

Science.gov (United States)

Fridén, Jan; Gohritz, Andreas

2015-12-01

Tetraplegia is a profound impairment of mobility manifesting as a paralysis of all 4 extremities owing to cervical spinal cord injury. The purpose of this article is to provide an update and analyze current management, treatment options, and outcomes of surgical reconstruction of arm and hand function. Surgical restoration of elbow and wrist extension or handgrip has tremendous potential to improve autonomy, mobility, and critical abilities, for example, eating, personal care, and self-catheterization and productive work in at least 70% of tetraplegic patients. Tendon and nerve transfers, tenodeses, and joint stabilizations reliably enable improved arm and hand usability, reduce muscle imbalance and pain in spasticity, and prevent joint contractures. One-stage combined procedures have proven considerable advantages over traditional multistage approaches. Immediate activation of transferred muscles reduces the risk of adhesions, facilitates relearning, avoids adverse effects of immobilization, and enhances functional recovery. Transfer of axillary, musculocutaneous, and radial nerve fascicles from above the spinal cord injury are effective and promising options to enhance motor outcome and sensory protection, especially in groups with limited resources. Improved communication between medical disciplines, therapists, patients, and their relatives should help that more individuals can benefit from these advances and could empower many thousands tetraplegic individuals "to take life into their own hands" and live more independently. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Does cramming work? Impact of National Web-Based Thoracic Surgery Curriculum login frequency on thoracic surgery in-training exam performance.

Science.gov (United States)

Luc, Jessica G Y; Verrier, Edward D; Allen, Mark S; Aloia, Lauren; Baker, Craig; Fann, James I; Iannettoni, Mark D; Yang, Stephen C; Vaporciyan, Ara A; Antonoff, Mara B

2018-04-18

Web-based curricula provide login data that can be advantageously used to characterize and analyze study habits. We sought to compare thoracic surgical trainee In-Training Examination percentiles with regard to their study habits (ie, cramming), as characterized by curriculum login frequency to the national Web-based Thoracic Surgery Curriculum. Furthermore, we then aimed to characterize the curriculum login frequency of trainees as stratified by their performance on the In-Training Examination and their improvement on the In-Training Examination over subsequent years. We performed a retrospective review of trainees who accessed the curriculum before the 2014 In-Training Examination, with curriculum login data collected from site analytics. Scores were compared between trainees who crammed (≥30% increase in logins in the month before the In-Training Examination) and those who did not. Trainees were stratified on the basis of 2014 In-Training Examination percentile and improvement in percentile from 2013 to 2014 into high, medium, and low scorers and improvers. Of 256 trainees who took the 2014 In-Training Examination, 63 (25%) met criteria as crammers. Crammers increased total study sessions immediately before the In-Training Examination (P < .001), but without impact on 2014 In-Training Examination percentile (P = .995) or year-to-year improvement (P = .234). Stratification by In-Training Examination percentile demonstrated that highest scoring trainees used the curriculum more frequently in the final month than medium-range scorers (P = .039). When stratified by extent of year-to-year improvement, those who improved the most accessed the curriculum significantly more often in the last month compared with baseline (P = .040). Moreover, those with greatest improvement logged in more in the final month than those with least improvement (P = .006). Increasing the frequency of study periods on the national Web-based thoracic surgery curriculum before the

Studying the potential impact of automated document classification on scheduling a systematic review update

Science.gov (United States)

2012-01-01

Background Systematic Reviews (SRs) are an essential part of evidence-based medicine, providing support for clinical practice and policy on a wide range of medical topics. However, producing SRs is resource-intensive, and progress in the research they review leads to SRs becoming outdated, requiring updates. Although the question of how and when to update SRs has been studied, the best method for determining when to update is still unclear, necessitating further research. Methods In this work we study the potential impact of a machine learning-based automated system for providing alerts when new publications become available within an SR topic. Some of these new publications are especially important, as they report findings that are more likely to initiate a review update. To this end, we have designed a classification algorithm to identify articles that are likely to be included in an SR update, along with an annotation scheme designed to identify the most important publications in a topic area. Using an SR database containing over 70,000 articles, we annotated articles from 9 topics that had received an update during the study period. The algorithm was then evaluated in terms of the overall correct and incorrect alert rate for publications meeting the topic inclusion criteria, as well as in terms of its ability to identify important, update-motivating publications in a topic area. Results Our initial approach, based on our previous work in topic-specific SR publication classification, identifies over 70% of the most important new publications, while maintaining a low overall alert rate. Conclusions We performed an initial analysis of the opportunities and challenges in aiding the SR update planning process with an informatics-based machine learning approach. Alerts could be a useful tool in the planning, scheduling, and allocation of resources for SR updates, providing an improvement in timeliness and coverage for the large number of medical topics needing SRs

Development and application of stent-based image guided navigation system for oral and maxillofacial surgery

Energy Technology Data Exchange (ETDEWEB)

Lee, Woo Jin; Kim, Dae Seung [Interdisciplinary Program in Radiation Applied Life Science, Dental Research Institute and BK21, College of Medicine, Seoul National University, Seoul (Korea, Republic of); Yi, Won Jin; Lee, Sam Sun; Choi, Soon Chul; Heo, Min Suk; Huh, Kyung Hoe; Kim, Myung Jin; Lee, Jee Ho [Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul (Korea, Republic of)

2009-09-15

The purpose of this study was to develop a stent-based image guided surgery system and to apply it to oral and maxillofacial surgeries for anatomically complex sites. We devised a patient-specific stent for patient-to-image registration and navigation. Three dimensional positions of the reference probe and the tool probe were tracked by an optical camera system and the relative position of the handpiece drill tip to the reference probe was monitored continuously on the monitor of a PC. Using 8 landmarks for measuring accuracy, the spatial discrepancy between CT image coordinate and physical coordinate was calculated for testing the normality. The accuracy over 8 anatomical landmarks showed an overall mean of 0.56 {+-} 0.16 mm. The developed system was applied to a surgery for a vertical alveolar bone augmentation in right mandibular posterior area and possible interior alveolar nerve injury case of an impacted third molar. The developed system provided continuous monitoring of invisible anatomical structures during operation and 3D information for operation sites. The clinical challenge showed sufficient accuracy and availability of anatomically complex operation sites. The developed system showed sufficient accuracy and availability in oral and maxillofacial surgeries for anatomically complex sites.

Quality of life and disability 12 months after surgery vs. conservative management for unruptured brain arteriovenous malformations: Scottish population-based and Australian hospital-based studies.

Science.gov (United States)

O'Donnell, Joan Margaret; Al-Shahi Salman, Rustam; Manuguerra, Maurizio; Assaad, Nazih; Morgan, Michael Kerin

2018-03-01

Few data are available on disability and quality of life (QOL) after surgery versus conservative management for unruptured brain arteriovenous malformations (uAVMs). The aim of this study was to test the hypothesis that QOL and disability are worse after surgery ± preoperative embolisation for uAVM compared with conservative management. We included consecutive patients diagnosed with uAVM from a prospective population-based study in Scotland (1999-2003; 2006-2010) and a prospective hospital-based series in Australia (2011-2015). We assessed outcomes on the modified Rankin Scale (mRS) and the Short Form (SF)-36 at ~ 12 months after surgery or conservative treatment and compared these groups using continuous ordinal regression in the two cohorts separately. Surgery was performed for 29% of all uAVM cases diagnosed in Scotland and 84% of all uAVM referred in Australia. There was no statistically significant difference between surgery and conservative management at 12 months among 79 patients in Scotland (mean SF-36 Physical Component Score (PCS) 39 [SD 14] vs. 39 [SD 13]; mean SF-36 Mental Component Score (MCS) 38 [SD 14] vs. 39 [SD 14]; mRS > 1, 24 vs. 9%), nor among 37 patients in Australia (PCS 51 [SD 10] vs. 49 [SD 6]; MCS 48 [SD 12] vs. 49 [SD 10]; mRS > 1, 19 vs. 30%). In the Australian series, there was no statistically significant change in the MCS and PCS between baseline before surgery or conservative management and 12 months. We did not find a statistically significant difference between surgery ± preoperative embolisation and conservative management in disability or QOL at 12 months.

Comparison of fiber delivered CO2 laser and electrocautery in transoral robot assisted tongue base surgery.

Science.gov (United States)

Karaman, Murat; Gün, Taylan; Temelkuran, Burak; Aynacı, Engin; Kaya, Cem; Tekin, Ahmet Mahmut

2017-05-01

To compare intra-operative and post-operative effectiveness of fiber delivered CO 2 laser to monopolar electrocautery in robot assisted tongue base surgery. Prospective non-randomized clinical study. Twenty moderate to severe obstructive sleep apnea (OSA) patients, non-compliant with Continuous Positive Airway Pressure (CPAP), underwent Transoral Robotic Surgery (TORS) using the Da Vinci surgical robot in our University Hospital. OSA was treated with monopolar electrocautery in 10 patients, and with flexible CO 2 laser fiber in another 10 patients. The following parameters in the two sets are analyzed: Intraoperative bleeding that required cauterization, robot operating time, need for tracheotomy, postoperative self-limiting bleeding, length of hospitalization, duration until start of oral intake, pre-operative and post-operative minimum arterial oxygen saturation, pre-operative and post-operative Epworth Sleepiness Scale score, postoperative airway complication and postoperative pain. Mean follow-up was 12 months. None of the patients required tracheotomy and there were no intraoperative complications related to the use of the robot or the CO 2 laser. The use of CO 2 laser in TORS-assisted tongue base surgery resulted in less intraoperative bleeding that required cauterization, shorter robot operating time, shorter length of hospitalization, shorter duration until start of oral intake and less postoperative pain, when compared to electrocautery. Postoperative apnea-hypopnea index scores showed better efficacy of CO 2 laser than electrocautery. Comparison of postoperative airway complication rates and Epworth sleepiness scale scores were found to be statistically insignificant between the two groups. The use of CO 2 laser in robot assisted tongue base surgery has various intraoperative and post-operative advantages when compared to monopolar electrocautery.

Update of CERN exchange network

CERN Multimedia

2003-01-01

An update of the CERN exchange network will be done next April. Disturbances or even interruptions of telephony services may occur from 4th to 24th April during evenings from 18:30 to 00:00 but will not exceed more than 4 consecutive hours (see tentative planning below). CERN divisions are invited to avoid any change requests (set-ups, move or removals) of telephones and fax machines from 4th to 25th April. Everything will be done to minimize potential inconveniences which may occur during this update. There will be no loss of telephone functionalities. CERN GSM portable phones won't be affected by this change. Should you need more details, please send us your questions by email to Standard.Telephone@cern.ch. DateChange typeAffected areas April 11 Update of switch in LHC 4 LHC 4 Point April 14 Update of switch in LHC 5 LHC 5 Point April 15 Update of switches in LHC 3 and LHC 2 Points LHC 3 and LHC 2 April 22 Update of switch N4 Meyrin Ouest April 23 Update of switch  N6 Prévessin Site Ap...

Rapid recovery programmes for hip and knee arthroplasty. An update.

Science.gov (United States)

Molko, S; Combalia, A

Fast-track surgery, or enhanced recovery, has appeared in the last 20 years or so as a combination of the optimisation of clinical protocols and organisational processes, pursuing the reduction in surgical stress with the aim of reducing peri-operative comorbidities, convalescence time, and functional recovery, resulting in a reduction in admission time. After a review of the European literature available on this subject, this article attempts to present an update. It highlights its interest and origins, basically being set out as a response to the question: 'Why is this patient in Hospital today?' It also attempts to summarise the essence of such programmes: the search for immediate post-surgical mobilisation, being supported in a multidisciplinary approach. This includes a multimodal intervention and analgesia, a limitation in the use of opiates, and the active participation by the patients in their own recovery. Furthermore, mention is made of the initiatives by European State organisation as a boost to enhanced recovery programmes in their respective countries, as is the case in Denmark, France, and the United Kingdom. The clinical outcomes published up to September 2015 have been reviewed. A subsequent decrease in mean hospital stay is observed in 11 studies, achieving patient satisfaction, low complication rates, a reduction in the transfusion rates, and with no apparent increase in re-admissions. Mention is also made of the financial consequences, and how to implement these protocols. As a conclusion, an analysis is made of the future challenges fast-track surgery, such as the possibility of moving towards outpatient surgery, or the obtaining of a surgery 'with no risk or pain' in general, for which there are other still open lines of work. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Decentralized Consistent Updates in SDN

KAUST Repository

Nguyen, Thanh Dang

2017-04-10

We present ez-Segway, a decentralized mechanism to consistently and quickly update the network state while preventing forwarding anomalies (loops and blackholes) and avoiding link congestion. In our design, the centralized SDN controller only pre-computes information needed by the switches during the update execution. This information is distributed to the switches, which use partial knowledge and direct message passing to efficiently realize the update. This separation of concerns has the key benefit of improving update performance as the communication and computation bottlenecks at the controller are removed. Our evaluations via network emulations and large-scale simulations demonstrate the efficiency of ez-Segway, which compared to a centralized approach, improves network update times by up to 45% and 57% at the median and the 99th percentile, respectively. A deployment of a system prototype in a real OpenFlow switch and an implementation in P4 demonstrate the feasibility and low overhead of implementing simple network update functionality within switches.

Finite element model updating of concrete structures based on imprecise probability

Science.gov (United States)

Biswal, S.; Ramaswamy, A.

2017-09-01

Imprecise probability based methods are developed in this study for the parameter estimation, in finite element model updating for concrete structures, when the measurements are imprecisely defined. Bayesian analysis using Metropolis Hastings algorithm for parameter estimation is generalized to incorporate the imprecision present in the prior distribution, in the likelihood function, and in the measured responses. Three different cases are considered (i) imprecision is present in the prior distribution and in the measurements only, (ii) imprecision is present in the parameters of the finite element model and in the measurement only, and (iii) imprecision is present in the prior distribution, in the parameters of the finite element model, and in the measurements. Procedures are also developed for integrating the imprecision in the parameters of the finite element model, in the finite element software Abaqus. The proposed methods are then verified against reinforced concrete beams and prestressed concrete beams tested in our laboratory as part of this study.

Updated cannulation technique for tissue plasminogen activator injection into peripapillary retinal vein for central retinal vein occlusion.

Science.gov (United States)

van Overdam, Koen A; Missotten, Tom; Spielberg, Leigh H

2015-12-01

To update the surgical technique in which a vitrectomy is performed and a retinal branch vein is cannulated and infused with recombinant tissue plasminogen activator (RTPA) to treat central retinal vein occlusion (CRVO) in patients who present with very low visual acuity (VA). Twelve consecutive patients (12 eyes) with CRVO and low VA (logMAR >1.00) at presentation were treated using this method. Cannulation of a peripapillary retinal vein and stable injection of RTPA was successfully performed without surgery-related complications in all 12 eyes. At 12 months after surgery, 8 of the 12 patients (67%) experienced at least one line of improvement in best corrected visual acuity; 6 of the 12 (50%) improved ≥5 lines and 2 (17%) improved ≥8 lines. After additional grid laser and/or subconjunctival or intravitreal corticosteroids, the mean decrease in central foveal thickness was 260 μm, and the mean total macular volume decreased from 12.10 mm(3) to 9.24 mm(3) . Four patients received panretinal photocoagulation to treat either iris neovascularization (n = 2) or neovascularization of the retina and/or disc (n = 2). Administration of RTPA via a peripapillary vein using this updated technique provides an alternative or additional treatment option for patients with very low VA after CRVO. © 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Objective assessment in residency-based training for transoral robotic surgery.

Science.gov (United States)

Curry, Martin; Malpani, Anand; Li, Ryan; Tantillo, Thomas; Jog, Amod; Blanco, Ray; Ha, Patrick K; Califano, Joseph; Kumar, Rajesh; Richmon, Jeremy

2012-10-01

To develop a robotic surgery training regimen integrating objective skill assessment for otolaryngology and head and neck surgery trainees consisting of training modules of increasing complexity leading up to procedure-specific training. In particular, we investigated applications of such a training approach for surgical extirpation of oropharyngeal tumors via a transoral approach using the da Vinci robotic system. Prospective blinded data collection and objective evaluation (Objective Structured Assessment of Technical Skills [OSATS]) of three distinct phases using the da Vinci robotic surgical system in an academic university medical engineering/computer science laboratory setting. Between September 2010 and July 2011, eight otolaryngology-head and neck surgery residents and four staff experts from an academic hospital participated in three distinct phases of robotic surgery training involving 1) robotic platform operational skills, 2) set up of the patient side system, and 3) a complete ex vivo surgical extirpation of an oropharyngeal tumor located in the base of tongue. Trainees performed multiple (four) approximately equally spaced training sessions in each stage of the training. In addition to trainees, baseline performance data were obtained for the experts. Each surgical stage was documented with motion and event data captured from the application programming interfaces of the da Vinci system, as well as separate video cameras as appropriate. All data were assessed using automated skill measures of task efficiency and correlated with structured assessment (OSATS and similar Likert scale) from three experts to assess expert and trainee differences and compute automated and expert assessed learning curves. Our data show that such training results in an improved didactic robotic knowledge base and improved clinical efficiency with respect to the set up and console manipulation. Experts (e.g., average OSATS, 25; standard deviation [SD], 3.1; module 1, suturing

Applications of navigation for orthognathic surgery.

Science.gov (United States)

Bobek, Samuel L

2014-11-01

Stereotactic surgical navigation has been used in oral and maxillofacial surgery for orbital reconstruction, reduction of facial fractures, localization of foreign bodies, placement of implants, skull base surgery, tumor removal, temporomandibular joint surgery, and orthognathic surgery. The primary goals in adopting intraoperative navigation into these different surgeries were to define and localize operative anatomy, to localize implant position, and to orient the surgical wound. Navigation can optimize the functional and esthetic outcomes in patients with dentofacial deformities by identifying pertinent anatomic structures, transferring the surgical plan to the patient, and verifying the surgical result. This article discusses the principles of navigation-guided orthognathic surgery. Copyright © 2014 Elsevier Inc. All rights reserved.

Web-Based Education Prior to Outpatient Orthopaedic Surgery Enhances Early Patient Satisfaction Scores: A Prospective Randomized Controlled Study.

Science.gov (United States)

van Eck, Carola F; Toor, Aneet; Banffy, Michael B; Gambardella, Ralph A

2018-01-01

A good patient-surgeon relationship relies on adequate preoperative education and counseling. Several multimedia resources, such as web-based education tools, have become available to enhance aspects of perioperative care. The purpose of this study was to evaluate the effect of an interactive web-based education tool on perioperative patient satisfaction scores after outpatient orthopaedic surgery. It was hypothesized that web-based education prior to outpatient orthopaedic surgery enhances patient satisfaction scores. Randomized controlled trial; Level of evidence, 1. All patients undergoing knee arthroscopy with meniscectomy, chondroplasty, or anterior cruciate ligament reconstruction or shoulder arthroscopy with rotator cuff repair were eligible for inclusion and were randomized to the study or control group. The control group received routine education by the surgeon, whereas the study group received additional web-based education. At the first postoperative visit, all patients completed the OAS CAHPS (Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems) survey. Differences in patient satisfaction scores between the study and control groups were determined with an independent t test. A total of 177 patients were included (104 [59%] males; mean age, 42 ± 14 years); 87 (49%) patients were randomized to receive additional web-based education. Total patient satisfaction score was significantly higher in the study group (97 ± 5) as compared with the control group (94 ± 8; P = .019), specifically for the OAS CAHPS core measure "recovery" (92 ± 13 vs 82 ± 23; P = .001). Age, sex, race, workers' compensation status, education level, overall health, emotional health, procedure type and complexity, and addition of a video did not influence patient satisfaction scores. Supplemental web-based patient education prior to outpatient orthopaedic surgery enhances patient satisfaction scores.

[Enhanced recovery after surgery based on medical ethics].

Science.gov (United States)

Zhao, Qingchuan

2016-03-01

Enhanced recovery after surgery (ERAS), a new model of perioperative management developed in recent years, can shorten hospital stay, reduce medical cost and postoperative discomfort. However, some of these measures under the strategy are negation of the traditional recommendation and many surgeons are concerned about the medical tangle by the complications coming with the ERAS strategy. In this paper, ERAS strategy is evaluated from an ethical standpoint and the assessment factors of medical behavior are introduced based on medical virtues and medical ethnics. It is also analyzed that how to deal with the conflicts between the textbooks and the ERAS strategy, and elaborated that the medical ethics should be observed if the ERAS strategy is implemented. The scientific principles must be followed, the rights and interests of the patients need to be protected, and the informed consent should be guaranteed.

