The globalization of science makes medical writing, editing and revision a rapidly growing field of linguistic study and practice. Medical science texts are written according to uniform, general guidelines and medical genres have become highly conventionalized in terms of structure and linguistic...... form. Medical editing often takes the form of peer review and mainly addresses issues of contents and overall validity. Medical revision incorporates the checking of the macrostructure and the microstructure of the text, its language and style and its suitability for the target reader or client...
Hinkson, Elizabeth; Mauter, Elaine; Wilson, Louise; Johansen, Annette; Maughan, Erin D.
It is the position of the National Association of School Nurses (NASN) that the registered professional school nurse (hereinafter referred to as school nurse) be responsible for medication administration in the school setting, leading the development of written medication administration policies and procedures that focus on safe and efficient…
... SOCIAL SECURITY ADMINISTRATION [Docket No. SSA-2010-0078] Revised Medical Criteria for Evaluating Visual Disorders AGENCY: Social Security Administration. ACTION: Final rules; Correction. SUMMARY: The Social Security Administration published a document in the Federal Register of March 28, 2013, in FR Doc...
Beichel, R.R.; Sonka, M.
This book constitutes the thoroughly refereed post proceedings of the international workshop Computer Vision Approaches to Medical Image Analysis, CVAMIA 2006, held in Graz, Austria in May 2006 as a satellite event of the 9th European Conference on Computer Vision, EECV 2006. The 10 revised full papers and 11 revised poster papers presented together with 1 invited talk were carefully reviewed and selected from 38 submissions. The papers are organized in topical sections on clinical applications, image registration, image segmentation and analysis, and the poster session. (orig.)
Meng, Yongliang; Liang, Yongxuan
The Bureau for Revising Medical Books was a temporary agency established by the government of the Northern Song Dynasty in 1057, the 2nd year of Jiayou of Emperor Renzong, exclusively for the edition, revision and publishing of ancient medical books. 11 medical books were revised and edited by 13 Bureau members in a period of 12 years until 1069, the 2nd year of Xining of Emperor ShenZong, which eventually became the final versions until today. 8 medical books were initially planned for the revision, but 11 were actually completed in the end. The time for completing a revision varied from over 10 years at most to less than 1 year at least. Instead of working in the office, the officers of the Bureau for Revising Medical Books did their works at home. The members of the said Bureau came from the Tiju officer of the Bureau for Revising Medical Books and the officials of revising medical books, consisting of both Confucian ministers and medical officers. Confucian ministers played an important role in revising medical books. The Bureau had a strict workflow in electing revising officials, making the project, and the determination of the principles and arrangements of the tasks of editing and proofreading.
The Centers for Disease Control and Prevention (CDC), within the Department of Health and Human Services (HHS), is issuing this final rule (FR) to amend its regulations governing medical examinations that aliens must undergo before they may be admitted to the United States. Based on public comment received, HHS/CDC did not make changes from the NPRM published on June 23, 2015. Accordingly, this FR will: Revise the definition of communicable disease of public health significance by removing chancroid, granuloma inguinale, and lymphogranuloma venereum as inadmissible health-related conditions for aliens seeking admission to the United States; update the notification of the health-related grounds of inadmissibility to include proof of vaccinations to align with existing requirements established by the Immigration and Nationality Act (INA); revise the definitions and evaluation criteria for mental disorders, drug abuse and drug addiction; clarify and revise the evaluation requirements for tuberculosis; clarify and revise the process for the HHS/CDC-appointed medical review board that convenes to reexamine the determination of a Class A medical condition based on an appeal; and update the titles and designations of federal agencies within the text of the regulation.
Seo, Jeong Seok; Wang, Hee Ryung; Woo, Young Sup; Park, Young-Min; Jeong, Jong-Hyun; Kim, Won; Shim, Se-Hoon; Lee, Jung Goo; Jon, Duk-In
Objective In 2002, the Korean Society for Affective Disorders developed the guidelines for the treatment of major depressive disorder (MDD), and revised it in 2006 and 2012. The third revision of these guidelines was undertaken to reflect advances in the field. Methods Using a 44-item questionnaire, an expert consensus was obtained on pharmacological treatment strategies for MDD 1) without or 2) with psychotic features, 3) depression subtypes, 4) maintenance, 5) special populations, 6) the choice of an antidepressant (AD) regarding safety and adverse effects, and 7) non-pharmacological biological therapies. Recommended first, second, and third-line strategies were derived statistically. Results AD monotherapy is recommended as the first-line strategy for non-psychotic depression in adults, children/adolescents, elderly adults, patient with persistent depressive disorder, and pregnant women or patients with postpartum depression or premenstrual dysphoric disorder. The combination of AD and atypical antipsychotics (AAP) was recommended for psychotic depression in adult, child/adolescent, postpartum depression, and mixed features or anxious distress. Most experts recommended stopping the ongoing initial AD and AAP after a certain period in patients with one or two depressive episodes. As an MDD treatment modality, 92% of experts are considering electroconvulsive therapy and 46.8% are applying it clinically, while 86% of experts are considering repetitive transcranial magnetic stimulation but only 31.6% are applying it clinically. Conclusion The pharmacological treatment strategy in 2017 is similar to that of Korean Medication Algorithm for Depressive Disorder 2012. The preference of AAPs was more increased. PMID:29397669
Seok Seo, Jeong; Rim Song, Hoo; Bin Lee, Hwang; Park, Young-Min; Hong, Jeong-Wan; Kim, Won; Wang, Hee-Ryung; Lim, Eun-Sung; Jeong, Jong-Hyun; Jon, Duk-In; Joon Min, Kyung; Sup Woo, Young; Bahk, Won-Myong
This study constitutes a revision of the guidelines for the treatment of major depressive disorder (MDD) issued by the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) 2006. In incorporates changes in the experts׳ consensus that occurred between 2006 and 2012 as well as information regarding newly developed and recently published clinical trials. Using a 44-item questionnaire, an expert consensus was obtained on pharmacological treatment strategies for (1) non-psychotic MDD, (2) psychotic MDD, (3) dysthymia and depression subtypes, (4) continuous and maintenance treatment, and (5) special populations; consensus was also obtained regarding (6) the choice of an antidepressant (AD) in the context of safety and adverse effects, and (7) non-pharmacological biological therapies. AD monotherapy was recommended as the first-line strategy for nonpsychotic depression in adults, children and adolescents, elderly adults, and patients with postpartum depression or premenstrual dysphoric disorder. The combination of AD and atypical antipsychotics (AAP) was recommended for psychotic depression. The duration of the initial AD treatment for psychotic depression depends on the number of depressive episodes. Most experts recommended stopping the initial AD and AAP therapy after a certain period in patients with one or two depressive episodes. However, for those with three or more episodes, maintenance of the initial treatment was recommended for as long as possible. Monotherapy with various selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) was recommended for dysthymic disorder and melancholic type MDD. The pharmacological treatment strategy of KMAP-DD 2012 is similar to that of KMAP-DD 2006; however, the preference for the first-line use of AAPs was stronger in 2012 than in 2006. Copyright © 2014 Elsevier B.V. All rights reserved.
Johannsen, Vivian Kvist; Nord-Larsen, Thomas; Riis-Nielsen, Torben
This report is a revised analysis of the Danish data on CO2 emissions from forest, afforestation and deforestation for the period 1990 - 2008 and a prognosis for the period until 2020. Revision have included measurements from 2009 in the estimations. The report is funded by the Ministry of Climate...
Full Text Available Young Sup Woo,1 Jung Goo Lee,2,3 Jong-Hyun Jeong,1 Moon-Doo Kim,4 Inki Sohn,5 Se-Hoon Shim,6 Duk-In Jon,7 Jeong Seok Seo,8 Young-Chul Shin,9 Kyung Joon Min,10 Bo-Hyun Yoon,11 Won-Myong Bahk1 1Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea; 2Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, South Korea;3Paik Institute for Clinical Research, Inje Univeristy, Busan, South Korea; 4Department of Psychiatry, Jeju National University Hospital, Jeju, South Korea; 5Department of Psychiatry, Keyo Hospital, Keyo Medical Foundation, Uiwang, South Korea; 6Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Soonchunhyang University, Cheonan, South Korea; 7Department of Psychiatry, Sacred Heart Hospital, Hallym University, Anyang, South Korea; 8Department of Psychiatry, School of Medicine, Konkuk University, Chungju, South Korea; 9Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, South Korea; 10Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, South Korea; 11Department of Psychiatry, Naju National Hospital, Naju, South Korea Objective: To constitute the third revision of the guidelines for the treatment of bipolar disorder issued by the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP 2014. Methods: A 56-item questionnaire was used to obtain the consensus of experts regarding pharmacological treatment strategies for the various phases of bipolar disorder and for special populations. The review committee included 110 Korean psychiatrists and 38 experts for child and adolescent psychiatry. Of the committee members, 64 general psychiatrists and 23 child and adolescent psychiatrists responded to the survey. Results: The treatment of choice (TOC for euphoric, mixed, and psychotic mania was the combination of a mood stabilizer (MS and an atypical antipsychotic (AAP; the TOC for
Unni, Elizabeth J; Olson, Jeffery L; Farris, Karen B
Medication non-adherence is a complex phenomenon that requires tailored interventions to improve it. A new self-reported measure of medication non-adherence was previously reported based on the commonly reported reasons underlying non-adherence with the intention to match the items in the scale with tailored interventions. The objectives were to revise the original Medication Adherence Reasons Scale (MAR-Scale) based on expert opinion and cognitive interviewing, and establish the psychometric properties of the revised scale. A cross-sectional design was used in cholesterol lowering and asthma maintenance medications in collaboration with an integrated medical center in the Mountain West. In the first phase, the original MAR-Scale was revised based on expert opinion and cognitive interviewing. In the second phase, the revised MAR-Scale was tested for psychometric properties in a random sample of 350 subjects on each medication. Revisions based on expert opinion included asking a global question about adherence in the past 7 days, simplifying the items and converting them into first person sentences, objective anchoring of the scale, and expanding the 'forgetfulness' item. Cognitive interviewing added one additional item to the survey. The revised MAR- Scale identified 50% of the cholesterol lowering respondents and 68% of the asthma maintenance respondents as non-adherents. An exploratory factor analysis identified four domains in the scale, with Cronbach's alpha ranging from 0.848-0.953 in cholesterol lowering and 0.827-0.891 in asthma maintenance medications. The scale also exhibited significant correlations with few other self-reported measures, consistent with hypotheses. A key limitation of the study was the moderate response rate to the survey for both medications. The revised MAR-Scale demonstrates better psychometric properties than the original.
Waste Management Group
These guidelines describe procedures to comply with all Federal and State laws and regulations and Lawrence Berkeley National Laboratory (LBNL) policy applicable to State-regulated medical and unregulated, but biohazardous, waste (medical/biohazardous waste). These guidelines apply to all LBNL personnel who: (1) generate and/or store medical/biohazardous waste, (2) supervise personnel who generate medical/biohazardous waste, or (3) manage a medical/biohazardous waste pickup location. Personnel generating biohazardous waste at the Joint Genome Institute/Production Genomics Facility (JGI/PGF) are referred to the guidelines contained in Section 9. Section 9 is the only part of these guidelines that apply to JGI/PGF. Medical/biohazardous waste referred to in this Web site includes biohazardous, sharps, pathological and liquid waste. Procedures for proper storage and disposal are summarized in the Solid Medical/Biohazardous Waste Disposal Procedures Chart. Contact the Waste Management Group at 486-7663 if you have any questions regarding medical/biohazardous waste management
This Guide describes the procedures required to comply with all federal and state laws and regulations and Lawrence Berkeley Laboratory (LBL) policy applicable to medical and biohazardous waste. The members of the LBL Biological Safety Subcommittee participated in writing these policies and procedures. The procedures and policies in this Guide apply to LBL personnel who work with infectious agents or potentially infectious agents, publicly perceived infectious items or materials (e.g., medical gloves, culture dishes), and sharps (e.g., needles, syringes, razor blades). If medical or biohazardous waste is contaminated or mixed with a hazardous chemical or material, with a radioactive material, or with both, the waste will be handled in accordance with the applicable federal and State of California laws and regulations for hazardous, radioactive, or mixed waste.
This Guide describes the procedures required to comply with all federal and state laws and regulations and Lawrence Berkeley Laboratory (LBL) policy applicable to medical and biohazardous waste. The members of the LBL Biological Safety Subcommittee participated in writing these policies and procedures. The procedures and policies in this Guide apply to LBL personnel who work with infectious agents or potentially infectious agents, publicly perceived infectious items or materials (e.g., medical gloves, culture dishes), and sharps (e.g., needles, syringes, razor blades). If medical or biohazardous waste is contaminated or mixed with a hazardous chemical or material, with a radioactive material, or with both, the waste will be handled in accordance with the applicable federal and State of California laws and regulations for hazardous, radioactive, or mixed waste
Mantas, John; Ammenwerth, Elske; Demiris, George; Hasman, Arie; Haux, Reinhold; Hersh, William; Hovenga, Evelyn; Lun, K. C.; Marin, Heimar; Martin-Sanchez, Fernando; Wright, Graham
Objective: The International Medical Informatics Association (IMIA) agreed on revising the existing international recommendations in health informatics/medical informatics education. These should help to establish courses, course tracks or even complete programs in this field, to further develop
... chronic anemia. We propose a new listing 7.05D for transfusion-dependent beta thalassemia major. In.../pdf ). Cunningham, M.J., et al., Complications of beta-thalassemia major in North America, Blood, Jul... equal medical significance to transfusion-dependent thalassemia. Proposed section 7.00D--What are...
Voracek, Martin; Tran, Ulrich S.; Sonneck, Gernot
Psychometric properties and demographic correlates of a German form of R. W. Hubbard and J. L. McIntosh's (1992) Revised Facts on Suicide Quiz (RFOS), an inventory for assessing overall knowledge about suicide, were investigated in a sample of 1,093 Austrian medical and psychology students. Internal consistency of the RFOS was weak, as were many…
Zamor, Eliza; Chigerwe, Munashe; Boudreaux, Karen A; Ilkiw, Jan E
The objective of this study was to determine if a revised, recently implemented curriculum, embracing an integrated block design with a focus on student-centered, inquiry-based learning, had a different effect on veterinary medical students' approaches to studying than the previous curriculum. A total of 577 students completed a questionnaire consisting of the short version of the Approaches and Study Skills Inventory for Students (ASSIST). It included questions relating to conceptions about learning, approaches to studying, and preferences for different types of courses and teaching. In addition, students were asked to respond to general questions regarding the design of the revised curriculum. The scores for the deep and strategic learning approaches were higher for students studying under the previous curriculum compared to the revised curriculum, despite the fact that the revised curriculum was specifically designed to foster deep learning. The scores for the surface learning approach were lower in the students studying the revised curriculum compared to students studying under the previous curriculum. We identified the following factors affecting student learning: alteration of learning activities, such as problem-based learning, from the recommended models; a lack of instructor support for the revised curriculum; assessments that were not aligned to encourage critical thinking; and directed self-learning activities that were too comprehensive to complete in the allotted time. The results of this study can be used to improve the implementation of student-centered and inquiry-based curricula by identifying potential problems that could prevent a deep learning approach in veterinary medical students.
Miyazaki, M.; Une, H.
In Japan, the waste management practice is carried out in accordance with the Waste Disposal Law of 1970. The first rule of infectious waste management was regulated in 1992, and infectious wastes are defined as the waste materials generated in medical institutions as a result of medical care or research which contain pathogens that have the potential to transmit infectious diseases. Revised criteria for infectious waste management were promulgated by the Ministry of Environment in 2004. Infectious waste materials are divided into three categories: the form of waste; the place of waste generation; the kind of infectious diseases. A reduction of infectious waste is expected. We introduce a summary of the revised regulation of infectious waste management in this article
... DEPARTMENT OF LABOR Employee Benefits Security Administration Proposed Revision of Information Collection: Comment Request National Medical Support Notice--Part B AGENCY: Employee Benefits Security... assess the impact of its collection requirements on respondents. Currently, the Employee Benefits...
Mataroria P Lyndon
Full Text Available Objective: The purpose of this study was to determine the impact of a revised curriculum on medical student academic motivation, burnout, and quality of life. Methods: This cross-sectional comparative study involved 2 medical school cohorts of second year and fourth year medical students at The University of Auckland: a cohort under a traditional curriculum (n = 437 and a cohort under a revised curriculum (n = 446. Participants completed self-reported questionnaires measuring academic motivation, burnout, and quality of life. Two multivariate analyses of covariance (MANCOVAs were conducted. Results: The response rate was 48%. No statistically significant differences were found between curriculum cohorts for mean scores of academic motivation, personal burnout, and quality of life. However, differences were found when comparing preclinical medical students and students in their clinical years of training. In comparison with Year 2 medical students, the MANCOVA for Year 4 students showed a significant main effect for the revised curriculum with respect to both physical and environmental quality of life. Conclusions: A revised medical curriculum had a differential effect on quality of life for Year 4 students in the latter years of medical school who are based in a clinical learning environment.
Michaud, Pierre-André; Jucker-Kupper, Patrick; The Profiles Working Group
The Joint Commission of the Swiss Medical Schools (SMIFK/CIMS) decided in 2000 to establish a Swiss Catalogue of Learning Objectives (SCLO) for undergraduate medical training, which was adapted from a similar Dutch blueprint. A second version of the SCLO was developed and launched in 2008. The catalogue is a prerequisite for the accreditation of the curricula of the six Swiss medical faculties and defines the contents of the Federal Licensing Examination (FLE). Given the evolution of the field of medicine and of medical education, the SMIFK/CIMS has decided to embark on a total revision of the SCLO. This article presents the proposed structure and content of Profiles, a new document which, in the future, will direct the format of undergraduate studies and of the FLE. Profiles stands for the Principal Relevant Objectives for Integrative Learning and Education in Switzerland. It is currently being developed by a group of experts from the six Swiss faculties as well as representatives of other institutions involved in these developments. The foundations of Profiles are grounded in the evolution of medical practice and of public health and are based on up-to-date teaching concepts, such as EPAs (entrustable professional activities). An introduction will cover the concepts and a tutorial will be displayed. Three main chapters will provide a description of the seven 2015 CanMEDS roles, a list of core EPAs and a series of ≈250 situations embracing the most frequent and current conditions affecting health. As Profiles is still a work in progress, it is hoped that this paper will attract the interest of all individuals involved in the training of medical students.
Full Text Available Objectives: Competency-based medical education (CBME requires factual knowledge to be practically applied together with skills and attitudes. With the National Competence-Based Learning Objectives for Undergraduate Medical Education (NKLM representing a strong official demand for competence-orientation, it is generally important to explicitly outline its characteristics and review its realisation in teacher trainings. Further requirements are given by the core competencies for medical teachers (KLM. As an example the MQ programme (“Medizindidaktische Qualifikation” in Baden-Wuerttemberg, a long established and well-accepted training, has been critically revised on this basis, concerning its suitability for the demands of CBME, its needs for adjustment and the efforts to be undertaken for its implementation.Methods: In a systematic quality management process the MQ curriculum and its organisational framing were analysed and further developed in a step-wise comprehensive approach, using the six-step cycle by Kern. The procedures included a thorough needs assessment (e.g. literature research, programme mapping, strategic decisions on structure and content, piloting and evaluation. During the process essential elements of project and change management were considered.Results: The experiences of the MQ example revealed helpful information for key factors to be considered in the pending change process any training provider will be confronted with. Guiding questions were developed related to the process phases. Our analyses showed persistent key points of proven value as stable foundation for change, as well as components needing special consideration to foster competence-oriented aims and transfer into practice: reflection, feedback, application-oriented methods and transparent competence development. These aspects have to be consciously perceived and experienced by participants. Taking this into account, we re-designed the course evidence
Aggarwal, Rakesh; Gogtay, Nithya; Kumar, Rajeev; Sahni, Peush
Note: This editorial is being published simultaneously in the Indian Heart Journal, Indian Journal of Anaesthesia, Indian Journal of Gastroenterology, Indian Journal of Medical Ethics, Indian Journal of Medical Microbiology, Indian Journal of Occupational and Environmental Medicine, Indian Journal of Pathology and Microbiology, Indian Journal of Pharmacology, Indian Journal of Physiology and Pharmacology, Indian Journal of Urology, Indian Pediatrics, International Journal of Health Research &...
Malling, Bente Vigh; Sørensen, Jette Led; Mikines, Kári J
The seven CanMEDS roles were adopted by the Danish reform in postgraduate medical education in 2004. The roles have become a natural part of defining specialist competence. However, the definition of the seven roles from 2000 might not be aligned with the perception of good medical practice anno...
Waste Management Group
These guidelines describe procedures to comply with all Federal and State laws and regulations and Lawrence Berkeley National Laboratory (LBNL) policy applicable to State-regulated medical and unregulated, but biohazardous, waste (medical/biohazardous waste). These guidelines apply to all LBNL personnel who: (1) generate and/or store medical/biohazardous waste, (2) supervise personnel who generate medical/biohazardous waste, or (3) manage a medical/biohazardous waste pickup location. Personnel generating biohazardous waste at the Joint Genome Institute/Production Genomics Facility (JGI/PGF) are referred to the guidelines contained in Section 9. Section 9 is the only part of these guidelines that apply to JGI/PGF. Medical/biohazardous waste referred to in this Web site includes biohazardous, sharps, pathological and liquid waste. Procedures for proper storage and disposal are summarized in the Solid Medical/Biohazardous Waste Disposal Procedures Chart. Contact the Waste Management Group at 486-7663 if you have any questions regarding medical/biohazardous waste management.
Springer, Shannon; Pitama, Suzanne; Leslie, Kate; Ewen, Shaun
Since 2006 the Australian Medical Council (AMC) accreditation standards have required medical schools to comprehensively address issues related to the health of Aboriginal and Torres Strait Islander peoples in Australia, and Māori in New Zealand. This has spanned areas of staff expertise, staff and student recruitment, curriculum and institutional leadership. These Indigenous specific standards have, until now, been absent for specialist medical college accreditation. The AMC revised its accreditation standards for specialist medical colleges in 2015, and for the first time included Indigenous specific standards. This commentary presents a guideline to support Australasian medical colleges' responsiveness to these Indigenous specific standards.
Schneider, K C
The "anti-dumping" provisions under Section 1867 of the Social Security Act have been clarified and strengthened by recent amendments. Medicare-participating hospitals must post signs informing the public of their obligation to examine, treat, and appropriately transfer individuals who request emergency services in the emergency department. Inquiries about an individual's method of payment or insurance source may not delay examination or treatment. Qualified personnel must perform medical screening of all emergency patients, and those to be transferred with emergency medical conditions which have not been stabilized must receive treatment to minimize the risk of transfer. There are stepped-up requirements for informed patient consent and documentation that the medical benefits of a transfer outweigh the risks. In physician-initiated transfers, the receiving hospital must be sent certification by a physician that the benefits of transfer outweigh the risks. Since there is evidence that medically appropriate transfers of persons with emergency medical conditions may actually be underutilized, particularly in rural settings, medical reviewers should avoid an anti-transfer bias.
Introduction The goal of teaching medical undergraduates Pharmacology is to form a sound foundation of therapeutics. The pharmacology record books are maintained as a part of the curriculum. The purpose of this study was to obtain feedback of the medical students about the new record adopted in the institution after major revision Materials and Methods This was a questionnaire based study done in a Government Medical College of Kerala in February 2013. The data was analysed using SPSS. The feedback on clinical pharmacology exercises was given positive and negative scores. Results Majority (64.5%) opined that the content in pharmacology record was good. A total of 78.1% completed the record during discussions in practical classes. Majority wrote the records for understanding pharmacology. For 79.8% General Pharmacology exercises were most relevant, 33.8% considered Clinical Pharmacology exercises to be the most thought provoking. Drug use in special groups received the maximum positive score. Conclusion The new improved pharmacology record is an effective teaching-learning method. Inclusion of more clinically oriented exercises has increased the interest of the students in the subject. PMID:26894083
Ohio State Dept. of Education, Columbus. Div. of Vocational Education.
This student manual, the third in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains one section covering the following topics: general anatomical terms, the body cavities and contents, the integumentary system, the skeletal system, the muscular system, the nervous system, the respiratory…
Pliszka, Steven R; Crismon, M Lynn; Hughes, Carroll W; Corners, C Keith; Emslie, Graham J; Jensen, Peter S; McCracken, James T; Swanson, James M; Lopez, Molly
In 1998, the Texas Department of Mental Health and Mental Retardation developed algorithms for medication treatment of attention-deficit/hyperactivity disorder (ADHD). Advances in the psychopharmacology of ADHD and results of a feasibility study of algorithm use in community mental health centers caused the algorithm to be modified and updated. We convened a consensus conference of academic clinicians and researchers, practicing clinicians, administrators, consumers, and families to revise the algorithms for the pharmacotherapy of ADHD itself as well as ADHD with specific comorbid disorders. New research was reviewed by national experts, and rationales were provided for proposed changes and additions to the algorithms. The changes to the algorithms were discussed and approved both by the national experts and experienced clinicians from the Texas public mental health system. The panel developed consensually agreed-upon algorithms for ADHD with and without comorbid disorders. The major changes included elimination of pemoline as a treatment option, adding atomoxetine to the algorithm, and refining guidelines for treating ADHD with comorbid depression, aggressive behaviors, and tic disorders. Medication algorithms for ADHD can be modified to keep abreast of developments in the field. Although these evidence- and consensus-based treatment recommendations may be a useful approach to guide the treatment of ADHD in children, additional research is needed to determine how these algorithms can be used to maximally benefit child outcomes.
Nikolai Nikolayevich Ivanets
Full Text Available The differential diagnosis of cognitive impairments is of great importance in mental disorders detectable in general medical practice. Objective: to study whether Addenbrooke's Cognitive Examination — Revised (ACE-R may be used in these patients. Patients and methods. The study was conducted in two steps at somatic hospitals and city polyclinics. It enrolled 130patients (36 men and 94 women with anxiety-depression spectrum disorders (ADSD, mild cognitive disorders (MCD and a concurrence of these conditions. The authors used the following psychometric scales: the hospital anxiety and depression scale; the mini-mental state examination; the frontal assessment battery; ACE-R; ten words learning test. The psychometric characteristics of ACE-R and the possibilities of its use were estimated to detect MCD. The differences in the spectrum of cognitive impairments were analyzed in patients with different types of ADSD. Results. ACE-R is shown to be an effective neuropsychological tool for the primary diagnosis, detection, and evaluation of MCD in the general medical network. The results of ACE-R use indicate that the spectrum of cognitive impairments has substantial differences in patients with different types of non-psychotic disorders.
According to the "Japan Revitalization Strategy" established in June 2013, "the government will promote better contributions of local pharmacies and pharmacists in encouraging self-medication of citizens by making pharmacies the community-based hub for providing information, giving advice on the proper use of non-prescription drugs, etc. and offering consultation and information service concerning health". In addition, the "Demanded Function and Ideal Form of Pharmacy," published in January 2014, requested a change, from pharmacies that specialized in dispensing medicines to pharmacies that serve as whole healthcare stations, providing pharmaceutical care based on patients' medical history, including the intake of dietary supplements. The medication fee was revised in April 2014 to enhance family pharmacy services and the management of pharmaceutical care. At that time, blood testing at a registered pharmacy was officially allowed under strict regulation. Revision of the "Pharmacist Law" in June 2014 included a request to pharmacists to provide pharmaceutical advice in addition to information. For the mitigation of drug-induced tragedies, the "Pharmaceutical Affairs Law" was amended to the "Pharmaceutical and Medical Device Act (PMD Act)" in November 2014, and proper use of medicines was imposed on healthcare professionals and other stakeholders. Patients were also requested to learn and understand the safety and harmful effects of medicines, and were requested to use medicines appropriately. As mentioned above, the status of pharmacies and pharmacists has dramatically changed in the past 2 years, and such changes over time are required.
Tucker, Phebe; Jeon-Slaughter, Haekyung; Sener, Ugur; Arvidson, Megan; Khalafian, Andrey
We explored the theory that measures of medical students' well-being and stress from different types of preclinical curricula are linked with performance on standardized assessment. Self-reported stress and quality of life among sophomore medical students having different types of preclinical curricula will vary in their relationships to USMLE Step 1 scores. Voluntary surveys in 2010 and 2011 compared self-reported stress, physical and mental health, and quality of life with Step 1 scores for beginning sophomore students in the final year of a traditional, discipline-based curriculum and the 1st year of a revised, systems-based curriculum with changed grading system. Wilcoxon rank sum tests and Spearman rank correlations were used to analyze data, significant at p life stress than traditional curriculum students. However, among curriculum-related stressors, few differences emerged; revised curriculum sophomores reported less stress working with real and standardized patients than traditional students. There were no class differences in respondents' Step 1 scores. Among emotional and physical health measures, only feelings of morale correlated negatively with Step 1 performance. Revised curriculum students' Step 1 scores correlated negatively with stress from difficulty of coursework. Although revised curriculum students reported worse quality of life, general stress, and health and less stress from patient interactions than traditional students, few measures were associated with performance differences on Step 1. Moreover, curriculum type did not appear to either hinder or help students' Step 1 performance. To identify and help students at risk for academic problems, future assessments of correlates of Step 1 performance should be repeated after the new curriculum is well established, relating them also to performance on other standardized assessments of communication skills, professionalism, and later clinical evaluations in clerkships or internships.
John W. Norbury
Full Text Available Background. A Required Fourth-Year Medical Student Physical Medicine and Rehabilitation (PM&R Clerkship was found to increase students’ knowledge of PM&R; however the students’ overall rotation evaluations were consistently lower than the other 8 required clerkships at the medical school. Objective. To describe the impact of a revised curriculum based upon Entrustable Professional Activities and focusing on basic pain management, musculoskeletal care, and neurology. Setting. Academic Medical Center. Participants. 73 fourth-year medical students. Methods. The curriculum changes included a shift in the required readings from rehabilitation specific topics toward more general content in the areas of clinical neurology and musculoskeletal care. Hands-on workshops on neurological and musculoskeletal physical examination techniques, small group case-based learning, an anatomy clinical correlation lecture, and a lecture on pain management were integrated into the curriculum. Main Outcome Measurements. Student evaluations of the clerkship. Results. Statistically significant improvements were found in the students’ evaluations of usefulness of lecturers, development of patient interviewing skills, and diagnostic and patient management skills (p≤0.05. Conclusions. This study suggests that students have a greater satisfaction with a required PM&R clerkship when lecturers utilize a variety of pedagogic methods to teach basic pain, neurology and musculoskeletal care skills in the rehabilitation setting rather than rehabilitation specific content.
Lehmann, Ronny; Hanebeck, Benjamin; Oberle, Stephan; Simon, Anke; Choukair, Daniela; Tönshoff, Burkhard; Huwendiek, Sören
Virtual patients (VPs) are a one-of-a-kind e-learning resource, fostering clinical reasoning skills through clinical case examples. The combination with face-to-face teaching is important for their successful integration, which is referred to as "blended learning". So far little is known about the use of VPs in the field of continuing medical education and residency training. The pilot study presented here inquired the application of VPs in the framework of a pediatric residency revision course. Around 200 participants of a pediatric nephology lecture ('nephrotic and nephritic syndrome in children') were offered two VPs as a wrap-up session at the revision course of the German Society for Pediatrics and Adolescent Medicine (DGKJ) 2009 in Heidelberg, Germany. Using a web-based survey form, different aspects were evaluated concerning the learning experiences with VPs, the combination with the lecture, and the use of VPs for residency training in general. N=40 evaluable survey forms were returned (approximately 21%). The return rate was impaired by a technical problem with the local Wi-Fi firewall. The participants perceived the work-up of the VPs as a worthwhile learning experience, with proper preparation for diagnosing and treating real patients with similar complaints. Case presentations, interactivity, and locally and timely independent repetitive practices were, in particular, pointed out. On being asked about the use of VPs in general for residency training, there was a distinct demand for more such offers. VPs may reasonably complement existing learning activities in residency training.
Rasmussen, Kirsten Wølch; Schjoldager, Anne
out by specialised revisers, but by staff translators, who revise the work of colleagues and freelancers on an ad hoc basis. Corrections are mostly given in a peer-to-peer fashion, though the work of freelancers and inexperienced in-house translators is often revised in an authoritative (nonnegotiable...
Stochik, A M; Zatravkin, S N
The article affirms that onset of revision of picture of analyzed reality, methodological approaches to studying of vital activity of human organism and philosophical basics of medical science refers to 1878 and is related to publishing of "The course of general physiology" by French physiologist Claude Bernard. The implemented analysis of the text of this work permit to establish that C. Bernard undertook an attempt to introduce conception of human organism as a processing system being self-reproduced as. a result of interaction with environment due to mechanisms of self-regulation. The necessity was substantiated to make experiment the leading method of cognition of vital activity. The living wholeness (organism, cell) was proposed to be an object of experimentation. In this living wholeness its natural capacities to self-regulation of main vital processes can be preserved at its maximum. The new senses were introduced into ontological categories of thing, process, causality, portion and whole.
Full Text Available Aim: Virtual patients (VPs are a one-of-a-kind e-learning resource, fostering clinical reasoning skills through clinical case examples. The combination with face-to-face teaching is important for their successful integration, which is referred to as “blended learning”. So far little is known about the use of VPs in the field of continuing medical education and residency training. The pilot study presented here inquired the application of VPs in the framework of a pediatric residency revision course. Methods: Around 200 participants of a pediatric nephology lecture (‘nephrotic and nephritic syndrome in children’ were offered two VPs as a wrap-up session at the revision course of the German Society for Pediatrics and Adolescent Medicine (DGKJ 2009 in Heidelberg, Germany. Using a web-based survey form, different aspects were evaluated concerning the learning experiences with VPs, the combination with the lecture, and the use of VPs for residency training in general.Results: N=40 evaluable survey forms were returned (approximately 21%. The return rate was impaired by a technical problem with the local Wi-Fi firewall. The participants perceived the work-up of the VPs as a worthwhile learning experience, with proper preparation for diagnosing and treating real patients with similar complaints. Case presentations, interactivity, and locally and timely independent repetitive practices were, in particular, pointed out. On being asked about the use of VPs in general for residency training, there was a distinct demand for more such offers. Conclusion: VPs may reasonably complement existing learning activities in residency training.
Mogre, Victor; Amalba, Anthony
We investigated the validity and reliability of the Revised Two Factor Study Process Questionnaire (R-SPQ2F) in preclinical students in Ghana. The R-SPQ2F was administered to 189 preclinical students of the University for Development Studies, School of Medicine and Health Sciences. Both descriptive and inferential statistics with Cronbach's alpha test and factor analysis were done. The mean age of the students was 22.69± 0.18years, 60.8% (n=115) were males and 42.3% (n=80) were in their second year of medical training. The students had higher mean deep approach scores (31.23±7.19) than that of surface approach scores (22.62±6.48). Findings of the R-SPQ2F gave credence to a solution of two-factors indicating deep and surface approaches accounting for 49.80% and 33.57%, respectively, of the variance. The scales of deep approach (Cronbach's alpha, 0.80) and surface approach (Cronbach's alpha, 0.76) and their subscales demonstrated an internal consistency that was good. The factorial validity was comparable to other studies. Our study confirms the construct validity and internal consistency of the R-SPQ2F for measuring approaches to learning in Ghanaian preclinical students. Deep approach was the most dominant learning approach among the students. The questionnaire can be used to measure students' approaches to learning in Ghana and in other African countries.
Full Text Available Background. Near-peer teaching is becoming increasingly popular as a learning methodology. We report the development of a novel near-peer biological sciences revision course and its acceptability and impact on student confidence and exam performance. Methods. A cross-sectional analysis of tutee-completed evaluation forms before and after each session was performed, providing demographic details, quality scores, and self-rating of confidence in the topic taught on a 0 to 100 mm visual analogue scale (VAS. The confidence data was examined using analysis of means. Exam performance was examined by analysis of variance and canonical correlation analysis. Results. Thirty-eight sessions were delivered to an average of 69.9 (±27.1 years 1 and 2 medical students per session generating 2656 adequately completed forms. There was a mean VAS gain of 19.1 (5.3 to 27.3 in self-reported confidence. Looking at relationship between attendance and exam scores, only two topics showed significant association between number of sessions attended and exam performance, fewer than hypothesised. Conclusion. The present study demonstrates that near-peer teaching for biological sciences is feasible and is associated with improved self-reported confidence in the sessions taught. The outcome data, showing significant effect for only a small number of items, demonstrates the difficulty of outcome related research.
Full Text Available Abstract Background Mental disorders such as depression are common and rank as major contributors to the global burden of disease. Condition recognition and subsequent management of depression is variable and influenced by the attitudes and beliefs of clinicians as well as those of patients. Most studies examining health professionals’ attitudes have been conducted in Western nations; this study explores beliefs and attitudes about depression among doctors working in Lahore, Pakistan. Methods A cross-sectional survey conducted in 2015 used a questionnaire concerning demographics, education in psychiatry, beliefs about depression causes, and attitudes about depression using the Revised Depression Attitude Questionnaire (R-DAQ. A convenience sample of 700 non-psychiatrist medical practitioners based in six hospitals in Lahore was approached to participate in the survey. Results Six hundred and one (86 % of the doctors approached consented to participate; almost all respondents (99 % endorsed one of various biopsychosocial causes of depression (38 to 79 % for particular causes, and 37 % (between 13 and 19 % for particular causes noted that supernatural forces could be responsible. Supernatural causes were more commonly held by female doctors, those working in rural settings, and those with greater psychiatry specialist education. Attitudes to depression were mostly less confident or optimistic and less inclined to a generalist perspective than those of clinicians in the UK or European nations, and deterministic perspectives that depression is a natural part of aging or due to personal failings were particularly common. However, there was substantial confidence in the efficacy of antidepressants and psychological therapy. More confident and therapeutically optimistic views and a more generalist perspective about depression management were associated with a rejection of supernatural explanations of the origin of depression. Conclusions Non
Haddad, Mark; Waqas, Ahmed; Qayyum, Wahhaj; Shams, Maryam; Malik, Saad
Mental disorders such as depression are common and rank as major contributors to the global burden of disease. Condition recognition and subsequent management of depression is variable and influenced by the attitudes and beliefs of clinicians as well as those of patients. Most studies examining health professionals' attitudes have been conducted in Western nations; this study explores beliefs and attitudes about depression among doctors working in Lahore, Pakistan. A cross-sectional survey conducted in 2015 used a questionnaire concerning demographics, education in psychiatry, beliefs about depression causes, and attitudes about depression using the Revised Depression Attitude Questionnaire (R-DAQ). A convenience sample of 700 non-psychiatrist medical practitioners based in six hospitals in Lahore was approached to participate in the survey. Six hundred and one (86 %) of the doctors approached consented to participate; almost all respondents (99 %) endorsed one of various biopsychosocial causes of depression (38 to 79 % for particular causes), and 37 % (between 13 and 19 % for particular causes) noted that supernatural forces could be responsible. Supernatural causes were more commonly held by female doctors, those working in rural settings, and those with greater psychiatry specialist education. Attitudes to depression were mostly less confident or optimistic and less inclined to a generalist perspective than those of clinicians in the UK or European nations, and deterministic perspectives that depression is a natural part of aging or due to personal failings were particularly common. However, there was substantial confidence in the efficacy of antidepressants and psychological therapy. More confident and therapeutically optimistic views and a more generalist perspective about depression management were associated with a rejection of supernatural explanations of the origin of depression. Non-psychiatrist medical practitioners in Pakistan hold a range of views
Cantillano, Pablo; Rubio, Fabián; Naser, Alfredo; Nazar, Rodolfo
Endoscopic sinonasal surgery is the procedure of choice in the treatment of chronic rhinosinusitis and sinonasal polyposis refractory to medical treatment, with high rates of success (76% to 97.5%). However, 2.5%-24% of those patients will require revision surgery (RESS). In this study, we present the clinical, anatomical, radiological and histological features of patients receiving RESS in our centre during a 3-year period. A retrospective review of clinical, anatomical, radiological and histopathological data of patients receiving revision endoscopic sinonasal surgery between 2012 and 2014 was carried out. From 299 surgery procedures performed, 27 (9%) were revision surgeries. The mean patient age was 46 years, with a male/female ratio of 1.4/1. The most frequent preoperative and postoperative diagnosis was chronic polypoid rhinosinusitis. The mean time since the previous surgery was 6.1 years, with 11.9 months of mean follow-up since that surgery. Stenotic antrostomy was found during revision in 81.5% of the patients and incomplete anterior ethmoidectomy and persistent uncinate process, in 59.3%. In radiology, 70.4% of patients had persistent anterior ethmoidal cells. Antrostomy or widening of antrostomy was performed in 96.3% of cases and anterior ethmoidectomy or completion of it was performed in 66.7%. Polyps, stenotic antrostomy and incomplete ethmoidectomy were the most frequent causes of revision surgery, in concordance with the procedures performed. The patients had long periods of time without follow-up between surgeries. Further investigation is necessary to generate measures to reduce the number of revision surgeries. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.
Mohammed A. Al-Ghazo
Full Text Available OBJECTIVE: To determine indications for circumcision revision and to identify the specialty of the person who performed unsatisfactory primary circumcision. MATERIALS AND METHODS: The authors reviewed medical records of 52 cases that underwent circumcision revision over a 6-year period (1998 to 2004. Sleeve surgical technique was used for revision in patients with redundant foreskin or concealed penis, penoplasty for partial or complete degloving of the penis and meatotomy for external meatal stenosis. The mean age of children was 32 months (range 6 months to 9 years. RESULTS: Most of unsatisfactory primary circumcisions (86.7% were performed by laymen. All patients who underwent circumcision revision had good to excellent cosmetic results. CONCLUSION: Primary circumcision performed by laymen carry a high complication rate and serious complications may occur. A period of training and direct supervision by physicians is required before allowing laymen to perform circumcision independently.
Johnston, R.; Crooks, V.A.; Ormond, M.E.
Background - Medical tourism is now targeted by many hospitals and governments worldwide for further growth and investment. Southeast Asia provides what is perhaps the best documented example of medical tourism development and promotion on a regional scale, but interest in the practice is growing in
Does the Cultural Formulation Interview (CFI) for the Fifth Revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) affect medical communication? A qualitative exploratory study from the New York site
Aggarwal, Neil K.; DeSilva, Ravi; Nicasio, Andel V.; Boiler, Marit; Lewis-Fernández, Roberto
Objectives Cross-cultural mental health researchers often analyze patient explanatory models of illness to optimize service provision. The Cultural Formulation Interview (CFI) is a cross-cultural assessment tool released in May 2013 with DSM-5 to revise shortcomings from the DSM-IV Outline for Cultural Formulation (OCF). The CFI field trial took place in 6 countries, 14 sites, and with 321 patients to explore its feasibility, acceptability, and clinical utility with patients and clinicians. We sought to analyze if and how CFI feasibility, acceptability, and clinical utility were related to patient-clinician communication. Design We report data from the New York site which enrolled 7 clinicians and 32 patients in 32 patient-clinician dyads. We undertook a data analysis independent of the parent field trial by conducting content analyses of debriefing interviews with all participants (n=64) based on codebooks derived from frameworks for medical communication and implementation outcomes. Three coders created codebooks, coded independently, established inter-rater coding reliability, and analyzed if the CFI affects medical communication with respect to feasibility, acceptability, and clinical utility. Results Despite racial, ethnic, cultural, and professional differences within our group of patients and clinicians, we found that promoting satisfaction through the interview, eliciting data, eliciting the patient’s perspective, and perceiving data at multiple levels were common codes that explained how the CFI affected medical communication. We also found that all but 2 codes fell under the implementation outcome of clinical utility, 2 fell under acceptability, and none fell under feasibility. Conclusion Our study offers new directions for research on how a cultural interview affects patient-clinician communication. Future research can analyze how the CFI and other cultural interviews impact medical communication in clinical settings with subsequent effects on outcomes
Does the Cultural Formulation Interview for the fifth revision of the diagnostic and statistical manual of mental disorders (DSM-5) affect medical communication? A qualitative exploratory study from the New York site.
Aggarwal, Neil K; Desilva, Ravi; Nicasio, Andel V; Boiler, Marit; Lewis-Fernández, Roberto
Cross-cultural mental health researchers often analyze patient explanatory models of illness to optimize service provision. The Cultural Formulation Interview (CFI) is a cross-cultural assessment tool released in May 2013 with DSM-5 to revise shortcomings from the DSM-IV Outline for Cultural Formulation (OCF). The CFI field trial took place in 6 countries, 14 sites, and with 321 patients to explore its feasibility, acceptability, and clinical utility with patients and clinicians. We sought to analyze if and how CFI feasibility, acceptability, and clinical utility were related to patient-clinician communication. We report data from the New York site which enrolled 7 clinicians and 32 patients in 32 patient-clinician dyads. We undertook a data analysis independent of the parent field trial by conducting content analyses of debriefing interviews with all participants (n = 64) based on codebooks derived from frameworks for medical communication and implementation outcomes. Three coders created codebooks, coded independently, established inter-rater coding reliability, and analyzed if the CFI affects medical communication with respect to feasibility, acceptability, and clinical utility. Despite racial, ethnical, cultural, and professional differences within our group of patients and clinicians, we found that promoting satisfaction through the interview, eliciting data, eliciting the patient's perspective, and perceiving data at multiple levels were common codes that explained how the CFI affected medical communication. We also found that all but two codes fell under the implementation outcome of clinical utility, two fell under acceptability, and none fell under feasibility. Our study offers new directions for research on how a cultural interview affects patient-clinician communication. Future research can analyze how the CFI and other cultural interviews impact medical communication in clinical settings with subsequent effects on outcomes such as medication adherence
Johnston, Rory; Crooks, Valorie A; Ormond, Meghann
Medical tourism is now targeted by many hospitals and governments worldwide for further growth and investment. Southeast Asia provides what is perhaps the best documented example of medical tourism development and promotion on a regional scale, but interest in the practice is growing in locations where it is not yet established. Numerous governments and private hospitals in the Caribbean have recently identified medical tourism as a priority for economic development. We explore here the projects, activities, and outlooks surrounding medical tourism and their anticipated economic and health sector policy implications in the Caribbean country of Jamaica. Specifically, we apply Pocock and Phua's previously-published conceptual framework of policy implications raised by medical tourism to explore its relevance in this new context and to identify additional considerations raised by the Jamaican context. Employing case study methodology, we conducted six weeks of qualitative fieldwork in Jamaica between October 2012 and July 2013. Semi-structured interviews with health, tourism, and trade sector stakeholders, on-site visits to health and tourism infrastructure, and reflexive journaling were all used to collect a comprehensive dataset of how medical tourism in Jamaica is being developed. Our analytic strategy involved organizing our data within Pocock and Phua's framework to identify overlapping and divergent issues. Many of the issues identified in Pocock and Phua's policy implications framework are echoed in the planning and development of medical tourism in Jamaica. However, a number of additional implications, such as the involvement of international development agencies in facilitating interest in the sector, cyclical mobility of international health human resources, and the significance of health insurance portability in driving the growth of international hospital accreditation, arise from this new context and further enrich the original framework. The framework
Ohio State Dept. of Education, Columbus. Div. of Vocational Education.
This training manual for emergency medical technicians, one of 14 modules that comprise the Emergency Victim Care textbook, covers water accidents, electrical emergencies, and hazardous materials and radiation accidents. Objectives stated for the three chapters are for the students to be able to describe: emergency care for specified water…
Keyes, A. A.