A study of internet of things real-time data updating based on WebSocket

Science.gov (United States)

Wei, Shoulin; Yu, Konglin; Dai, Wei; Liang, Bo; Zhang, Xiaoli

2015-12-01

The Internet of Things (IoT) is gradually entering the industrial stage. Web applications in IoT such as monitoring, instant messaging, real-time quote system changes need to be transmitted in real-time mode to client without client constantly refreshing and sending the request. These applications often need to be as fast as possible and provide nearly real-time components. Real-time data updating is becoming the core part of application layer visualization technology in IoT. With support of data push in server-side, running state of "Things" in IoT could be displayed in real-time mode. This paper discusses several current real-time data updating method and explores the advantages and disadvantages of each method. We explore the use of WebSocket in a new approach for real-time data updating in IoT, since WebSocket provides low delay, low network throughput solutions for full-duplex communication.

Efficacy and Safety of Adjuvant Proton Therapy Combined With Surgery for Chondrosarcoma of the Skull Base: A Retrospective, Population-Based Study.

Science.gov (United States)

Feuvret, Loïc; Bracci, Stefano; Calugaru, Valentin; Bolle, Stéphanie; Mammar, Hamid; De Marzi, Ludovic; Bresson, Damien; Habrand, Jean-Louis; Mazeron, Jean-Jacques; Dendale, Rémi; Noël, Georges

2016-05-01

Chondrosarcoma is a rare malignant tumor of the cartilage affecting young adults. Surgery, followed by charged-particle irradiation, is considered the reference standard for the treatment of patients with grade I to II skull base chondrosarcoma. The present study was conducted to assess the effect of the quality of surgery and radiation therapy parameters on local control (LC) and overall survival (OS). From 1996 to 2013, 159 patients (median age 40 years, range 12-83) were treated with either protons alone or a combination of protons and photons. The median total dose delivered was 70.2 Gy (relative biologic effectiveness [RBE]; range 67-71). Debulking and biopsy were performed in 133 and 13 patients, respectively. With a median follow-up of 77 months (range 2-214), 5 tumors relapsed based on the initial gross tumor volume. The 5- and 10-year LC rates were 96.4% and 93.5%, respectively, and the 5- and 10-year OS rates were 94.9% and 87%, respectively. A total of 16 patients died (13 of intercurrent disease, 3 of disease progression). On multivariate analysis, age chondrosarcoma can achieve a high LC rate with a low toxicity profile. Maximal safe surgery, followed by high-dose conformal proton therapy, is therefore recommended. Copyright © 2016 Elsevier Inc. All rights reserved.

Adoption of intracameral antibiotic prophylaxis of endophthalmitis following cataract surgery: update on the ESCRS Endophthalmitis Study.

LENUS (Irish Health Repository)

Barry, Peter

2014-01-01

To determine the use of intracameral cefuroxime at the end of cataract surgery since the beneficial results were first reported by the European Society of Cataract and Refractive Surgeons Endophthalmitis Study Group in 2006, 250 ophthalmic surgeons affiliated with both public and private hospitals and clinics across Europe were surveyed. The questions regarded their awareness of the results of the ESCRS endophthalmitis study and their current use or non-use of intracameral antibiotics in their cataract procedures. Seventy-four percent of respondents said they always or usually use intracameral antibiotics in their cataract surgery procedures. The most frequently cited reasons for not using cefuroxime or other intracameral antibiotics was the lack of an approved commercial preparation and related anxieties regarding the risk of dilution errors and contamination. More than 90% of respondents said they would use cefuroxime if an approved single-unit dose product were commercially available.

VIRGY: a virtual reality and force feedback based endoscopic surgery simulator.

Science.gov (United States)

Baur, C; Guzzoni, D; Georg, O

1998-01-01

This paper describes the VIRGY project at the VRAI Group (Virtual Reality and Active Interface), Swiss Federal Institute of Technology (Lausanne, Switzerland). Since 1994, we have been investigating a variety of virtual-reality based methods for simulating laparoscopic surgery procedures. Our goal is to develop an endoscopic surgical training tool which realistically simulates the interactions between one or more surgical instruments and gastrointestinal organs. To support real-time interaction and manipulation between instruments and organs, we have developed several novel graphic simulation techniques. In particular, we are using live video texturing to achieve dynamic effects such as bleeding or vaporization of fatty tissues. Special texture manipulations allows us to generate pulsing objects while minimizing processor load. Additionally, we have created a new surface deformation algorithm which enables real-time deformations under external constraints. Lastly, we have developed a new 3D object definition which allows us to perform operations such as total or partial object cuttings, as well as to selectively render objects with different levels of detail. To provide realistic physical simulation of the forces and torques on surgical instruments encountered during an operation, we have also designed a new haptic device dedicated to endososcopic surgery constraints. We are using special interpolation and extrapolation techniques to integrate our 25 Hz visual simulation with the 300 Hz feedback required for realistic tactile interaction. The fully VIRGY simulator has been tested by surgeons and the quality of both our visual and haptic simulation has been judged sufficient for training basic surgery gestures.

Canadian Thoracic Society 2011 Guideline Update: Diagnosis and Treatment of Sleep Disordered Breathing

Directory of Open Access Journals (Sweden)

John Fleetham

2011-01-01

Full Text Available The Canadian Thoracic Society (CTS published an executive summary of guidelines for the diagnosis and treatment of sleep disordered breathing in 2006/2007. These guidelines were developed during several meetings by a group of experts with evidence grading based on committee consensus. These guidelines were well received and the majority of the recommendations remain unchanged. The CTS embarked on a more rigorous process for the 2011 guideline update, and addressed eight areas that were believed to be controversial or in which new data emerged. The CTS Sleep Disordered Breathing Committee posed specific questions for each area. The recommendations regarding maximum assessment wait times, portable monitoring, treatment of asymptomatic adult obstructive sleep apnea patients, treatment with conventional continuous positive airway pressure compared with automatic continuous positive airway pressure, and treatment of central sleep apnea syndrome in heart failure patients replace the recommendations in the 2006/2007 guidelines. The recommendations on bariatric surgery, complex sleep apnea and optimum positive airway pressure technologies are new topics, which were not covered in the 2006/2007 guidelines.

Update on Smoking Cessation: E-Cigarettes, Emerging Tobacco Products Trends, and New Technology-Based Interventions.

Science.gov (United States)

Das, Smita; Tonelli, Makenzie; Ziedonis, Douglas

2016-05-01

Tobacco use disorders (TUDs) continue to be overly represented in patients treated in mental health and addiction treatment settings. It is the most common substance use disorder (SUD) and the leading cause of health disparities and increased morbidity/mortality amongst individuals with a psychiatric disorder. There are seven Food and Drug Administration (FDA) approved medications and excellent evidence-based psychosocial treatment interventions to use in TUD treatment. In the past few years, access to and use of other tobacco or nicotine emerging products are on the rise, including the highly publicized electronic cigarette (e-cigarette). There has also been a proliferation of technology-based interventions to support standard TUD treatment, including mobile apps and web-based interventions. These tools are easily accessed 24/7 to support outpatient treatment. This update will review the emerging products and counter-measure intervention technologies, including how clinicians can integrate these tools and other community-based resources into their practice.

Improving the visual realism of virtual surgery.

Science.gov (United States)

Jin, Wei; Lim, Yi-Je; Xu, Xie George; Singh, Tejinder P; De, Suvranu

2005-01-01

In this work we focus our attention on improving the visual realism of virtual surgery. A synthetic solution by innovative use of various image-based rendering methods is presented for realistic rendering of virtual surgery scenes. We have, for the first time, developed a methodology for generating virtual surgery scenes with realistic glistening effects by a combination of various image-based rendering techniques, including image mosaicing and view-dependent texture mapping. Realistic examples are presented to showcase the results.

One life saved by four prevented recurrencies? Update of the early breast cancer trialists confirms. Postoperative radiotherapy improves survival after breast conserving surgery

International Nuclear Information System (INIS)

Sautter-Bihl, M.L.; Budach, W.

2012-01-01

The debate about the impact of local control on survival in early breast cancer patients is still going on, in spite of the continuously growing evidence that avoidance of locoregional disease reduces the risk of tumor-specific death. Recently, B. Fisher, one of the pioneers of breast conserving therapy claimed that during the last two decades, as a result of the use of systemic therapy in conjunction with breast conserving surgery and radiation, the incidence of locoregional recurrence has been reduced to a level where further reduction is likely to have little impact on survival. The penultimate meta-analysis of the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) reported the effect of radiotherapy in early breast cancer on recurrence and survival in 2005 and provided the essential message that four prevented local recurrences at 5 years would avoid one breast cancer death in 15 years. The scientific community has eagerly awaited the quinquennial update of the EBCTCG which has now been published. A total of 17 randomized studies comparing postoperative radiotherapy vs. none were analyzed and comprised 7 new studies in addition to follow-up data of from 9 previously reported trials. A total of 10,801 patients with pT1-2 tumors were included, the majority of whom (n=7,287) were node negative, while 1,050 were node positive (2,464 unknown). In contrast to the previous meta-analysis, all patients received breast conserving surgery, consisting of lumpectomy (n=8,422) or more extensive techniques like quadrantectomy or sectoral resection (n= 2,399). The effect of radiotherapy on 10-year recurrences of any type and their relation to the 15-year breast cancer death rate were studied in correlation to various prognostic parameters and treatment characteristics (e.g., surgery, tamoxifen use). Moreover, a subgroup analysis was performed according to low, intermediate, and high initial risk of recurrence, from which the expected absolute benefit was derived by

Vasectomy reversal: a clinical update

Directory of Open Access Journals (Sweden)

Abhishek P Patel

2016-01-01

Full Text Available Vasectomy is a safe and effective method of contraception used by 42-60 million men worldwide. Approximately 3%-6% of men opt for a vasectomy reversal due to the death of a child or divorce and remarriage, change in financial situation, desire for more children within the same marriage, or to alleviate the dreaded postvasectomy pain syndrome. Unlike vasectomy, vasectomy reversal is a much more technically challenging procedure that is performed only by a minority of urologists and places a larger financial strain on the patient since it is usually not covered by insurance. Interest in this procedure has increased since the operating microscope became available in the 1970s, which consequently led to improved patency and pregnancy rates following the procedure. In this clinical update, we discuss patient evaluation, variables that may influence reversal success rates, factors to consider in choosing to perform vasovasostomy versus vasoepididymostomy, and the usefulness of vasectomy reversal to alleviate postvasectomy pain syndrome. We also review the use of robotics for vasectomy reversal and other novel techniques and instrumentation that have emerged in recent years to aid in the success of this surgery.

Dissociating Working Memory Updating and Automatic Updating: The Reference-Back Paradigm

Science.gov (United States)

Rac-Lubashevsky, Rachel; Kessler, Yoav

2016-01-01

Working memory (WM) updating is a controlled process through which relevant information in the environment is selected to enter the gate to WM and substitute its contents. We suggest that there is also an automatic form of updating, which influences performance in many tasks and is primarily manifested in reaction time sequential effects. The goal…

Surgery of language-eloquent tumors in patients not eligible for awake surgery: the impact of a protocol based on navigated transcranial magnetic stimulation on presurgical planning and language outcome, with evidence of tumor-induced intra-hemispheric plasticity.

Science.gov (United States)

Raffa, Giovanni; Quattropani, Maria C; Scibilia, Antonino; Conti, Alfredo; Angileri, Filippo Flavio; Esposito, Felice; Sindorio, Carmela; Cardali, Salvatore Massimiliano; Germanò, Antonino; Tomasello, Francesco

2018-05-01

Awake surgery and intraoperative monitoring represent the gold standard for surgery of brain tumors located in the perisylvian region of the dominant hemisphere due to their ability to map and preserve the language network during surgery. Nevertheless, in some cases awake surgery is not feasible. This could increase the risk of postoperative language deficit. Navigated transcranial magnetic stimulation (nTMS) and nTMS-based DTI fiber tracking (DTI-FT) provide a preoperative mapping and reconstruction of the cortico-subcortical language network. This can be used to plan and guide the surgical strategy to preserve the language function. The objective if this study is to describe the impact of a non-invasive preoperative protocol for mapping the language network through the nTMS and nTMS-based DTI-FT in patients not eligible for awake surgery and thereby operated under general anesthesia for suspected language-eloquent brain tumors. We reviewed clinical data of patients not eligible for awake surgery and operated under general anaesthesia between 2015 and 2016. All patients underwent nTMS language cortical mapping and nTMS-based DTI-FT of subcortical language fascicles. The nTMS findings were used to plan and guide the maximal safe resection of the tumor. The impact on postoperative language outcome and the accuracy of the nTMS-based mapping in predicting language deficits were evaluated. Twenty patients were enrolled in the study. The nTMS-based reconstruction of the language network was successful in all patients. Interestingly, we observed a significant association between tumor localization and the cortical distribution of the nTMS errors (p = 0.004), thereby suggesting an intra-hemispheric plasticity of language cortical areas, probably induced by the tumor itself. The nTMS mapping disclosed the true-eloquence of lesions in 12 (60%) of all suspected cases. In the remaining 8 cases (40%) the suspected eloquence of the lesion was disproved. The nTMS-based

The role of similarity in updating numerical information in working memory: decomposing the numerical distance effect.

Science.gov (United States)

Lendínez, Cristina; Pelegrina, Santiago; Lechuga, M Teresa

2014-01-01

The present study investigates the process of updating representations in working memory (WM) and how similarity between the information involved influences this process. In WM updating tasks, the similarity in terms of numerical distance between the number to be substituted and the new one facilitates the updating process. We aimed to disentangle the possible effect of two dimensions of similarity that may contribute to this numerical effect: numerical distance itself and common digits shared between the numbers involved. Three experiments were conducted in which different ranges of distances and the coincidence between the digits of the two numbers involved in updating were manipulated. Results showed that the two dimensions of similarity had an effect on updating times. The greater the similarity between the information maintained in memory and the new information that substituted it, the faster the updating. This is consistent both with the idea of distributed representations based on features, and with a selective updating process based on a feature overwriting mechanism. Thus, updating in WM can be understood as a selective substitution process influenced by similarity in which only certain parts of the representation stored in memory are changed.

Eponyms in elbow fracture surgery

NARCIS (Netherlands)

Somford, Matthijs P.; Wiegerinck, Johannes I.; Hoornenborg, Daniël; van den Bekerom, Michel P. J.; Eygendaal, Denise

2015-01-01

Eponyms are common in medicine and in orthopaedic surgery. For future reference and historical considerations, we present common eponyms in elbow fracture surgery. We describe in short the biography of the name giver and give, where possible, the original description on which the eponym was based.

Video-based peer feedback through social networking for robotic surgery simulation: a multicenter randomized controlled trial.

Science.gov (United States)

Carter, Stacey C; Chiang, Alexander; Shah, Galaxy; Kwan, Lorna; Montgomery, Jeffrey S; Karam, Amer; Tarnay, Christopher; Guru, Khurshid A; Hu, Jim C

2015-05-01

To examine the feasibility and outcomes of video-based peer feedback through social networking to facilitate robotic surgical skill acquisition. The acquisition of surgical skills may be challenging for novel techniques and/or those with prolonged learning curves. Randomized controlled trial involving 41 resident physicians performing the Tubes (Da Vinci Intuitive Surgical, Sunnyvale, CA) simulator exercise with versus without peer feedback of video-recorded performance through a social networking Web page. Data collected included simulator exercise score, time to completion, and comfort and satisfaction with robotic surgery simulation. There were no baseline differences between the intervention group (n = 20) and controls (n = 21). The intervention group showed improvement in mean scores from session 1 to sessions 2 and 3 (60.7 vs 75.5, P feedback subjects were more comfortable with robotic surgery than controls (90% vs 62%, P = 0.021) and expressed greater satisfaction with the learning experience (100% vs 67%, P = 0.014). Of the intervention subjects, 85% found that peer feedback was useful and 100% found it effective. Video-based peer feedback through social networking appears to be an effective paradigm for surgical education and accelerates the robotic surgery learning curve during simulation.

Evaluation of efficiency, effectiveness and social equity of the property tax in the municipality of Sogamoso, based on the last cadastral update

Directory of Open Access Journals (Sweden)

Juan Sebastián Izaquita-Orduz

2013-12-01

equity of the tax collection process on property in the city of Sogamoso, based on the last cadastral update. Basically, it was established the amount caused by this tax before the last cadastral update and was compared with the actual amount in the same period, as well as the resources used to achieve the collection of each fiscal year. The result of this comparison broadly determined that the level of effectiveness is satisfactory in terms of money but it was not in terms of number of properties, and that the efficiency of the collection process was greatly encouraging. In terms of meters built since last cadastral update, it was established its evolution between each cadastral update. In addition, it was analyzed the social equity component which involves the collection of property tax, and which was an important element in determining the degree of efficiency and effectiveness that was intended to establish. Besides showing the evolution of the collection, this project presents results that will be decisive in action and budget execution plans for the current tax administration in general and for property tax in particular.

Updates on the web-based VIOLIN vaccine database and analysis system.

Science.gov (United States)

He, Yongqun; Racz, Rebecca; Sayers, Samantha; Lin, Yu; Todd, Thomas; Hur, Junguk; Li, Xinna; Patel, Mukti; Zhao, Boyang; Chung, Monica; Ostrow, Joseph; Sylora, Andrew; Dungarani, Priya; Ulysse, Guerlain; Kochhar, Kanika; Vidri, Boris; Strait, Kelsey; Jourdian, George W; Xiang, Zuoshuang

2014-01-01

The integrative Vaccine Investigation and Online Information Network (VIOLIN) vaccine research database and analysis system (http://www.violinet.org) curates, stores, analyses and integrates various vaccine-associated research data. Since its first publication in NAR in 2008, significant updates have been made. Starting from 211 vaccines annotated at the end of 2007, VIOLIN now includes over 3240 vaccines for 192 infectious diseases and eight noninfectious diseases (e.g. cancers and allergies). Under the umbrella of VIOLIN, >10 relatively independent programs are developed. For example, Protegen stores over 800 protective antigens experimentally proven valid for vaccine development. VirmugenDB annotated over 200 'virmugens', a term coined by us to represent those virulence factor genes that can be mutated to generate successful live attenuated vaccines. Specific patterns were identified from the genes collected in Protegen and VirmugenDB. VIOLIN also includes Vaxign, the first web-based vaccine candidate prediction program based on reverse vaccinology. VIOLIN collects and analyzes different vaccine components including vaccine adjuvants (Vaxjo) and DNA vaccine plasmids (DNAVaxDB). VIOLIN includes licensed human vaccines (Huvax) and veterinary vaccines (Vevax). The Vaccine Ontology is applied to standardize and integrate various data in VIOLIN. VIOLIN also hosts the Ontology of Vaccine Adverse Events (OVAE) that logically represents adverse events associated with licensed human vaccines.

Fast Updating National Geo-Spatial Databases with High Resolution Imagery: China's Methodology and Experience

Science.gov (United States)

Chen, J.; Wang, D.; Zhao, R. L.; Zhang, H.; Liao, A.; Jiu, J.

2014-04-01

Geospatial databases are irreplaceable national treasure of immense importance. Their up-to-dateness referring to its consistency with respect to the real world plays a critical role in its value and applications. The continuous updating of map databases at 1:50,000 scales is a massive and difficult task for larger countries of the size of more than several million's kilometer squares. This paper presents the research and technological development to support the national map updating at 1:50,000 scales in China, including the development of updating models and methods, production tools and systems for large-scale and rapid updating, as well as the design and implementation of the continuous updating workflow. The use of many data sources and the integration of these data to form a high accuracy, quality checked product were required. It had in turn required up to date techniques of image matching, semantic integration, generalization, data base management and conflict resolution. Design and develop specific software tools and packages to support the large-scale updating production with high resolution imagery and large-scale data generalization, such as map generalization, GIS-supported change interpretation from imagery, DEM interpolation, image matching-based orthophoto generation, data control at different levels. A national 1:50,000 databases updating strategy and its production workflow were designed, including a full coverage updating pattern characterized by all element topographic data modeling, change detection in all related areas, and whole process data quality controlling, a series of technical production specifications, and a network of updating production units in different geographic places in the country.

Updated embrittlement trend curve for reactor pressure vessel steels

International Nuclear Information System (INIS)

Kirk, M.; Santos, C.; Eason, E.; Wright, J.; Odette, G.R.

2003-01-01

The reactor pressure vessels of commercial nuclear power plants are subject to embrittlement due to exposure to high energy neutrons from the core. Irradiation embrittlement of RPV belt-line materials is currently evaluated using US Regulatory Guide 1.99 Revision 2 (RG 1.99 Rev 2), which presents methods for estimating the Charpy transition temperature shift (ΔT30) at 30 ft-lb (41 J) and the drop in Charpy upper shelf energy (ΔUSE). A more recent embrittlement model, based on a broader database and more recent research results, is presented in NUREG/CR-6551. The objective of this paper is to describe the most recent update to the embrittlement model in NUREG/CR-6551, based upon additional data and increased understanding of embrittlement mechanisms. The updated ΔT30 and USE models include fluence, copper, nickel, phosphorous content, and product form; the ΔT30 model also includes coolant temperature, irradiation time (or flux), and a long-time term. The models were developed using multi-variable surface fitting techniques, understanding of the ΔT30 mechanisms, and engineering judgment. The updated ΔT30 model reduces scatter significantly relative to RG 1.99 Rev 2 on the currently available database for plates, forgings, and welds. This updated embrittlement trend curve will form the basis of revision 3 to Regulatory Guide 1.99. (author)

Update in women's health.

Science.gov (United States)

Ganschow, Pamela S; Jacobs, Elizabeth A; Mackinnon, Jennifer; Charney, Pamela

2009-06-01

The aim of this clinical update is to summarize articles and guidelines published in the last year with the potential to change current clinical practice as it relates to women's health. We used two independent search strategies to identify articles relevant to women's health published between March 1, 2007 and February 29, 2008. First, we reviewed the Cochrane Database of Systematic Reviews and journal indices from the ACP Journal Club, Annals of Internal Medicine, Archives of Internal Medicine, British Medical Journal, Circulation, Diabetes, JAMA, JGIM, Journal of Women's Health, Lancet, NEJM, Obstetrics and Gynecology, and Women's Health Journal Watch. Second, we performed a MEDLINE search using the medical subject heading term "sex factors." The authors, who all have clinical and/or research experience in the area of women's health, reviewed all article titles, abstracts, and, when indicated, full publications. We excluded articles related to obstetrical aspects of women's health focusing on those relevant to general internists. We had two acceptance criteria, scientific rigor and potential to impact women's health. We also identified new and/or updated women's health guidelines released during the same time period. We identified over 250 publications with potential relevance to women's health. Forty-six articles were selected for presentation as part of the Clinical Update, and nine were selected for a more detailed discussion in this paper. Evidence-based women's health guidelines are listed in Table 1. Table 1 Important Women's Health Guidelines in 2007-2008: New or Updated Topic Issuing organization Updated recommendations and comments Mammography screening in women 40-4917 ACP Individualized risk assessment and informed decision making should be used to guide decisions about mammography screening in this age group. To aid in the risk assessment, a discussion of the risk factors, which if present in a woman in her 40s increases her risk to above that of an

Venous thromboembolism prophylaxis in plastic surgery

DEFF Research Database (Denmark)

Nielsen, Lea Juul; Matzen, Steen H

2017-01-01

BACKGROUND: Venous thromboembolism is a well-documented complication of surgery, including plastic surgery. However, few consensus guidelines on thromboembolism prophylaxis exist in plastic surgery and, thus, the different approaches in the public as well as the private clinics in Denmark were...... investigated using a web-based survey. METHODS: Forty-two clinics were contacted and 45% responded. RESULTS: The collected data reveals a lack of consensus in plastic surgery in Denmark, not only regarding the use of mechanical and chemical prophylaxis, but also which type of prophylaxis to apply, the duration...... of prophylaxis, and how to risk stratify the patients. CONCLUSION: The development of a guideline, based on plastic surgical data, using a validated risk assessment model, which combines the surgical risk with the patient related risk and recommends guidelines for mechanical as well as chemoprophylaxis...

Prediction-error variance in Bayesian model updating: a comparative study

Science.gov (United States)

Asadollahi, Parisa; Li, Jian; Huang, Yong

2017-04-01

In Bayesian model updating, the likelihood function is commonly formulated by stochastic embedding in which the maximum information entropy probability model of prediction error variances plays an important role and it is Gaussian distribution subject to the first two moments as constraints. The selection of prediction error variances can be formulated as a model class selection problem, which automatically involves a trade-off between the average data-fit of the model class and the information it extracts from the data. Therefore, it is critical for the robustness in the updating of the structural model especially in the presence of modeling errors. To date, three ways of considering prediction error variances have been seem in the literature: 1) setting constant values empirically, 2) estimating them based on the goodness-of-fit of the measured data, and 3) updating them as uncertain parameters by applying Bayes' Theorem at the model class level. In this paper, the effect of different strategies to deal with the prediction error variances on the model updating performance is investigated explicitly. A six-story shear building model with six uncertain stiffness parameters is employed as an illustrative example. Transitional Markov Chain Monte Carlo is used to draw samples of the posterior probability density function of the structure model parameters as well as the uncertain prediction variances. The different levels of modeling uncertainty and complexity are modeled through three FE models, including a true model, a model with more complexity, and a model with modeling error. Bayesian updating is performed for the three FE models considering the three aforementioned treatments of the prediction error variances. The effect of number of measurements on the model updating performance is also examined in the study. The results are compared based on model class assessment and indicate that updating the prediction error variances as uncertain parameters at the model

Model-based formalization of medical knowledge for context-aware assistance in laparoscopic surgery

Science.gov (United States)

Katić, Darko; Wekerle, Anna-Laura; Gärtner, Fabian; Kenngott, Hannes G.; Müller-Stich, Beat P.; Dillmann, Rüdiger; Speidel, Stefanie

2014-03-01

The increase of technological complexity in surgery has created a need for novel man-machine interaction techniques. Specifically, context-aware systems which automatically adapt themselves to the current circumstances in the OR have great potential in this regard. To create such systems, models of surgical procedures are vital, as they allow analyzing the current situation and assessing the context. For this purpose, we have developed a Surgical Process Model based on Description Logics. It incorporates general medical background knowledge as well as intraoperatively observed situational knowledge. The representation consists of three parts: the Background Knowledge Model, the Preoperative Process Model and the Integrated Intraoperative Process Model. All models depend on each other and create a concise view on the surgery. As a proof of concept, we applied the system to a specific intervention, the laparoscopic distal pancreatectomy.

Development and application of stent-based image guided navigation system for oral and maxillofacial surgery

International Nuclear Information System (INIS)

Lee, Woo Jin; Kim, Dae Seung; Yi, Won Jin; Lee, Sam Sun; Choi, Soon Chul; Heo, Min Suk; Huh, Kyung Hoe; Kim, Myung Jin; Lee, Jee Ho

2009-01-01

The purpose of this study was to develop a stent-based image guided surgery system and to apply it to oral and maxillofacial surgeries for anatomically complex sites. We devised a patient-specific stent for patient-to-image registration and navigation. Three dimensional positions of the reference probe and the tool probe were tracked by an optical camera system and the relative position of the handpiece drill tip to the reference probe was monitored continuously on the monitor of a PC. Using 8 landmarks for measuring accuracy, the spatial discrepancy between CT image coordinate and physical coordinate was calculated for testing the normality. The accuracy over 8 anatomical landmarks showed an overall mean of 0.56 ± 0.16 mm. The developed system was applied to a surgery for a vertical alveolar bone augmentation in right mandibular posterior area and possible interior alveolar nerve injury case of an impacted third molar. The developed system provided continuous monitoring of invisible anatomical structures during operation and 3D information for operation sites. The clinical challenge showed sufficient accuracy and availability of anatomically complex operation sites. The developed system showed sufficient accuracy and availability in oral and maxillofacial surgeries for anatomically complex sites.

Prediction and Prevention of Acute Kidney Injury after Cardiac Surgery

Directory of Open Access Journals (Sweden)

Su Rin Shin

2016-01-01

Full Text Available The incidence of acute kidney injury after cardiac surgery (CS-AKI ranges from 33% to 94% and is associated with a high incidence of morbidity and mortality. The etiology is suggested to be multifactorial and related to almost all aspects of perioperative management. Numerous studies have reported the risk factors and risk scores and novel biomarkers of AKI have been investigated to facilitate the subclinical diagnosis of AKI. Based on the known independent risk factors, many preventive interventions to reduce the risk of CS-AKI have been tested. However, any single preventive intervention did not show a definite and persistent benefit to reduce the incidence of CS-AKI. Goal-directed therapy has been considered to be a preventive strategy with a substantial level of efficacy. Many pharmacologic agents were tested for any benefit to treat or prevent CS-AKI but the results were conflicting and evidences are still lacking. The present review will summarize the current updated evidences about the risk factors and preventive strategies for CS-AKI.

Fusion strategies for selecting multiple tuning parameters for multivariate calibration and other penalty based processes: A model updating application for pharmaceutical analysis

Energy Technology Data Exchange (ETDEWEB)

Tencate, Alister J. [Department of Chemistry, Idaho State University, Pocatello, ID 83209 (United States); Kalivas, John H., E-mail: kalijohn@isu.edu [Department of Chemistry, Idaho State University, Pocatello, ID 83209 (United States); White, Alexander J. [Department of Physics and Optical Engineering, Rose-Hulman Institute of Technology, Terre Huate, IN 47803 (United States)

2016-05-19

New multivariate calibration methods and other processes are being developed that require selection of multiple tuning parameter (penalty) values to form the final model. With one or more tuning parameters, using only one measure of model quality to select final tuning parameter values is not sufficient. Optimization of several model quality measures is challenging. Thus, three fusion ranking methods are investigated for simultaneous assessment of multiple measures of model quality for selecting tuning parameter values. One is a supervised learning fusion rule named sum of ranking differences (SRD). The other two are non-supervised learning processes based on the sum and median operations. The effect of the number of models evaluated on the three fusion rules are also evaluated using three procedures. One procedure uses all models from all possible combinations of the tuning parameters. To reduce the number of models evaluated, an iterative process (only applicable to SRD) is applied and thresholding a model quality measure before applying the fusion rules is also used. A near infrared pharmaceutical data set requiring model updating is used to evaluate the three fusion rules. In this case, calibration of the primary conditions is for the active pharmaceutical ingredient (API) of tablets produced in a laboratory. The secondary conditions for calibration updating is for tablets produced in the full batch setting. Two model updating processes requiring selection of two unique tuning parameter values are studied. One is based on Tikhonov regularization (TR) and the other is a variation of partial least squares (PLS). The three fusion methods are shown to provide equivalent and acceptable results allowing automatic selection of the tuning parameter values. Best tuning parameter values are selected when model quality measures used with the fusion rules are for the small secondary sample set used to form the updated models. In this model updating situation, evaluation of

Fusion strategies for selecting multiple tuning parameters for multivariate calibration and other penalty based processes: A model updating application for pharmaceutical analysis

International Nuclear Information System (INIS)

Tencate, Alister J.; Kalivas, John H.; White, Alexander J.

2016-01-01

New multivariate calibration methods and other processes are being developed that require selection of multiple tuning parameter (penalty) values to form the final model. With one or more tuning parameters, using only one measure of model quality to select final tuning parameter values is not sufficient. Optimization of several model quality measures is challenging. Thus, three fusion ranking methods are investigated for simultaneous assessment of multiple measures of model quality for selecting tuning parameter values. One is a supervised learning fusion rule named sum of ranking differences (SRD). The other two are non-supervised learning processes based on the sum and median operations. The effect of the number of models evaluated on the three fusion rules are also evaluated using three procedures. One procedure uses all models from all possible combinations of the tuning parameters. To reduce the number of models evaluated, an iterative process (only applicable to SRD) is applied and thresholding a model quality measure before applying the fusion rules is also used. A near infrared pharmaceutical data set requiring model updating is used to evaluate the three fusion rules. In this case, calibration of the primary conditions is for the active pharmaceutical ingredient (API) of tablets produced in a laboratory. The secondary conditions for calibration updating is for tablets produced in the full batch setting. Two model updating processes requiring selection of two unique tuning parameter values are studied. One is based on Tikhonov regularization (TR) and the other is a variation of partial least squares (PLS). The three fusion methods are shown to provide equivalent and acceptable results allowing automatic selection of the tuning parameter values. Best tuning parameter values are selected when model quality measures used with the fusion rules are for the small secondary sample set used to form the updated models. In this model updating situation, evaluation of

Sustained effects of a psychoeducational group intervention following bariatric surgery: follow-up of the randomized controlled BaSE study.

Science.gov (United States)

Wild, Beate; Hünnemeyer, Katharina; Sauer, Helene; Schellberg, Dieter; Müller-Stich, Beat Peter; Königsrainer, Alfred; Weiner, Rudolf; Zipfel, Stephan; Herzog, Wolfgang; Teufel, Martin

2017-09-01

Evidence regarding the efficacy of psychosocial interventions after bariatric surgery is rare and shows conflicting results. The Bariatric Surgery and Education (BaSE) study aimed to assess the efficacy of a psychoeducational group intervention in patients after bariatric surgery. The BaSE study was a randomized, controlled, multicenter clinical trial involving 117 patients who underwent bariatric surgery. Patients received either conventional postsurgical visits or, in addition, a 1-year psychoeducational group program. The present study evaluated the sustained effects of the intervention program. Mean follow-up duration was 37.9 months (standard deviation [SD] 8.2 months) after surgery. Outcome measures were as follows: body mass index (BMI), weight loss, self-efficacy, depression severity, and health-related quality of life (HRQOL). Groups were compared using an intention-to-treat approach with a mixed model for repeated measurements. A total of 74 patients (63.2%) completed the follow-up (T5) assessment. Mean weight loss for all patients was 43 kg (SD 15.5 kg) at T5 (mean BMI 35.1 kg/m 2 ). Mean excess weight loss was 60.4%. The effects of the surgery during the first postsurgical year were reflected, on average, by both decreasing weight and psychosocial burden. At the T5 time point, patients had slowly started to regain weight and to deteriorate regarding psychosocial aspects. However, at T5, patients who had participated in the intervention program (n = 39) showed significantly lower depression severity scores (p = .03) and significantly higher self-efficacy (p = .03) compared to the control group (n = 35). The 2 groups did not differ regarding weight loss and quality of life. Psychoeducational intervention shows sustained effects on both depression severity scores and self-efficacy. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

A Population-based Study Evaluating the Association between Surgery in Early Life and Child Development at Primary School Entry.

Science.gov (United States)

O'Leary, James D; Janus, Magdalena; Duku, Eric; Wijeysundera, Duminda N; To, Teresa; Li, Ping; Maynes, Jason T; Crawford, Mark W

2016-08-01

It is unclear whether exposure to surgery in early life has long-term adverse effects on child development. The authors aimed to investigate whether surgery in early childhood is associated with adverse effects on child development measured at primary school entry. The authors conducted a population-based cohort study in Ontario, Canada, by linking provincial health administrative databases to children's developmental outcomes measured by the Early Development Instrument (EDI). From a cohort of 188,557 children, 28,366 children who underwent surgery before EDI completion (age 5 to 6 yr) were matched to 55,910 unexposed children. The primary outcome was early developmental vulnerability, defined as any domain of the EDI in the lowest tenth percentile of the population. Subgroup analyses were performed based on age at first surgery (less than 2 and greater than or equal to 2 yr) and frequency of surgery. Early developmental vulnerability was increased in the exposed group (7,259/28,366; 25.6%) compared with the unexposed group (13,957/55,910; 25.0%), adjusted odds ratio, 1.05; 95% CI, 1.01 to 1.08. Children aged greater than or equal to 2 yr at the time of first surgery had increased odds of early developmental vulnerability compared with unexposed children (odds ratio, 1.05; 95% CI, 1.01 to 1.10), but children aged less than 2 yr at the time of first exposure were not at increased risk (odds ratio, 1.04; 95% CI, 0.98 to 1.10). There was no increase in odds of early developmental vulnerability with increasing frequency of exposure. Children who undergo surgery before primary school age are at increased risk of early developmental vulnerability, but the magnitude of the difference between exposed and unexposed children is small.

A Logic of Blockchain Updates

OpenAIRE

Brünnler, Kai; Flumini, Dandolo; Studer, Thomas

2017-01-01

Blockchains are distributed data structures that are used to achieve consensus in systems for cryptocurrencies (like Bitcoin) or smart contracts (like Ethereum). Although blockchains gained a lot of popularity recently, there is no logic-based model for blockchains available. We introduce BCL, a dynamic logic to reason about blockchain updates, and show that BCL is sound and complete with respect to a simple blockchain model.

Aesthetic Surgery Reality Television Shows: Do they Influence Public Perception of the Scope of Plastic Surgery?

Science.gov (United States)

Denadai, Rafael; Araujo, Karin Milleni; Samartine Junior, Hugo; Denadai, Rodrigo; Raposo-Amaral, Cassio Eduardo

2015-12-01

The purpose of this survey was to assess the influence of aesthetic surgery "reality television" shows viewing on the public's perception of the scope of plastic surgery practice. Perceptions of the scope of plastic surgery (33 scenarios), aesthetic surgery "reality television" viewing patterns ("high," "moderate," or "low" familiarity, similarity, confidence, and influence viewers), sociodemographic data, and previous plastic surgery interaction were collected from 2148 members of the public. Response patterns were created and bivariate and multivariate analyses were applied to assess the possible determinants of overall public choice of plastic surgeons as experts in the plastic surgery-related scenarios. Both "plastic surgeons" and "plastic surgeons alone" were the main response patterns (all p television" viewing negatively influences the public perception of the broad scope of plastic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Ontology Update in the Cognitive Model of Ontology Learning

Directory of Open Access Journals (Sweden)

Zhang De-Hai

2016-01-01

Full Text Available Ontology has been used in many hot-spot fields, but most ontology construction methods are semiautomatic, and the construction process of ontology is still a tedious and painstaking task. In this paper, a kind of cognitive models is presented for ontology learning which can simulate human being’s learning from world. In this model, the cognitive strategies are applied with the constrained axioms. Ontology update is a key step when the new knowledge adds into the existing ontology and conflict with old knowledge in the process of ontology learning. This proposal designs and validates the method of ontology update based on the axiomatic cognitive model, which include the ontology update postulates, axioms and operations of the learning model. It is proved that these operators subject to the established axiom system.

Cognitive-Behavioral-Based Physical Therapy for Patients With Chronic Pain Undergoing Lumbar Spine Surgery: A Randomized Controlled Trial.

Science.gov (United States)

Archer, Kristin R; Devin, Clinton J; Vanston, Susan W; Koyama, Tatsuki; Phillips, Sharon E; George, Steven Z; McGirt, Matthew J; Spengler, Dan M; Aaronson, Oran S; Cheng, Joseph S; Wegener, Stephen T

2016-01-01

The purpose of this study was to determine the efficacy of a cognitive-behavioral-based physical therapy (CBPT) program for improving outcomes in patients after lumbar spine surgery. A randomized controlled trial was conducted on 86 adults undergoing a laminectomy with or without arthrodesis for a lumbar degenerative condition. Patients were screened preoperatively for high fear of movement using the Tampa Scale for Kinesiophobia. Randomization to either CBPT or an education program occurred at 6 weeks after surgery. Assessments were completed pretreatment, posttreatment and at 3-month follow-up. The primary outcomes were pain and disability measured by the Brief Pain Inventory and Oswestry Disability Index. Secondary outcomes included general health (SF-12) and performance-based tests (5-Chair Stand, Timed Up and Go, 10-Meter Walk). Multivariable linear regression analyses found that CBPT participants had significantly greater decreases in pain and disability and increases in general health and physical performance compared with the education group at the 3-month follow-up. Results suggest a targeted CBPT program may result in significant and clinically meaningful improvement in postoperative outcomes. CBPT has the potential to be an evidence-based program that clinicians can recommend for patients at risk for poor recovery after spine surgery. This study investigated a targeted cognitive-behavioral-based physical therapy program for patients after lumbar spine surgery. Findings lend support to the hypothesis that incorporating cognitive-behavioral strategies into postoperative physical therapy may address psychosocial risk factors and improve pain, disability, general health, and physical performance outcomes. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

A visual tracking method based on deep learning without online model updating

Science.gov (United States)

Tang, Cong; Wang, Yicheng; Feng, Yunsong; Zheng, Chao; Jin, Wei

2018-02-01

The paper proposes a visual tracking method based on deep learning without online model updating. In consideration of the advantages of deep learning in feature representation, deep model SSD (Single Shot Multibox Detector) is used as the object extractor in the tracking model. Simultaneously, the color histogram feature and HOG (Histogram of Oriented Gradient) feature are combined to select the tracking object. In the process of tracking, multi-scale object searching map is built to improve the detection performance of deep detection model and the tracking efficiency. In the experiment of eight respective tracking video sequences in the baseline dataset, compared with six state-of-the-art methods, the method in the paper has better robustness in the tracking challenging factors, such as deformation, scale variation, rotation variation, illumination variation, and background clutters, moreover, its general performance is better than other six tracking methods.