The article discusses the history of copyright laws, the directions which copyright revision can take, and the rationale behind revision. Regulations for protecting various media such as sound recordings, performances, and cable television are discussed. (JAB)
Komiya, Isao; Umezu, Yoshiyuki; Fujibuchi, Toshiou; Nakamura, Kazumasa; Baba, Shingo; Honda, Hiroshi
The non-self-shield compact medical cyclotron and the cyclotron vault room were in operation for 27 years. They have now been decommissioned. We efficiently implemented a technique to identify an activation product in the cyclotron vault room. Firstly, the distribution of radioactive concentrations in the concrete of the cyclotron vault room was estimated by calculation from the record of the cyclotron operation. Secondly, the comparison of calculated results with an actual measurement was performed using a NaI scintillation survey meter and a high-purity germanium detector. The calculated values were overestimated as compared to the values measured using the Nal scintillation survey meter and the high-purity germanium detector. However, it could limit the decontamination area. By simulating the activation range, we were able to minimize the concrete core sampling. Finally, the appropriate range of radioactivated area in the cyclotron vault room was decontaminated based on the results of the calculation. After decontamination, the radioactive concentration was below the detection limit value in all areas inside the cyclotron vault room. By these procedures, the decommissioning process of the cyclotron vault room was more efficiently performed. (author)
Goldman, Ellen F.; Mintz, Matthew L.
Curricular revision can be an arduous and challenging process. The literature favors a rational planned process for doing so, but offers little advice regarding how to proceed when the time required for such an approach is not available. This article describes our use of four concepts from complexity science to revise a medical school curriculum…
Beckmann, Nicholas A.; Weiss, Stefan; Klotz, Matthias C.M.
The best method of revision acetabular arthroplasty remains unclear. Consequently, we reviewed the literature on the treatment of revision acetabular arthroplasty using revision rings (1541 cases; mean follow-up (FU) 5.7 years) and Trabecular Metal, or TM, implants (1959 cases; mean FU 3.7 years......) to determine if a difference with regard to revision failure could be determined. Failure rates of the respective implants were compared statistically using a logistic regression model with adjustment for discrepancies in FU time. In our study, TM shows statistically significant decreased loosening rates...... relative to revision rings for all grades including severe acetabular defects and pelvic discontinuity. The severe defects appear to benefit the most from TM....
The year 2009 saw a number of developments in Medical Education in Malta that were initiated as a result of a commitment to revising the medical curriculum in order to meet the challenges in medical education. A record number of students were admitted to the medical course in 2009. There is concern that eventually this exponential increase in admissions is not sustainable due to infrastructural, financial and human resource restraints. Meanwhile there has been a simultane...
Earth Data Analysis Center, University of New Mexico — The National Flood Hazard Layer (NFHL) data incorporates all Digital Flood Insurance Rate Map(DFIRM) databases published by FEMA, and any Letters Of Map Revision...
Tamminga, Allard; Verhaegh, Sander
Quine's holistic empiricist account of scientific inquiry can be characterized by three constitutive principles: noncontradiction, universal revisability and pragmatic ordering. We show that these constitutive principles cannot be regarded as statements within a holistic empiricist's scientific
... fiscal guidance, establishes guidance on the veterinary role in the human-animal bond, prescribes new and revised forms used to record animal medical information and allows for the use of computers...
A revision of Pachycentria Blume, which includes the monotypic Pogonanthera Blume, is presented. Pachycentria comprises eight species and one subspecies. Two species, P. vogelkopensis and P. hanseniana, are newly described. The genus is distinguished from other genera in the Medinillinae by a small
He, G.; Zhang, L.; Mol, A.P.J.; Lu, Y.; Liu, Wenling; Liu, J.
China's Environmental Protection Law (EPL) is the main national environmental legislative framework. Yet the environmental legal system is incomplete, and implementation and enforcement of environmental laws have shown major shortcomings (1–3). A controversial attempt to revise the EPL could have
Lam, H.J.; Varossieau, W.W.
The genus Sarcosperma was excluded from the Sapotaceae by the first-named writer in 1925, the group being considered as of family rank. In 1926 the same author published a concise and fragmentary revision of the monotypic order, in which two new Malaysian species were described. The continental
Junikka, L.; Maas, P.J.M.; Maas-van de Kamer, H.; Westra, L.Y.Th.
A taxonomic revision is given of the Neotropical genus Oxandra (Annonaceae). Within the genus 27 species are recognized, 4 of which are new to science. Most of the species are occurring in tropical South America, whereas a few (6) are found in Mexico and Central America and two in the West Indies
We show that Herzberger’s and Gupta’s revision theories of truth can be recast in purely inductive terms, without any appeal neither to the transfinite ordinal numbers nor to the axiom of Choice. The result is presented in an abstract and general setting, emphasising both its validity for a wide
Wertsch, James V.
Examines the production of new history textbooks that appeared after the breakup of the Soviet Union. Argues that the radical revisions in official history in this context are shaped by the Bakhtinian process of "hidden dialogicality." Suggests that the importance of hidden dialogicality between narrative forms must be considered. (SC)
The role of experience for belief revision is seldom explicitly discussed. This is surprising as it seems obvious that experiences play a major role for most of our belief changes. In this work, the two most plausible views on the role of experience for belief change are investigated: the view that
Revising and Editing for Translators provides guidance and learning materials for translation students learning to edit texts written by others, and professional translators wishing to improve their self-revision ability or learning to revise the work of others. Editing is understood as making corrections and improvements to texts, with particular attention to tailoring them to the given readership. Revising is this same task applied to draft translations. The linguistic work of editors and revisers is related to the professional situations in which they work. Mossop offers in-depth coverage of a wide range of topics, including copyediting, style editing, structural editing, checking for consistency, revising procedures and principles, and translation quality assessment. This third edition provides extended coverage of computer aids for revisers, and of the different degrees of revision suited to different texts. The inclusion of suggested activities and exercises, numerous real-world examples, a proposed gra...
Motte, Kristin; Caldwell, C Brooke; Lamson, Karen S; Ferimer, Suzanne; Nims, J Chris
This Association of Vision Science Librarians revision of the "Standards for Vision Science Libraries" aspires to provide benchmarks to address the needs for the services and resources of modern vision science libraries (academic, medical or hospital, pharmaceutical, and so on), which share a core mission, are varied by type, and are located throughout the world. Through multiple meeting discussions, member surveys, and a collaborative revision process, the standards have been updated for the first time in over a decade. While the range of types of libraries supporting vision science services, education, and research is wide, all libraries, regardless of type, share core attributes, which the standards address. The current standards can and should be used to help develop new vision science libraries or to expand the growth of existing libraries, as well as to support vision science librarians in their work to better provide services and resources to their respective users.
Motte, Kristin; Caldwell, C. Brooke; Lamson, Karen S.; Ferimer, Suzanne; Nims, J. Chris
Objective: This Association of Vision Science Librarians revision of the “Standards for Vision Science Libraries” aspires to provide benchmarks to address the needs for the services and resources of modern vision science libraries (academic, medical or hospital, pharmaceutical, and so on), which share a core mission, are varied by type, and are located throughout the world. Methods: Through multiple meeting discussions, member surveys, and a collaborative revision process, the standards have been updated for the first time in over a decade. Results: While the range of types of libraries supporting vision science services, education, and research is wide, all libraries, regardless of type, share core attributes, which the standards address. Conclusions: The current standards can and should be used to help develop new vision science libraries or to expand the growth of existing libraries, as well as to support vision science librarians in their work to better provide services and resources to their respective users. PMID:25349547
[A multicenter cross-sectional study on the health related quality of life of patients with rheumatoid arthritis using a revised Japanese version of the arthritis impact measurement scales version 2 (AIMS 2), focusing on the medical care costs and their associative factors].
Hashimoto, Akira; Sato, Hajime; Nishibayahi, Yasuro; Shiino, Yasuaki; Kutsuna, Tatsuo; Ishihara, Yoshihiro; Hoshi, Keiko; Fujimori, Juro; Tsuboi, Seiji; Kondo, Hirobumi; Akizuki, Masashi; Moroi, Yasuoki; Yoshida, Shunji
To survey the actual conditions of medical care costs incurred by Japanese patients with rheumatoid arthritis, and to investigate impacts of health status, demographic and socioeconomic factors, clinical and laboratory measures, and medications on disease costs. Self-reported health status questionnaires of the revised Japanese version of AIMS 2, and reports on out-of-pocket medical care costs were collected from 1471 patients with classical and definite rheumatoid arthritis recruited through the arthritis study group of Ministry of Public Health and Welfare consisting of eleven arthritis centers across the country during three months from September, 1994. Impacts of health status and other demographic and clinical factors on medical care costs were statistically analyzed by using chi-square tests for categorical variables and Spearman's rank correlation analysis for numerical variables. 1. Averaged out-of-pocket medical care costs for RA patients was estimated at yen 25,225 ($253.5) per person-month in 1994, in which direct medical care costs accounted for 53.9% and indirect medical care costs accounted for 46.1% of the total. Averaged substantial direct medical care costs including the costs covered by the public health insurance in addition to out-of-pocket costs was estimated at yen 512,000 ($5,140) per person-year based on the averaged 11.8% self-pay rate of the public health insurance in 1994. 2. The distribution curve of the total out-of-pocket medical care costs was highly skewed. Averaged total medical care costs in the 90th, 95th, and 100th percentiles were 4.5, 8.1, and 48 times as large as those in the median percentile, respectively. 3. Out-of-pocket direct medical care costs totaled in the top 1 and 5 percentiles reached 26.6%, and 57.6% of those in whole patients, respectively. 4. Variables most strongly related to the total out-of-pocket medical care costs were work disability in AIMS health status scales, followed by physical disability, rate of
... control over the utilization of services; and (2) Conducts reviews in a way that improves the quality of...) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time Requirements § 456.523 Revised...
Schrama, Johannes Cornelis; Fenstad, Anne M; Dale, Håvard
Background and purpose-Medical treatment of rheumatoid arthritis (RA) has changed dramatically over the last 15 years, including immune modulation. We investigated the risk of revision for infection after primary total hip replacement (THR) in patients with rheumatoid arthritis over a 16-year......, with revision for infection as the endpoint, were constructed. Cox regression analyses were performed to calculate the relative risk (RR) of revision for infection adjusted for age, sex, fixation technique, and year of primary surgery.Results-RA patients had a 1.3 times (95% CI 1.0-1.6) higher risk of revision...
R. M. Tikhilov
Full Text Available The revision rate of total hip arthroplasty (THA is increasing with growth of number primary THA. The problems of revision procedures are associated with high technical demands and high incidence of poor results. Besides of medical problems the cost of revisions has impact on health care system even in developed countries. With improving of funding Russian Health Care System there is significant growth of number of total hip arthroplasties in Russia. Hence it is interesting to find out about world experience, forecasts of experts involved in the issue and current trends in revision hip arthroplasty.
Thoft-Christensen, Palle; Jensen, F. M.; Middleton, C.
This paper is based on research performed for the Highway Agency, London, UK under the project DPU/9/44 "Revision of Bridge Assessment Rules Based on Whole Life Performance: Concrete Bridges" It contains details of a methodology which can be used to generate Whole Life (WL) reliability profiles....... These WL reliability profiles may be used to establish revised rules for Concrete Bridges....
Trevors, Gregory J.; Kendeou, Panayiota; Butterfuss, Reese
In recent years, a number of insights have been gained into the cognitive processes that explain how individuals overcome misconceptions and revise their previously acquired incorrect knowledge. The current study complements this line of research by investigating the moment-by-moment emotion processes that occur during knowledge revision using a…
Medical tourism, often addressed as health tourism, is a new concept in terms of tourism industry in general, and it is also one of the rapidly developing and growing ones. This thesis gives information on the medical tourism in general and its history. It also revises the development stages of the medical tourism in the world. Cuban medical tourism is analyzed on its own, as well as Russian medical tourism and the demand for it. Medical tourism is rather popular among Russians due to various...
Haynes, Jacob A; Stambough, Jeffrey B; Sassoon, Adam A; Johnson, Staci R; Clohisy, John C; Nunley, Ryan M
Revision total hip arthroplasty (THA) represents nearly 15% of all hip arthroplasty procedures in the United States and is projected to increase. The purpose of our study was to summarize the contemporary indications for revision THA surgery at a tertiary referral medical center. We also sought to identify the indications for early and late revision surgery and define the prevalence of outside institution referral for revision THA. Using our institution's arthroplasty registry, we identified a retrospective cohort of 870 consecutive patients who underwent revision THA at our hospital from 2004 to 2014. Records were reviewed to collect data on patient's primary and revision THA procedures, and the interval between primary THA and revision surgery was determined. Aseptic loosening (31.3%), osteolysis (21.8%), and instability (21.4%) were the overall most common indications for revision THA and the most common indications for revision surgery within 5 years of primary THA. Aseptic loosening and osteolysis were the most common indications for revision greater than 5 years from primary THA. Only 16.4% of revised hips had their index arthroplasty performed at our hospital, whereas 83.6% were referred to our institution. Aseptic loosening, osteolysis, and instability remain the most common contemporary indications for revision THA in an era of alternative bearings and modular components. Most of our revisions were referred from outside institutions, which highlights the transfer of a large portion of the revision THA burden to tertiary referral centers, a pattern that could be exacerbated under future bundled payment models. Copyright © 2016 Elsevier Inc. All rights reserved.
Full Text Available Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods.
Tsuchihashi, Keichiro; Ishiguro, Yukio; Kaneko, Kunio; Ido, Masaru.
Since the publication of JAERI-1285 in 1983 for the preliminary version of the SRAC code system, a number of additions and modifications to the functions have been made to establish an overall neutronics code system. Major points are (1) addition of JENDL-2 version of data library, (2) a direct treatment of doubly heterogeneous effect on resonance absorption, (3) a generalized Dancoff factor, (4) a cell calculation based on the fixed boundary source problem, (5) the corresponding edit required for experimental analysis and reactor design, (6) a perturbation theory calculation for reactivity change, (7) an auxiliary code for core burnup and fuel management, etc. This report is a revision of the users manual which consists of the general description, input data requirements and their explanation, detailed information on usage, mathematics, contents of libraries and sample I/O. (author)
Kee, James R; Mears, Simon C; Edwards, Paul K; Barnes, C Lowry
Obesity, smoking, uncontrolled diabetes, and poor dental health are modifiable risk factors for revision total joint arthroplasty. To protect patients from revision surgery while also reducing cost, some joint arthroplasty practices use these conditions as contraindications until they are improved. However, this practice is variable among joint arthroplasty surgeons. We hypothesize that a relatively high rate of revision arthroplasty patients had modifiable risk factors at the time of primary surgery. A retrospective review of all revision total hip and knee arthroplasties performed at an academic, tertiary referral center within 2 years of primary surgery was conducted. The presence of body mass index >40, hemoglobin A1c >8, poor dentition, and smoking status were obtained from the electronic medical record. Risk factors were described and compared between infected revisions and noninfected revisions. A total of 128 revision arthroplasties were performed at our institution in one year. And 23 of 57 (40.4%) total hip revision and 31 of 71 (43.7%) total knee revision patients had at least 1 modifiable risk factor. Infected hip revision patients were more likely to have increased body mass index compared to noninfected patients. Infected knee revision patients were more likely to smoke, have poor dentition, and have >1 contraindication compared to noninfected patients. A high percentage of patients undergoing early revision arthroplasty had at least 1 modifiable risk factor for a primary joint arthroplasty. Joint arthroplasty surgeons may help reduce revision surgery through counseling and appropriate referral for modification of risk factors. Copyright © 2017 Elsevier Inc. All rights reserved.
Revised sections F7.5 (quantitative amino acid analysis) and F7.6 (qualitative amino acid analysis): American College of Medical Genetics Standards and Guidelines for Clinical Genetics Laboratories, 2003.
Grier, Robert E; Gahl, William A; Cowan, Tina; Bernardini, Isa; McDowell, Geraldine A; Rinaldo, Piero
Determination of plasma amino acid levels has become a key piece of information in the diagnosis and clinical management of a group of metabolic genetic disorders. Appropriate laboratory methodologies have been published for amino acid analysis, yet there is a need for direction for the laboratory in performing this testing. The following guidelines were generated by a working group of the American College of Medical Genetics Laboratory Quality Assurance Committee. Based upon a body of knowledge and professional experience, these guidelines and standards are to be the benchmark for performance of amino acid analysis for clinical interpretation.
Nelson, T.A.; Murray, R.C.; Short, S.A.
The original version of ASCE Standard 4, ''Seismic Analysis of Safety-Related Nuclear Structures'' was published in September 1986. It is ASCE policy to update its standards on a five year interval and the Working Group on Seismic Analysis of Safety Related Nuclear Structures was reconvened to formulate the revisions. The goal in updating the standard is to make sure that it is still relevant and that it incorporates the state of the practice in seismic engineering or, in some cases, where it has been demonstrated that state-of-the-art improvements need to be made to standard practice; new improvements are included. The contents of the new standard cover the same areas as the original version, with some additions. The contents are as follows: Input - response spectra and time histories; modeling of structures; analysis of structures; soil-structure interaction; input for subsystem analysis; special structures - buried pipes and conduits, earth-retaining walls, above-ground vertical tanks, raceways, and base-isolated structures; and an appendix providing seismic probabilistic risk assessment and margin assessment
This reference authority has been created and is maintained to provide standard forms for recording the names of organizations consistently in bibliographic citations. This revision includes approximately 42,000 entries established since 1973
In this revision test evaluates the acquired knowledge in case of radiological emergency confront. Actions to be taken in relation to people, equipment and the environment. Doses, radioactive sources, pollution
Full Text Available This paper builds on an extraordinary revision of regional accounts whose results were published in November 2011 following previous revision of the national accounts time series (September 2011. The first chapter provides description of working procedures and results of the gross value added (GVA revision for the period 1995–2007. The second chapter deals with methodological corrections and models whose revision had the biggest impact on the change of the GDP regional structure. The most important was the implementation of a new method of the regional allocation of imputed rent, new regional GVA estimates from individual housing construction and from a segment of illegal economy. The following chapters provide results of regional accounts revision carried out in standard way, i.e. sets of accounts for 2008 and 2009 and preliminary versions for 2010 including the analysis of economic devolution in regions in the above years. Finally, the article deals with the impact of revision on international position of the Czech regions specifically in relation to the EU average.
Park, Kwan J; Couch, Cory G; Edwards, Paul K; Siegel, Eric R; Mears, Simon C; Barnes, C Lowry
The use of tranexamic acid (TEA) can significantly reduce the need for allogenic blood transfusions in elective primary joint arthroplasty. Revision total hip arthroplasty (THA) requires increased utilization of postoperative blood transfusions for acute blood loss anemia compared with elective primary hip arthroplasty. There is limited literature to support the routine use of TEA in revision THA. We performed a retrospective review of 161 consecutive patients who underwent revision THA from 2012 to 2014 at a single institution by 2 fellowship-trained surgeons. We compared the transfusion requirements and the postoperative hemoglobin drop of the TEA group (109 patients, 114 hips) vs the no-TEA group (52 patients, 56 hips). Our standard protocol for administering TEA is 1000 mg IV at incision and the same dose repeated 2 hours later. The no-TEA group did not receive the medication because of previous hospital contraindication criteria. The transfusion rate was significantly less for the TEA group (7%) compared with the no-TEA group (34%; P revision THA demonstrated a significant reduction in allogenic blood transfusion rates. The postoperative hemoglobin drop was also significantly less with the use of TEA. We recommend the routine use of TEA during revision THA. Published by Elsevier Inc.
Eslami, Yadollah; Fakhraie, Ghasem; Moghimi, Sasan; Zarei, Reza; Mohammadi, Masoud; Nabavi, Amin; Yaseri, Mehdi; Izadi, Ali
To evaluate the outcome of excisonal bleb revision in patients with failed Ahmed glaucoma valve (AGV). In total, 29 patients with uncontrolled intraocular pressure (IOP) despite of maximal tolerated medical therapy at least 6 months after AGV implantation were enrolled in this prospective interventional case series. Excision of fibrotic tissue around the reservoir with application of mitomycin C 0.02% was performed. IOP, number of glaucoma medications were evaluated at baseline and 1 week and 1, 3, 6, and 12 months postoperatively. Complete and qualified success was defined as IOP≤21 mm Hg with or without glaucoma medications, respectively. Intraoperative and postopervative complications were also recorded. Mean IOP was reduced from 30±4.2 mm Hg at baseline to 19.2±3.1 mm Hg at 12-month follow-up visit (Pglaucoma medications was decrease from 3.2±0.5 at baseline to 1.9±0.7 at 12-month follow-up (Pglaucoma surgeries were significantly associated with the failure of excisonal bleb revision. Excisional bleb revision could be considered as a relatively effective alternative option for management of inadequate IOP control after AGV implantation.
Khan, Prince Shanavas; Thilak, Jai
There is limited information in English literature regarding the cause of revision total knee arthroplasty (TKA) in emerging economies. The purpose of this study is to report a detailed analysis of the TKA failure mechanisms from a referral hospital in India and to determine whether the failure mechanisms of primary TKA are different from that of the western world. A total of 53 revision TKAs performed at our institution over the past 5 years were identified. The revision TKA group was divided into subgroups according to the cause of failure, including infection, aseptic loosening, periprosthetic fracture, instability, extensor mechanism failure, and other causes. All revision TKA patients were subdivided into early (less than 2 years from primary) and late (more than 2 years from primary) failure groups depending upon the time interval between primary TKA and revision procedure. The overall common failure mechanisms were infection (73.58%), aseptic loosening (13.2%), and periprosthetic fracture (5.6%). Infection was the most common failure mechanism for early revision (revision. Our study shows a pattern similar to the earliest trends of revision TKA in western literature reporting infection as the major cause for revision. The level of evidence for the study is Level 3. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Full Text Available "nThe most common cause of failure during the first trimester after trabeculectomy is encapsulated bleb and needling bleb revision is a less invasive method in the management of refractory cases. The purpose of this study is to determine the efficacy and safety of mitomycin-C (MMC augmented bleb revision of failed filtration surgery. This study is a before-after (paired observation. 33 patients with failed trabeculectomy because of bleb encapsulation, whose intraocular pressure (IOP was not reduced under 21 mmHg despite of medications and digital massage , underwent needling bleb revision and subconjunctival injection of 0.1 ml MMC (0.4 mg/ml.The mean follow-up time was 9.24 ± 5.27 months (1-20 months. Statistical analysis of the data included the paired two-tailed Student's t test for preoperative and postoperative IOP and number of medications. 36 needling procedures (mean, 1.09 ± 0.21 revisions per eye were performed on 33 eyes. Patients were between 10-80 years old (mean, 45.67 ± 22.41 years and mean follow-up was 9.24 ± 5.27 months. IOP decreased from 29.06 ± 5.03 mmHg to 18.21 ± 6.76 mmHg at last follow-up (P= 0.000. Antiglaucoma medications decreased from 2.18 ± 0.58 to 1.36 ± 0.29 at last follow-up (P= 0.000.Overall, 6 (18.2% of 33 cases achieved a complete success and 20 (60.6% of cases achieved a qualified success. The complications of this procedure were subconjunctival hemorrhage (17 cases, hyphema (5 cases and conjunctival button hole (2 cases. Needling bleb revision with mitomycin-C appears to be an effective and relatively safe way to revive failed filtration surgery.
Tack, C.J.J.; Plasschaert, A.J.M.
As part of a revised dental curriculum, a 3(rd) year module on medical subjects was developed based on a mixture of self-study and problem-oriented approach using cases. Pairs of students had to select a specific medical problem and solve a paper patient case using a problem-solving cycle. Results
Mays, G.T.; Poore, W.P.