Quantifying Update Effects in Citizen-Oriented Software

Directory of Open Access Journals (Sweden)

Ion Ivan

2009-02-01

Full Text Available Defining citizen-oriented software. Detailing technical issues regarding update process in this kind of software. Presenting different effects triggered by types of update. Building model for update costs estimation, including producer-side and consumer-side effects. Analyzing model applicability on INVMAT – large scale matrix inversion software. Proposing a model for update effects estimation. Specifying ways for softening effects of inaccurate updates.

Updating Stiffness and Hysteretic Damping Matrices Using Measured Modal Data

OpenAIRE

Jiashang Jiang; Yongxin Yuan

2018-01-01

A new direct method for the finite element (FE) matrix updating problem in a hysteretic (or material) damping model based on measured incomplete vibration modal data is presented. With this method, the optimally approximated stiffness and hysteretic damping matrices can be easily constructed. The physical connectivity of the original model is preserved and the measured modal data are embedded in the updated model. The numerical results show that the proposed method works well.

Can evidence change the rate of back surgery? A randomized trial of community-based education.

Science.gov (United States)

Goldberg, H I; Deyo, R A; Taylor, V M; Cheadle, A D; Conrad, D A; Loeser, J D; Heagerty, P J; Diehr, P

2001-01-01

Timely adoption of clinical practice guidelines is more likely to happen when the guidelines are used in combination with adjuvant educational strategies that address social as well as rational influences. To implement the conservative, evidence-based approach to low-back pain recommended in national guidelines, with the anticipated effect of reducing population-based rates of surgery. A randomized, controlled trial. Ten communities in western Washington State with annual rates of back surgery above the 1990 national average (158 operations per 100,000 adults). Spine surgeons, primary care physicians, patients who were surgical candidates, and hospital administrators. The five communities randomized to the intervention group received a package of six educational activities tailored to local needs by community planning groups. Surgeon study groups, primary care continuing medical education conferences, administrative consensus processes, videodisc-aided patient decision making, surgical outcomes management, and generalist academic detailing were serially implemented over a 30-month intervention period. Quarterly observations of surgical rates. After implementation of the intervention, surgery rates declined in the intervention communities but increased slightly in the control communities. The net effect of the intervention is estimated to be a decline of 20.9 operations per 100,000, a relative reduction of 8.9% (P = 0.01). We were able to use scientific evidence to engender voluntary change in back pain practice patterns across entire communities.

Bases of updating of nuclear safety regulations for NPP in Romania

International Nuclear Information System (INIS)

Biro, Lucian; Serbanescu, Dan

1999-01-01

The paper presents the basic principles of reviewing and updating process of the regulatory environment pyramid. The main part of this review process refers to Cernavoda NPP Unit 2. However, there is an important impact on Cernavoda NPP Unit 1. The basic principles were defined in 1993/1994 when the licensing process for Unit 1 was resumed in order to be in accordance with the latest developments of Candu 600 worldwide and with the IAEA and NEA latest recommended documents and practices. After the licensing process for the Unit 1 was completed up to operation stage, CNCAN developed new updated regulations on nuclear safety and the regulatory pyramid in the framework of the RAMG PHARE project. CNCAN issued in 1996 the regulatory Policy for Unit 2, self-sustained and independent of future possible revisions of the regulations. The use of the concept of hierarchical systems, systematic review of safety criteria and objectives and margins along with the feedback from international and national experience on this topic ensured issuance of a reference document for future approach of nuclear safety in Romania. (authors)

Spotlighting the role of photodynamic therapy in cutaneous malignancy: an update and expansion.

Science.gov (United States)

Ross, Kate; Cherpelis, Basil; Lien, Mary; Fenske, Neil

2013-12-01

Topical photodynamic therapy (PDT) is an option for the treatment of cutaneous malignancy. To present an update and expansion on a previous review of the use of PDT in the current literature in the treatment of actinic keratoses (AK), superficial and nodular basal cell carcinoma (sBCC, nBCC), squamous cell carcinoma (SCC), Bowen's disease, cutaneous T cell lymphoma (CTCL), malignant melanoma, and its use in chemoprevention. Extensive PubMed search January 2013. We find sufficient evidence to recommend the use of PDT in certain patients in the treatment of AK, Bowen's disease, sBCC, and nBCC. It is especially useful in those with contraindications to surgery, widespread areas of involvement, and large lesions. Not only can it be considered superior to other therapies as far as recovery time, tolerance, and cosmetic outcomes, but it also should be considered, when indicated, as first-line treatment in the above conditions. Investigations continue for the use of PDT in the treatment of melanoma, SCC, chemoprevention, and CTCL. © 2013 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

Are Forecast Updates Progressive?

NARCIS (Netherlands)

C-L. Chang (Chia-Lin); Ph.H.B.F. Franses (Philip Hans); M.J. McAleer (Michael)

2010-01-01

textabstractMacro-economic forecasts typically involve both a model component, which is replicable, as well as intuition, which is non-replicable. Intuition is expert knowledge possessed by a forecaster. If forecast updates are progressive, forecast updates should become more accurate, on average,

Are general surgery residents adequately prepared for hepatopancreatobiliary fellowships? A questionnaire-based study

Science.gov (United States)

Osman, Houssam; Parikh, Janak; Patel, Shirali; Jeyarajah, D Rohan

2015-01-01

Background The present study was conducted to assess the preparedness of hepatopancreatobiliary (HPB) fellows upon entering fellowship, identify challenges encountered by HPB fellows during the initial part of their HPB training, and identify potential solutions to these challenges that can be applied during residency training. Methods A questionnaire was distributed to all HPB fellows in accredited HPB fellowship programmes in two consecutive academic years (n = 42). Reponses were then analysed. Results A total of 19 (45%) fellows responded. Prior to their fellowship, 10 (53%) were in surgical residency and the rest were in other surgical fellowships or surgical practice. Thirteen (68%) were graduates of university-based residency programmes. All fellows felt comfortable in performing basic laparoscopic procedures independently at the completion of residency and less comfortable in performing advanced laparoscopy. Eight (42%) fellows cited a combination of inadequate case volume and lack of autonomy during residency as the reasons for this lack of comfort. Thirteen (68%) identified inadequate preoperative workup and management as their biggest fear upon entering practice after general surgery training. A total of 17 (89%) fellows felt they were adequately prepared to enter HPB fellowship. Extra rotations in transplant, vascular or minimally invasive surgery were believed to be most helpful in preparing general surgery residents pursing HPB fellowships. Conclusions Overall, HPB fellows felt themselves to be adequately prepared for fellowship. Advanced laparoscopic procedures and the perioperative management of complex patients are two of the challenges facing HPB fellows. General surgery residents who plan to pursue an HPB fellowship may benefit from spending extra rotations on certain subspecialties. Focus on perioperative workup and management should be an integral part of residency and fellowship training. PMID:25387852

Finite-element-model updating using computational intelligence techniques applications to structural dynamics

CERN Document Server

Marwala, Tshilidzi

2010-01-01

Finite element models (FEMs) are widely used to understand the dynamic behaviour of various systems. FEM updating allows FEMs to be tuned better to reflect measured data and may be conducted using two different statistical frameworks: the maximum likelihood approach and Bayesian approaches. Finite Element Model Updating Using Computational Intelligence Techniques applies both strategies to the field of structural mechanics, an area vital for aerospace, civil and mechanical engineering. Vibration data is used for the updating process. Following an introduction a number of computational intelligence techniques to facilitate the updating process are proposed; they include: • multi-layer perceptron neural networks for real-time FEM updating; • particle swarm and genetic-algorithm-based optimization methods to accommodate the demands of global versus local optimization models; • simulated annealing to put the methodologies into a sound statistical basis; and • response surface methods and expectation m...

Crucial role of strategy updating for coexistence of strategies in interaction networks

Science.gov (United States)

Zhang, Jianlei; Zhang, Chunyan; Cao, Ming; Weissing, Franz J.

2015-04-01

Network models are useful tools for studying the dynamics of social interactions in a structured population. After a round of interactions with the players in their local neighborhood, players update their strategy based on the comparison of their own payoff with the payoff of one of their neighbors. Here we show that the assumptions made on strategy updating are of crucial importance for the strategy dynamics. In the first step, we demonstrate that seemingly small deviations from the standard assumptions on updating have major implications for the evolutionary outcome of two cooperation games: cooperation can more easily persist in a Prisoner's Dilemma game, while it can go more easily extinct in a Snowdrift game. To explain these outcomes, we develop a general model for the updating of states in a network that allows us to derive conditions for the steady-state coexistence of states (or strategies). The analysis reveals that coexistence crucially depends on the number of agents consulted for updating. We conclude that updating rules are as important for evolution on a network as network structure and the nature of the interaction.

Impact of Virtual and Augmented Reality Based on Intraoperative Magnetic Resonance Imaging and Functional Neuronavigation in Glioma Surgery Involving Eloquent Areas.

Science.gov (United States)

Sun, Guo-Chen; Wang, Fei; Chen, Xiao-Lei; Yu, Xin-Guang; Ma, Xiao-Dong; Zhou, Ding-Biao; Zhu, Ru-Yuan; Xu, Bai-Nan

2016-12-01

The utility of virtual and augmented reality based on functional neuronavigation and intraoperative magnetic resonance imaging (MRI) for glioma surgery has not been previously investigated. The study population consisted of 79 glioma patients and 55 control subjects. Preoperatively, the lesion and related eloquent structures were visualized by diffusion tensor tractography and blood oxygen level-dependent functional MRI. Intraoperatively, microscope-based functional neuronavigation was used to integrate the reconstructed eloquent structure and the real head and brain, which enabled safe resection of the lesion. Intraoperative MRI was used to verify brain shift during the surgical process and provided quality control during surgery. The control group underwent surgery guided by anatomic neuronavigation. Virtual and augmented reality protocols based on functional neuronavigation and intraoperative MRI provided useful information for performing tailored and optimized surgery. Complete resection was achieved in 55 of 79 (69.6%) glioma patients and 20 of 55 (36.4%) control subjects, with average resection rates of 95.2% ± 8.5% and 84.9% ± 15.7%, respectively. Both the complete resection rate and average extent of resection differed significantly between the 2 groups (P virtual and augmented reality based on functional neuronavigation and intraoperative MRI can facilitate resection of gliomas involving eloquent areas. Copyright © 2016 Elsevier Inc. All rights reserved.

Predicting Surgery Targets in Temporal Lobe Epilepsy through Structural Connectome Based Simulations.

Directory of Open Access Journals (Sweden)

Frances Hutchings

2015-12-01

Full Text Available Temporal lobe epilepsy (TLE is a prevalent neurological disorder resulting in disruptive seizures. In the case of drug resistant epilepsy resective surgery is often considered. This is a procedure hampered by unpredictable success rates, with many patients continuing to have seizures even after surgery. In this study we apply a computational model of epilepsy to patient specific structural connectivity derived from diffusion tensor imaging (DTI of 22 individuals with left TLE and 39 healthy controls. We validate the model by examining patient-control differences in simulated seizure onset time and network location. We then investigate the potential of the model for surgery prediction by performing in silico surgical resections, removing nodes from patient networks and comparing seizure likelihood post-surgery to pre-surgery simulations. We find that, first, patients tend to transit from non-epileptic to epileptic states more often than controls in the model. Second, regions in the left hemisphere (particularly within temporal and subcortical regions that are known to be involved in TLE are the most frequent starting points for seizures in patients in the model. In addition, our analysis also implicates regions in the contralateral and frontal locations which may play a role in seizure spreading or surgery resistance. Finally, the model predicts that patient-specific surgery (resection areas chosen on an individual, model-prompted, basis and not following a predefined procedure may lead to better outcomes than the currently used routine clinical procedure. Taken together this work provides a first step towards patient specific computational modelling of epilepsy surgery in order to inform treatment strategies in individuals.

Postoperative nausea and vomiting following orthognathic surgery

Science.gov (United States)

Phillips, C.; Brookes, C. D.; Rich, J.; Arbon, J.; Turvey, T. A.

2015-01-01

The purpose of this study was to assess the incidence and risk factors associated with postoperative nausea (PON) and vomiting (POV) after orthognathic surgery. A review of the clinical records of consecutively enrolled subjects (2008–2012) at a single academic institution was conducted between 9/2013 and 3/2014. Data on the occurrence of PON and POV and potential patient-related, intraoperative, and postoperative explanatory factors were extracted from the medical records. Logistic models were used for the presence/absence of postoperative nausea and vomiting separately. Data from 204 subjects were analyzed: 63% were female, 72% Caucasian, and the median age was 19 years. Thirty-three percent had a mandibular osteotomy alone, 27% a maxillary osteotomy alone, and 40% had bimaxillary osteotomies. Sixty-seven percent experienced PON and 27% experienced POV. The most important risk factors for PON in this series were female gender, increased intravenous fluids, and the use of nitrous oxide, and for POV were race, additional procedures, and morphine administration. The incidence of PON and POV following orthognathic surgery in the current cohort of patients, after the introduction of the updated 2007 consensus guidelines for the management of postoperative nausea and vomiting, has not decreased substantially from that reported in 2003–2004. PMID:25655765

40 years of advances in Bariatric Surgery

Directory of Open Access Journals (Sweden)

Aniceto Baltasar

2017-09-01

Full Text Available Introduction: Bariatric surgical practice changes in the community setting may be under-reported. We present the developments in a Spanish bariatric surgical practice in the community setting of Alcoy from 1977 through the present. Methods: Bariatric surgical techniques employed in a country community setting over the course of nearly four decades were reviewed retrospectively and qualitatively. Results: Surgeons and medical professionals from Alcoy, Spain were involved in the evolution of bariatric surgery patient management and surgical technique from 1977s through 2017. During the last 40 years, 1,495 patients were treated in our clinics. Spanish bariatric surgeons contributed to advances in gastric bypass (GBP in the 1970s, vertical banded gastroplasty (VBG in the 1980s, bilio-pancreatic diversion/duodenal switch (BPD/DS in the 1990s, and innovations associated with laparoscopy from the 1990s onward. Outcomes and approaches to prevention and treatment of bariatric surgical complications are reviewed from a community perspective. Contributions to the bariatric surgical nomenclature and weight-loss reporting are noted. Conclusions: The practice of bariatric surgery in the community hospital and private clinic must be updated continuously, as in any human and surgical endeavor. Medical professionals in community bariatric practices should contribute their experiences to the field through all avenues of scientific interaction and publication.

Predictors of Recurrence and Complications After Chronic Subdural Hematoma Surgery: A Population-Based Study.

Science.gov (United States)

Bartek, Jiri; Sjåvik, Kristin; Kristiansson, Helena; Ståhl, Fredrik; Fornebo, Ida; Förander, Petter; Jakola, Asgeir S

2017-10-01

To investigate predictors of recurrence and moderate to severe complications after burr-hole surgery for chronic subdural hematoma (cSDH). A retrospective review was conducted in a Scandinavian single-center population-based cohort of 759 adult patients with cSDH operated with burr-hole surgery between January 1, 2005 and December 31, 2010. Possible predictors of recurrence and complications, assessed using a standardized reporting system of adverse events, were identified and analyzed in univariable analyses. Variables with a P value hematoma (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.25-3.35; P hematoma diameter in millimeters (OR, 1.05; 95% CI, 1.01-1.09; P 1 (OR, 2.28; 95% CI, 1.10-4.75; P = 0.03) were independent predictors of moderate to severe complications. Recurrence after cSDH surgery is more often encountered in patients with radiologically more extensive disease reflected by bilateral hematoma and large hematoma diameter. On the other hand, moderate to severe complications are more often seen in patients in a worse clinical condition, reflected by decreased level of consciousness and more comorbidities. Copyright © 2017 Elsevier Inc. All rights reserved.

One lung ventilation strategies for infants and children undergoing video assisted thoracoscopic surgery

Directory of Open Access Journals (Sweden)

Teddy Suratos Fabila

2013-01-01

Full Text Available The advantages of video assisted thoracoscopic surgery (VATS in children have led to its increased usage over the years. VATS, however, requires an efficient technique for one lung ventilation. Today, there is an increasing interest in developing the technique for lung isolation to meet the anatomic and physiologic variations in infants and children. This article aims to provide an updated and comprehensive review on one-lung ventilation strategies for infants and children undergoing VATS. Search of terms such as ′One lung ventilation for infants and children′, ′Video assisted thoracoscopic surgery for infants and children′, and ′Physiologic changes during one lung ventilation for infants and children′ were used. The search mechanics and engines for this review included the following: Kandang Kerbau Hospital (KKH eLibrary, PubMed, Ovid Medline, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. During the search the author focused on significant current and pilot randomized control trials, case reports, review articles, and editorials. Critical decision making on what device to use based on the age, weight, and pathology of the patient; and how to use it for lung isolation are discussed in this article. Furthermore, additional information regarding the advantages, limitations, techniques of insertion and maintenance of each device for one lung ventilation in infants and children were the highlights in this article.

Assessing distractors and teamwork during surgery: developing an event-based method for direct observation.

Science.gov (United States)

Seelandt, Julia C; Tschan, Franziska; Keller, Sandra; Beldi, Guido; Jenni, Nadja; Kurmann, Anita; Candinas, Daniel; Semmer, Norbert K

2014-11-01

To develop a behavioural observation method to simultaneously assess distractors and communication/teamwork during surgical procedures through direct, on-site observations; to establish the reliability of the method for long (>3 h) procedures. Observational categories for an event-based coding system were developed based on expert interviews, observations and a literature review. Using Cohen's κ and the intraclass correlation coefficient, interobserver agreement was assessed for 29 procedures. Agreement was calculated for the entire surgery, and for the 1st hour. In addition, interobserver agreement was assessed between two tired observers and between a tired and a non-tired observer after 3 h of surgery. The observational system has five codes for distractors (door openings, noise distractors, technical distractors, side conversations and interruptions), eight codes for communication/teamwork (case-relevant communication, teaching, leadership, problem solving, case-irrelevant communication, laughter, tension and communication with external visitors) and five contextual codes (incision, last stitch, personnel changes in the sterile team, location changes around the table and incidents). Based on 5-min intervals, Cohen's κ was good to excellent for distractors (0.74-0.98) and for communication/teamwork (0.70-1). Based on frequency counts, intraclass correlation coefficient was excellent for distractors (0.86-0.99) and good to excellent for communication/teamwork (0.45-0.99). After 3 h of surgery, Cohen's κ was 0.78-0.93 for distractors, and 0.79-1 for communication/teamwork. The observational method developed allows a single observer to simultaneously assess distractors and communication/teamwork. Even for long procedures, high interobserver agreement can be achieved. Data collected with this method allow for investigating separate or combined effects of distractions and communication/teamwork on surgical performance and patient outcomes. Published by the

Fusion Energy Update

International Nuclear Information System (INIS)

Whitson, M.O.

1982-01-01

Fusion Energy Update (CFU) provides monthly abstracting and indexing coverage of current scientific and technical reports, journal articles, conference papers and proceedings, books, patents, theses, and monographs for all sources on fusion energy. All information announced in CFU, plus additional backup information, is included in the energy information data base of the Department of Energy's Technical Information Center. The subject matter covered by CFU includes plasma physics, the physics and engineering of blankets, magnet coils and fields, power supplies and circuitry, cooling systems, fuel systems, radiation hazards, power conversion systems, inertial confinement systems, and component development and testing

WIMS Library updating

International Nuclear Information System (INIS)

Ravnik, M.; Trkov, A.; Holubar, A.

1992-01-01

At the end of 1990 the WIMS Library Update Project (WLUP) has been initiated at the International Atomic Energy Agency. The project was organized as an international research project, coordinated at the J. Stefan Institute. Up to now, 22 laboratories from 19 countries joined the project. Phase 1 of the project, which included WIMS input optimization for five experimental benchmark lattices, has been completed. The work presented in this paper describes also the results of Phase 2 of the Project, in which the cross sections based on ENDF/B-IV evaluated nuclear data library have been processed. (author) [sl

Effective Filtering of Query Results on Updated User Behavioral Profiles in Web Mining

Directory of Open Access Journals (Sweden)

S. Sadesh

2015-01-01

Full Text Available Web with tremendous volume of information retrieves result for user related queries. With the rapid growth of web page recommendation, results retrieved based on data mining techniques did not offer higher performance filtering rate because relationships between user profile and queries were not analyzed in an extensive manner. At the same time, existing user profile based prediction in web data mining is not exhaustive in producing personalized result rate. To improve the query result rate on dynamics of user behavior over time, Hamilton Filtered Regime Switching User Query Probability (HFRS-UQP framework is proposed. HFRS-UQP framework is split into two processes, where filtering and switching are carried out. The data mining based filtering in our research work uses the Hamilton Filtering framework to filter user result based on personalized information on automatic updated profiles through search engine. Maximized result is fetched, that is, filtered out with respect to user behavior profiles. The switching performs accurate filtering updated profiles using regime switching. The updating in profile change (i.e., switches regime in HFRS-UQP framework identifies the second- and higher-order association of query result on the updated profiles. Experiment is conducted on factors such as personalized information search retrieval rate, filtering efficiency, and precision ratio.

Design and implementation of a PC-based image-guided surgical system.

Science.gov (United States)

Stefansic, James D; Bass, W Andrew; Hartmann, Steven L; Beasley, Ryan A; Sinha, Tuhin K; Cash, David M; Herline, Alan J; Galloway, Robert L

2002-11-01

In interactive, image-guided surgery, current physical space position in the operating room is displayed on various sets of medical images used for surgical navigation. We have developed a PC-based surgical guidance system (ORION) which synchronously displays surgical position on up to four image sets and updates them in real time. There are three essential components which must be developed for this system: (1) accurately tracked instruments; (2) accurate registration techniques to map physical space to image space; and (3) methods to display and update the image sets on a computer monitor. For each of these components, we have developed a set of dynamic link libraries in MS Visual C++ 6.0 supporting various hardware tools and software techniques. Surgical instruments are tracked in physical space using an active optical tracking system. Several of the different registration algorithms were developed with a library of robust math kernel functions, and the accuracy of all registration techniques was thoroughly investigated. Our display was developed using the Win32 API for windows management and tomographic visualization, a frame grabber for live video capture, and OpenGL for visualization of surface renderings. We have begun to use this current implementation of our system for several surgical procedures, including open and minimally invasive liver surgery.

The sticky business of adhesion prevention in minimally invasive gynecologic surgery.

Science.gov (United States)

Han, Esther S; Scheib, Stacey A; Patzkowsky, Kristin E; Simpson, Khara; Wang, Karen C

2017-08-01

The negative impact of postoperative adhesions has long been recognized, but available options for prevention remain limited. Minimally invasive surgery is associated with decreased adhesion formation due to meticulous dissection with gentile tissue handling, improved hemostasis, and limiting exposure to reactive foreign material; however, there is conflicting evidence on the clinical significance of adhesion-related disease when compared to open surgery. Laparoscopic surgery does not guarantee the prevention of adhesions because longer operative times and high insufflation pressure can promote adhesion formation. Adhesion barriers have been available since the 1980s, but uptake among surgeons remains low and there is no clear evidence that they reduce clinically significant outcomes such as chronic pain or infertility. In this article, we review the ongoing magnitude of adhesion-related complications in gynecologic surgery, currently available interventions and new research toward more effective adhesion prevention. Recent literature provides updated epidemiologic data and estimates of healthcare costs associated with adhesion-related complications. There have been important advances in our understanding of normal peritoneal healing and the pathophysiology of adhesions. Adhesion barriers continue to be tested for safety and effectiveness and new agents have shown promise in clinical studies. Finally, there are many experimental studies of new materials and pharmacologic and biologic prevention agents. There is great interest in new adhesion prevention technologies, but new agents are unlikely to be available for clinical use for many years. High-quality effectiveness and outcomes-related research is still needed.

Laparoscopic colonic surgery in Denmark 2004-2007

DEFF Research Database (Denmark)

Schulze, S.; Iversen, M.G.; Bendixen, A.

2008-01-01

OBJECTIVE: Laparoscopic colonic surgery was introduced about 15 years ago and has together with the evidence-based 'fast-track' methodology improved early postoperative outcome. The purpose of this study was to asses the organization and early outcome after laparoscopic colonic surgery in Denmark...... of laparoscopic colonic surgery but probably performed in too many low volume departments. Laparoscopic colonic surgery should be monitored and further advances secured by adjustment of perioperative care to fast-track care Udgivelsesdato: 2008/11...

Second Language Writing Online: An Update

Science.gov (United States)

Godwin-Jones, Robert

2018-01-01

This article provides an update to the author's overview of developments in second language (L2) online writing that he wrote in 2008. There has been renewed interest in L2 writing through the wide use of social media, along with the rising popularity of computer-mediated communication (CMC) and telecollaboration (class-based online exchanges).…

Levosimendan in Patients with Left Ventricular Dysfunction Undergoing Cardiac Surgery: An Update Meta-Analysis and Trial Sequential Analysis

Directory of Open Access Journals (Sweden)

Benji Wang

2018-01-01

Full Text Available Background. Recent studies suggest that levosimendan does not provide mortality benefit in patients with low cardiac output syndrome undergoing cardiac surgery. These results conflict with previous findings. The aim of the current study is to assess whether levosimendan reduces postoperative mortality in patients with impaired left ventricular function (mean EF ≤ 40% undergoing cardiac surgery. Methods. We conducted a comprehensive search of PubMed, EMBASE, and Cochrane Library Database through November 20, 2017. Inclusion criteria were random allocation to treatment with at least one group receiving levosimendan and another group receiving placebo or other treatments and cardiac surgery patients with a left ventricular ejection fraction of 40% or less. The primary endpoint was postoperative mortality. Secondary outcomes were cardiac index, pulmonary capillary wedge pressure (PCWP, length of intensive care unit (ICU stay, postoperative atrial fibrillation, and postoperative renal replacement therapy. We performed trial sequential analysis (TSA to evaluate the reliability of the primary endpoint. Results. Data from 2,152 patients in 15 randomized clinical trials were analyzed. Pooled results demonstrated a reduction in postoperative mortality in the levosimendan group [RR = 0.53, 95% CI (0.38–0.73, I2=0]. However, the result of TSA showed that the conclusion may be a false positive. Secondary outcomes demonstrated that PCWP, postoperative renal replacement therapy, and length of ICU stay were significantly reduced. Cardiac index was greater in the levosimendan group. No difference was found in the rate of postoperative atrial fibrillation. Conclusions. Levosimendan reduces the rate of death and other adverse outcomes in patients with low ejection fraction who were undergoing cardiac surgery, but results remain inconclusive. More large-volume randomized clinical trials (RCTs are warranted.

Office-based surgery – why it is important

African Journals Online (AJOL)

of skills and practices, development of new procedures and technologies and a ... bad outcomes may have detracted from the ostensible advantages. Definitions ... for day surgery or procedure patients where professional health care is ...

How Useful are Orthopedic Surgery Residency Web Pages?

Science.gov (United States)

Oladeji, Lasun O; Yu, Jonathan C; Oladeji, Afolayan K; Ponce, Brent A

2015-01-01

Medical students interested in orthopedic surgery residency positions frequently use the Internet as a modality to gather information about individual residency programs. Students often invest a painstaking amount of time and effort in determining programs that they are interested in, and the Internet is central to this process. Numerous studies have concluded that program websites are a valuable resource for residency and fellowship applicants. The purpose of the present study was to provide an update on the web pages of academic orthopedic surgery departments in the United States and to rate their utility in providing information on quality of education, faculty and resident information, environment, and applicant information. We reviewed existing websites for the 156 departments or divisions of orthopedic surgery that are currently accredited for resident education by the Accreditation Council for Graduate Medical Education. Each website was assessed for quality of information regarding quality of education, faculty and resident information, environment, and applicant information. We noted that 152 of the 156 departments (97%) had functioning websites that could be accessed. There was high variability regarding the comprehensiveness of orthopedic residency websites. Most of the orthopedic websites provided information on conference, didactics, and resident rotations. Less than 50% of programs provided information on resident call schedules, resident or faculty research and publications, resident hometowns, or resident salary. There is a lack of consistency regarding the content presented on orthopedic residency websites. As the competition for orthopedic websites continues to increase, applicants flock to the Internet to learn more about orthopedic websites in greater number. A well-constructed website has the potential to increase the caliber of students applying to a said program. Copyright © 2015 Association of Program Directors in Surgery. Published by

Ultrasound-based tumor movement compensation during navigated laparoscopic liver interventions.

Science.gov (United States)

Shahin, Osama; Beširević, Armin; Kleemann, Markus; Schlaefer, Alexander

2014-05-01

Image-guided navigation aims to provide better orientation and accuracy in laparoscopic interventions. However, the ability of the navigation system to reflect anatomical changes and maintain high accuracy during the procedure is crucial. This is particularly challenging in soft organs such as the liver, where surgical manipulation causes significant tumor movements. We propose a fast approach to obtain an accurate estimation of the tumor position throughout the procedure. Initially, a three-dimensional (3D) ultrasound image is reconstructed and the tumor is segmented. During surgery, the position of the tumor is updated based on newly acquired tracked ultrasound images. The initial segmentation of the tumor is used to automatically detect the tumor and update its position in the navigation system. Two experiments were conducted. First, a controlled phantom motion using a robot was performed to validate the tracking accuracy. Second, a needle navigation scenario based on pseudotumors injected into ex vivo porcine liver was studied. In the robot-based evaluation, the approach estimated the target location with an accuracy of 0.4 ± 0.3 mm. The mean navigation error in the needle experiment was 1.2 ± 0.6 mm, and the algorithm compensated for tumor shifts up to 38 mm in an average time of 1 s. We demonstrated a navigation approach based on tracked laparoscopic ultrasound (LUS), and focused on the neighborhood of the tumor. Our experimental results indicate that this approach can be used to quickly and accurately compensate for tumor movements caused by surgical manipulation during laparoscopic interventions. The proposed approach has the advantage of being based on the routinely used LUS; however, it upgrades its functionality to estimate the tumor position in 3D. Hence, the approach is repeatable throughout surgery, and enables high navigation accuracy to be maintained.

Multimodal pain management after arthroscopic surgery

DEFF Research Database (Denmark)

Rasmussen, Sten

Multimodal Pain Management after Arthroscopic Surgery By Sten Rasmussen, M.D. The thesis is based on four randomized controlled trials. The main hypothesis was that multimodal pain treatment provides faster recovery after arthroscopic surgery. NSAID was tested against placebo after knee arthroscopy...

Updating of working memory: lingering bindings.

Science.gov (United States)

Oberauer, Klaus; Vockenberg, Kerstin

2009-05-01

Three experiments investigated proactive interference and proactive facilitation in a memory-updating paradigm. Participants remembered several letters or spatial patterns, distinguished by their spatial positions, and updated them by new stimuli up to 20 times per trial. Self-paced updating times were shorter when an item previously remembered and then replaced reappeared in the same location than when it reappeared in a different location. This effect demonstrates residual memory for no-longer-relevant bindings of items to locations. The effect increased with the number of items to be remembered. With one exception, updating times did not increase, and recall of final values did not decrease, over successive updating steps, thus providing little evidence for proactive interference building up cumulatively.

Design and development for updating national 1:50,000 topographic databases in China

Directory of Open Access Journals (Sweden)

CHEN Jun

2010-02-01

Full Text Available 1.1 Objective Map databases are irreplaceable national treasure of immense importance. Their currency referring to its consistency with respect to the real world plays a critical role in its value and applications. The continuous updating of map databases at 1:50,000 scales is a massive and difficult task for larger countries of the size of more than several million’s kilometer squares. This paper presents the research and technological development to support the national map updating at 1:50,000 scales in China, including the development of updating models and methods, production tools and systems for large-scale and rapid updating, as well as the design and implementation of the continuous updating workflow. 1.2 Methodology The updating of map databases is different than its original creation, and a number of new problems should be solved, such as change detection using latest multi-source data, incremental object revision and relation amendment. The methodology of this paper consists of the following three parts: 1 Examine the four key aspects of map database updating and develop basic updating models/methods, such as currentness-oriented integration of multi-resource data, completeness-based incremental change detection in the context of existing datasets, consistency-aware processing of updated data sets, and user-friendly propagation and services of updates. 2 Design and develop specific software tools and packages to support the large-scale updating production with high resolution imagery and large-scale data generalization, such as map generalization, GIS-supported change interpretation from imagery, DEM interpolation, image matching-based orthophoto generation, data control at different levels. 3 Design a national 1:50,000 databases updating strategy and its production workflow, including a full coverage updating pattern characterized by all element topographic data modeling, change detection in all related areas, and whole process

Updating Stiffness and Hysteretic Damping Matrices Using Measured Modal Data

Directory of Open Access Journals (Sweden)

Jiashang Jiang

2018-01-01

Full Text Available A new direct method for the finite element (FE matrix updating problem in a hysteretic (or material damping model based on measured incomplete vibration modal data is presented. With this method, the optimally approximated stiffness and hysteretic damping matrices can be easily constructed. The physical connectivity of the original model is preserved and the measured modal data are embedded in the updated model. The numerical results show that the proposed method works well.

The role of 3-D imaging and computer-based postprocessing for surgery of the liver and pancreas

International Nuclear Information System (INIS)

Grenacher, L.; Kauffmann, G.W.; Richter, G.M.; Thorn, M.; Vetter, M.; Hassenpflug, P.; Meinzer, H.P.; Knaebel, H.P.; Kraus, T.; Buechler, M.W.

2005-01-01

Cross-sectional imaging based on navigation and virtual reality planning tools are well-established in the surgical routine in orthopedic surgery and neurosurgery. In various procedures, they have achieved a significant clinical relevance and efficacy and have enhanced the discipline's resection capabilities. In abdominal surgery, however, these tools have gained little attraction so far. Even with the advantage of fast and high resolution cross-sectional liver and pancreas imaging, it remains unclear whether 3D planning and interactive planning tools might increase precision and safety of liver and pancreas surgery. The inability to simply transfer the methodology from orthopedic or neurosurgery is mainly a result of intraoperative organ movements and shifting and corresponding technical difficulties in the on-line applicability of presurgical cross sectional imaging data. For the interactive planning of liver surgery, three systems partly exist in daily routine: HepaVision2 (MeVis GmbH, Bremen), LiverLive (Navidez Ltd. Slovenia) and OrgaNicer (German Cancer Research Center, Heidelberg). All these systems have realized a half- or full-automatic liver-segmentation procedure to visualize liver segments, vessel trees, resected volumes or critical residual organ volumes, either for preoperative planning or intraoperative visualization. Acquisition of data is mainly based on computed tomography. Three-dimensional navigation for intraoperative surgical guidance with ultrasound is part of the clinical testing. There are only few reports about the transfer of the visualization of the pancreas, probably caused by the difficulties with the segmentation routine due to inflammation or organ-exceeding tumor growth. With this paper, we like to evaluate and demonstrate the present status of software planning tools and pathways for future pre- and intraoperative resection planning in liver and pancreas surgery. (orig.)

78 FR 65932 - Updating OSHA Standards Based on National Consensus Standards; Signage

Science.gov (United States)

2013-11-04

...; Signage AGENCY: Occupational Safety and Health Administration (OSHA), Department of Labor. ACTION... accompanied its direct final rule revising its signage standards for general industry and construction. DATES... proposed rule (NPRM) along with the direct final rule (DFR) (see 78 FR 35585) updating its signage...

How do we update faces? Effects of gaze direction and facial expressions on working memory updating

Directory of Open Access Journals (Sweden)

Caterina eArtuso

2012-09-01

Full Text Available The aim of the study was to investigate how the biological binding between different facial dimensions, and their social and communicative relevance, may impact updating processes in working memory (WM. We focused on WM updating because it plays a key role in ongoing processing. Gaze direction and facial expression are crucial and changeable components of face processing. Direct gaze enhances the processing of approach-oriented facial emotional expressions (e.g. joy, while averted gaze enhances the processing of avoidance-oriented facial emotional expressions (e.g. fear. Thus, the way in which these two facial dimensions are combined communicates to the observer important behavioral and social information. Updating of these two facial dimensions and their bindings has not been investigated before, despite the fact that they provide a piece of social information essential for building and maintaining an internal ongoing representation of our social environment. In Experiment 1 we created a task in which the binding between gaze direction and facial expression was manipulated: high binding conditions (e.g. joy-direct gaze were compared to low binding conditions (e.g. joy-averted gaze. Participants had to study and update continuously a number of faces, displaying different bindings between the two dimensions. In Experiment 2 we tested whether updating was affected by the social and communicative value of the facial dimension binding; to this end, we manipulated bindings between eye and hair color, two less communicative facial dimensions. Two new results emerged. First, faster response times were found in updating combinations of facial dimensions highly bound together. Second, our data showed that the ease of the ongoing updating processing varied depending on the communicative meaning of the binding that had to be updated. The results are discussed with reference to the role of WM updating in social cognition and appraisal processes.

How do we update faces? Effects of gaze direction and facial expressions on working memory updating.

Science.gov (United States)

Artuso, Caterina; Palladino, Paola; Ricciardelli, Paola

2012-01-01

The aim of the study was to investigate how the biological binding between different facial dimensions, and their social and communicative relevance, may impact updating processes in working memory (WM). We focused on WM updating because it plays a key role in ongoing processing. Gaze direction and facial expression are crucial and changeable components of face processing. Direct gaze enhances the processing of approach-oriented facial emotional expressions (e.g., joy), while averted gaze enhances the processing of avoidance-oriented facial emotional expressions (e.g., fear). Thus, the way in which these two facial dimensions are combined communicates to the observer important behavioral and social information. Updating of these two facial dimensions and their bindings has not been investigated before, despite the fact that they provide a piece of social information essential for building and maintaining an internal ongoing representation of our social environment. In Experiment 1 we created a task in which the binding between gaze direction and facial expression was manipulated: high binding conditions (e.g., joy-direct gaze) were compared to low binding conditions (e.g., joy-averted gaze). Participants had to study and update continuously a number of faces, displaying different bindings between the two dimensions. In Experiment 2 we tested whether updating was affected by the social and communicative value of the facial dimension binding; to this end, we manipulated bindings between eye and hair color, two less communicative facial dimensions. Two new results emerged. First, faster response times were found in updating combinations of facial dimensions highly bound together. Second, our data showed that the ease of the ongoing updating processing varied depending on the communicative meaning of the binding that had to be updated. The results are discussed with reference to the role of WM updating in social cognition and appraisal processes.

Benchmarking Distance Control and Virtual Drilling for Lateral Skull Base Surgery.