Licensee Event Reports (LERs) provide the basis for evaluating and assessing operating experience information from nuclear power plants. The reporting requirements for submitting LERs to the Nuclear Regulatory Commission have been revised. Effective Jan. 1, 1984, all events were to be submitted in accordance with 10 CFR 50.73 of the Code of Federal Regulations. Report NUREG-1022, Licensee Event Report System-Description of System and Guidelines for Reporting, describes the guidelines on reportability of events. This article summarizes the reporting requirements as presented in NUREG-1022, high-lights differences in data reported between the revised and previous LER systems, and presents results from a preliminary assessment of LERs submitted under the revised LER reporting system
Zarin, Jeffrey; Grosvenor, David; Schurman, David; Goodman, Stuart
Patients undergoing revision total hip arthroplasty frequently require perioperative blood transfusion, increasing the risk for blood-borne disease and anaphylactic and hemolytic reactions. The purpose of this retrospective study was to evaluate the effect of intraoperative blood collection and reinfusion on net blood loss in patients undergoing revision hip arthroplasty. The medical records of 126 patients who had had a revision total hip arthroplasty with intraoperative blood salvage, with use of a collection and reinfusion device, during a twenty-eight-month period were reviewed. For comparison, the medical records of ninety-six patients who had undergone revision hip arthroplasty without intraoperative blood salvage were reviewed. Each of the 222 patients was categorized into a group on the basis of the type of revision. Patients who had a revision of the femoral and acetabular components (Group C) had significantly higher mean intraoperative and total blood loss than did those who had a revision of the femoral component only (Group A [p = 0.009 and p = 0.02, respectively]) or a revision of the acetabular component only (Group B [p = 0.0001 for both]). Total blood loss was not significantly different between Groups A and B. The mean amount of blood reinfused intraoperatively was 356 mL for the patients in Group A, 374 mL for the patients in Group B, and 519 mL for the patients in Group C. Regression analysis showed a significant decrease in net blood loss with intraoperative collection and reinfusion in Groups B (p = 0.002) and C (p = 0.0001) but not in Group A. Intraoperative collection and reinfusion substantially decreased net perioperative blood loss in patients who had a revision of both components (Group C) and in those who had a revision of the acetabular component (Group B). The use of intraoperative blood collection and reinfusion appears to be a valuable method of preserving blood volume in the perioperative period.
Shipler, D.B.; Napier, B.A.
This report is a revision of the previous Hanford Environmental Dose Reconstruction (HEDR) Project modeling approach report. This revised report describes the methods used in performing scoping studies and estimating final radiation doses to real and representative individuals who lived in the vicinity of the Hanford Site. The scoping studies and dose estimates pertain to various environmental pathways during various periods of time. The original report discussed the concepts under consideration in 1991. The methods for estimating dose have been refined as understanding of existing data, the scope of pathways, and the magnitudes of dose estimates were evaluated through scoping studies
Song, Dawei; Zhang, Peng; Wang, Lei; Arafat, Sachi
This book constitutes the thoroughly refereed post-conference proceedings of the 5th International Symposium on Quantum Interaction, QI 2011, held in Aberdeen, UK, in June 2011. The 26 revised full papers and 6 revised poster papers, presented together with 1 tutorial and 1 invited talk were carefully reviewed and selected from numerous submissions during two rounds of reviewing and improvement. The papers show the cross-disciplinary nature of quantum interaction covering topics such as computation, cognition, mechanics, social interaction, semantic space and information representation and retrieval. (orig.)
Shipler, D.B.; Napier, B.A.
This report is a revision of the previous Hanford Environmental Dose Reconstruction (HEDR) Project modeling approach report. This revised report describes the methods used in performing scoping studies and estimating final radiation doses to real and representative individuals who lived in the vicinity of the Hanford Site. The scoping studies and dose estimates pertain to various environmental pathways during various periods of time. The original report discussed the concepts under consideration in 1991. The methods for estimating dose have been refined as understanding of existing data, the scope of pathways, and the magnitudes of dose estimates were evaluated through scoping studies.
Full Text Available Nabokov revised his works as he translated them and, on another plane, canon revisionism has been having its backlash and provoked other refracting waves. The purpose of the conference was to advance Nabokov studies through the discussion of how our view of Nabokov’s standing and his works today should be revised, especially after the publication of The Original of Laura. However the conference was not confined to just this theme, since “revising” is a word rich with implications. To borrow s...
A Draft Technical Information Document (HNF-1855) is being prepared to evaluate proposed interim tritium and medical isotope production at the Fast Flux Test Facility (FFTF). This assessment examines the potential health and safety impacts of transportation operations associated with the production of medical isotopes. Incident-free and accidental impacts are assessed using bounding source terms for the shipment of nonradiological target materials to the Hanford Site, the shipment of irradiated targets from the FFTF to the 325 Building, and the shipment of medical isotope products from the 325 Building to medical distributors. The health and safety consequences to workers and the public from the incident-free transportation of targets and isotope products would be within acceptable levels. For transportation accidents, risks to works and the public also would be within acceptable levels. This assessment is based on best information available at this time. As the medical isotope program matures, this analysis will be revised, if necessary, to support development of a final revision to the Technical Information Document
A Draft Technical Information Document (HNF-1855) is being prepared to evaluate proposed interim tritium and medical isotope production at the Fast Flux Test Facility (FFTF). This assessment examines the potential health and safety impacts of transportation operations associated with the production of medical isotopes. Incident-free and accidental impacts are assessed using bounding source terms for the shipment of nonradiological target materials to the Hanford Site, the shipment of irradiated targets from the FFTF to the 325 Building, and the shipment of medical isotope products from the 325 Building to medical distributors. The health and safety consequences to workers and the public from the incident-free transportation of targets and isotope products would be within acceptable levels. For transportation accidents, risks to works and the public also would be within acceptable levels. This assessment is based on best information available at this time. As the medical isotope program matures, this analysis will be revised, if necessary, to support development of a final revision to the Technical Information Document.
Leta, Tesfaye H; Lygre, Stein Håkon L; Skredderstuen, Arne; Hallan, Geir; Furnes, Ove
In Norway, the proportion of revision knee arthroplasties increased from 6.9% in 1994 to 8.5% in 2011. However, there is limited information on the epidemiology and causes of subsequent failure of revision knee arthroplasty. We therefore studied survival rate and determined the modes of failure of aseptic revision total knee arthroplasties. This study was based on 1,016 aseptic revision total knee arthroplasties reported to the Norwegian Arthroplasty Register between 1994 and 2011. Revisions done for infections were not included. Kaplan-Meier and Cox regression analyses were used to assess the survival rate and the relative risk of re-revision with all causes of re-revision as endpoint. 145 knees failed after revision total knee arthroplasty. Deep infection was the most frequent cause of re-revision (28%), followed by instability (26%), loose tibial component (17%), and pain (10%). The cumulative survival rate for revision total knee arthroplasties was 85% at 5 years, 78% at 10 years, and 71% at 15 years. Revision total knee arthroplasties with exchange of the femoral or tibial component exclusively had a higher risk of re-revision (RR = 1.7) than those with exchange of the whole prosthesis. The risk of re-revision was higher for men (RR = 2.0) and for patients aged less than 60 years (RR = 1.6). In terms of implant survival, revision of the whole implant was better than revision of 1 component only. Young age and male sex were risk factors for re-revision. Deep infection was the most frequent cause of failure of revision of aseptic total knee arthroplasties.
Johnson, William R; Makani, Amun; Wall, Andrew J; Hosseini, Ali; Hampilos, Perry; Li, Guoan; Gill, Thomas J
Patient outcomes and predictors of success after revision anterior cruciate ligament (ACL) reconstruction are currently limited in the literature. Existing studies either have a small study size or are difficult to interpret because of the multiple surgeons involved in the care of the study sample. To determine patient outcomes and predictors of success or failure after a single-stage revision ACL reconstruction by a single fellowship-trained senior surgeon at a single institution. Case series; Level of evidence, 4. A total of 78 patients who underwent revision ACL reconstruction by a single surgeon from 2010 to 2014 were contacted and available for follow-up. The mean time from revision procedure to follow-up was 52 months. Those patients who were able to participate in the study sent in a completed Tegner activity level scale, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and IKDC Current Health Assessment Form. The patients' medical records were also thoroughly reviewed. Five patients had subsequent failure after revision surgery. The median Tegner score was 6 at follow-up, and the mean subjective IKDC score was 72.5. There was no statistically significant difference in outcome scores when comparing revision graft type, body mass index, sex, need for bone grafting, and time from failure to revision. Patients with failures after primary ACL reconstruction secondary to a traumatic event were found to have statistically significantly higher IKDC scores (mean, 76.6) after revision when compared with nontraumatic failures (mean, 67.1), even when controlling for confounders (P Revision ACL reconstruction is effective in improving patient activity levels and satisfaction. However, the subjective IKDC results are quite variable and likely based on multiple factors. Patients with traumatic injuries contributing to graft failure after primary ACL reconstruction had a statistically significantly, although not clinically significant
ReviewsGCSE Book Review: Modular Science for AQA GCSE Book Review: Modular Science for Edexcel GCSE Book Review: Revise for GCSE Science (Edexcel Modular Foundation and Higher) GCSE Book Review: AQA GCSE Physics, AQA GCSE Physics Additions Book Review: Studying Maths and its Applications Book Review: Medical Physics, 2nd edition Book Review: The Physics of Hockey Book Review: Nine Crazy Ideas In Science Book Review: Light and Dark Talking Point: The Skeptical Environmentalist Places To Visit: Centre for Alternative Technology, Machynlleth, Powys Resources: Sources of Energy Web Watch: Terence, this is stupid stuff...
GCSE BOOK REVIEWS (162) Modular Science for AQA Modular Science for Edexcel Revise for GCSE Science (Edexcel Modular Foundation and Higher) AQA GCSE Physics, AQA GCSE Physics Additions BOOK REVIEWS (166) Studying Maths and its Applications Medical Physics, 2nd edition The Physics of Hockey Nine Crazy Ideas In Science Light and Dark TALKING POINT (169) The Skeptical Environmentalist PLACES TO VISIT (170) Centre for Alternative Technology, Machynlleth, Powys RESOURCES (172) Sources of Energy WEB WATCH (173) Terence, this is stupid stuff...
Wilson, Arlette C.; Key, Kimberly
The Financial Accounting Standards Board (FASB) has recently issued Statement of Financial Accounting Standards No. 141 (Revised 2007) Business Combinations. The object of this Statement is to improve the relevance, representational faithfulness, and comparability of reported information about a business combination and its effects. This Statement…
Full Text Available A revision of the Asian palm genus Wallichia is given, based on examination of morphology of herbarium specimens. Eight species are recognized, one of which, W. lidiae, is described as new. Lectotypes are chosen for W. disticha, W. gracilis, and W. oblongifolia. A key, complete synonymy, descriptions, pinnae shape illustrations, and distribution maps are given for all species.
This revised and updated book is written to inform the citizens on the nature, causes, and effects of air pollution. It is written in terms familiar to the layman with the purpose of providing knowledge and motivation to spur community action on clean air policies. Numerous charts and drawings are provided to support discussion of air pollution…
Analytical chemists need to revise curricula and make better use of computers to improve the status of their discipline. Highlights of an international panel of leading analytical chemists which addressed topics and issues related to these needs are presented. A chart showing the five-year Soviet chemistry curriculum is included. (JN)
The signature on 12 February 2004 of the Protocols amending respectively the 1960 Paris Convention and the 1963 Brussels Supplementary Convention was the second step of the process of modernisation of the international nuclear liability regime after the adoption in September 1997 of a Protocol revising the 1963 Vienna Convention and of a new Convention on Supplementary Compensation for Nuclear Damage. The common objective of the new instruments is to provide more funds to compensate a larger number of potential victims in respect of a broader range of damage. Another goal of the revision exercise was to maintain the compatibility between the Paris and Vienna based systems, a commitment enshrined in the 1988 Joint Protocol, as well as to ascertain that Paris/Brussels countries could also become a Party to the Convention on Supplementary Compensation. However, while generally consistent vis a vis the Joint Protocol, the provisions of the Paris and Vienna Conventions, as revised, differ on some significant aspects. Another remaining issue is whether the improved international nuclear liability regime will succeed in attracting in the future a larger number of countries, particularly outside Europe, and will so become truly universal. Therefore, the need for international co-operation to address these issues, to facilitate the adoption of new implementing legislation and to ensure that this special regime keeps abreast of economic and technological developments, is in no way diminished after the revision of the Conventions.(author)
The genus Ichnocarpus is revised. A total of 12 species are recognised, of which one new species is described. Three new combinations in Ichnocarpus and one in Anodendron are made. Micrechites and Lamechites are treated as synonyms of Ichnocarpus. Nomina nuda and species exclusae have been given as
Lam, H.J.; Royen, van P.
After the senior writer, together with W. W. Varossieau, had published a revision of this monogeneric family (Blumea III, 1938—’39 and IV, 1941), some more material has been examined by us and, moreover, some new species have been described. Thanks to the courtesy of Prof. F. Gagnepain of Paris, and
This checklist consolidates the changes to the Federal code addressed by the Toxicity Characteristic (TC) Rule [55 FR 11798; March 29, 1990; Revision Checklist 74] and subsequent revisions which have occurred through December 31, 2002.
The following details all additions and revisions made to the DHQ nutrient and food database. This revision history is provided as a reference for investigators who may have performed analyses with a previous release of the database.
Wilde, Jeffrey; Bedi, Asheesh; Altchek, David W.
Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B. PMID:25364483
The present paper is an extension of my revision of the Malaysian species of the genus Dillenia L. (Wormia Rottb. included) inserted in the revision of the Dilleniaceae in the Flora Malesiana ser. I, vol. 4, part 3, pp. 141—174, published in December 1951. A critical revision of the whole genus has
... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Budget revisions. 968.225 Section... Fewer Than 250 Units) § 968.225 Budget revisions. (a) A PHA shall not incur any modernization cost in excess of the total HUD-approved CIAP budget. A PHA shall submit a budget revision, in a form prescribed...
... 7 Agriculture 15 2010-01-01 2010-01-01 false Budget revisions. 3015.115 Section 3015.115..., DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Programmatic Changes and Budget Revisions § 3015.115 Budget revisions. (a) Nonconstruction projects. (1) Except as provided in paragraph (a)(2) of...
Peach, Chris A; Salama, Amir; Stanley, David
The use of cortical windows for revision elbow arthroplasty has not previously been widely reported. Their use aids safe revision of a well fixed humeral prosthesis and can be used in the setting of dislocation, periprosthetic fracture or aseptic loosening of the ulnar component. We describe our technique and results of cortical windows in the distal humerus for revision elbow arthroplasty surgery.
... human environment. Therefore, neither an environmental assessment nor an environmental impact statement..., Confidential business information, Medical devices, Medical research, Reporting and recordkeeping requirements... revising the second sentence in paragraph (a) to read as follows: Sec. 870.3600 External pacemaker pulse...
Qu-Knafo, Lise; Le Du, Brivael; Boumendil, Julien; Nordmann, Jean-Philippe
We report the first description of temporalis fascia autograft to repair a late leakage bleb with scleral defect that occurred long time after trabeculectomy with mitomycin C. A 65-year-old woman was referred to our hospital with chronic late bleb leakage on her right eye. She had previously undergone a trabeculectomy with mitomycin C 3 years ago for a pigmentary glaucoma. Bleb leakage occurred 1½ year after the initial surgery. She underwent 2 surgical revisions consisting of a conjunctival advancement then an autologous conjunctival with partial scleral grafts without success. The initial best-corrected visual acuity of the right eye was 20/50 (Snellen scale). Slit-lamp examination revealed an avascular filtering bleb with leakage (massive positive Seidel test) and a scleral defect. The anterior chamber was deep and intraocular pressure (IOP) was 9 mm Hg.Faced with the risk of blebitis, endophthalmitis, and with the failure of the previous surgeries announced earlier, a surgical revision with autologous superficial temporalis fascia graft was decided to repair the leaking bleb. After local anesthesia, a sample of superficial temporalis fascia was harvested. The necrotic avascular conjunctiva around the bleb was dissected to separate and excise it from the sclera. The autologous fascia graft was sutured on the scleral defect with 10-0 nylon. Subsequently healthy conjunctiva was sutured above the graft. No bleb leakage occurred postoperatively, best-corrected visual acuity improved to 20/25, and IOP remained within normal levels 6 months after surgery without IOP-lowering medication. Superficial temporalis fascia autograft seems to be an effective, safe, and easy technique for ophthalmologists. It is a new procedure in the management of late-onset bleb leakage.
... the ``speech education and articulation'' of children in bilingual or multilingual environments... conducted for children who are bilingual or multilingual would be invalid. We did not adopt this comment. We agree that children who are bilingual or multilingual do not always develop in the same way as children...
Azevedo, Valderilio Feijó; Lopes, Maicon Piana; Catholino, Nathan Marostica; Paiva, Eduardo Dos Santos; Araújo, Vitor Andrei; Pinheiro, Geraldo da Rocha Castelar
Gout is considered the most common form of inflammatory arthritis in men over 40 years. The authors present a brief review of the current treatment of gout and discuss the existing pharmacological limitations in Brazil for the treatment of this disease. Although allopurinol is still the main drug administered for decreasing serum levels of uric acid in gout patients in this country, the authors also present data that show a great opportunity for the Brazilian drug market for the treatment of hyperuricemia and gout and especially for patients using private and public (SUS) health care systems. Copyright © 2017 Elsevier Editora Ltda. All rights reserved.
... listings. We propose to remove current 6.00B that lists definitions because we would provide a definition... period of time to evaluate hypertension (proposed 6.05B3a), vascular congestion (proposed 6.05B3b), and... determining whether a person is disabled under the statutory definition? The Act authorizes us to make rules...
... conditions that meet listings in other body systems due to complications of DM. \\4\\ The definition of... definition? Under the Act, we have full power and authority to make rules and regulations and to establish... hypertension that worsens heart failure or causes recurrent arrhythmias under 4.00; adrenal-related weight loss...
... current listing 112.12, Developmental and Emotional Disorders of Newborn and Younger Infants (Birth to....07 Somatoform Disorders 12.07 Somatoform Disorders. 12.08 Personality Disorders 12.08 Personality...
.... We would add the definition of the term mean deviation (or defect), abbreviated as MD, which we use... the word ``central'' before ``visual acuity'' to correct the definition of statutory blindness in... disorder that may result in abnormalities that do not appear on a standard eye examination. We also intend...
...) A definition of ``marked'' based on a standardized test score that is two standard deviations below... measure of functional parameters, a valid score that is two standard deviations below the norm for the... tests are used as the measure of functional abilities, a valid score that is two standard deviations or...
... disorders are abnormalities of the eye, the optic nerve, the optic tracts, or the brain that may cause a... any diameter on which it falls. 7. How do we determine your visual acuity efficiency, visual field...? Visual disorders are abnormalities of the eye, the optic nerve, the optic tracts, or the brain that may...
Lindberg-Larsen, Martin; Jørgensen, Christoffer C; Bagger, Jens
Background and purpose - The surgical treatment of periprosthetic knee infection is generally either a partial revision procedure (open debridement and exchange of the tibial insert) or a 2-stage exchange arthroplasty procedure. We describe the failure rates of these procedures on a nationwide...... - The failure rates of 43% after the partial revision procedures and 30% after the 2-stage revisions in combination with the higher mortality outside high-volume centers call for centralization and reconsideration of surgical strategies....... ≤ 90 days postoperatively, re-revision due to infection, or not reaching the second stage for a planned 2-stage procedure within a median follow-up period of 3.2 (2.2-4.2) years. Results - The failure rate of the partial revisions was 43%. 71 of the partial revisions (67%) were revisions of a primary...
The present publication is an updated version of the IAEA Assessment of Safety Significant Events Team (ASSET) Guidelines, IAEA-TECDOC-573, published in 1990. Sections 5 and 6 include revised definitions and investigation guidelines for identification of both direct and root causes. These revisions were recommended by a Consultants Meeting held in Vienna on 3-7 December 1990. This guidance is not intended to infringe an expert's prerogative to investigate additional items. Its main purpose is to provide a basic structure and ensure consistency in the assessments. Use of the ASSET guidelines should also facilitate comparison between the observations made in different nuclear power plants and harmonize the reporting of generic ASSET results. The guidelines should always be used with a critical attitude and a view to possible improvements
Kondo, Tadashi; Ueno, Junji; Takao, Shoichiro
A revised Group Method of Data Handling (GMDH)-type neural network algorithm using artificial intelligence technology for medical image diagnosis is proposed and is applied to medical image diagnosis of liver cancer. In this algorithm, the knowledge base for medical image diagnosis are used for organizing the neural network architecture for medical image diagnosis. Furthermore, the revised GMDH-type neural network algorithm has a feedback loop and can identify the characteristics of the medical images accurately using feedback loop calculations. The optimum neural network architecture fitting the complexity of the medical images is automatically organized so as to minimize the prediction error criterion defined as Prediction Sum of Squares (PSS). It is shown that the revised GMDH-type neural network can be easily applied to the medical image diagnosis. (author)
This Reference Book contains a current copy of the Clean Air Act, as amended, and those regulations that implement the statute and appear to be most relevant to DOE activities. The document is provided to DOE and contractor staff for informational purposes only and should not be interpreted as legal guidance. This Reference Book has been completely revised and is current through February 15, 1994.
Jang, Young Ai; Lee, Haeng Shin; Kim, Bok Hee; Lee, Yoonna; Lee, Hae Jeung; Moon, Jae Jin; Kim, Cho-il
With rapidly changing dietary environment, dietary guidelines for Koreans were revised and relevant action guides were developed. First, the Dietary Guidelines Advisory Committee was established with experts and government officials from the fields of nutrition, preventive medicine, health promotion, agriculture, education and environment. The Committee set dietary goals for Koreans aiming for a better nutrition state of all after a thorough review and analysis of recent information related to nutritional status and/or problems of Korean population, changes in food production/supply, disease pattern, health policy and agricultural policy. Then, the revised dietary guidelines were proposed to accomplish these goals in addition to 6 different sets of dietary action guides to accommodate specific nutrition and health problems of respective age groups. Subsequently, these guidelines and guides were subjected to the focus group review, consumer perception surveys, and a public hearing for general and professional comments. Lastly, the language was clarified in terms of public understanding and phraseology. The revised Dietary guidelines for Koreans are as follows: eat a variety of grains, vegetables, fruits, fish, meat, poultry and dairy products; choose salt-preserved foods less, and use less salt when you prepare foods; increase physical activity for a healthy weight, and balance what you eat with your activity; enjoy every meal, and do not skip breakfast; if you drink alcoholic beverages, do so in moderation; prepare foods properly, and order sensible amounts; enjoy our rice-based diet.
Fenstad, Anne M; Dale, Håvard; Havelin, Leif; Hallan, Geir; Overgaard, Søren; Pedersen, Alma B; Kärrholm, Johan; Garellick, Göran; Pulkkinen, Pekka; Eskelinen, Antti; Mäkelä, Keijo; Engesæter, Lars B; Fevang, Bjørg-Tilde
Background and purpose Medical treatment of rheumatoid arthritis (RA) has changed dramatically over the last 15 years, including immune modulation. We investigated the risk of revision for infection after primary total hip replacement (THR) in patients with rheumatoid arthritis over a 16-year period, and compared it with that in THR patients with osteoarthritis (OA). Patients and methods We identified 13,384 THRs in RA patients and 377,287 THRs in OA patients from 1995 through 2010 in a dataset from the Nordic Arthroplasty Register Association (NARA). Kaplan-Meier survival curves, with revision for infection as the endpoint, were constructed. Cox regression analyses were performed to calculate the relative risk (RR) of revision for infection adjusted for age, sex, fixation technique, and year of primary surgery. Results RA patients had a 1.3 times (95% CI 1.0–1.6) higher risk of revision for infection. After 2001, this risk increased more for RA patients than for OA patients. During the first 3 months and from 8 years postoperatively, the risk of revision for infection was higher in RA patients with THRs fixated with antibiotic-loaded cement than in corresponding OA patients. Interpretation We found a slightly higher overall risk of revision for infection in RA patients than in OA patients, but this difference was only present after 2001. In THRs with antibiotic-loaded cement, the risk of very early and late infections leading to revision was higher in RA patients than in OA patients. PMID:25782042
Riesgo, Aldo M; Hochfelder, Jason P; Adler, Edward M; Slover, James D; Specht, Lawrence M; Iorio, Richard
We retrospectively reviewed 161 revision THAs with diaphyseal fitting, mid-modular femoral components performed by ten surgeons at two academic medical centers. The average follow-up was 6.1 years. At final follow-up, 4 patients required re-revision for failure of the femoral component; 3 (2%) for aseptic loosening and 1 for mechanical failure of stem in setting of periprosthetic fracture. There were a total of 24 (14.9%) revisions for any reason, with the most common reason being septic failure (10 of 24). To our knowledge, this is the largest reported series of mid-term survivorship and complications of revision THA with mid-modular femoral components. Our results show that these stems have a low rate of aseptic loosening, subsidence, and mechanical failure. Copyright © 2015 Elsevier Inc. All rights reserved.