Science.gov (United States)

Voormolen, Eduard H J; Diederen, Sander; van Stralen, Marijn; Woerdeman, Peter A; Noordmans, Herke Jan; Viergever, Max A; Regli, Luca; Robe, Pierre A; Berkelbach van der Sprenkel, Jan Willem

2018-01-01

Novel audiovisual feedback methods were developed to improve image guidance during skull base surgery by providing audiovisual warnings when the drill tip enters a protective perimeter set at a distance around anatomic structures ("distance control") and visualizing bone drilling ("virtual drilling"). To benchmark the drill damage risk reduction provided by distance control, to quantify the accuracy of virtual drilling, and to investigate whether the proposed feedback methods are clinically feasible. In a simulated surgical scenario using human cadavers, 12 unexperienced users (medical students) drilled 12 mastoidectomies. Users were divided into a control group using standard image guidance and 3 groups using distance control with protective perimeters of 1, 2, or 3 mm. Damage to critical structures (sigmoid sinus, semicircular canals, facial nerve) was assessed. Neurosurgeons performed another 6 mastoidectomy/trans-labyrinthine and retro-labyrinthine approaches. Virtual errors as compared with real postoperative drill cavities were calculated. In a clinical setting, 3 patients received lateral skull base surgery with the proposed feedback methods. Users drilling with distance control protective perimeters of 3 mm did not damage structures, whereas the groups using smaller protective perimeters and the control group injured structures. Virtual drilling maximum cavity underestimations and overestimations were 2.8 ± 0.1 and 3.3 ± 0.4 mm, respectively. Feedback methods functioned properly in the clinical setting. Distance control reduced the risks of drill damage proportional to the protective perimeter distance. Errors in virtual drilling reflect spatial errors of the image guidance system. These feedback methods are clinically feasible. Copyright © 2017 Elsevier Inc. All rights reserved.

Information Updating in Working Memory: Its Effect on Teacher Efficacy

Directory of Open Access Journals (Sweden)

Jun Tao

2012-01-01

Full Text Available Teacher efficacy has a great impact on effective teaching and has been studied in various perspectives. The updating information ability in working memory is always related with many capabilities of cognition. An experiment of N-back task and a questionnaire of teacher efficacy were conducted in this study to test the effect of the ability of information updating in working memory on the teacher efficacy. A significant difference was found in the reaction time between high teacher efficacy group and low teacher efficacy group. The results showed that teachers who scored higher in the teacher efficacy scale tended to react faster than those who scored lower based on the same accuracy. And the updating information ability could serve as a predictor of teacher efficacy.

49 CFR 1002.3 - Updating user fees.

Science.gov (United States)

2010-10-01

... updating fees. Each fee shall be updated by updating the cost components comprising the fee. Cost... direct labor costs are direct labor costs determined by the cost study set forth in Revision of Fees For... by total office costs for the Offices directly associated with user fee activity. Actual updating of...

Aircraft engine sensor fault diagnostics using an on-line OBEM update method.

Directory of Open Access Journals (Sweden)

Xiaofeng Liu

Full Text Available This paper proposed a method to update the on-line health reference baseline of the On-Board Engine Model (OBEM to maintain the effectiveness of an in-flight aircraft sensor Fault Detection and Isolation (FDI system, in which a Hybrid Kalman Filter (HKF was incorporated. Generated from a rapid in-flight engine degradation, a large health condition mismatch between the engine and the OBEM can corrupt the performance of the FDI. Therefore, it is necessary to update the OBEM online when a rapid degradation occurs, but the FDI system will lose estimation accuracy if the estimation and update are running simultaneously. To solve this problem, the health reference baseline for a nonlinear OBEM was updated using the proposed channel controller method. Simulations based on the turbojet engine Linear-Parameter Varying (LPV model demonstrated the effectiveness of the proposed FDI system in the presence of substantial degradation, and the channel controller can ensure that the update process finishes without interference from a single sensor fault.

Clinical effectiveness and cost-effectiveness of laparoscopic surgery for colorectal cancer: systematic reviews and economic evaluation.

Science.gov (United States)

Murray, A; Lourenco, T; de Verteuil, R; Hernandez, R; Fraser, C; McKinley, A; Krukowski, Z; Vale, L; Grant, A

2006-11-01

years. Assuming equivalence of long-term outcomes, a judgement is required as to whether the benefits associated with earlier recovery are worth this extra cost. The long-term follow-up of the RCT cohorts would be very useful further research and ideally these data should be incorporated into a wider IPD meta-analysis. Data on the long-term complications of surgery such as incisional hernias and differences in outcomes such as persisting pain would also be valuable. Once available, further data on both costs and utilities should be included in an updated model. At this point, further consideration should then be given as to whether additional data should be collected within ongoing trials. Few data were available to assess the relative merits of HALS. Ideally, there should be more data from methodologically sound RCTs. Further research is needed on whether the balance of advantages and disadvantages of laparoscopic surgery varies within subgroups based on the different stages and locations of disease. Research relating to the effect of experience on performance is also required.

First Application of 7T Magnetic Resonance Imaging in Endoscopic Endonasal Surgery of Skull Base Tumors

Science.gov (United States)

Barrett, Thomas F; Dyvorne, Hadrien A; Padormo, Francesco; Pawha, Puneet S; Delman, Bradley N; Shrivastava, Raj K; Balchandani, Priti

2018-01-01

Background Successful endoscopic endonasal surgery for the resection of skull base tumors is reliant on preoperative imaging to delineate pathology from the surrounding anatomy. The increased signal-to-noise ratio afforded by 7T MRI can be used to increase spatial and contrast resolution, which may lend itself to improved imaging of skull base. In this study, we apply a 7T imaging protocol to patients with skull base tumors and compare the images to clinical standard of care. Methods Images were acquired at 7T on 11 patients with skull base lesions. Two neuroradiologists evaluated clinical 1.5T, 3T, and 7T scans for detection of intracavernous cranial nerves and ICA branches. Detection rates were compared. Images were utilized for surgical planning and uploaded to a neuronavigation platform and used to guide surgery. Results Image analysis yielded improved detection rates of cranial nerves and ICA branches at 7T. 7T images were successfully incorporated into preoperative planning and intraoperative neuronavigation. Conclusion Our study represents the first application of 7T MRI to the full neurosurgical workflow for endoscopic endonasal surgery. We detected higher rates of cranial nerves and ICA branches at 7T MRI compared to 3T and 1.5 T, and found that integration of 7T into surgical planning and guidance was feasible. These results suggest a potential for 7T MRI to reduce surgical complications. Future studies comparing standardized 7T, 3T, and 1.5 T MRI protocols in a larger number of patients are warranted to determine the relative benefit of 7T MRI for endonasal endoscopic surgical efficacy. PMID:28359922

First Application of 7-T Magnetic Resonance Imaging in Endoscopic Endonasal Surgery of Skull Base Tumors.

Science.gov (United States)

Barrett, Thomas F; Dyvorne, Hadrien A; Padormo, Francesco; Pawha, Puneet S; Delman, Bradley N; Shrivastava, Raj K; Balchandani, Priti

2017-07-01

Successful endoscopic endonasal surgery for the resection of skull base tumors is reliant on preoperative imaging to delineate pathology from the surrounding anatomy. The increased signal-to-noise ratio afforded by 7-T MRI can be used to increase spatial and contrast resolution, which may lend itself to improved imaging of the skull base. In this study, we apply a 7-T imaging protocol to patients with skull base tumors and compare the images with clinical standard of care. Images were acquired at 7 T on 11 patients with skull base lesions. Two neuroradiologists evaluated clinical 1.5-, 3-, and 7-T scans for detection of intracavernous cranial nerves and internal carotid artery (ICA) branches. Detection rates were compared. Images were used for surgical planning and uploaded to a neuronavigation platform and used to guide surgery. Image analysis yielded improved detection rates of cranial nerves and ICA branches at 7 T. The 7-T images were successfully incorporated into preoperative planning and intraoperative neuronavigation. Our study represents the first application of 7-T MRI to the full neurosurgical workflow for endoscopic endonasal surgery. We detected higher rates of cranial nerves and ICA branches at 7-T MRI compared with 3- and 1.5-T MRI, and found that integration of 7 T into surgical planning and guidance was feasible. These results suggest a potential for 7-T MRI to reduce surgical complications. Future studies comparing standardized 7-, 3-, and 1.5-T MRI protocols in a larger number of patients are warranted to determine the relative benefit of 7-T MRI for endonasal endoscopic surgical efficacy. Copyright © 2017 Elsevier Inc. All rights reserved.

Self-shielding models of MICROX-2 code: Review and updates

International Nuclear Information System (INIS)

Hou, J.; Choi, H.; Ivanov, K.N.

2014-01-01

Highlights: • The MICROX-2 code has been improved to expand its application to advanced reactors. • New fine-group cross section libraries based on ENDF/B-VII have been generated. • Resonance self-shielding and spatial self-shielding models have been improved. • The improvements were assessed by a series of benchmark calculations against MCNPX. - Abstract: The MICROX-2 is a transport theory code that solves for the neutron slowing-down and thermalization equations of a two-region lattice cell. The MICROX-2 code has been updated to expand its application to advanced reactor concepts and fuel cycle simulations, including generation of new fine-group cross section libraries based on ENDF/B-VII. In continuation of previous work, the MICROX-2 methods are reviewed and updated in this study, focusing on its resonance self-shielding and spatial self-shielding models for neutron spectrum calculations. The improvement of self-shielding method was assessed by a series of benchmark calculations against the Monte Carlo code, using homogeneous and heterogeneous pin cell models. The results have shown that the implementation of the updated self-shielding models is correct and the accuracy of physics calculation is improved. Compared to the existing models, the updates reduced the prediction error of the infinite multiplication factor by ∼0.1% and ∼0.2% for the homogeneous and heterogeneous pin cell models, respectively, considered in this study

Surgery during holiday periods and prognosis in oesophageal cancer: a population-based nationwide Swedish cohort study.

Science.gov (United States)

Markar, Sheraz R; Wahlin, Karl; Mattsson, Fredrik; Lagergren, Pernilla; Lagergren, Jesper

2016-09-06

Previous studies indicate an increased short-term and long-term mortality from major cancer surgery performed towards the end of the working week or during the weekend. We hypothesised that the prognosis after major cancer surgery is also negatively influenced by surgery conducted during holiday periods. Population-based nationwide Swedish cohort study. Patients undergoing oesophagectomy for oesophageal cancer between 1987 and 2010. Among 1820 included patients, 206 (11.3%) and 373 (20.5%) patients were operated on during narrow and wide holiday periods, respectively. Narrow (7 weeks) and wide (14 weeks) Swedish holiday periods. 90-day all-cause, 5-year all-cause and 5-year disease-specific mortality. Narrow holiday period did not increase all-cause 90-day (HR=0.84, 95% CI 0.53 to 1.33), all-cause 5-year (HR=1.01, 95% CI 0.85 to 1.21) or disease-specific 5-year mortality (HR=1.04, 95% CI 0.87 to 1.26). Similarly, wide holiday period did not increase the risk of 90-day (HR=0.79, 95% CI 0.55 to 1.13), all-cause 5-year (HR=0.96, 95% CI 0.84 to 1.1) or disease-specific 5-year mortality (HR=1.03, 95% CI 0.89 to 1.19). No measurable effects of holiday periods on short-term or longer term mortality following surgery for oesophageal cancer were observed in this population-based study, indicating that an adequate surgical experience was maintained during holiday periods. 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/

Updated BG Prasad socioeconomic classification, 2014: a commentary.

Science.gov (United States)

Mangal, Abha; Kumar, Varun; Panesar, Sanjeet; Talwar, Richa; Raut, Deepak; Singh, Saudan

2015-01-01

Modified BG Prasad socioeconomic scale is widely used to determine the socioeconomic status of study subjects in health studies in India. It is an income-based scale and, therefore, has to be constantly updated to take inflation and depreciation of rupee into account. The Consumer Price Index (CPI) for industrial workers (IW) is used to calculate updated income categories for January 2014. Details of the calculations involved will enable young researchers to calculate specific income categories for their research work. State-specific CPI values are also available on the Department of Labour website and should be used to determine more accurate income categories for the study area.

Long-Term Stability of Pre-Orthodontic Orthognathic Bimaxillary Surgery Using Intraoral Vertical Ramus Osteotomy Versus Conventional Surgery.

Science.gov (United States)

Jeong, Jeong-Hwa; Choi, Sung-Hwan; Kim, Kee-Deog; Hwang, Chung-Ju; Lee, Sang-Hwy; Yu, Hyung-Seog

2018-02-20

The aim of the present study was to compare the long-term stability of bimaxillary surgery using an intraoral vertical ramus osteotomy (IVRO) with and without presurgical orthodontic treatment. The present retrospective study included 31 consecutive patients with skeletal Class III malocclusions who had undergone bimaxillary surgery (Le Fort I osteotomy and bilateral IVRO). Patients were divided into 2 groups based on treatment type: pre-orthodontic orthognathic surgery (POGS; n = 17) and conventional surgery with presurgical orthodontic treatment (CS; n = 14). Lateral cephalograms were obtained before surgery, 1 day after surgery, 1 month after surgery, 1 year after surgery, and 2 years after surgery to evaluate skeletal and soft tissue changes between the 2 groups. Data were analyzed using χ 2 tests, Mann-Whitney U tests, repeated-measures analyses of variance, and independent t tests. There was no significant difference in skeletal or soft tissue measurements-with the exception of the angle between the sella-and-nasion plane and the occlusal plane (SN-OP; P surgery. These findings suggest that POGS and CS have similar long-term stability in patients with skeletal Class III malocclusion. Copyright © 2018. Published by Elsevier Inc.

Basal Cell Carcinoma of the Dorsal Foot: An Update and Comprehensive Review of the Literature.

Science.gov (United States)

Loh, Tiffany Y; Rubin, Ashley G; Jiang, Shang I Brian

2017-01-01

Ultraviolet radiation is a well-known risk factor for basal cell carcinoma (BCC). Therefore, the high incidence of BCCs in sun-exposed areas such as the head and neck is unsurprising. However, unexpectedly, BCCs on the sun-protected dorsal foot have also been reported, and tumor occurrence here suggests that other factors besides ultraviolet radiation may play a role in BCC pathogenesis. Because only few dorsal foot BCCs have been reported, data on their clinical features and management are limited. To perform an updated review of the literature on clinical characteristics and treatment of dorsal foot BCCs. We conducted a comprehensive literature review by searching the PubMed database with the key phrases "basal cell carcinoma dorsal foot," "basal cell carcinoma foot," and "basal cell carcinoma toe." We identified 20 cases of dorsal foot BCCs in the literature, 17 of which had sufficient data for analysis. Only 1 case was treated with Mohs micrographic surgery. We present 8 additional cases of dorsal foot BCCs treated with Mohs micrographic surgery. Basal cell carcinomas on the dorsal foot are rare, and potential risk factors include Caucasian descent and personal history of skin cancer. Mohs micrographic surgery seems to be an effective treatment option.

Epilepsy surgery: Recommendations for India

Directory of Open Access Journals (Sweden)

Chandra P

2010-01-01

Full Text Available The following article recommends guidelines for epilepsy surgery for India. This article reviews the indications, the various surgical options available and the outcome of surgery for drug resistant epilepsy based on current evidence. Epilepsy surgery is a well-established option for patients who have been diagnosed to have drug resistant epilepsy (DRE (on at least two appropriate, adequate anti-epileptic drugs (AEDs (either in monotherapy or in combination with continuing seizures, where the presurgical work-up has shown concordance of structural imaging (magnetic resonance imaging and electrical mapping data (electroencephalography (EEG, video EEG. There may be a requirement of functional imaging techniques in a certain number of DRE like positron emission tomography (PET, single photon emission tomography, (SPECT. Invasive monitoring should be restricted to a few when all noninvasive investigations are inconclusive, there is a dual pathology or there is a discordance of noninvasive data. The types of surgery could be curative (resective surgeries: amygdalo hippocampectomy, lesionectomy and multilobar resections; functional surgeries: hemispherotomy and palliative (multiple subpial transaction, corpus callosotomy, vagal nerve stimulation. Epilepsy surgery in indicated cases has a success range from 50 to 86% in achieving seizure freedom as compared with < 5% success rate with AEDs only in persons with DRE. Centers performing surgery should be categorized into Level I and Level II.

Internet-Based Digital Simulation for Cleft Surgery Education: A 5-Year Assessment of Demographics, Usage, and Global Effect.

Science.gov (United States)

Kantar, Rami S; Plana, Natalie M; Cutting, Court B; Diaz-Siso, Jesus Rodrigo; Flores, Roberto L

2018-01-29

In October 2012, a freely available, internet-based cleft simulator was created in partnership between academic, nonprofit, and industry sectors. The purpose of this educational resource was to address global disparities in cleft surgery education. This report assesses demographics, usage, and global effect of our simulator, in its fifth year since inception. Evaluate the global effect, usage, and demographics of an internet-based educational digital simulation cleft surgery software. Simulator modules, available in five languages demonstrate surgical anatomy, markings, detailed procedures, and intraoperative footage to supplement digital animation. Available data regarding number of users, sessions, countries reached, and content access were recorded. Surveys evaluating the demographic characteristics of registered users and simulator use were collected by direct e-mail. The total number of simulator new and active users reached 2865 and 4086 in June 2017, respectively. By June 2017, users from 136 countries had accessed the simulator. From 2015 to 2017, the number of sessions was 11,176 with a monthly average of 399.0 ± 190.0. Developing countries accounted for 35% of sessions and the average session duration was 9.0 ± 7.3 minutes. This yields a total simulator screen time of 100,584 minutes (1676 hours). Most survey respondents were surgeons or trainees (87%) specializing in plastic, maxillofacial, or general surgery (89%). Most users found the simulator to be useful (88%), at least equivalent or more useful than other resources (83%), and used it for teaching (58%). Our internet-based interactive cleft surgery platform reaches its intended target audience, is not restricted by socioeconomic barriers to access, and is judged to be useful by surgeons. More than 4000 active users have been reached since inception. The total screen time over approximately 2 years exceeded 1600 hours. This suggests that future surgical simulators of this kind may be sustainable by

78 FR 35585 - Updating OSHA Standards Based on National Consensus Standards; Signage

Science.gov (United States)

2013-06-13

...; Signage AGENCY: Occupational Safety and Health Administration (OSHA), Department of Labor. ACTION: Notice... Administration (``OSHA'' or ``the Agency'') proposes to update its general industry and construction signage... standards, ANSI Z53.1-1967, Z35.1-1968, and Z35.2-1968, in its signage standards, thereby providing...

Web-based nursing intervention for self-management of pain after cardiac surgery: pilot randomized controlled trial.

Science.gov (United States)

Martorella, Géraldine; Côté, José; Racine, Mélanie; Choinière, Manon

2012-12-14

Most adults undergoing cardiac surgery suffer from moderate to severe pain for up to 6 days after surgery. Individual barriers and attitudes regarding pain and its relief make patients reluctant to report their pain and ask for analgesic medication, which results in inadequate pain management. More innovative educational interventions for postoperative pain relief are needed. We developed a Web-based nursing intervention to influence patient's involvement in postoperative pain management. The intervention (SOULAGE-TAVIE) includes a preoperative 30-minute Web-based session and 2 brief face-to-face postoperative booster sessions. The Web application generates reflective activities and tailored educational messages according to patients' beliefs and attitudes. The messages are transmitted through videos of a virtual nurse, animations, stories, and texts. The aim of this single-blinded pilot randomized trial was to investigate the preliminary effects of a virtual nursing intervention (SOULAGE-TAVIE) to improve pain relief in patients undergoing cardiac surgery. Participants (N = 60) were adults scheduled for their first cardiac surgery. They were randomly assigned to the experimental group using SOULAGE-TAVIE (n = 30) or the control group using usual care, including an educational pamphlet and postoperative follow-up (n = 30). Data were collected through questionnaires at the time of admission and from day 1 to day 7 after surgery with the help of a blinded research assistant. Outcomes were pain intensity, pain interference with daily activities, patients' pain barriers, tendency to catastrophize in face of pain, and analgesic consumption. The two groups were comparable at baseline across all demographic measures. Results revealed that patients in the experimental group did not experience less intense pain, but they reported significantly less pain interference when breathing/coughing (P = .04). A severe pain interference with breathing/coughing (pain ranked ≥ 7

Energy consumption for heat based on the Energy Balance. Update 2010; Het energieverbruik voor warmte afgeleid uit de Energiebalans. Update 2010

Energy Technology Data Exchange (ETDEWEB)

Segers, R.

2012-04-15

In 2008 the Dutch Expertise Centre for Heat asked Statistics Netherlands and ECN to provide indications of how much energy is used for heat for various applications and sectors. That resulted in a report, published in 2009 with the same title as this report, which is an update of the 2009 report. The aim is to indicate how energy use for heat can be derived from the Energy Balance of Statistics Netherlands. The energy use is compared to the energy use for three other applications: electricity, transport fuels and feedstocks. Moreover, it is also indicated how the amount of renewable heat can be derived from renewable energy statistics [Dutch] Het Expertisecentrum Warmte heeft in 2008 aan het CBS en het ECN gevraagd om aan te geven hoeveel energie er wordt gebruikt voor warmte voor verschillende toepassingen en sectoren. Dat heeft geresulteerd in het 2009 rapport 'Het energieverbruik voor warmte afgeleid uit de Energiebalans'. De meest recente cijfers in dat rapport hebben betrekking op het jaar 2006. Voorliggend document is een nieuwe update met cijfers over 2010.

Neural network based online simultaneous policy update algorithm for solving the HJI equation in nonlinear H∞ control.

Science.gov (United States)

Wu, Huai-Ning; Luo, Biao

2012-12-01

It is well known that the nonlinear H∞ state feedback control problem relies on the solution of the Hamilton-Jacobi-Isaacs (HJI) equation, which is a nonlinear partial differential equation that has proven to be impossible to solve analytically. In this paper, a neural network (NN)-based online simultaneous policy update algorithm (SPUA) is developed to solve the HJI equation, in which knowledge of internal system dynamics is not required. First, we propose an online SPUA which can be viewed as a reinforcement learning technique for two players to learn their optimal actions in an unknown environment. The proposed online SPUA updates control and disturbance policies simultaneously; thus, only one iterative loop is needed. Second, the convergence of the online SPUA is established by proving that it is mathematically equivalent to Newton's method for finding a fixed point in a Banach space. Third, we develop an actor-critic structure for the implementation of the online SPUA, in which only one critic NN is needed for approximating the cost function, and a least-square method is given for estimating the NN weight parameters. Finally, simulation studies are provided to demonstrate the effectiveness of the proposed algorithm.

Parallel main-memory indexing for moving-object query and update workloads

DEFF Research Database (Denmark)

Sidlauskas, Darius; Saltenis, Simonas; Jensen, Christian Søndergaard

2012-01-01

of supporting the location-related query and update workloads generated by very large populations of such moving objects. This paper presents a main-memory indexing technique that aims to support such workloads. The technique, called PGrid, uses a grid structure that is capable of exploiting the parallelism...... offered by modern processors. Unlike earlier proposals that maintain separate structures for updates and queries, PGrid allows both long-running queries and rapid updates to operate on a single data structure and thus offers up-to-date query results. Because PGrid does not rely on creating snapshots...... on the same current data-store state, PGrid outperforms snapshot-based techniques in terms of both query freshness and CPU cycle-wise efficiency....

Rectal cancer surgery: volume-outcome analysis.

LENUS (Irish Health Repository)

Nugent, Emmeline

2010-12-01

There is strong evidence supporting the importance of the volume-outcome relationship with respect to lung and pancreatic cancers. This relationship for rectal cancer surgery however remains unclear. We review the currently available literature to assess the evidence base for volume outcome in relation to rectal cancer surgery.

Education on the Business of Plastic Surgery During Training: A Survey of Plastic Surgery Residents.

Science.gov (United States)

Ovadia, Steven A; Gishen, Kriya; Desai, Urmen; Garcia, Alejandro M; Thaller, Seth R

2018-06-01

Entrepreneurial skills are important for physicians, especially plastic surgeons. Nevertheless, these skills are not typically emphasized during residency training. Evaluate the extent of business training at plastic surgery residency programs as well as means of enhancing business training. A 6-question online survey was sent to plastic surgery program directors for distribution to plastic surgery residents. Responses from residents at the PGY2 level and above were included for analysis. Tables were prepared to present survey results. Hundred and sixty-six residents including 147 PGY2 and above residents responded to our survey. Only 43.5% reported inclusion of business training in their plastic surgery residency. A majority of residents reported they do not expect on graduation to be prepared for the business aspects of plastic surgery. Additionally, a majority of residents feel establishment of a formal lecture series on the business of plastic surgery would be beneficial. Results from our survey indicate limited training at plastic surgery programs in necessary business skills. Plastic surgery residency programs should consider incorporating or enhancing elements of business training in their curriculum. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Immediate Sequential Bilateral Cataract Surgery

DEFF Research Database (Denmark)

Kessel, Line; Andresen, Jens; Erngaard, Ditte

2015-01-01

The aim of the present systematic review was to examine the benefits and harms associated with immediate sequential bilateral cataract surgery (ISBCS) with specific emphasis on the rate of complications, postoperative anisometropia, and subjective visual function in order to formulate evidence......-based national Danish guidelines for cataract surgery. A systematic literature review in PubMed, Embase, and Cochrane central databases identified three randomized controlled trials that compared outcome in patients randomized to ISBCS or bilateral cataract surgery on two different dates. Meta-analyses were...... performed using the Cochrane Review Manager software. The quality of the evidence was assessed using the GRADE method (Grading of Recommendation, Assessment, Development, and Evaluation). We did not find any difference in the risk of complications or visual outcome in patients randomized to ISBCS or surgery...

TCAM-based High Speed Longest Prefix Matching with Fast Incremental Table Updates

DEFF Research Database (Denmark)

Rasmussen, Anders; Kragelund, A.; Berger, Michael Stübert

2013-01-01

and consequently a higher throughput of the network search engine, since the TCAM down time caused by incremental updates is eliminated. The LPM scheme is described in HDL for FPGA implementation and compared to an existing scheme for customized CAM circuits. The paper shows that the proposed scheme can process...

Ranking Hospitals Based on Colon Surgery and Abdominal Hysterectomy Surgical Site Infection Outcomes: Impact of Limiting Surveillance to the Operative Hospital.

Science.gov (United States)

Yokoe, Deborah S; Avery, Taliser R; Platt, Richard; Kleinman, Ken; Huang, Susan S

2018-03-16

Hospital-specific surgical site infection (SSI) performance following colon surgery and abdominal hysterectomies can impact hospitals' relative rankings around quality metrics used to determine financial penalties. Current SSI surveillance largely focuses on SSI detected at the operative hospital. Retrospective cohort study to assess the impact on hospitals' relative SSI performance rankings when SSI detected at non-operative hospitals are included. We utilized data from a California statewide hospital registry to assess for evidence of SSI following colon surgery or abdominal hysterectomies performed 3/1/2011-11/30/2013 using previously validated claims-based SSI surveillance methods. Risk-adjusted hospital-specific rankings based on SSI detected at operative hospitals versus any California hospital were generated. Among 60,059 colon surgeries at 285 hospitals and 64,918 abdominal hysterectomies at 270 hospitals, 5,921 (9.9%) colon surgeries and 1,481 (2.3%) abdominal hysterectomies received a diagnosis code for SSI within the 30 days following surgery. 7.2% of colon surgery and 13.4% of abdominal hysterectomy SSI would have been missed by operative hospital surveillance alone. The proportion of individual hospital's SSI detected during hospitalizations at other hospitals varied widely. Including non-operative hospital SSI resulted in improved relative ranking of 11 (3.9%) colon surgery and 13 (4.8%) hysterectomy hospitals so that they were no longer in the worst performing quartile, mainly among hospitals with relatively high surgical volumes. Standard SSI surveillance that mainly focuses on infections detected at the operative hospital causes varying degrees of SSI under-estimation, leading to inaccurate assignment or avoidance of financial penalties for approximately one in eleven to sixteen hospitals.

Solid tumors after chemotherapy or surgery for testicular nonseminoma: a population-based study.

Science.gov (United States)

Fung, Chunkit; Fossa, Sophie D; Milano, Michael T; Oldenburg, Jan; Travis, Lois B

2013-10-20

Increased risks of solid tumors after older radiotherapy strategies for testicular cancer (TC) are well established. Few population-based studies, however, focus on solid cancer risk among survivors of TC managed with nonradiotherapy approaches. We quantified the site-specific risk of solid cancers among testicular nonseminoma patients treated in the modern era of cisplatin-based chemotherapy, without radiotherapy. Standardized incidence ratios (SIRs) for solid tumors were calculated for 12,691 patients with testicular nonseminoma reported to the population-based Surveillance, Epidemiology, and End Results program (1980 to 2008) and treated initially with either chemotherapy (n = 6,013) or surgery (n = 6,678) without radiotherapy. Patients accrued 116,073 person-years of follow-up. Two hundred ten second solid cancers were observed. No increased risk followed surgery alone (SIR, 0.93; 95% CI, 0.76 to 1.14; n = 99 solid cancers), whereas significantly increased 40% excesses (SIR, 1.43; 95% CI, 1.18 to 1.73; n = 111 solid cancers) occurred after chemotherapy. Increased risks of solid cancers after chemotherapy were observed in most follow-up periods (median latency, 12.5 years), including more than 20 years after treatment (SIR, 1.54; 95% CI, 0.96 to 2.33); significantly increased three- to seven-fold risks occurred for cancers of the kidney (SIR, 3.37; 95% CI, 1.79 to 5.77), thyroid (SIR, 4.40; 95% CI, 2.19 to 7.88), and soft tissue (SIR, 7.49; 95% CI, 3.59 to 13.78). To our knowledge, this is the first large population-based series reporting significantly increased risks of solid cancers among patients with testicular nonseminoma treated in the modern era of cisplatin-based chemotherapy. Subsequent analytic studies should focus on the evaluation of dose-response relationships, types of solid cancers, latency patterns, and interactions with other possible factors, including genetic susceptibility.

Corrective Jaw Surgery

Medline Plus

Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

To Your Health: NLM update transcript - Gun safety strategies

Science.gov (United States)

... transcript040918.html To Your Health: NLM update Transcript Gun safety strategies : 04/09/2018 To use the ... on weekly topics. An evidence-based, public health gun safety strategy that is consistent with second amendment ...

Main-Memory Operation Buffering for Efficient R-Tree Update

DEFF Research Database (Denmark)

Jensen, Christian Søndergaard; Saltenis, Simonas; Biveinis, Laurynas

2007-01-01

the buffering of update operations in main memory as well as the grouping of operations to reduce disk I/O. In particular, operations are performed in bulk so that multiple operations are able to share I/O. The paper presents an analytical cost model that is shown to be accurate by empirical studies...... the main memory that is indeed available, or do not support some of the standard index operations. Assuming a setting where the index updates need not be written to disk immediately, we propose an R-tree-based indexing technique that does not exhibit any of these drawbacks. This technique exploits...

Quantifying the cognitive cost of laparo-endoscopic single-site surgeries: Gaze-based indices.

Science.gov (United States)

Di Stasi, Leandro L; Díaz-Piedra, Carolina; Ruiz-Rabelo, Juan Francisco; Rieiro, Héctor; Sanchez Carrion, Jose M; Catena, Andrés

2017-11-01

Despite the growing interest concerning the laparo-endoscopic single-site surgery (LESS) procedure, LESS presents multiple difficulties and challenges that are likely to increase the surgeon's cognitive cost, in terms of both cognitive load and performance. Nevertheless, there is currently no objective index capable of assessing the surgeon cognitive cost while performing LESS. We assessed if gaze-based indices might offer unique and unbiased measures to quantify LESS complexity and its cognitive cost. We expect that the assessment of surgeon's cognitive cost to improve patient safety by measuring fitness-for-duty and reducing surgeons overload. Using a wearable eye tracker device, we measured gaze entropy and velocity of surgical trainees and attending surgeons during two surgical procedures (LESS vs. multiport laparoscopy surgery [MPS]). None of the participants had previous experience with LESS. They performed two exercises with different complexity levels (Low: Pattern Cut vs. High: Peg Transfer). We also collected performance and subjective data. LESS caused higher cognitive demand than MPS, as indicated by increased gaze entropy in both surgical trainees and attending surgeons (exploration pattern became more random). Furthermore, gaze velocity was higher (exploration pattern became more rapid) for the LESS procedure independently of the surgeon's expertise. Perceived task complexity and laparoscopic accuracy confirmed gaze-based results. Gaze-based indices have great potential as objective and non-intrusive measures to assess surgeons' cognitive cost and fitness-for-duty. Furthermore, gaze-based indices might play a relevant role in defining future guidelines on surgeons' examinations to mark their achievements during the entire training (e.g. analyzing surgical learning curves). Copyright © 2017 Elsevier Ltd. All rights reserved.

Current status of natural orifice trans-endoscopic surgery (NOTES and laparoendoscopic single site surgery (LESS in urologic surgery

Directory of Open Access Journals (Sweden)

Rafael E. Sanchez-Salas

2010-08-01

Full Text Available Laparoendoscopic single site surgery (LESS and natural orifice transluminal endoscopic surgery (NOTES represent novel approaches in urological surgery. To perform a review of the literature in order describe the current status of LESS and NOTES in Urology. References for this manuscript were obtained by performing a review of the available literature in PubMed from 01-01-02 to 15-05-09. Search terms included single port, single site, NOTES, LESS and single incision. A total of 412 manuscripts were initially identified. Out of these, 64 manuscripts were selected based in their urological content. The manuscript features subheadings for experimental and clinical studies, as NOTES-LESS is a new surgical technique and its future evolution will probably rely in initial verified feasibility. A subheading for reviews presents information regarding common language and consensus for the techniques. The issue of complications published in clinical series and the future needs of NOTES-LESS, are also presented.

10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands : a population-based study

NARCIS (Netherlands)

van Maaren, Marissa C.; de Munck, Linda; de Bock, Geertruida H.; Jobsen, Jan J.; van Dalen, Thijs; Linn, Sabine C.; Poortmans, Philip; Strobbe, Luc J A; Siesling, Sabine

Background Investigators of registry-based studies report improved survival for breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer. As these studies did not present long-term overall and breast cancer-specific survival, the effect of breast-conserving surgery

Uniting Evidence-Based Evaluation with the ACGME Plastic Surgery Milestones: A Simple and Reliable Assessment of Resident Operative Performance.

Science.gov (United States)

Kobraei, Edward M; Bohnen, Jordan D; George, Brian C; Mullen, John T; Lillemoe, Keith D; Austen, William G; Liao, Eric C

2016-08-01

Milestones evaluations in plastic surgery reflect a shift toward competency-based training but have created a number of challenges. The authors have incorporated the smartphone application evaluation tool, System for Improving and Measuring Procedural Learning (SIMPL), that was recently developed by a multi-institutional research collaborative. In this pilot study, the authors hypothesize that SIMPL can improve resident evaluation and also collect granular performance data to simplify compliance with the plastic surgery Milestones. SIMPL was prospectively piloted with a plastic surgery resident and faculty surgeon at Massachusetts General Hospital in this institutional review board-approved study. The study period was a 2-month interval corresponding to the resident's rotation. The resident-faculty combination performed 20 cases together. All cases were evaluated with SIMPL. SIMPL evaluations uniformly took under 1 minute to submit. The average time to completed evaluation from surgery completion was 5 hours (technology will support a shared vocabulary between residents and faculty to enhance intraoperative education.

Readability of Patient Education Materials in Hand Surgery and Health Literacy Best Practices for Improvement.

Science.gov (United States)

Hadden, Kristie; Prince, Latrina Y; Schnaekel, Asa; Couch, Cory G; Stephenson, John M; Wyrick, Theresa O

2016-08-01

This study aimed to update a portion of a 2008 study of patient education materials from the American Society for Surgery of the Hand Web site with new readability results, to compare the results to health literacy best practices, and to make recommendations to the field for improvement. A sample of 77 patient education documents were downloaded from the American Society for Surgery of the Hand Web site, handcare.org, and assessed for readability using 4 readability tools. Mean readability grade-level scores were derived. Best practices for plain language for written health materials were compiled from 3 government agency sources. The mean readability of the 77 patient education documents in the study was 9.3 grade level. This reading level is reduced from the previous study in 2008 in which the overall mean was 10.6; however, the current sample grade level still exceeds recommended readability according to best practices. Despite a small body of literature on the readability of patient education materials related to hand surgery and other orthopedic issues over the last 7 years, readability was not dramatically improved in our current sample. Using health literacy as a framework, improvements in hand surgery patient education may result in better understanding and better outcomes for patients seeing hand surgeons. Improved understanding of patient education materials related to hand surgery may improve preventable negative outcomes that are clinically significant as well as contribute to improved quality of life for patients. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Dendritic cell-based vaccine in advanced melanoma: update of clinical outcome.

Science.gov (United States)

Ridolfi, Laura; Petrini, Massimiliano; Fiammenghi, Laura; Granato, Anna Maria; Ancarani, Valentina; Pancisi, Elena; Brolli, Claudia; Selva, Mirna; Scarpi, Emanuela; Valmorri, Linda; Nicoletti, Stefania Vittoria Luisa; Guidoboni, Massimo; Riccobon, Angela; Ridolfi, Ruggero

2011-12-01

Dendritic cells (DCs) are unique specialized antigen-presenting cells capable of priming naive T cells and inducing antigen-specific cytotoxic T lymphocytes. This study presents an update of clinical results from a DC-based phase I-II clinical vaccine trial in stage IV melanoma. From 2003 to 2010, 27 patients with metastatic melanoma were treated with mature DCs pulsed with autologous tumor lysate and keyhole limpet hemocyanin and with subcutaneous low-dose interleukin-2. Delayed-type hypersensitivity (DTH) tests for in-vivo immunomonitoring were performed at baseline and every four vaccinations thereafter. Two complete, two mixed and six partial responses, and five stable diseases were observed (overall response, 37.0%; clinical benefit, 55.5%). All 15 responders showed DTH positivity. A median overall survival of 22.9 months [95% confidence interval (CI): 13.4-61.3] for DTH-positive patients (19) and 4.8 months (95% CI: 3.9-11.9) for DTH-negative patients (8; log rank=7.26; P=0.007) was observed. The overall median overall survival was 16 months (95% CI: 9-33). Our results would seem to highlight a relationship between positive-DTH test and an improved survival.

Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016.

Science.gov (United States)

Bikson, Marom; Grossman, Pnina; Thomas, Chris; Zannou, Adantchede Louis; Jiang, Jimmy; Adnan, Tatheer; Mourdoukoutas, Antonios P; Kronberg, Greg; Truong, Dennis; Boggio, Paulo; Brunoni, André R; Charvet, Leigh; Fregni, Felipe; Fritsch, Brita; Gillick, Bernadette; Hamilton, Roy H; Hampstead, Benjamin M; Jankord, Ryan; Kirton, Adam; Knotkova, Helena; Liebetanz, David; Liu, Anli; Loo, Colleen; Nitsche, Michael A; Reis, Janine; Richardson, Jessica D; Rotenberg, Alexander; Turkeltaub, Peter E; Woods, Adam J

2016-01-01

This review updates and consolidates evidence on the safety of transcranial Direct Current Stimulation (tDCS). Safety is here operationally defined by, and limited to, the absence of evidence for a Serious Adverse Effect, the criteria for which are rigorously defined. This review adopts an evidence-based approach, based on an aggregation of experience from human trials, taking care not to confuse speculation on potential hazards or lack of data to refute such speculation with evidence for risk. Safety data from animal tests for tissue damage are reviewed with systematic consideration of translation to humans. Arbitrary safety considerations are avoided. Computational models are used to relate dose to brain exposure in humans and animals. We review relevant dose-response curves and dose metrics (e.g. current, duration, current density, charge, charge density) for meaningful safety standards. Special consideration is given to theoretically vulnerable populations including children and the elderly, subjects with mood disorders, epilepsy, stroke, implants, and home users. Evidence from relevant animal models indicates that brain injury by Direct Current Stimulation (DCS) occurs at predicted brain current densities (6.3-13 A/m(2)) that are over an order of magnitude above those produced by conventional tDCS. To date, the use of conventional tDCS protocols in human trials (≤40 min, ≤4 milliamperes, ≤7.2 Coulombs) has not produced any reports of a Serious Adverse Effect or irreversible injury across over 33,200 sessions and 1000 subjects with repeated sessions. This includes a wide variety of subjects, including persons from potentially vulnerable populations. Copyright © 2016 Elsevier Inc. All rights reserved.