Authored by a leading educator, this book is ideal for medical imaging courses. Rather than focus on imaging modalities the book delves into the mechanisms of image formation and image quality common to all imaging systems: contrast mechanisms, noise, and spatial and temporal resolution. This is an extensively revised new edition of The Physics of Medical X-Ray Imaging by Bruce Hasegawa (Medical Physics Publishing, 1991). A wide range of modalities are covered including X-ray CT, MRI and SPECT.
They completed self-report questionnaires about their demographic and medical data, their illness perception using the Illness Perception Questionnaire-Revised (IPQ-R) and their medication adherence using the Medication Adherence Report Scale-5 (MARS5). The outcome of the analysis using the Pearson Product ...
Der Unterricht zur Arzt-Patientin-Beziehung (APB im Fach Medizinische Soziologie an den medizinischen Fakultäten der Bundesrepublik Deutschland nach Änderung der Approbationsordnung für ��rzte [Teaching the doctor-patient relationship in medical sociology within German medical faculties following revisions to licensing regulations for physicians
Full Text Available [english] Background: Changes in requirements governing licensing regulations for physicians in Germany (ÄAppO in 2002, has led to complex discussions within the German Society of Medical Sociology (DGMS. In order to support the process of curricular agreement, the DGMS workgroup entitled ‘teaching’ conducted a survey on how the doctor–patient relationship is taught in medical sociology. Method: The survey was conducted in spring 2005 via e-mail. A standardized questionnaire including a total of thirty educational objectives comprised the survey, whereby each objective was evaluated by five criteria. Thirteen experts in the field of medical sociology variously representing eleven medical faculties responded. According to suggested methods of the Delphi survey, means and ranges were calculated. Results: Of the thirty educational objectives surveyed, two were evaluated negatively by a majority of individuals. Twenty objectives showed variances in evaluation (i.e., controversial objectives. Eight objectives, for example, the social framing of the doctor–patient relationship, the elaborateness of language use, or the asymmetry of the doctor–patient relationship, were generally judged positively. Controversial objectives revealed some areas of contradiction. Some objectives – for example, exploring the social background of a patient – were evaluated as important items but were not frequently taught during regular sociology courses. Conclusions: The results show an interesting picture of present teaching practices in eleven medical faculties and will likely stimulate further discussion in the field of medical sociology. The response rate and discussions held in recent years demonstrate the need to discuss questions of relevance to medical education before a wider audience, both within the DGMS and other disciplines. Educational objectives and didactic methods need to be further developed to bring teaching in step with actual practice as
Ramírez, Martha Delgado; Gómez-Restrepo, Carlos
The assessment of medical education is fundamental for proper feedback and evaulation of students. The overall purpose of the evaluation is numerically and formatively revised. The suggested evaluation processes is described taking into account the Miller competence pyramid as a tool for designing evaluations and concepts of validity and reproducibility in assessments. The utility of student and the teacher is also raised. The issue of assessment should leave the knowledge parameters that are usually used. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.
Krieg, S M; Meyer, H S; Meyer, B
Non-fusion spinal implants are designed to reduce the commonly occurring risks and complications of spinal fusion surgery, e.g. long duration of surgery, high blood loss, screw loosening and adjacent segment disease, by dynamic or movement preserving approaches. This principle could be shown for interspinous spacers, cervical and lumbar total disc replacement and dynamic stabilization; however, due to the continuing high rate of revision surgery, the indications for surgery require as much attention and evidence as comparative data on the surgical technique itself.
Norsk, P; Drummer, C; Christensen, N J
Results from space have been unexpected and not predictable from the results of ground-based simulations. Therefore, the concept of how weightlessness and gravity modulates the regulation of body fluids must be revised and a new simulation model developed. The main questions to ask in the future...... activated by spaceflight? Why are the renal responses to saline and water stimuli in space attenuated compared with those of ground simulations? How can the effects of weightlessness on fluid and electrolyte regulation be correctly simulated on the ground? The information obtained from space may...... be of relevance to fluid and electrolyte balance in edematous patients....
Lam, Samuel M
Revision rhinoplasty of the Asian nose requires a combination of cultural sensitivity and unique surgical strategies to achieve a successful outcome. Cultural sensitivity means understanding some of the folkloric motivations to undergo rhinoplasty and divergent ethnic standards of beauty. Basic techniques for Asian rhinoplasty are reviewed as a prerequisite knowledge for revision rhinoplasty of the Asian nose, specifically a combination technique of expanded polytetrafluoroethylene for bridge augmentation and autogenous cartilage tip grafting. Revision Asian nose surgery oftentimes involves removal of a previously placed solid silicone implant, which remains the most popular option for augmentation rhinoplasty in Asia. Strategies for revision rhinoplasty in the Asian nose are then reviewed.
Luo, Linlin; Kiewra, Kenneth A.; Samuelson, Lydia
Note taking has been categorized as a two-stage process: the recording of notes and the review of notes. We contend that note taking might best involve a three-stage process where the missing stage is revision. This study investigated the benefits of revising lecture notes and addressed two questions: First, is revision more effective than…
... ``preliminary.'' Only after we receive States' reports of the actual medical assistance expenditures through the... and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be... 0938-AP66 Medicaid Program; Final FY 2008, Revised Preliminary FY 2009, and Preliminary FY 2010...
... anatomical, physiological, or psychological abnormalities shown by medically acceptable clinical and... published revised growth charts for children that adopt the World Health Organization (WHO) standards for... world health organization and CDC growth charts for children aged 0- 59 months in the United States...
Beckmann, J; Lüring, C; Springorum, R; Köck, F X; Grifka, J; Tingart, M
Early aseptic loosening is a major complication in revision total knee arthroplasty (TKA). It is well accepted that intramedullary stems improve the anchoring of the prosthetic components; however, controversy still exists about the optimal fixation technique of the stems (cementless, hybrid, cemented). A literature review was carried out in the main medical databases from 1980 to 04/2010 to evaluate the available literature by evidence-based criteria and to analyse the results of the single studies regarding fixation technique in knee revision arthroplasty. There are four studies regarding the cementless fixation. Eight studies reported the hybrid technique and five studies the cemented technique. Hybrid and cemented techniques are comparable regarding the survival of arthroplasties, the rate of aseptic loosening and the clinical outcome. However, most studies just show a low level of evidence (LoE III and IV), a small to medium number of cases and a short follow-up. Based on the current literature, no final statement can be drawn regarding the optimal fixation technique in revision TKA. Future RCTs are needed to enable conclusive statements about the possible advantages and disadvantages of the single fixation techniques, although the clinical implementation often is critical.
Full Text Available Abstract Background The health-related quality of life (HRQoL is currently weighted more heavily when evaluating health status, particularly regarding medical treatments and interventions. However, it is rarely used by physicians to compare responsiveness. Additionally, responsiveness estimates derived by the Harris Hip Score (HHS and the Short Form 36 (SF-36 before and after revision total hip arthroplasty (THA have not been clinically compared. This study compared responsiveness and minimal important differences (MID between HHS and SF-36. Methods All revision THA patients completed the disease-specific HHS and the generic SF-36 before and 6 months after surgery. Scores using these instruments were interpreted by generalized estimating equation (GEE before and after revision THA. The bootstrap estimation and modified Jacknife test were used to derive 95% confidence intervals for differences in the responsiveness estimates. Results Comparisons of effect size (ES, standardized response means (SRM, relative efficiency (RE (>1 and MID indicated that the responsiveness of HHS was superior to that of SF-36. The ES and SRM for pain and physical functions in the HHS were significantly larger than those of the SF-36 (p Conclusion The data in this study indicated that clinicians and health researchers should weight disease-specific measures more heavily than generic measures when evaluating treatment outcomes.
Loskutov A.E.; Digtiar A.V.; Stepanskiy D.A.
In our study there is presented information on the research of antagonistic activity of medications octenidine, decamethoxine, dioxydine, myramistin, povidone-iodine, chlorhexidine in standard dosage form and in dilution (1:1 and 1:5) on microorganisms: S. aureus, S. epidermidis, S. haemolitycus, P. aeruginоsa, E. agglomerans, E. coli isolated from patients in revision hip arthroplasty. A considerable bacrteriostatic and bacreticidal activity of investigated medications on microorganisms was ...
Joshi, Anuradha; Ganjiwale, Jaishree
Various studies in medical education have shown that active learning strategies should be incorporated into the teaching-learning process to make learning more effective, efficient and meaningful. The aim of this study was to evaluate student's perceptions on an innovative revision method conducted in Pharmacology i.e. in form of Autobiography of Drugs. The main objective of study was to help students revise the core topics in Pharmacology in an interesting way. Questionnaire based survey on a newer method of pharmacology revision in two batches of second year MBBS students of a tertiary care teaching medical college. Various sessions on Autobiography of Drugs were conducted amongst two batches of second year MBBS students, during their Pharmacology revision classes. Student's perceptions were documented with the help of a five point likert scale through a questionnaire regarding quality, content and usefulness of this method. Descriptive analysis. Students of both the batches appreciated the innovative method taken up for revision. The median scores in most of the domains in both batches were four out of five, indicative of good response. Feedback from open-ended questions also revealed that the innovative module on "Autobiography of Drugs" was taken as a positive learning experience by students. Autobiography of drugs has been used to help students recall topics that they have learnt through other teachings methods. Autobiography sessions in Pharmacology during revision slots, can be one of the interesting ways in helping students revise and recall topics which have already been taught in theory classes.
Bovonratwet, P; Malpani, R; Ottesen, T D; Tyagi, V; Ondeck, N T; Rubin, L E; Grauer, J N
The aim of this study was to compare the rate of perioperative complications following aseptic revision total hip arthroplasty (THA) in patients aged ≥ 80 years with that in those aged revision THA were identified in the 2005 to 2015 National Surgical Quality Improvement Program (NSQIP) database and stratified into two age groups: those aged revision THA is associated with greater risks in patients aged ≥ 80 years compared with younger patients. This is important for counselling and highlights the need for medical optimization in these vulnerable patients. Cite this article: Bone Joint J 2018;100-B:143-51. ©2018 The British Editorial Society of Bone & Joint Surgery.
... 25 Indians 1 2010-04-01 2010-04-01 false Budget revision. 276.14 Section 276.14 Indians BUREAU OF... UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS § 276.14 Budget revision. Criteria and procedures to be followed by grantees in reporting deviations from grant budgets and requesting approval for budget...
Full Text Available determining one-step revision. But in those approaches describing a family of operators there is usually little indication of how to proceed uniquely after the first revision step. In this paper we contribute towards addressing that deficiency by providing a...
... measurement and balancing of alphabetical stretches for the revised dictionary in terms of time, average length of articles and number of pages per alphabetical category. It is not possible to present all aspects of the revision within the scope of a journal article but the most prominent ones as well as a selection of typical ...
Kelley, A.P.; Boyack, B.E.; Torri, A.
This paper presents a summary of the recently revised gas-cooled fast breeder reactor (GCFR) safety program plan. The activities under this plan are organized to support six lines of protection (LOPs) for protection of the public from postulated GCFR accidents. Each LOP provides an independent, sequential, quantifiable risk barrier between the public and the radiological hazards associated with postulated GCFR accidents. To implement a quantitative risk-based approach in identifying the important technology requirements for each LOP, frequency and consequence-limiting goals are allocated to each. To ensure that all necessary tasks are covered to achieve these goals, the program plan is broken into a work breakdown structure (WBS). Finally, the means by which the plan is being implemented are discussed
Full Text Available The potentialities of a revised quantum electrodynamic theory (RQED earlier established by the author are reconsidered, also in respect to other fundamental theories such as those by Dirac and Higgs. The RQED theory is characterized by intrinsic linear symmetry breaking due to a nonzero divergence of the electric field strength in the vacuum state, as supported by the Zero Point Energy and the experimentally confirmed Casimir force. It includes the results of electron spin and antimatter by Dirac, as well as the rest mass of elementary particles predicted by Higgs in terms of spontaneous nonlinear symmetry breaking. It will here be put into doubt whether the approach by Higgs is the only theory which becomes necessary for explaining the particle rest masses. In addition, RQED theory leads to new results beyond those being available from the theories by Dirac, Higgs and the Standard Model, such as in applications to leptons and the photon.
This Lawrence Berkeley National Laboratory Radiological Control Manual (LBNL RCM) has been prepared to provide guidance for site-specific additions, supplements and interpretation of the DOE Radiological Control Manual. The guidance provided in this manual is one methodology to implement the requirements given in Title 10 Code of Federal Regulations Part 835 (10 CFR 835) and the DOE Radiological Control Manual. Information given in this manual is also intended to provide demonstration of compliance to specific requirements in 10 CFR 835. The LBNL RCM (Publication 3113) and LBNL Health and Safety Manual Publication-3000 form the technical basis for the LBNL RPP and will be revised as necessary to ensure that current requirements from Rules and Orders are represented. The LBNL RCM will form the standard for excellence in the implementation of the LBNL RPP.
This Lawrence Berkeley National Laboratory Radiological Control Manual (LBNL RCM) has been prepared to provide guidance for site-specific additions, supplements and interpretation of the DOE Radiological Control Manual. The guidance provided in this manual is one methodology to implement the requirements given in Title 10 Code of Federal Regulations Part 835 (10 CFR 835) and the DOE Radiological Control Manual. Information given in this manual is also intended to provide demonstration of compliance to specific requirements in 10 CFR 835. The LBNL RCM (Publication 3113) and LBNL Health and Safety Manual Publication-3000 form the technical basis for the LBNL RPP and will be revised as necessary to ensure that current requirements from Rules and Orders are represented. The LBNL RCM will form the standard for excellence in the implementation of the LBNL RPP
This Engineering Study revision evaluated the alternatives to provide tank waste characterization analytical samples for a time period as recommended by the Tank Waste Remediation Systems Program. The recommendation of storing 40 ml segment samples for a period of approximately 18 months (6 months past the approval date of the Tank Characterization Report) and then composite the core segment material in 125 ml containers for a period of five years. The study considers storage at 222-S facility. It was determined that the critical storage problem was in the hot cell area. The 40 ml sample container has enough material for approximately 3 times the required amount for a complete laboratory re-analysis. The final result is that 222-S can meet the sample archive storage requirements. During the 100% capture rate the capacity is exceeded in the hot cell area, but quick, inexpensive options are available to meet the requirements
Beez, Thomas; Steiger, Hans-Jakob
Shunt surgery is common in pediatric neurosurgery and is associated with relevant complication rates. We aimed to compare previously published metrics in a single data set and propose the Negative Shunt Revision Rate (NSRR), defined as proportion of shunt explorations revealing a properly working system, as a new quality metric. Retrospective analysis of our shunt surgery activity in 2015 was performed. Demographic, clinical, and radiologic variables were extracted from electronic medical notes. Surgical Activity Rate, Revision Quotient, 30-day shunt malfunction rate, 90-day global shunt revision rate, Preventable Shunt Revision Rate, and novel NSRR were calculated. Of 60 shunt operations analyzed, 18 (39%) were new shunt insertions, and 42 (70%) were revisions. Median age was 18 months (range, 0.03-204 months), and main etiologies were posthemorrhagic (n = 16; 41%), congenital (n = 11; 28%), and tumor-associated (n = 8; 21%) hydrocephalus. Within 90 days after index surgery, 13 shunt failures occurred, predominantly owing to proximal failure (n = 6; 46%). Surgical Activity Rate was 0.127, Revision Quotient was 2.333, 30-day shunt malfunction rate was 0.166, 90-day global shunt revision rate was 21.7%, and Preventable Shunt Revision Rate was 38.5%. NSRR was 7.1%. Our results correlate with published values and offer measurement of quality that can be compared across studies and considered patient-oriented, easily measurable, and potentially modifiable. We propose NSRR as a new quality metric, covering an aspect of shunt surgery that was not addressed previously. Copyright © 2017 Elsevier Inc. All rights reserved.
Qureshi, Rabia; Puvanesarajah, Varun; Jain, Amit; Kebaish, Khaled; Shimer, Adam; Shen, Francis; Hassanzadeh, Hamid
Adult spinal deformity (ASD) is an important problem to consider in the elderly. Although studies have examined the complications of ASD surgery and have compared functional and radiographic results of primary surgery versus revision, no studies have compared the costs of primary procedures with revisions. We assessed the in-hospital costs of these 2 surgery types in patients with ASD. The PearlDiver Database, a database of Medicare records, was used in this study. Mutually exclusive groups of patients undergoing primary or revision surgery were identified. Patients in each group were queried for age, sex, and comorbidities. Thirty-day readmission rates, 30-day and 90-day complication rates, and postoperative costs of care were assessed with multivariate analysis. For analyses, significance was set at P average reimbursement of the primary surgery cohort was $57,078 ± $30,767. Reimbursement of revision surgery cohort was $52,999 ± $27,658. The adjusted difference in average costs between the 2 groups is $4773 ± $1069 (P day and 90-day adjusted difference in cost of care when sustaining any of the major medical complications in primary surgery versus revision surgery was insignificant. Patients undergoing primary and revision corrective procedures for ASD have similar readmission rates, lengths of stays, and complication rates. Our data showed a higher cost of primary surgery compared with revision surgery, although costs of sustaining postoperative complications were similar. This finding supports the decision to perform revision procedures in patients with ASD when indicated because neither outcomes nor costs are a hindrance to correction. Copyright © 2017 Elsevier Inc. All rights reserved.
Wells, Timothy S
...). The current revised protocol involves surveillance of electronic impatient and outpatient medical records, and evaluation of self-reported symptoms and conditions among smallpox-vaccinated and non...
Purpose: To examine philosophical stances underpinning medical identity and assess the conceptual relationship between physician, medical practice and culture. Argument: Medical identity is about the ideals and moral positions that physicians take when justifying themselves. Medical identity...... hedonistic versus sentimentalist approaches to medical identity. The sociocultural philosophical analysis of medical identity can shed light on what it means conceptually for a physician to harbor beliefs associated with him/her being taken to be an autonomous professional. It is important because it touches...
Jones, Mark D; Parry, Michael; Whitehouse, Michael R; Blom, Ashley W
The frequency of primary total hip arthroplasty procedures is increasing, with a subsequent rise in revision procedures. This study aims to describe timing and surgical mortality associated with revision total hip arthroplasty (THA) compared to those on the waiting list. All patients from a single institution who underwent revision total hip arthroplasty or were added to the waiting list for the same procedure between 2003 and 2013 were recorded. Mortality rates were calculated at 30 and 90 days following surgery or addition to the waiting list. 561 patients were available for the survivorship analysis in the surgical group. Following exclusion, 901 and 484 patients were available for the 30 and the 90-day analysis in the revision THA waiting list group.30- and 90-day mortality rates were significantly greater for the revision THA group compared to the waiting list group (excess surgical mortality at 30 days = 0.357%, p = 0.037; odds ratio of 5.22, excess surgical mortality at 90 days = 0.863%, p = 0.045). Revision total hip arthroplasty is associated with a significant excess surgical mortality rate until 90 days post-operation when compared to the waiting list population. We would encourage other authors with access to larger samples to use our method to quantify excess mortality after both primary and revision arthroplasty procedures.
Amaral, Maria Stella Arantes do; Reis, Ana Cláudia Mirândola B; Massuda, Eduardo T; Hyppolito, Miguel Angelo
The surgery during which the cochlear implant internal device is implanted is not entirely free of risks and may produce problems that will require revision surgeries. To verify the indications for cochlear implantation revision surgery for the cochlear implant internal device, its effectiveness and its correlation with certain variables related to language and hearing. A retrospective study of patients under 18 years submitted to cochlear implant Surgery from 2004 to 2015 in a public hospital in Brazil. Data collected were: age at the time of implantation, gender, etiology of the hearing loss, audiological and oral language characteristics of each patient before and after Cochlear Implant surgery and any need for surgical revision and the reason for it. Two hundred and sixty-five surgeries were performed in 236 patients. Eight patients received a bilateral cochlear implant and 10 patients required revision surgery. Thirty-two surgeries were necessary for these 10 children (1 bilateral cochlear implant), of which 21 were revision surgeries. In 2 children, cochlear implant removal was necessary, without reimplantation, one with cochlear malformation due to incomplete partition type I and another due to trauma. With respect to the cause for revision surgery, of the 8 children who were successfully reimplanted, four had cochlear calcification following meningitis, one followed trauma, one exhibited a facial nerve malformation, one experienced a failure of the cochlear implant internal device and one revision surgery was necessary because the electrode was twisted. The incidence of the cochlear implant revision surgery was 4.23%. The period following the revision surgeries revealed an improvement in the subject's hearing and language performance, indicating that these surgeries are valid in most cases. Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.
This new edition presents information and knowledge on the field of biomedical devices and surgical tools. The authors look at the interactions between nanotechnology, nanomaterials, design, modeling, and tools for surgical and dental applications, as well as how nanostructured surfaces can be created for the purposes of improving cell adhesion between medical devices and the human body. Each original chapter is revised in this second edition and describes developments in coatings for heart valves, stents, hip and knee joints, cardiovascular devices, orthodontic applications, and regenerative materials such as bone substitutes. There are also 8 new chapters that address: Microvascular anastomoses Inhaler devices used for pulmonary delivery of medical aerosols Surface modification of interference screws Biomechanics of the mandible (a detailed case study) Safety and medical devices The synthesis of nanostructured material Delivery of anticancer molecules using carbon nanotubes Nano and micro coatings for medic...
Full Text Available Conventional theory, as based on Maxwell’s equations and associated quantum electrodynamical concepts in the vacuum, includes the condition of zero electric field divergence. In applications to models of the individual photon and to dense light beams such a theory exhibits several discrepancies from experimental evidence. These include the absence of angular momentum (spin, and the lack of spatially limited geometry in the directions transverse to that of the propagation. The present revised theory includes on the other hand a nonzero electric field divergence, and this changes the field equations substantially. It results in an extended quantum electrodynamical approach, leading to nonzero spin and spatially limited geometry for photon models and light beams. The photon models thereby behave as an entirety, having both particle and wave properties and possessing wave-packet solutions which are reconcilable with the photoelectric effect, and with the dot-shaped marks and interference patterns on a screen by individual photons in a two-slit experiment.
Kohri, Kenjiro; Suzuki, Koji
Progress has been made in the diagnosis and treatment of urolithiasis over the last 10 years, after the first version of the Guidelines on Urolithiasis was published in December 2002. Considering such a situation, the revised version is due for publication soon. At this symposium, 3 persons who were engaged in the revision of the guidelines presented its digest. The revised version is characterized by the adoption of a "Frequently asked questions style", aiming to facilitate its usage as a reference book or dictionary readers can refer to when a question is raised in practice. It may be possible to further promote the medical treatment of urolithiasis by effectively using this in combination with the relatively textbook-like first version.
Asa, Sylvia L.; Dralle, Henning; Elisei, Rossella; Evans, Douglas B.; Gagel, Robert F.; Lee, Nancy; Machens, Andreas; Moley, Jeffrey F.; Pacini, Furio; Raue, Friedhelm; Frank-Raue, Karin; Robinson, Bruce; Rosenthal, M. Sara; Santoro, Massimo; Schlumberger, Martin; Shah, Manisha; Waguespack, Steven G.