The quality of research synthesis in surgery: the case of laparoscopic surgery for colorectal cancer

Directory of Open Access Journals (Sweden)

Martel Guillaume

2012-02-01

Full Text Available Abstract Background Several systematic reviews and meta-analyses populate the literature on the effectiveness of laparoscopic surgery for colorectal cancer. The utility of this body of work is unclear. The objective of this study was to synthesize all such systematic reviews in terms of clinical effectiveness, to appraise their quality, and to determine whether areas of duplication exist across reviews. Methods Systematic reviews comparing laparoscopic and open surgery for colorectal cancer were identified using a comprehensive search protocol (1991 to 2008. The primary outcome was overall survival. The methodological quality of reviews was appraised using the Assessment of Multiple Systematic Reviews (AMSTAR instrument. Abstraction and quality appraisal was carried out by two independent reviewers. Reviews were synthesized, and outcomes were compared qualitatively. A citation analysis was carried out using simple matrices to assess the comprehensiveness of each review. Results In total, 27 reviews were included; 13 reviews included only randomized controlled trials. Rectal cancer was addressed exclusively by four reviews. There was significant overlap between review purposes, populations and, outcomes. The mean AMSTAR score (out of 11 was 5.8 (95% CI: 4.6 to 7.0. Overall survival was evaluated by ten reviews, none of which found a significant difference. Three reviews provided a selective meta-analysis of time-to-event data. Previously published systematic reviews were poorly and highly selectively referenced (mean citation ratio 0.16, 95% CI: 0.093 to 0.22. Previously published trials were not comprehensively identified and cited (mean citation ratio 0.56, 95% CI: 0.46 to 0.65. Conclusions Numerous overlapping systematic reviews of laparoscopic and open surgery for colorectal cancer exist in the literature. Despite variable methods and quality, survival outcomes are congruent across reviews. A duplication of research efforts appears to exist

Lecithin-based nanostructured gels for skin delivery: an update on state of art and recent applications.

Science.gov (United States)

Elnaggar, Yosra S R; El-Refaie, Wessam M; El-Massik, Magda A; Abdallah, Ossama Y

2014-04-28

Conventional carriers for skin delivery encounter obstacles of drug leakage, scanty permeation and low entrapment efficiency. Phospholipid nanogels have recently been recognized as prominent delivery systems to circumvent such obstacles and impart easier application. The current review provides an overview on different types of lecithin nanostructured gels, with particular emphasis on liposomal versus microemulsion gelled systems. Liposomal gels investigated encompassed classic liposomal hydrogel, modified liposomal gels (e.g. Transferosomal, Ethosomal, Pro-liposomal and Phytosomal gels), Microgel in liposomes (M-i-L) and Vesicular phospholipid gel (VPG). Microemulsion gelled systems encompassed Lecithin microemulsion-based organogels (LMBGs), Pluronic lecithin organogels (PLOs) and Lecithin-stabilized microemulsion-based hydrogels. All systems were reviewed regarding matrix composition, state of art, characterization and updated applications. Different classes of lecithin nanogels exhibited crucial impact on transdermal delivery regarding drug permeation, drug loading and stability aspects. Future perspectives of this theme issue are discussed based on current laboratory studies. Copyright © 2014 Elsevier B.V. All rights reserved.

[History of cranial surgery, cerebral tumor surgery and epilepsy surgery in Mexico].

Science.gov (United States)

Chico-Ponce de León, F

2009-08-01

The first report of intra-cerebral tumor surgery was provided by Bennett & Goodle, in London, 1884. Worldwide this kind of surgery was performed in France by Chipault, in Italy by Durante, in the United States by Keen and in Deutchland by Krause & Oppenheim. Lavista in Mexico City operated on intra-cerebral tumor in 1891, and the report was printed in 1892. In the same publication, Lavista exhibited the first cases of epilepsy surgery. Since now, it is the first report of this kind of surgery in the Spanish-speaking world.

Detection of the early keratoconus based on corneal biomechanical properties in the refractive surgery candidates

Directory of Open Access Journals (Sweden)

Zofia Pniakowska

2016-01-01

Full Text Available Context: Subclinical keratoconus is contraindication to refractive surgery. The currently used methods of preoperative screening do not always allow differentiating between healthy eyes and those with subclinical keratoconus. Aim: To evaluate biomechanical parameters of the cornea, waveform score (WS, and intraocular pressure (IOP as potentially useful adjuncts to the diagnostic algorithm for precise detection of the early keratoconus stages and selection of refractive surgery candidates. Settings and Design: Department of Ophthalmology and prospective cross-sectional study. Patients and Methods: Patients enrolled in the study were diagnosed with refractive disorders. We assessed parameters of corneal biomechanics such as corneal hysteresis (CH, corneal resistance factor (CRF, Goldman-correlated IOP (IOPg, corneal compensated IOP, WS, and keratoconus match index (KMI. They were classified into one of three groups based on the predefined KMI range: Group 1 (from 0.352 to 0.757 – 45 eyes, Group 2 (from −0.08 to 0.313 – 52 eyes, and Group 0 - control group (from 0.761 to 1.642 – 80 eyes. Results: In both study groups, IOPg, CRF, and CH were decreased when compared to control (P < 0.0001. In control group, there was positive correlation between CH and KMI (P < 0.05, with no correlations in any of the two study groups. CRF correlated positively with KMI in control (P < 0.0001 and in Group 2 (P < 0.05. Conclusions: CH and CRF, together with WS and IOPg, consist a clinically useful adjunct to detect subclinical keratoconus in patients referred for refractive surgery when based on KMI staging.

Adolescent bariatric surgery: review on nutrition considerations.

Science.gov (United States)

Nogueira, Isadora; Hrovat, Kathleen

2014-12-01

The prevalence of obesity in adolescents has dramatically increased over the past 3 decades in the United States. Weight loss surgery is becoming a viable treatment option for obese adolescents. The number of surgeries being performed yearly is rising, and this trend is likely to continue. Adolescent patients present a unique challenge to clinicians. There are currently best-practice recommendations and evidence-based nutrition guidelines for the treatment of the adolescent bariatric patient. A review of the current literature was performed to discuss bariatric surgery and nutrition for the adolescent patient. Studies show that most adolescents with obesity will become obese adults, thus increasing their risk of developing serious and debilitating health conditions. It is recommended that the candidates for surgery be referred to a practice that has a multidisciplinary team experienced in meeting the distinct physical and psychological needs of adolescents. Specific nutrition concerns for the adolescent bariatric patient include preoperative educational pathway, postoperative dietary progression, female reproduction, compliance with vitamin/supplementation recommendations, laboratory tests, and long-term monitoring. The medical literature has reported positive outcomes of bariatric surgery in adolescents with severe obesity. Before surgery is offered as an option, unique factors to adolescents must be addressed. The multidisciplinary clinical team must consider the adolescents' cognitive, social, and emotional development when considering their candidacy for surgery. As the number of adolescent bariatric surgery programs increases, continued research and long-term outcome data need to be collected and shared to base future treatment decisions. © 2014 American Society for Parenteral and Enteral Nutrition.

Laser apparatus for surgery and force therapy based on high-power semiconductor and fibre lasers

International Nuclear Information System (INIS)

Minaev, V P

2005-01-01

High-power semiconductor lasers and diode-pumped lasers are considered whose development qualitatively improved the characteristics of laser apparatus for surgery and force therapy, extended the scope of their applications in clinical practice, and enhanced the efficiency of medical treatment based on the use of these lasers. The characteristics of domestic apparatus are presented and their properties related to the laser emission wavelength used in them are discussed. Examples of modern medical technologies based on these lasers are considered. (invited paper)

An evidence-based approach to perioperative nutrition support in the elective surgery patient.

Science.gov (United States)

Miller, Keith R; Wischmeyer, Paul E; Taylor, Beth; McClave, Stephen A

2013-09-01

In surgical practice, great attention is given to the perioperative management of the elective surgical patient with regard to surgical planning, stratification of cardiopulmonary risk, and postoperative assessment for complication. However, growing evidence supports the beneficial role for implementation of a consistent and literature-based approach to perioperative nutrition therapy. Determining nutrition risk should be a routine component of the preoperative evaluation. As with the above issues, this concept begins with the clinician's first visit with the patient as risk is assessed and the severity of the surgical insult considered. If the patient is an appropriate candidate for benefit from preoperative support, a plan for initiation and reassessment should be implemented. Once appropriate nutrition end points have been achieved, special consideration should be given to beneficial practices the immediate day preceding surgery that may better prepare the patient for the intervention from a metabolic standpoint. In the operating room, consideration should be given to the potential placement of enteral access during the index operation as well as judicious and targeted intraoperative resuscitation. Immediately following the intervention, adequate resuscitation and glycemic control are key concepts, as is an evidence-based approach to the early advancement of an enteral/oral diet in the postoperative patient. Through the implementation of perioperative nutrition therapy plans in the elective surgery setting, outcomes can be improved.

WIMS-D library update

International Nuclear Information System (INIS)

2007-05-01

WIMS-D (Winfrith Improved Multigroup Scheme-D) is the name of a family of software packages for reactor lattice calculations and is one of the few reactor lattice codes in the public domain and available on noncommercial terms. WIMSD-5B has recently been released from the OECD Nuclear Energy Agency Data Bank, and features major improvements in machine portability, as well as incorporating a few minor corrections. This version supersedes WIMS-D/4, which was released by the Winfrith Technology Centre in the United Kingdom for IBM machines and has been adapted for various other computer platforms in different laboratories. The main weakness of the WIMS-D package is the multigroup constants library, which is based on very old data. The relatively good performance of WIMS-D is attributed to a series of empirical adjustments to the multigroup data. However, the adjustments are not always justified on the basis of more accurate and recent experimental measurements. Following the release of new and revised evaluated nuclear data files, it was felt that the performance of WIMS-D could be improved by updating the associated library. The WIMS-D Library Update Project (WLUP) was initiated in the early 1990s with the support of the IAEA. This project consisted of voluntary contributions from a large number of participants. Several benchmarks for testing the library were identified and analysed, the WIMSR module of the NJOY code system was upgraded and the author of NJOY accepted the proposed updates for the official code system distribution. A detailed parametric study was performed to investigate the effects of various data processing input options on the integral results. In addition, the data processing methods for the main reactor materials were optimized. Several partially updated libraries were produced for testing purposes. The final stage of the WLUP was organized as a coordinated research project (CRP) in order to speed up completion of the fully updated library

Technical procedures for template-guided surgery for mandibular reconstruction based on digital design and manufacturing.

Science.gov (United States)

Liu, Yun-feng; Xu, Liang-wei; Zhu, Hui-yong; Liu, Sean Shih-Yao

2014-05-23

The occurrence of mandibular defects caused by tumors has been continuously increasing in China in recent years. Conversely, results of the repair of mandibular defects affect the recovery of oral function and patient appearance, and the requirements for accuracy and high surgical quality must be more stringent. Digital techniques--including model reconstruction based on medical images, computer-aided design, and additive manufacturing--have been widely used in modern medicine to improve the accuracy and quality of diagnosis and surgery. However, some special software platforms and services from international companies are not always available for most of researchers and surgeons because they are expensive and time-consuming. Here, a new technical solution for guided surgery for the repair of mandibular defects is proposed, based on general popular tools in medical image processing, 3D (3 dimension) model reconstruction, digital design, and fabrication via 3D printing. First, CT (computerized tomography) images are processed to reconstruct the 3D model of the mandible and fibular bone. The defect area is then replaced by healthy contralateral bone to create the repair model. With the repair model as reference, the graft shape and cutline are designed on fibular bone, as is the guide for cutting and shaping. The physical model, fabricated via 3D printing, including surgical guide, the original model, and the repair model, can be used to preform a titanium locking plate, as well as to design and verify the surgical plan and guide. In clinics, surgeons can operate with the help of the surgical guide and preformed plate to realize the predesigned surgical plan. With sufficient communication between engineers and surgeons, an optimal surgical plan can be designed via some common software platforms but needs to be translated to the clinic. Based on customized models and tools, including three surgical guides, preformed titanium plate for fixation, and physical models of

Bipolar disorder: an update | Outhoff | South African Family Practice

African Journals Online (AJOL)

Bipolar disorder, characterised by alternating discrete episodes of (hypo)mania and depression, provides unique diagnostic and treatment challenges. Updated diagnostic (DSM-5) and current pharmacological treatment recommendations are briefly reviewed here. Keywords: bipolar disorder; diagnosis; evidence-based ...

Reliability based impact localization in composite panels using Bayesian updating and the Kalman filter

Science.gov (United States)

Morse, Llewellyn; Sharif Khodaei, Zahra; Aliabadi, M. H.

2018-01-01

In this work, a reliability based impact detection strategy for a sensorized composite structure is proposed. Impacts are localized using Artificial Neural Networks (ANNs) with recorded guided waves due to impacts used as inputs. To account for variability in the recorded data under operational conditions, Bayesian updating and Kalman filter techniques are applied to improve the reliability of the detection algorithm. The possibility of having one or more faulty sensors is considered, and a decision fusion algorithm based on sub-networks of sensors is proposed to improve the application of the methodology to real structures. A strategy for reliably categorizing impacts into high energy impacts, which are probable to cause damage in the structure (true impacts), and low energy non-damaging impacts (false impacts), has also been proposed to reduce the false alarm rate. The proposed strategy involves employing classification ANNs with different features extracted from captured signals used as inputs. The proposed methodologies are validated by experimental results on a quasi-isotropic composite coupon impacted with a range of impact energies.

Remission of Type 2 Diabetes Mellitus in Patients After Different Types of Bariatric Surgery: A Population-Based Cohort Study in the United Kingdom.

Science.gov (United States)

Yska, Jan Peter; van Roon, Eric N; de Boer, Anthonius; Leufkens, Hubert G M; Wilffert, Bob; de Heide, Loek J M; de Vries, Frank; Lalmohamed, Arief

2015-12-01

To our knowledge, an observational study on the remission of type 2 diabetes mellitus (T2DM) after different types of bariatric surgery based on data from general practice has not been carried out. To assess the effect of different types of bariatric surgery in patients with T2DM on diabetes remission compared with matched control patients, and the effect of the type of bariatric surgery on improvement of glycemic control and related clinical parameters. A retrospective cohort study conducted from May 2013 to May 2014 within the Clinical Practice Research Datalink involving 2978 patients with a record of bariatric surgery (2005-2012) and a body mass index (calculated as weight in kilograms divided by height in meters squared) of 35 or greater. We identified 569 patients with T2DM and matched them to 1881 patients with diabetes without bariatric surgery. Data on the use of medication and laboratory results were evaluated. Bariatric surgery, stratified by type of surgery (gastric banding, Roux-en-Y gastric bypass, sleeve gastrectomy, or other/unknown). Remission of T2DM (complete discontinuation of glycemic therapy, accompanied with a subsequently recorded hemoglobin A1c levelpatients undergoing bariatric surgery, we found a prevalence of 19.1% for T2DM. Per 1000 person-years, 94.5 diabetes mellitus remissions were found in patients who underwent bariatric surgery compared with 4.9 diabetes mellitus remissions in matched control patients. Patients with diabetes who underwent bariatric surgery had an 18-fold increased chance for T2DM remission (adjusted relative rate [RR], 17.8; 95% CI, 11.2-28.4) compared with matched control patients. The greatest effect size was observed for gastric bypass (adjusted RR, 43.1; 95% CI, 19.7-94.5), followed by sleeve gastrectomy (adjusted RR, 16.6; 95% CI, 4.7-58.4) and gastric banding (adjusted RR, 6.9; 95% CI, 3.1-15.2). Body mass index and triglyceride, blood glucose, and hemoglobin A1c levels sharply decreased during the first 2

Updated clinical guidelines experience major reporting limitations

Directory of Open Access Journals (Sweden)

Robin W.M. Vernooij

2017-10-01

Full Text Available Abstract Background The Checklist for the Reporting of Updated Guidelines (CheckUp was recently developed. However, so far, no systematic assessment of the reporting of updated clinical guidelines (CGs exists. We aimed to examine (1 the completeness of reporting the updating process in CGs and (2 the inter-observer reliability of CheckUp. Methods We conducted a systematic assessment of the reporting of the updating process in a sample of updated CGs using CheckUp. We performed a systematic search to identify updated CGs published in 2015, developed by a professional society, reporting a systematic review of the evidence, and containing at least one recommendation. Three reviewers independently assessed the CGs with CheckUp (16 items. We calculated the median score per item, per domain, and overall, converting scores to a 10-point scale. Multiple linear regression analyses were used to identify differences according to country, type of organisation, scope, and health topic of updated CGs. We calculated the intraclass coefficient (ICC and 95% confidence interval (95% CI for domains and overall score. Results We included in total 60 updated CGs. The median domain score on a 10-point scale for presentation was 5.8 (range 1.7 to 10, for editorial independence 8.3 (range 3.3 to 10, and for methodology 5.7 (range 0 to 10. The median overall score on a 10-point scale was 6.3 (range 3.1 to 10. Presentation and justification items at recommendation level (respectively reported by 27 and 38% of the CGs and the methods used for the external review and implementing changes in practice were particularly poorly reported (both reported by 38% of the CGs. CGs developed by a European or international institution obtained a statistically significant higher overall score compared to North American or Asian institutions (p = 0.014. Finally, the agreement among the reviewers on the overall score was excellent (ICC 0.88, 95% CI 0.75 to 0.95. Conclusions The

The updating of clinical practice guidelines: insights from an international survey

Directory of Open Access Journals (Sweden)

Solà Ivan

2011-09-01

Full Text Available Abstract Background Clinical practice guidelines (CPGs have become increasingly popular, and the methodology to develop guidelines has evolved enormously. However, little attention has been given to the updating process, in contrast to the appraisal of the available literature. We conducted an international survey to identify current practices in CPG updating and explored the need to standardize and improve the methods. Methods We developed a questionnaire (28 items based on a review of the existing literature about guideline updating and expert comments. We carried out the survey between March and July 2009, and it was sent by email to 106 institutions: 69 members of the Guidelines International Network who declared that they developed CPGs; 30 institutions included in the U.S. National Guideline Clearinghouse database that published more than 20 CPGs; and 7 institutions selected by an expert committee. Results Forty-four institutions answered the questionnaire (42% response rate. In the final analysis, 39 completed questionnaires were included. Thirty-six institutions (92% reported that they update their guidelines. Thirty-one institutions (86% have a formal procedure for updating their guidelines, and 19 (53% have a formal procedure for deciding when a guideline becomes out of date. Institutions describe the process as moderately rigorous (36% or acknowledge that it could certainly be more rigorous (36%. Twenty-two institutions (61% alert guideline users on their website when a guideline is older than three to five years or when there is a risk of being outdated. Twenty-five institutions (64% support the concept of "living guidelines," which are continuously monitored and updated. Eighteen institutions (46% have plans to design a protocol to improve their guideline-updating process, and 21 (54% are willing to share resources with other organizations. Conclusions Our study is the first to describe the process of updating CPGs among prominent

Circular Updates

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Circular Updates are periodic sequentially numbered instructions to debriefing staff and observers informing them of changes or additions to scientific and specimen...

The Plastic Surgery Hand Curriculum.

Science.gov (United States)

Silvestre, Jason; Levin, L Scott; Serletti, Joseph M; Chang, Benjamin

2015-12-01

Designing an effective hand rotation for plastic surgery residents is difficult. The authors address this limitation by elucidating the critical components of the hand curriculum during plastic surgery residency. Hand questions on the Plastic Surgery In-Service Training Exam for six consecutive years (2008 to 2013) were characterized by presence of imaging, vignette setting, question taxonomy, answer domain, anatomy, and topic. Answer references were quantified by source and year of publication. Two hundred sixty-six questions were related to hand surgery (22.7 percent of all questions; 44.3 per year) and 61 were accompanied by an image (22.9 percent). Vignettes tended to be clinic- (50.0 percent) and emergency room-based (35.3 percent) (p < 0.001). Questions required decision-making (60.5 percent) over interpretation (25.9 percent) and recall skills (13.5 percent) (p < 0.001). Answers focused on interventions (57.5 percent) over anatomy/pathology (25.2 percent) and diagnoses (17.3 percent) (p < 0.001). Nearly half of the questions focused on the digits. The highest yield topics were trauma (35.3 percent), reconstruction (24.4 percent), and aesthetic and functional problems (14.2 percent). The Journal of Hand Surgery (American volume) (20.5 percent) and Plastic and Reconstructive Surgery (18.0 percent) were the most-cited journals, and the median publication lag was 7 years. Green's Operative Hand Surgery was the most-referenced textbook (41.8 percent). These results will enable trainees to study hand surgery topics with greater efficiency. Faculty can use these results to ensure that tested topics are covered during residency training. Thus, a benchmark is established to improve didactic, clinical, and operative experiences in hand surgery.