Introduction: The American Thyroid Association appointed a Task Force of experts to revise the original Medullary Thyroid Carcinoma: Management Guidelines of the American Thyroid Association. Methods: The Task Force identified relevant articles using a systematic PubMed search, supplemented with additional published materials, and then created evidence-based recommendations, which were set in categories using criteria adapted from the United States Preventive Services Task Force Agency for Healthcare Research and Quality. The original guidelines provided abundant source material and an excellent organizational structure that served as the basis for the current revised document. Results: The revised guidelines are focused primarily on the diagnosis and treatment of patients with sporadic medullary thyroid carcinoma (MTC) and hereditary MTC. Conclusions: The Task Force developed 67 evidence-based recommendations to assist clinicians in the care of patients with MTC. The Task Force considers the recommendations to represent current, rational, and optimal medical practice. PMID:25810047
In the present revision of Nephelium 22 species are recognised, 6 of which are new (1 unnamed). Nephelium cuspidatum is subdivided into 6 varieties and 4 subvarieties; N. lappaceum comprises 3 varieties. The systematic connections within the genus are unclear.
The Guide is intended to provide guidelines for the initial preparation of FFTF Operating Procedures. The Procedures Preparation Guide was developed from the plan presented and approved in the FFTF Reactor Plant Procedures Plan, PC-1, Revision 3
Hansson, Sven Ove
This book provides a critical examination of how the choice of what to believe is represented in the standard model of belief change. In particular the use of possible worlds and infinite remainders as objects of choice is critically examined. Descriptors are introduced as a versatile tool for expressing the success conditions of belief change, addressing both local and global descriptor revision. The book presents dynamic descriptors such as Ramsey descriptors that convey how an agent’s beliefs tend to be changed in response to different inputs. It also explores sentential revision and demonstrates how local and global operations of revision by a sentence can be derived as a special case of descriptor revision. Lastly, the book examines revocation, a generalization of contraction in which a specified sentence is removed in a process that may possibly also involve the addition of some new information to the belief set.
This form should be completed when a water system collects any required Revised Total Coliform Rule (RTCR) samples. It should also be used when collecting “Special” non-compliance samples for the RTCR.
This webinar was created to assist Primacy Agencies in the implementation of the Revised Total Coliform Rule. It provides an overview of the requirements in the rule and implementation guidance for Primacy Agencies.
EPA has finalized stronger standards for people who apply restricted use pesticides (RUPs). These revisions to the Certification of Pesticide Applicators rule will reduce the likelihood of harm from the misapplication of toxic pesticides.
Alfaham, M; Gray, O P; Davies, D P
Most teaching of child health in Cardiff takes place in block attachments of 8 weeks. There is an introductory seminar of 2 days followed by a 6-week clinical attachment in a district general hospital in Wales, and then a revision period of one week designed to help students formalize and structure their basic knowledge and to clarify aspects of child health which they may have had difficulty in understanding. The revision programme has to take into account: the short time available, the small number of teaching staff, the most relevant basic knowledge and active participation by the student. This paper describes how this week has been improved through the use of student-initiated revision (SIR). The students' appraisal of this revision and in particular SIR is presented.
Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B
Abstract Background and purpose Fast-track surgery has reduced the length of hospital stay (LOS), morbidity, and convalescence in primary hip and knee arthroplasty (TKA). We assessed whether patients undergoing revision TKA for non-septic indications might also benefit from fast-track surgery....... Methods 29 patients were operated with 30 revision arthroplasties. Median age was 67 (34-84) years. All patients followed a standardized fast-track set-up designed for primary TKA. We determined the outcome regarding LOS, morbidity, mortality, and satisfaction. Results Median LOS was 2 (1-4) days...... undergoing revision TKA for non-septic reasons may be included in fast-track protocols. Outcome appears to be similar to that of primary TKA regarding LOS, morbidity, and satisfaction. Our findings call for larger confirmatory studies and studies involving other indications (revision THA, 1-stage septic...
Stoddart, Greg L.
This paper presents a historical review of applications of effort-reporting in medical education, comments on key methodological issues and describes a revised methodology of a 2-step estimating process that is flexible enough to accommodate a multidisciplinary medical education. (Editor/PG)
There is deficiency and gaps among medical graduates in performing certain procedures and skills. Till recent years, some school used an apprenticeship model for teaching procedures. The way of teaching skills should be revised and reinforced. Medical schools showed adopt formal curricula based training for teaching ...
Vasso, Michele; Beaufils, Philippe; Schiavone Panni, Alfredo
Along with the increase in primary total knee arthroplasty, there has been an increase in the number of revisions. The aim of this study was to propose a selection algorithm for the knee revision constraint according to the state of ligaments and to the bone defects Anderson Orthopaedic Research Institute Classification [AORI] classification. The hypothesis was that this algorithm would facilitate the appropriate choice of prosthesis constraint, thus providing stable components and a good long-term survivorship of the knee revisions. Sixty consecutive revision knee arthroplasties in 57 patients were prospectively evaluated. Prostheses implanted at revision included postero-stabilised, condylar constrained and rotating hinged, relative to the state of the ligaments and of the bone loss around the knee. The median follow-up was nine years (range, 4-12). The median IKS knee and function scores and HSS score were 41 (15-62), 21.5 (12-43) and 34 (23-65) points, respectively, before the operation, and 81 (48-97), 79 (56-92) and 83.5 (62-98) points (p < 0.001) at the latest follow-up evaluation. The median ROM increased from 74° (29-110°) preoperatively to 121° (98-132°) (p < 0.01) at the final follow-up. Re-revision was necessary in five (8.3%) patients. A selection algorithm for the revision implant constraint based on the state of ligaments and the bone loss AORI classification could provide stable knee reconstructions and long-term success of knee revisions.
Baker, R.E.; Cool, W.S.; Mills, W.A.
The Nuclear Regulatory Commission's pollution standards have been revised since publication in the late 1950s, but the basic approach has not changed. The revisions resulted in inaccuracies, conflicts, and ambiguities in requirements. The need for comprehensive updating including radiation-protection principles, risk, occupational exposure dose limits, standards for the public (including de minimis level), surveys and monitoring, disposal into sewerage systems, and records is discussed. 2 tables
How do you show students that revision is more than a classroom exercise to please the teacher? Take them into the real world of writing for publication. In Real Revision, award-winning author and teacher Kate Messner demystifies the revision process for teachers and students alike and provides tried-and-true revision strategies, field tested by…
Zinser, Brian; Brunswick, Gary
The rate of textbook revision cycles is examined in light of the recent trend towards more rapid revisions (and adoptions of textbooks). The authors conduct background research to better understand the context for textbook revision cycles and the environmental forces that have been influencing what appears to be more rapid textbook revisions. A…
This document supersedes DOE/NV/25946--801, “Nevada Test Site Radiological Control Manual,” Revision 0 issued in October 2009. Brief Description of Revision: A minor revision to correct oversights made during revision to incorporate the 10 CFR 835 Update; and for use as a reference document for Tenant Organization Radiological Protection Programs.
Hooper, David A [ORNL; Jodoin, Vincent J [ORNL
The Defense Land Fallout Interpretive Code (DELFIC) was originally released in 1968 as a tool for modeling fallout patterns and for predicting exposure rates. Despite the continual advancement of knowledge of fission yields, decay behavior of fission products, and biological dosimetry, the decay data and logic of DELFIC have remained mostly unchanged since inception. Additionally, previous code revisions caused a loss of conservation of radioactive nuclides. In this report, a new revision of the decay database and the Particle Activity Module is introduced and explained. The database upgrades discussed are replacement of the fission yields with ENDF/B-VII data as formatted in the Oak Ridge Isotope Generation (ORIGEN) code, revised decay constants, revised exposure rate multipliers, revised decay modes and branching ratios, and revised boiling point data. Included decay logic upgrades represent a correction of a flaw in the treatment of the fission yields, extension of the logic to include more complex decay modes, conservation of nuclides (including stable nuclides) at all times, and conversion of key variables to double precision for nuclide conservation. Finally, recommended future work is discussed with an emphasis on completion of the overall radiation physics upgrade, particularly for dosimetry, induced activity, decay of the actinides, and fractionation.
Alan de Paula Mozella
Full Text Available OBJECTIVE: to determine the causes of unicondylar knee arthroplasty failures, as well as identify the implants used and the need of bone grafting in patients undergoing revision UKA in Center of Knee Surgery at the Instituto Nacional de Traumatologia e Ortopedia (INTO in the period between January 1990 and January 2013.METHODS: a retrospective analysis of the medical documentation and imaging, determining the cause of failure of UKA and the time of its occurrence, as well as prosthetic components implanted during the review and the need for bone grafting.RESULTS: in this study, 27 UKA failures in 26 patients were included. Collapse of one or more components was the main cause of failure, occurring in 33% of patients. Aseptic failure was identified in 30% of cases, progression of osteoarthrosis in 15%, infection and pain 7% each, and osteolysis and polyethylene failure in 4% each. Early failure occurred in 41% of all revisions of UKA and late failure in 59%. 23 patients have undergone revision of UK.CONCLUSION: in 35% of revisions the use of bone grafting was needed in tibial area; in 3 cases we needed allograft from Tissue Bank. We did not use metal increase in any of the revision. In one patient we used implant constraint for instability.
Mozella, Alan de Paula; Borges Gonçalves, Felipe; Osterno Vasconcelos, Jansen; de Araújo Barros Cobra, Hugo Alexandre
Objective to determine the causes of unicondylar knee arthroplasty failures, as well as identify the implants used and the need of bone grafting in patients undergoing revision UKA in Center of Knee Surgery at the Instituto Nacional de Traumatologia e Ortopedia (INTO) in the period between January 1990 and January 2013. Methods a retrospective analysis of the medical documentation and imaging, determining the cause of failure of UKA and the time of its occurrence, as well as prosthetic components implanted during the review and the need for bone grafting. Results in this study, 27 UKA failures in 26 patients were included. Collapse of one or more components was the main cause of failure, occurring in 33% of patients. Aseptic failure was identified in 30% of cases, progression of osteoarthrosis in 15%, infection and pain 7% each, and osteolysis and polyethylene failure in 4% each. Early failure occurred in 41% of all revisions of UKA and late failure in 59%. 23 patients have undergone revision of UK. Conclusion in 35% of revisions the use of bone grafting was needed in tibial area; in 3 cases we needed allograft from Tissue Bank. We did not use metal increase in any of the revision. In one patient we used implant constraint for instability. PMID:26229792
Gastaud, O; Cambas, P M; Tabutin, J
The use of a primary cementless component is a tempting option for revision total hip arthrosplasty (reTHA), however, the results of this type of revision have not been clearly determined. The goal of this retrospective study was to determine: if revision with a primary anatomical cementless femoral stem gives adequate bone fixation; the rate of secondary subsidence or recurrent loosening; the survival rate with this device. Revision with a primary anatomical cementless femoral stem results in a low rate of subsidence and recurrent loosening. This retrospective series of 43 reTHA performed between 1994 and 2012 included 43 patients, mean age 66 years old (37-90) with a minimum follow-up of 24months. There were grade 1 (n=24) or 2A (n=19) bone defects according to the Paprosky classification. The causes of revision were: aseptic loosening in 27, septic loosening in 6, malposition of the implant in 7 and periprosthetic fractures in 3. Clinical (Postel Merle d'Aubigné [PMA] and Harris scores), and radiological (subsidence) assessment was performed, as well as survival analysis (with a 95% confidence interval). All components were changed through posterolateral approach without femorotomy. In four cases de-escalation (use of a primary component for secondary revision of a prior revision component) was performed. There were no perioperative fractures or perforations. After a mean 47months (24-134), the mean PMA score increased from 10 (5-15) to 16 (11-18), and the Harris score from 58 (20-80) to 85 (66-96). Radiological assessment did not show any extensive radiolucencies or secondary subsidence. Only 3 components were placed in a varus position, with no clinical consequences. One patient had subsequent revision for recurrent dislocations. Estimated survival at 80months by Kaplan-Meier analysis was 85% (CI 95%: 64-100%). There are very few studies in the literature (7 series) on this topic, which shows the reluctance of surgeons to use this technique. Placement of a
Medical tourism is a burgeoning industry in our region. It involves patients travelling outside of their home country for medical treatment. This article provides an outline of the current research around medical tourism, especially its impact on Australians. Patients are increasingly seeking a variety of medical treatments abroad, particularly those involving cosmetic surgery and dental treatment, often in countries in South-East Asia. Adverse events may occur during medical treatment abroad, which raises medico-legal and insurance issues, as well as concerns regarding follow-up of patients. General practitioners need to be prepared to offer advice, including travel health advice, to patients seeking medical treatment abroad.
Bennett, Antonia V; Lozano, Paula; Richardson, Laura P; McCauley, Elizabeth; Katon, Wayne J
To develop a definition of high-risk asthma that more precisely identifies patients needing case management than the 2006 Healthcare Effectiveness Data and Information Set (HEDIS) definition. Two-year claims-based study, with cross-sectional phone survey data, for a sample of 769 youths (age 11-17 years) with asthma. The 2006 HEDIS measure defines high-risk asthma as meeting any of the following criteria: >1 emergency department (ED) visits, > or =1 hospitalizations for asthma, > or =4 asthma medication prescriptions, or > or =4 ambulatory visits for asthma with > or =2 prescriptions for asthma medication in 1 year. We created a revised definition (> or =1 ED visits or > or =1 hospitalizations for asthma or > or =1 oral steroid prescriptions for asthma) and identified patients with high-risk asthma in year 1 according to each definition. We compared the 2 groups on demographic and clinical characteristics, and healthcare utilization and costs in years 1 and 2. The revised definition identified 29% of the sample as having high-risk asthma, whereas the 2006 definition identified 67%. Compared with the 2006 definition, the revised definition identified patients with significantly greater asthma-related physical health problems and higher medical costs in year 1. In year 2, youths classified as high risk by the revised definition made more ED visits and were more likely to use oral steroids than those classified as high risk by the 2006 definition. The revised high-risk asthma definition identifies half as many individuals and is better able to identify patients with poorly controlled asthma in the subsequent year.
Smith, Marie Anne; Deakin, Angela H; Allen, David; Baines, Joe
The growth in hip arthroplasty surgery has meant a corresponding escalating revision burden with increasing challenges for the orthopaedic surgeon. The purpose of this study was to review clinical outcomes of a modular revision hip system within a single institution. We retrospectively reviewed a cohort of modular revision hip system stems performed in our institution between January 2005 and October 2012 giving a potential minimum follow-up of 2 years. Clinical outcomes data on complications, Oxford Hip Score (OHS, 0-48) and patient satisfaction were collected. Radiographic outcomes including subsidence were assessed. Implant survival was estimated using Kaplan Meier analysis. 115 stems in 106 patients were identified. All cause survival was 82% (95%CIs: 73%-89%) at 6.1 years; survival excluding infection being 99% (95%CIs: 93%-100%). There was a low incidence of subsidence (seven stems) and no peri-prosthetic fractures. Primary cause of re-revision in this series was re-infection with only one re-revision for mechanical failure. Median Oxford Hip Score at mean follow up 4.1 years (2-9) was 40 (14-48) and 93% of patients reported being satisfied with their revision surgery. This study showed good clinical outcomes and survival using a modular revision stem with low mechanical failure and subsidence. Recurrence of infection remains a challenge in revision surgery. Copyright © 2016 Elsevier Inc. All rights reserved.
Kachlík, D; Bozdechová, I; Cech, P; Musil, V; Báca, V
Ten years ago, the latest revision of the Latin anatomical nomenclature was approved and published as Terminologia Anatomica (International Anatomical Terminology), and is acknowledged by the organization uniting national anatomical societies--International Federation of Associations of Anatomists. The authors concentrate on new terms included in the nomenclature and on the linguistic changes of terminology. The most frequent errors done by medical specialists in the usage of the Latin anatomical terminology are emphasized and the situation of eponyms in contemporary anatomy is discussed in detail as well. The last version of the nomenclature makes its way very slowly in the professional community and it is necessary to refer to positive changes and advantages it has brought. The usage of this Latin anatomical nomenclature version is suggested by the International Federation to follow in theoretical and clinical fields of medicine. The authors of the article strongly recommend using the recent revision of the Latin anatomical nomenclature both in the oral and written forms, when educating and publishing.
... email share facebook twitter google plus linkedin Medical Management Although there’s no cure for CMT, there are ... individualized physical therapy program. For more on medical management of CMT, see Surgery Sometimes, Bracing Often, Caution ...
... for You Agency for Healthcare Research and Quality: Medical Errors and Patient Safety Centers for Disease Control and ... Quality Chasm Series National Coordinating Council for Medication Error Reporting and Prevention ... Devices Radiation-Emitting Products Vaccines, Blood & Biologics Animal & ...
Zipper, St G
Medical negligence is a matter of growing public interest. This review outlines various aspects of medical negligence: epidemiology, taxonomy, and the risks, causes, psychology, management and prevention of errors.
Aarnio, Matti; Nieminen, Juha; Pyörälä, Eeva; Lindblom-Ylänne, Sari
This study examined teaching teamwork skills to first-year medical students. Teamwork skills focused on verbal communication in PBL-tutorial sessions and in healthcare teams. The aim was to find out how to teach teamwork skills to first-year medical students and how to motivate them to learn these skills. Three consecutive classes of first-year medical students (N = 342) participated in teamwork skills module in the years 2006, 2007 and 2008. After the first year, the introduction to the topic was revised in order to be more motivating to medical students. After each module data were collected with a feedback questionnaire containing numerical and open questions. By analyzing the students' numerical answers and the content of students' open answers regarding the module, we examined how the revised introduction affected students' perceptions of the usefulness of the module. Medical students' feedback in the years 1 (n = 81), 2 (n = 99) and 3 (n = 95) showed that the students found the module in the second and third years significantly more useful than in the first year. These results support earlier findings that clearly stated clinical relevance motivates medical students. When introducing multidisciplinary subjects to medical students, it is important to think through the clinical relevance of the topic and how it is introduced to medical students.
Podgorsak, Ervin B
This well-received textbook and reference summarizes the basic knowledge of atomic, nuclear, and radiation physics that professionals working in medical physics and biomedical engineering need for efficient and safe use of ionizing radiation. Concentrating on the underlying principles of radiation physics, it covers the prerequisite knowledge for medical physics courses on the graduate and post-graduate levels in radiotherapy physics, radiation dosimetry, imaging physics, and health physics, thus providing the link between elementary physics on the one hand and the intricacies of the medical physics specialties on the other hand. This expanded and revised second edition offers reorganized and expanded coverage. Several of the original chapters have been split into two with new sections added for completeness and better flow. New chapters on Coulomb scattering; on energy transfer and energy absorption in photon interactions; and on waveguide theory have been added in recognition of their importance. Others tra...
Alentorn-Geli, Eduard; Clark, Nicholas J; Assenmacher, Andrew T; Samuelsen, Brian T; Sánchez-Sotelo, Joaquín; Cofield, Robert H; Sperling, John W
By the time patients with a failed shoulder arthroplasty require revision surgery, a substantial number are older than 80 years. The risk of complications of revision arthroplasty in this elderly population is largely unknown and needs to be considered when contemplating whether these patients are too frail for revision surgery. (1) What are the 90-day medical and surgical complications after revision to reverse shoulder arthroplasty (RSA) in patients older than 80 years? (2) What are the 2- and 5-year survival rates after revision? (3) Was there an improvement in pain at rest or with activity, range of motion (ROM), and strength after revision surgery? Between 2004 and 2013, 38 patients who were older than 80 years (84 ± 3 years) underwent revision surgery to a RSA. Of those, five were lost to followup before 2 years, and two had died within 2 years of revision surgery, leaving 31 for analysis of our survivorship, pain, ROM, and strength endpoints at a minimum of 2 years or until revision surgery had occurred (mean, 28 months; range, 1-77 months); all 38 patients were included for purposes of evaluating medical and surgical complications at 90 days. During the period in question, our general indication for using RSA included failure of previous shoulder arthroplasty because of instability, glenoid loosening with bone loss, or rotator cuff insufficiency. The indication for revision to RSA did not change during the study period. The index procedure (revision to RSA at the age of 80 years or older) was the first revision arthroplasty in 33 (87%) patients and the second in five (13%) patients. We tallied 90-day medical and surgical complications by performing a retrospective chart and institutional joint registry review. The cumulative incidence of implant loosening (implant migration or tilting, or complete radiolucent lines present) and revision surgery was calculated at 2 and 5 years using competing risk of death method. Pain levels at rest or with activity (rated
Papatheodorou, Loukia K; Winston, Jonathan D; Bielicka, Deidre L; Rogozinski, Benjamin J; Lourie, Gary M; Sotereanos, Dean G
To evaluate the outcome of revision surgery for failed thumb carpometacarpal (CMC) arthroplasty. We retrospectively analyzed 32 patients with failed thumb CMC arthroplasty. The primary reason for revision was pain caused by metacarpal subsidence. Revision surgery included soft tissue interposition and distraction pinning to address the metacarpal subsidence. Additional ligament reconstruction was performed in patients with thumb instability. Eight patients required additional metacarpophalangeal joint fusion for concomitant joint hyperextension. Eleven required additional partial excision of the trapezoid for concomitant scaphotrapezoidal joint arthritis. All patients were evaluated clinically and radiographically. Mean follow-up was 57 months (range, 24-121 months). Pain levels evaluated by visual analog scale were significantly reduced in all patients after revision surgery. Mean grip strength and key pinch strength significantly increased. Twenty-seven patients achieved good functional results; those for 5 patients were fair. This study showed that revision surgery with distraction pinning and soft tissue interposition with or without ligament reconstruction was an effective treatment for failed CMC arthroplasty of the thumb. Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
McGregor Joan L
Full Text Available Abstract Advance health care directives and informed consent remain the cornerstones of patients' right to self-determination regarding medical care and preferences at the end-of-life. However, the effectiveness and clinical applicability of advance health care directives to decision-making on the use of life support systems at the end-of-life is questionable. The Uniform Anatomical Gift Act (UAGA has been revised in 2006 to permit the use of life support systems at or near death for the purpose of maximizing procurement opportunities of organs medically suitable for transplantation. Some states have enacted the Revised UAGA (2006 and a few of those have included amendments while attempting to preserve the uniformity of the revised Act. Other states have introduced the Revised UAGA (2006 for legislation and remaining states are likely to follow soon. The Revised UAGA (2006 poses challenges to the Patient Self Determination Act (PSDA embodied in advance health care directives and individual expression about the use of life support systems at the end-of-life. The challenges are predicated on the UAGA revising the default choice to presumption of donation intent and the use of life support systems to ensure medical suitability of organs for transplantation. The default choice trumps the expressed intent in an individual's advance health care directive to withhold and/or withdraw life support systems at the end-of-life. The Revised UAGA (2006 overrides advance directives on utilitarian grounds, which is a serious ethical challenge to society. The subtle progression of the Revised UAGA (2006 towards the presumption about how to dispose of one's organs at death can pave the way for an affirmative "duty to donate". There are at least two steps required to resolve these challenges. First, physicians and hospitals must fulfill their responsibilities to educate patients on the new legislations and document their preferences about the use of life support
von Mallek, D; Biersack, H-J; Mull, R; Wilhelm, K; Heinz, B; Mellert, F
The education of medical professionals is divided into medical studies, postgraduate training leading to the qualification as a specialist, and continuing professional development. During education, all scientific knowledge and practical skills are to be acquired, which enable the physician to practice responsibly in a specialized medical area. In the present article, relevant curricula are analyzed regarding the consideration of medical device-related topics, as the clinical application of medical technology has reached a central position in modern patient care. Due to the enormous scientific and technical progress, this area has become as important as pharmacotherapy. Our evaluation shows that medical device-related topics are currently underrepresented in the course of medical education and training and should be given greater consideration in all areas of medical education. Possible solutions are presented.
PhD Ad J.J.M. Vingerhoets; PhD Marjet G.B.G. Blokhorst; MSc Jolene L.M. Reimus; MSc Annemieke M.A. van Nunen; MD E.J.M. Wouters
The Pictorial Representation of Illness and Self Measure (PRISM) assesses suffering. In this article, the authors explored the feasibility and psychometric qualities of 2 revised versions of the PRISM-PRISM-R1 and PRISM-R2-that they used in 3 studies of participants with different medical problems.
... Transportation, with the advice of the MRB and the chief medical examiner, to establish, review, and revise...-0362 and FMCSA-2006-26367] Motor Carrier Safety Advisory Committee (MCSAC) and Medical Review Board... Carrier Safety Advisory Committee (MCSAC) and Medical Review Board (MRB) on September 9-10, 2013. MCSAC...
Kang, Zhaofeng; Li, Tianjun; Sun, Zheng
The well-accepted Nelson-Seiberg theorem relates R-symmetries to supersymmetry (SUSY) breaking vacua, and provides a guideline for SUSY model building which is the most promising physics beyond the Standard Model. In the case of Wess-Zumino models with perturbative superpotentials, we revise the theorem to a combined necessary and sufficient condition for SUSY breaking which can be easily checked before solving the vacuum. The revised theorem provides a powerful tool to construct either SUSY breaking or SUSY vacua, and offers many practicable applications in low energy SUSY model building and string phenomenology.
Borghetto, Enrico; Mäder, Lars Kai
European Union research has made great strides in understanding the dynamics of the European Union decision-making process. In contrast to this progress, the dynamics unfolding after the enactment of a European Union secondary legislative act has largely been ignored. Some of these acts remain...... revisions of European Union legislative acts are more likely to occur. Based on an analysis of the revision histories of 158 major European Union acts in the time period between 1958 and 2003, we find significant support for this hypothesis....
Beal, G; Chan, A; Chapman, S; Edgar, J; McInnis-Perry, G; Osborne, M; Mina, E S
As part of ongoing quality improvement initiatives, the Canadian Standards for Psychiatric-Mental Health Nursing were recently revised. For the first time since the standards were published in 1995, the input of consumers of mental health services was sought. Thirty-one consumers from across Canada participated in focus groups, and answered questions related to the domains of practice as identified in the standards document. Through this input, consumers were able to inform the committee regarding areas of satisfaction and dissatisfaction from their unique perspective. Through this article, the process of consumer collaboration is illustrated in relation to how it shaped Standards revision, and finally how it affected the practitioners involved.
Jensen, Andreas Schmidt; Villadsen, Jørgen
When information is shared between agents of unknown reliability, it is possible that their belief bases become inconsistent. In such cases, the belief base must be revised to restore consistency, so that the agent is able to reason. In some cases the inconsistent information may be due to use of...... of incorrect plans. We extend work by Alechina et al. to revise belief bases in which plans can be dynamically added and removed. We present an implementation of the algorithm in the AgentSpeak implementation Jason....
This e-book contains the 2013 Revision of RDA: Resource Description and Access, and includes the July 2013 Update. This e-book offers links within the RDA text and the capability of running rudimentary searches of RDA, but please note that this e-book does not have the full range of content or functionality provided by the subscription product RDA Toolkit. Included: A full accumulation of RDA- the revision contains a full set of all current RDA instructions. It replaces the previous version of RDA Print as opposed to being an update packet to that version. RDA has gone through many changes sin
The aim of this study was to classify meniscal tear forms as found in 195 revision arthroscopies. Interval between primary arthroscopy and revision was 7.8±5.6 month. All patients were available for control after 1 year. In 174 knees the lesion was located in the medial meniscus and in 21 knees in the lateral meniscus. In the medial meniscus an unstable posterior meniscal horn was seen in 93 knees followed by incomplete horizontal tear and meniscal destruction in 37. Flap tear, circumferentia...
Medical criminalistics is an essential part of legal/forensic medicine. It includes the clinical examination of surviving victims and suspects, the inspection of the scene in suspicious deaths with subsequent performance of medico-legal autopsies, the assessment of (biological) traces and the reconstruction of criminal events under medical aspects. Just as the circumstances of life and the manifestations of crime are changing with time, there is a permanent alteration regarding the issues of medical criminalistics. Legal/forensic medicine is a university subject in most countries and therefore, research work is one of the main tasks also in medical criminalistics. In contrast to clinical medicine and basic research, some common study designs are not suitable for the special needs of medical criminalistics, whereas other types are more appropriate like epidemiological evaluations, cross-sectional studies and (retrospective) observation studies. Moreover, experimental model tests and case reports also rate high in medical criminalistics.
Full Text Available Abstract Background Since June 2002, revised regulations in Germany have required "Emergency Medical Care" as an interdisciplinary subject, and state that emergency treatment should be of increasing importance within the curriculum. A survey of the current status of undergraduate medical education in emergency medical care establishes the basis for further committee work. Methods Using a standardized questionnaire, all medical faculties in Germany were asked to answer questions concerning the structure of their curriculum, representation of disciplines, instructors' qualifications, teaching and assessment methods, as well as evaluation procedures. Results Data from 35 of the 38 medical schools in Germany were analysed. In 32 of 35 medical faculties, the local Department of Anaesthesiology is responsible for the teaching of emergency medical care; in two faculties, emergency medicine is taught mainly by the Department of Surgery and in another by Internal Medicine. Lectures, seminars and practical training units are scheduled in varying composition at 97% of the locations. Simulation technology is integrated at 60% (n = 21; problem-based learning at 29% (n = 10, e-learning at 3% (n = 1, and internship in ambulance service is mandatory at 11% (n = 4. In terms of assessment methods, multiple-choice exams (15 to 70 questions are favoured (89%, n = 31, partially supplemented by open questions (31%, n = 11. Some faculties also perform single practical tests (43%, n = 15, objective structured clinical examination (OSCE; 29%, n = 10 or oral examinations (17%, n = 6. Conclusion Emergency Medical Care in undergraduate medical education in Germany has a practical orientation, but is very inconsistently structured. The innovative options of simulation technology or state-of-the-art assessment methods are not consistently utilized. Therefore, an exchange of experiences and concepts between faculties and disciplines should be promoted to guarantee a standard
Marmor, J B
Although many clinical studies suggest the medical utility of marijuana for some conditions, the scientific evidence is weak. Many patients in California are self-medicating with marijuana, and physicians need data to assess the risks and benefits. The only reasonable solution to this problem is to encourage research on the medical effects of marijuana. The current regulatory system should be modified to remove barriers to clinical research with marijuana. The NIH panel has identified several...
The European Federation of Organisations in Medical Physics (EFOMP) mission and objectives are briefly presented. The most attention is given to the education and training activities of the EFOMP. Revised EFOMP recommendations on Education, Training and CPD of Medical Physicists and Policy Statements are listed. In order for Medical Physics to be recognised by the European Union as a profession some future activities like Bologna Declaration process, continuous professional development, European Network for Medical Physics training Schools, actions for the harmonisation of the Education and Training of the Medical Physicist in Europe in accordance with EU Directive 2005/36/EC and EU Recommendation 2008/C 111/01 are also discussed
Jebb, Matthew; Cheek, Martin
A skeletal world revision of the genus is presented to accompany a family account for Flora Malesiana. 82 species are recognised, of which 74 occur in the Malesiana region. Six species are described as new, one species is raised from infraspecific status, and five species are restored from synonymy.
The present study deals with the systematics and taxonomy of the genus Lamium (Lamiaceae). The taxonomic revision is mainly based on the study of herbarium collections, and to a smaller degree on field observations and abstracts from literature. The research was done at the Rijksherbarium, Leyden,
Roy E. Halling; Beatriz Ortiz-Santana
Taxa included in Boletellus section Ixocephali sensu Singer are re-evaluated and species limits are clarified in a morphological context. In this revision, we recognize four distinct morphological species: B. jalapensis, B. elatus, B. longicollis, and B. singerii. Among these, we have...
Im Rijksmuseum van Natuurlijke Historie, Leiden, befand sich eine Anzahl noch von Grouvelle determinierter Exemplare der Gattung Aphanocephalus Wollaston, die bei meiner Revision dieser Gattung (John, 1956, Ent. Blätt. 52) nicht berücksichtigt werden konnte, da das Material mir damals nicht
Versteegh, C.P.C.; Sosef, M.S.M.
complete revision, including a key to the species, drawings and distribution maps, of the tropical African Annonaceae genus Annickia (= Enantia Oliv., non Falc.) is presented. The exact phylogenetic position of this genus within the family has long been, and in fact still is, unclear. The status of
Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B
Abstract Background and purpose Fast-track surgery has reduced the length of hospital stay (LOS), morbidity, and convalescence in primary hip and knee arthroplasty (TKA). We assessed whether patients undergoing revision TKA for non-septic indications might also benefit from fast-track surgery...
Avignon, France . His manuscript of the revised version of Soviet Style in War had to be brought to completion without him. The people at The RAND Cor...for the offensive is such that even when the side tak- ing the offensive is "Westerners," as in Kafka , conducted in the pres- ence of Marshal Grechko
In August 2013, EPA submitted a revised draft IRIS assessment of ammonia to the agency's Science Advisory Board (SAB) and posted this draft on the IRIS website. EPA had previously released a draft of the assessment for public comment, held a public meeting about the draft, and then revised it based on the comments received. The SAB CAAC-Ammonia panel will review this draft assessment. Details about the meeting dates, times, and location are available via the Federal Register Notice posted on March 25, 2014. The SAB provided information on how the public can participate in the external peer review meetings, as well as instructions about how to provide comments to the SAB in the notice. Additional information on the SAB review of ammonia is on the SAB website. Report Information: The Toxicological Review of Ammonia was originally released for a 60-day public comment period on June 8, 2012. [Federal Register Notice Jun 8, 2012] EPA revised the toxicological review in response to the public comments received. EPA has released the revised external review draft ammonia assessment and the SAB CAAC is conducting a peer review of the scientific basis supporting the assessment that will appear in the Integrated Risk Information System (IRIS) database. Information regarding the peer review can be found at the SAB review of ammonia website. EPA is undertaking an Integrated Risk Information System (IRIS) health assessment for ammonia. IRIS is an EPA database cont
Clayton, E. D.; Prichard, Andrew W.; Durst, Bonita E.; Erickson, David; Puigh, Raymond J.
This report is revision 6 of the Anomalies of Nuclear Criticality. This report is required reading for the training of criticality professionals in many organizations both nationally and internationally. This report describes many different classes of nuclear criticality anomalies that are different than expected.
Full Text Available Corrective feedback, the necessity of providing it, and how it should be provided has been one of the hot topics in the area of ELT. Amid continuing controversies over whether providing feedback helps L2 learners improve their writing accuracy, many research studies have been undertaken to compare the relative effectiveness of different types of feedback. However, the difference between two types of indirect corrective feedback, namely indication and indication plus location, have not been properly examined yet. Motivated to narrow this gap, this study is designed to compare two groups of Iranian learners, each revising their papers based on one of the aforementioned options. For data analysis, a series of independent samples t tests were employed. The results revealed that the difference between the two groups in their reduction of errors from the original draft to the revision of each task followed a growing trend and became significant. Nonetheless, the difference in accuracy of new pieces of writing fell short of significance. Finally, it was found that error reduction in revision stage cannot be considered as learning. The results of the study, discussed in relation to that of others, implicate that the purpose for which feedback is provided is essential in determining the type of feedback; more explicit feedback is better for revising purposes while more implicit feedback is good for learning purposes.
de Paepe, A.; Devereux, R. B.; Dietz, H. C.; Hennekam, R. C.; Pyeritz, R. E.
In 1986, the diagnosis of the Marfan syndrome was codified on the basis of clinical criteria in the Berlin nosology [Beighton et al., 1988]. Over time, weaknesses have emerged in these criteria, a problem accentuated by the advent of molecular testing. In this paper, we propose a revision of
Full Text Available a version of Lewis Imaging as the revision operation. The correctness of the approach is proved. The expressivity of the belief bases under consideration are rather restricted, but has some applications. We also discuss methods of belief base...
A revision of Beilschmiedia Nees (Lauraceae) in Borneo is given. Descriptions, distribution maps, illustrations of leaves, terminal buds, and flowers, and a key to the species are provided. Twenty-six species were recognized, including one newly described species. The new species is distinguished
Cheek, M.; Feika, A.; Lebbie, A.; Goyder, D.; Tchiengue, B.; Sene, O.; Tchouto, P.; Burgt, van der X.
Six new species of Inversodicraea (I. feika from Sierra Leone, I. liberia from Liberia, and I. ebo, I. eladii, I. tchoutoi, and I. xanderi from Cameroon) are described as new to science in the context of a synoptic revision of this African genus, now comprising 30 species, including I. cussetiana
Foda, Hossam M T
To evaluate the problems encountered on revising a multiply operated nose and the methods used in correcting such problems. The study included 50 cases presenting for revision rhinoplasty after having had 2 or more previous rhinoplasties. An external rhinoplasty approach was used in all cases. Simultaneous septal surgery was done whenever indicated. All cases were followed for a mean period of 32 months (range, 1.5-8 years). Evaluation of the surgical result depended on clinical examination, comparison of pre- and postoperative photographs, and degree of patients' satisfaction with their aesthetic and functional outcome. Functionally, 68% suffered nasal obstruction that was mainly caused by septal deviations and nasal valve problems. Aesthetically, the most common deformities of the upper two thirds of the nose included pollybeak (64%), dorsal irregularities (54%), dorsal saddle (44%), and open roof deformity (42%), whereas the deformities of lower third included depressed tip (68%), tip contour irregularities (60%), and overrotated tip (42%). Nasal grafting was necessary in all cases; usually more than 1 type of graft was used in each case. Postoperatively, 79% of the patients, with preoperative nasal obstruction, reported improved breathing; 84% were satisfied with their aesthetic result; and only 8 cases (16%) requested further revision to correct minor deformities. Revision of a multiply operated nose is a complex and technically demanding task, yet, in a good percentage of cases, aesthetic as well as functional improvement are still possible.
Mols, J.B.; Keßler, P.J.A.
A revision of the genus Phaeanthus Hook.f. & Thomson (Annonaceae) is presented. The genus comprises 8 species. A key to the fruiting and/or flowering specimens of the genus is included. The genus consists of shrubs to small-sized trees from Malesia and Vietnam. It is characterised by sepals and
..., ``Factors Affecting Assessment of Violations'' The phrase ``onsite or offsite chemical hazard exposures... construction activities, flexibility is needed to factor in the lower risk associated with certain violations... address construction-related topics, including enforcement discretion. DATES: This revision of the NRC...
Welzen, van P.C.; Sweet, F.S.T.; Fernández-Casas, F.J.
Jatropha, a widespread, species rich genus, ranges from the Americas and Caribbean to Africa and India. In Malesia five species occur, all of which were introduced and originated in Central and South America. The five species are revised and an identification key, nomenclature, descriptions,
A world wide revision of the family with a general discussion of the systematic position, the affinities within the family, the morphology of leaves, flowers, and seeds, the chromosome number, and the geographic distribution. Types of ruminate endosperm of the seed, previously unknown in the family,
Zhang, Xian-Chun; Nooteboom, H.P.
A taxonomic revision of Plagiogyriaceae is presented. One genus and 11 species are recognised. One species, P. egenolfioides, is subdivided into four varieties. Only one species, P. pectinata, occurs in the New World, all others in the Old World. One species, P. glauca, and one variety, P.
Hu, Gaojie; Liu, Kai; Williams, Lawrence J
Insight derived from a synthetic model, calculated (13)C NMR data, and comparison to experimental data indicate that the proposed allenic structure A, originally assigned to an isolate from Brosimum acutifolium Huber, should be revised to B, a natural product and nonallenic substance, mururin C.
control parameters = number of global variables used as data = number of global variables used as control = number of modules called ( fan ...out) = number of modules calling the module under consideration ( fan -in) NAWCWD TP 8823, Revision 1 6 Distribution Statement A. These
...--Auxiliary emblem: We propose to revise this section. Provisions of the existing Sec. 5.41 would be... existing Sec. 5.47(c) describing the Auxiliary emblem and explain the use of the emblem as identification...), and 5.36(c). Added language to describe the Auxiliary emblem and discuss when it can be worn and used...
Lindberg-Larsen, M.; Hansen, Torben Bæk
aseptic revision THRs from 1st October 2009 to 30th September 2011 using the Danish National Patient Registry, with additional information from the Danish Hip Arthroplasty Registry. There were 1553 procedures (1490 patients) performed in 40 centres and we divided them into total revisions, acetabular......Data on early morbidity and complications after revision total hip replacement (THR) are limited. The aim of this nationwide study was to describe and quantify early morbidity after aseptic revision THR and relate the morbidity to the extent of the revision surgical procedure. We analysed all...... component revisions, femoral stem revisions and partial revisions. The mean age of the patients was 70.4 years (25 to 98) and the median hospital stay was five days (interquartile range 3 to 7). Within 90 days of surgery, the readmission rate was 18.3%, mortality rate 1.4%, re-operation rate 6...
Dy, Christopher J.; Bozic, Kevin J.; Pan, Ting Jung; Wright, Timothy M.; Padgett, Douglas E.; Lyman, Stephen
Objective Revision total hip arthroplasty (THA) is associated with increased cost, morbidity, and technical challenge compared to primary THA. A better understanding of the risk factors for early revision is needed to inform strategies to optimize patient outcomes. Methods 207,256 patients who underwent primary THA between 1997–2005 in California and New York were identified from statewide databases. Unique patient identifiers were used to identify early revision THA (revision. Results The probabilities of undergoing early aseptic revision and early septic revision were 4% and less than 1% at 5 years, respectively. Women were 29% less likely than men to undergo early septic revision (prevision than privately-insured patients (p=0.01; prevision compared to hospitals performing >400 THA annually (prevision THA. Patient-level characteristics distinctly affect the risk of revision within 10 years, particularly if due to infection. Our findings reinforce the need for continued investigation of the predictors of early failure following THA. PMID:24285406
EPA has developed the Revised Total Coliform Rule Assessment and Corrective Actions Guidance Manual for public water systems (e.g., owners and operators) to assist in complying with the requirements of the Revised Total Coliform Rule.
Garcia, Susan E.; Giannelli, Joseph F.
BWRVIP-190: BWR Water Chemistry Guidelines – 2008 Revision has been revised. The revision committee consisted of U.S. and non-U.S. utilities (members of the BWR Vessel and Internals Protection (BWRVIP) Mitigation Committee), reactor system manufacturers, fuel suppliers, and EPRI and industry experts. The revised document, BWRVIP-190 Revision 1, was completely reformatted into two volumes, with a simplified presentation of water chemistry control, diagnostic and good practice parameters in Volume 1 and the technical bases in Volume 2, to facilitate use. The revision was developed in parallel and in coordination with preparation of the Fuel Reliability Guidelines Revision 1: BWR Fuel Cladding Crud and Corrosion. Guidance is included for plants operating under normal water chemistry (NWC), moderate hydrogen water chemistry (HWC-M), and noble metal application (GE-Hitachi NobleChem™) plus hydrogen injection. Volume 1 includes significant changes to BWR feedwater and reactor water chemistry control parameters to provide increased assurance of intergranular stress corrosion cracking (IGSCC) mitigation of reactor materials and fuel reliability during all plant conditions, including cold shutdown (≤200°F (93°C)), startup/hot standby (>200°F (93°C) and ≤ 10%) and power operation (>10% power). Action Level values for chloride and sulfate have been tightened to minimize environmentally assisted cracking (EAC) of all wetted surfaces, including those not protected by hydrogen injection, with or without noble metals. Chemistry control guidance has been enhanced to minimize shutdown radiation fields by clarifying targets for depleted zinc oxide (DZO) injection while meeting requirements for fuel reliability. Improved tabular presentations of parameter values explicitly indicate levels at which actions are to be taken and required sampling frequencies. Volume 2 provides the technical bases for BWR water chemistry control for control of EAC, flow accelerated corrosion
Rasmussen, J V; Polk, A; Sorensen, A K
In this study, we evaluated patient-reported outcomes, the rate of revision and the indications for revision following resurfacing hemiarthroplasty of the shoulder in patients with osteoarthritis. All patients with osteoarthritis who underwent primary resurfacing hemiarthroplasty and reported...... to the Danish Shoulder Arthroplasty Registry (DSR), between January 2006 and December 2010 were included. There were 772 patients (837 arthroplasties) in the study. The Western Ontario Osteoarthritis of the Shoulder (WOOS) index was used to evaluate patient-reported outcome 12 months (10 to 14) post......-operatively. The rates of revision were calculated from the revisions reported to the DSR up to December 2011 and by checking deaths with the Danish National Register of Persons. A complete questionnaire was returned by 688 patients (82.2%). The mean WOOS was 67 (0 to 100). A total of 63 hemiarthroplasties (7...
Bucher, Leandra; Röser, Florian; Nejasmic, Jelica; Hamburger, Kai
Belief revision is required when veridical information surfaces that contradicts what was previously thought to be the case. In way-finding, belief revision frequently occurs, for example, when the travelled route has led one astray, instead of to one's chosen destination. In past cognitive research, the topics of belief revision and way-finding have been treated in isolation. Here, we introduce an approach for linking the two fields and assess belief revision as it occurs in the process of way-finding. We report the results of two experiments that put participants in (virtual) situations where elements of a previously learned route description do not match the actual environment (thereby requiring the revision of a previously held belief). Experiment 1 puts participants in a highly artificial virtual environment where the landmarks to be used in navigation have a low degree of semantic salience (houses of various color). Experiment 2 puts subjects in a photorealistic environment where the objects to be used in navigation are well-known landmarks (such as the Eiffel Tower) and thus have a high degree of semantic salience. In both experiments, participants are confronted with T-junctions, where a landmark that was expected to indicate the correct route is discovered to be in an unexpected location. The results of the experiments show that a participant's choice of route, in such cases, is affected by differences in the structure of the relevant initial instruction. More precisely, the route chosen by participants is affected by whether the relevant landmark was described as being on the same side of the path as they were instructed to turn (congruent case) or as located on the opposite side of the path as they were instructed to turn (incongruent case).
is only when mistakes are recognised that learning can occur...All our previous medical training has taught us to fear error, as error is associated with blame. This fear may lead to concealment and this is turn can lead to fraud'. How real this fear is! All of us, during our medical training, have had the maxim 'prevention is.
Olopade, Funmilayo Eniola; Adaramoye, Oluwatosin Adekunle; Raji, Yinusa; Fasola, Abiodun Olubayo; Olapade-Olaopa, Emiola Oluwabunmi
The College of Medicine of the University of Ibadan recently revised its MBBS and BDS curricula to a competency-based medical education method of instruction. This paper reports the process of revising the methods of instruction and assessment in the core basic medical sciences directed at producing medical and dental graduates with a sound knowledge of the subjects sufficient for medical and dental practice and for future postgraduate efforts in the field or related disciplines. The health needs of the community and views of stakeholders in the Ibadan medical and dental schools were determined, and the “old” curriculum was reviewed. This process was directed at identifying the strengths and weaknesses of the old curricula and the newer competences required for modern-day medical/dental practice. The admission criteria and processes and the learning methods of the students were also studied. At the end of the review, an integrated, system-based, community-oriented, person-centered, and competency-driven curriculum was produced and approved for implementation. Four sets of students have been admitted into the curriculum. There have been challenges to the implementation process, but these have been overcome by continuous faculty development and reorientation programs for the nonteaching staff and students. Two sets of students have crossed over to the clinical school, and the consensus among the clinical teachers is that their knowledge and application of the basic medical sciences are satisfactory. The Ibadan medical and dental schools are implementing their competency-based medical education curricula successfully. The modifications to the teaching and assessment of the core basic medical science subjects have resulted in improved learning and performance at the final examinations. PMID:27486351
Olopade, Funmilayo Eniola; Adaramoye, Oluwatosin Adekunle; Raji, Yinusa; Fasola, Abiodun Olubayo; Olapade-Olaopa, Emiola Oluwabunmi
The College of Medicine of the University of Ibadan recently revised its MBBS and BDS curricula to a competency-based medical education method of instruction. This paper reports the process of revising the methods of instruction and assessment in the core basic medical sciences directed at producing medical and dental graduates with a sound knowledge of the subjects sufficient for medical and dental practice and for future postgraduate efforts in the field or related disciplines. The health needs of the community and views of stakeholders in the Ibadan medical and dental schools were determined, and the "old" curriculum was reviewed. This process was directed at identifying the strengths and weaknesses of the old curricula and the newer competences required for modern-day medical/dental practice. The admission criteria and processes and the learning methods of the students were also studied. At the end of the review, an integrated, system-based, community-oriented, person-centered, and competency-driven curriculum was produced and approved for implementation. Four sets of students have been admitted into the curriculum. There have been challenges to the implementation process, but these have been overcome by continuous faculty development and reorientation programs for the nonteaching staff and students. Two sets of students have crossed over to the clinical school, and the consensus among the clinical teachers is that their knowledge and application of the basic medical sciences are satisfactory. The Ibadan medical and dental schools are implementing their competency-based medical education curricula successfully. The modifications to the teaching and assessment of the core basic medical science subjects have resulted in improved learning and performance at the final examinations.
Jiloha, R C
Psychiatry as a medical discipline has been variously described. Even among medical community psychiatry was looked down upon as medical speciality. After World War II when psychiatry's importance was realized for total treatment, its image was supposed to have improved. In the light of these ups and downs a survey of medical community consisting of 5000 doctors was conducted results of which reveal that the role of psychiatry is favourable. Respondent's comments and criticism were constructive and consistent. Important facts highlighted by this survey are that the undergraduate training in psychiatry is inadequate and the general public carries a frightening image about psychiatry according to the medical men. Therefore, it is suggested that medicos need more exposure to psychiatry and undergraduate training in psychiatry needs to be revised.
...-delivered, cable-affiliated programming; and (ii) potential revisions to our program access rules to better... Revision of the Commission's Program Access Rules; Proposed Rule #0;#0;Federal Register / Vol. 77 , No. 78... Part 76 [MB Docket Nos. 12-68, 07-18, and 05-192; FCC 12-30] Revision of the Commission's Program...
We set out to study the cases undergoing amputation surgery with special interest of determining the prevalence rate of revision amputation surgery; its indication ... The commonest indication found for amputation surgery was trauma while it was ascending gangrene for revision amputation. Among those who had revision ...
... HUMAN SERVICES Administration for Children and Families Notice of Revised Child Outcomes Framework AGENCY: Office of Head Start (OHS), HHS. ACTION: Notice of Revised Child Outcomes Framework. SUMMARY: This notice announces and informs the public of the revised Head Start Child Outcomes Framework...
... 40 Protection of Environment 6 2010-07-01 2010-07-01 false Hg budget permit revisions. 60.4124... Coal-Fired Electric Steam Generating Units Permits § 60.4124 Hg budget permit revisions. Except as provided in § 60.4123(b), the permitting authority will revise the Hg Budget permit, as necessary, in...
Simian, E; Chatellard, R; Druon, J; Berhouet, J; Rosset, P
Dislocation is a common complication of total hip arthroplasty (THA), particularly when performed as revision surgery. Dual mobility cups (DMCs) minimize the risk of instability when implanted during primary THA. However, their usefulness and survival in revision THA remain unclear. We therefore conducted a retrospective study to assess DMC stability and survival at a minimal follow-up period of 5years after revision THA. The dislocation rate associated with DMCs for revision THA is similar to that seen after primary THA. Cup exchange with implantation of a DMC was performed in 71 patients (74 hips) between 2000 and 2007, for the following reasons: recurrent dislocation (n=22), aseptic loosening (n=38), and infection (n=14). The DMCs were cemented in 47 cases and cementless in 27 cases. The clinical variables (Merle d'Aubigné-Postel score and Harris Hip Score) and radiological findings were collected retrospectively from the medical records and compared with those obtained at the last follow-up visit. Of the 74 cases, 2 were lost to follow-up. At last follow-up, the mean Merle d'Aubigné-Postel score was 15.2 (11-18) and the mean Harris Hip Score was 80.4 (51-98). Of the 8 failures, 2 (2/72, 2.7%) were related to mechanical factors (1 case each of aseptic loosening and dislocation) and 6 were changed because of infection (recurrent infection, n=4). Mechanical failure was not linked to a specific reason for revision THA. A radiolucent line was visible in 4 cases but this finding was not associated with clinical manifestations. When failure was defined as cup revision for any non-infectious complication, 5-year implant survival was 99% (95% confidence interval, 93-100%). Use of a DMC in revision THA was associated with a slightly higher dislocation rate (1/72, 1.4%) than in primary THA, whereas 5-year survival was comparable. Cemented DMCs were not associated with a greater risk of loosening. DMCs are useful to decrease the risk of dislocation in revision THA
AlFaris, Eiad; Abdulgader, Abdelgalil; Alkhenizan, Abdullah
(EBME) [corrected] is an attitude of mind that entails the creation of a culture in which teachers think critically about what they are doing, look at the best evidence available and on this basis, make decisions about their teaching practice, and subsequently, undertake the necessary revision and change. More medical schools have opened in Saudi Arabia in the last few years than have existed over the last three decades. Currently, the education of health professionals is based on assumption and traditions and rarely on research findings. Medical teaching has evolved from being opinion-based to evidence-based and the art of teaching is rapidly becoming the 'science' of teaching. The need for evidence in our teaching and medical education practices is as important as it is in assessing a new therapy. This approach to education is not only associated with better results in terms of better learning, from the side of the students (the consumers), but also has a wider impact on patient care and the community. Moreover, in this age of accountability, litigations and quality assurance, the need for BEME becomes greater. Some suggestions to implement BEME in Saudi Arabia have been put forward and these are the training of medical education professionals in the use the existing information systems, and disseminating information through the creation of a BEME journal (secondary publication) that publishes a critically appraised summary of medical education articles that are both valid and of immediate clinical use.
Costescu, Dustin; Guilbert, Edith; Bernardin, Jeanne; Black, Amanda; Dunn, Sheila; Fitzsimmons, Brian; Norman, Wendy V; Pymar, Helen; Soon, Judith; Trouton, Konia; Wagner, Marie-Soleil; Wiebe, Ellen; Gold, Karen; Murray, Marie-Ève; Winikoff, Beverly; Reeves, Matthew
This guideline reviews the evidence relating to the provision of first-trimester medical induced abortion, including patient eligibility, counselling, and consent; evidence-based regimens; and special considerations for clinicians providing medical abortion care. Gynaecologists, family physicians, registered nurses, midwives, residents, and other healthcare providers who currently or intend to provide pregnancy options counselling, medical abortion care, or family planning services. Women with an unintended first trimester pregnancy. Published literature was retrieved through searches of PubMed, MEDLINE, and Cochrane Library between July 2015 and November 2015 using appropriately controlled vocabulary (MeSH search terms: Induced Abortion, Medical Abortion, Mifepristone, Misoprostol, Methotrexate). Results were restricted to systematic reviews, randomized controlled trials, clinical trials, and observational studies published from June 1986 to November 2015 in English. Additionally, existing guidelines from other countries were consulted for review. A grey literature search was not required. The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force for Preventive Medicine rating scale (Table 1). Medical abortion is safe and effective. Complications from medical abortion are rare. Access and costs will be dependent on provincial and territorial funding for combination mifepristone/misoprostol and provider availability. Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care. Copyright © 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
Full Text Available Funmilayo Eniola Olopade,1 Oluwatosin Adekunle Adaramoye,2 Yinusa Raji,3 Abiodun Olubayo Fasola,4 Emiola Oluwabunmi Olapade-Olaopa5 1Department of Anatomy, 2Department of Biochemistry, 3Department of Physiology, 4Department of Oral Pathology, 5Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria Abstract: The College of Medicine of the University of Ibadan recently revised its MBBS and BDS curricula to a competency-based medical education method of instruction. This paper reports the process of revising the methods of instruction and assessment in the core basic medical sciences directed at producing medical and dental graduates with a sound knowledge of the subjects sufficient for medical and dental practice and for future postgraduate efforts in the field or related disciplines. The health needs of the community and views of stakeholders in the Ibadan medical and dental schools were determined, and the “old” curriculum was reviewed. This process was directed at identifying the strengths and weaknesses of the old curricula and the newer competences required for modern-day medical/dental practice. The admission criteria and processes and the learning methods of the students were also studied. At the end of the review, an integrated, system-based, community-oriented, person-centered, and competency-driven curriculum was produced and approved for implementation. Four sets of students have been admitted into the curriculum. There have been challenges to the implementation process, but these have been overcome by continuous faculty development and reorientation programs for the nonteaching staff and students. Two sets of students have crossed over to the clinical school, and the consensus among the clinical teachers is that their knowledge and application of the basic medical sciences are satisfactory. The Ibadan medical and dental schools are implementing their competency-based medical education curricula
Yang Guang-Zhong; Jiang Tianzi; Shen Dinggang; Gu Lixu; Yang Jie
This book constitutes the refereed proceedings of the Third International Workshop on Medical Imaging and Augmented Reality, MIAR 2006, held in Shanghai, China, in August 2006. The 45 revised full papers presented together with 4 invited papers were carefully reviewed and selected from 87 submissions. The papers are organized in topical sections on shape modeling and morphometry, patient specific modeling and quantification, surgical simulation and skills assessment, surgical guidance and navigation, image registration, PET image reconstruction, and image segmentation. (orig.)
... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What activities require a revision to my SAP... OUTER CONTINENTAL SHELF Plans and Information Requirements Activities Under An Approved Sap § 285.617 What activities require a revision to my SAP, and when will MMS approve the revision? (a) You must...
The Council of the European Communities in its Directive of June 1, 1976 has laid down revised basic safety standards for the health protection of the general public and workers against the danger of ionising radiation. The Directive requires each Member State of the Community 'for the guidance of medical practitioners.....to draw up a list, which need not be exhaustive, of the criteria which should be taken into account when judging a worker's fitness to be exposed to ionising radiation'. Medical officers with current responsibility for radiation workers in the U.K. therefore met recently for informal exploratory discussion at the National Radiological Protection Board's headquarters, and an account is given of the views expressed there about the composition of the required 'list', and the possibility of standardizing the procedure adopted. Consideration was given to the objectives of medical examinations, the form of examination, and specific conditions which may give rise to difficulty in making a fitness assessment. These conditions are skin abnormalities, blood abnormalities, cataract, pregnancy, and psychological and psychiatric conditions. It was concluded that the medical examination of radiation workers, including blood examinations, are of value to the extent that they form part of any good general occupational health practice. The promulgation of the Euratom Directive has provided an opportunity for reviewing and standardising procedures for medical surveillance in the light of current knowledge concerning average occupational radiation doses and dose-response relationships. (U.K.)
MM first came to the attention of policy makers primarily in the USA where, from the 1970s, healthcare providers denounced problems in getting insurance for medical liability, pointing out to a crisis in the MM insurance market (Sage WM (2003) Understanding the first malpractice crisis of the 21th...... in the last decades also among European countries (Hospitals of the European Union (HOPE) (2004) Insurance and malpractice, final report. Brussels, www.hope.be; OECD (2006) Medical malpractice, insurance and coverage options, policy issues in insurance n.11; EC (European Commission, D.G. Sanco) (2006......) Special eurobarometer medical errors)....
... THC is a cannabinoid that can affect the brain and change your mood or consciousness. Different varieties of marijuana contain different amounts of cannabinoids. This sometimes makes the effects of medical marijuana hard to predict or control. ...
Friesel, D. L.; Antaya, T. A.
Particle accelerators were initially developed to address specific scientific research goals, yet they were used for practical applications, particularly medical applications, within a few years of their invention. The cyclotron's potential for producing beams for cancer therapy and medical radioisotope production was realized with the early Lawrence cyclotrons and has continued with their more technically advanced successors — synchrocyclotrons, sector-focused cyclotrons and superconducting cyclotrons. While a variety of other accelerator technologies were developed to achieve today's high energy particles, this article will chronicle the development of one type of accelerator — the cyclotron, and its medical applications. These medical and industrial applications eventually led to the commercial manufacture of both small and large cyclotrons and facilities specifically designed for applications other than scientific research.
... Have a suspected pregnancy outside of the uterus (ectopic pregnancy). Have certain medical conditions. These include bleeding disorders; ... pregnancy and confirm it's not outside the uterus (ectopic pregnancy) and not a tumor that developed in the ...
Barker, M. C. J.
Discusses four main types of medical imaging (x-ray, radionuclide, ultrasound, and magnetic resonance) and considers their relative merits. Describes important recent and possible future developments in image processing. (Author/MKR)
Penrose, Colin T; Seyler, Thorsten M; Wellman, Samuel S; Bolognesi, Michael P; Lachiewicz, Paul F
Isolated revision of the acetabular component in the setting of total hip arthroplasty has an increased risk of dislocation. With local soft tissue destruction frequently associated with failed metal-on-metal (MoM) bearings, it is presumed that acetabular revision of these hips will have even greater risk of complications. However, no study directly compares the complications of MoM with metal-on-polyethylene (MoP) acetabular revisions. In the context of a large database analysis, we asked the following questions: (1) Are there differences in early medical or wound complications after isolated acetabular revision of MoM and MoP bearing surfaces? (2) Are there differences in the frequency of dislocation, deep infection, and rerevision based on the bearing surface of the original implant? A review of the 100% Medicare database from 2005 to 2012 was performed using International Classification of Diseases, 9th Revision and Current Procedural Terminology codes. We identified 451 patients with a MoM bearing and 628 patients with a MoP bearing who had an isolated acetabular revision and a minimum followup of 2 years. The incidence, odds ratios, and 95% confidence intervals for early medical or wound complications were calculated using a univariate analysis at 30 days with patient sex and age group-adjusted analysis for blood transfusion. The incidence, odds ratio, and 95% confidence intervals for dislocation, deep infection, and rerevision were calculated using a univariate analysis at 30 day, 90 days, 1 year, and 2 years using a subgroup analysis with the Cochran-Mantel-Haenszel test to adjust for patient gender and age groups. There were no differences between the MoM and MoP isolated acetabular revisions in the incidence of 30-day local complications. There was a greater risk of transfusion in the MoP group than the MoM group (134 of 451 [30%] versus 230 of 628 [37%]; odds ratio [OR], 0.731; 95% confidence interval [CI], 0.565-0.948; p = 0.018). There were no
Biscari, C.; Falbo, L.
The use of accelerators for medical applications has evolved from initial experimentation to turn-key devices commonly operating in hospitals. New applications are continuously being developed around the world, and the hadrontherapy facilities of the newest generation are placed at the frontier between industrial production and advanced R&D. An introduction to the different medical application accelerators is followed by a description of the hadrontherapy facilities, with special emphasis on ...
This leaflet in the At-a-Glance Series describes the medical use of X-rays, how X-rays help in diagnosis, radiation protection of the patient, staff protection, how radioactive materials in nuclear medicine examinations help in diagnosis and the use of radiation in radiotherapy. Magnetic resonance imaging, a diagnostic technique involving no ionizing radiation, is also briefly examined. The role of the NRPB in the medical use of radiation is outlined. (UK).
In theory, the Medical Council of India (MCI) determines the standards and qualifications of medical schools. It also sanctions curricula and ensures standards. Yet no standards exist on the mode of selection in medical schools, duration of study, course content, student stipends or period of internship. It takes 4.5 years to finish medical school. Students undergo preclinical, paraclinical, and clinical training. Most courses are in English which tends to favor the urban elite. Students cannot always communicate with patients in local languages. Textbooks often provide medical examples unrelated to India. Pedagogy consists mainly of lectures and rote learning predominates. Curricula tend not to provide courses in community health. Students pick up on the elitist attitudes of the faculty. For example, faculty do not put much emphasis on community health, individual health, equity in health care delivery, and teamwork. Further the education system is not patient oriented, but hospital or disease oriented. Faculty should train students in creating sanitation programs, knowing local nutritious foods, and in making community diagnoses. Yet they tend to be practitioners 1st then educators. Further faculty are not paid well and are not always invited to take part in improving curriculum, so morale is often low. Moreover experience in health planning and management issues is not required for administrators. In addition, medical schools are not well equipped with learning aids, libraries, or teaching staff. Tax revenues finance medical education. 75% of graduating physicians set up a private practice. Further many physicians go to urban areas. 34-57% emigrate to other countries. The problems of medical education will not be solved until the political and economic system becomes more responsive to the health needs of the people.
The identification of the variable stars published on IBVS 3573 has ben revised on the basis of the original (unpublished) finding charts. Cross check with the 2MASS catalog has been made to get more accurate coordinates and to confirm their nature from their , colors. The Mira stars, given their known periods, could be used with the astrometric parallaxes of the forthcoming Gaia catalog to improve the Period-Luminosity relation.
The present study deals with the systematics and taxonomy of the genus Lamium (Lamiaceae). The taxonomic revision is mainly based on the study of herbarium collections, and to a smaller degree on field observations and abstracts from literature. The research was done at the Rijksherbarium, Leyden, while many other Herbaria were shortly visited. As the genus Lamium was never before monographed, a short survey is given of the taxonomic history of Lamium, which goes back as far as Linnaeus (1753...
Please note that the Revised Safety Instruction No. 41 (IS41 REV.), entitled 'The use of plastic and other non-metallic materials at CERN with respect to fire safety and radiation resistance' is available on the web at the following url: https://edms.cern.ch/document/335806/LAST_RELEASED Paper copies can also be obtained from the SC Unit Secretariat, e-mail: email@example.com SC Secretariat
Van Passel, Steven
Sustainability assessment is an essential process in our aim to reach a more sustainable production and consumption pattern. This research revises the food miles concept as a guiding tool to assess sustainability. Food miles measure the distance that food travels from where it is grown or raised to where it is consumed. Three different concepts to assess sustainability are described: (i) food miles, (ii) enhanced food miles, (iii) food chain sustainability. An illustrative case study shows th...
Leveling, A.; /Fermilab
A procedure for unfilling used lithium lenses to has been described in Pbar Note 664. To date, the procedure has been used to disassemble lenses 20, 21, 17, 18, and 16. As a result of this work, some parts of the original procedure were found to be time consuming and ineffective. Modifications to the original procedure have been made to streamline the process and are discussed in this note. The revised procedure is included in this note.
Dohi, Takeyoshi; Sakuma, Ichiro; Liao, Hongen
This book constitutes the refereed proceedings of the 4th International Workshop on Medical Imaging and Augmented Reality, MIAR 2008, held in Tokyo, Japan, in August 2008. The 44 revised full papers presented together with 3 invited papers were carefully reviewed and selected from 90 submissions. The papers are organized in topical sections on surgical planning and simulation, medical image computing, image analysis, shape modeling and morphometry, image-guided robotics, image-guided intervention, interventional imaging, image registration, augmented reality, and image segmentation. (orig.)
Kudera, D.E.; McMurtrey, C.D.; Meagher, B.G.
This document provides guidance for the revision of DOE Order 5820.2A, ``Radioactive Waste Management.`` Technical Working Groups have been established and are responsible for writing the revised order. The Technical Working Groups will use this document as a reference for polices and procedures that have been established for the revision process. The overall intent of this guidance is to outline how the order will be revised and how the revision process will be managed. In addition, this document outlines technical issues considered for inclusion by a Department of Energy Steering Committee.
Badarudeen, Sameer; Shu, Albert C; Ong, Kevin L; Baykal, Doruk; Lau, Edmund; Malkani, Arthur L
The purpose of this study was to identify the incidence and types of complications after revision total hip arthroplasty (THA) within the first year, and determine the relative risk factors for these complications and of re-revision. The sample size of 5% Medicare claims data from 1998-2011 was studied. Primary THA patients who underwent subsequent revision were identified using ICD-9-CM codes. Outcomes and complications after revision THA were assessed. Multivariate Cox regression was used to evaluate the effect of patient demographic characteristics on the adjusted complication risk for revision THA patients. Of the 64,260 primary THA patients identified between 1998 and 2011, 3555 patients (5.71%) underwent revision THA. Etiology of primary hip failure included mechanical complications such as loosening and wear (40.7%), dislocation (14.0%), and infection (11.3%). Complications after revision THA included infection and redo revision, 17.3% and 15.8% followed by venous thromboembolic disease (VTE) at 11.1%, dislocation at 5.43%, PE at 3.24%, and death at 2.11%. The rate of "new" infections after an aseptic revision was 8.13%. Patients in the 85+-year-old age group had a 100% greater adjusted risk of VTE (P revision THA (P = .011). Advanced age is a clear risk factor for VTE and mortality, but not for dislocation, infection, or re-revision. Higher Charlson index was found to be a risk factor for every complication after revision except dislocation. Greater attention is required to address the high rate of infection and re-do revision after revision THA (17.3% and 15.8%). Copyright © 2017 Elsevier Inc. All rights reserved.
Elshahat, Ahmed; Lashin, Riham
Facial scaring is considered one of the most difficult cosmetic problems for any plastic surgeon to solve. The condition is more difficult if the direction of the scar is not parallel to relaxed skin tension lines. Attempts to manage this difficult situation included revisions using geometric designs, Z plasties or W plasties to camouflage the straight line visible scaring. The use of long-lasting resorbable sutures was tried too. Recently, the use of botulinum toxin during revision improved the results. Fractional CO2 lasers, microfat grafts, and platelet-rich plasma were added to the armamentarium. The scar is least visible if placed in the junction between the facial subunits. The aim of this study is to investigate the use of the subunit principle to improve the results of scar revision. Four patients were included in this study. Tissue expansion of the intact part of the subunit allowed shifting the scar to the junction between the affected subunit and the adjacent one. Tissue expansion, delivery of the expanders, and advancement of the flaps were successful in all patients. The fact that this is a 2-stage procedure and sacrifices some of the intact skin from the affected facial subunit, makes this technique reserved to patients with ugly facial scars who are ambitious to improve their appearance.
The United States Nuclear Regulatory Commission (NRC) regulates nuclear power plants to assure adequate protection of the public and the environment from the dangers associated with nuclear materials. NRC fulfills this responsibility through comprehensive safety reviews of nuclear facilities, licensing of organizations that use nuclear materials, and continuing inspection. The NRC inspection program is currently conducted from the five regional offices in or near Philadelphia, Atlanta, Chicago, Dallas and San Francisco. Inspectors travel from the regional offices to nuclear power plants in various phases of construction, test and operation in order to conduct inspections. However, in June 1977 the Commission approved a revision to the inspection program that will include stationing inspectors at selected plants under construction and at all plants in operation. In addition, the revised program provides for appraising the performance of licensees on a national basis and involves more direct measurement and observation by NRC inspectors of work and tests in progress. The program also includes enhanced career management consisting of improved training and career development for inspectors and other professionals. The report was requested in the Conference Report on the NRC Authorization for Appropriations for Fiscal Year 1978. The report provides a discussion of the basis for both the current and revised inspection programs, describes these programs, and shows how the NRC inspection force will be trained and utilized. In addition, the report includes a discussion of the actions that will be taken to assure the objectivity of inspectors
Neul, Jeffrey L.; Kaufmann, Walter E.; Glaze, Daniel G.; Christodoulou, John; Clarke, Angus J.; Bahi-Buisson, Nadia; Leonard, Helen; Bailey, Mark E. S.; Schanen, N. Carolyn; Zappella, Michele; Renieri, Alessandra; Huppke, Peter; Percy, Alan K.
Objective Rett syndrome (RTT) is a severe neurodevelopmental disease that affects approximately 1 in 10,000 live female births and is often caused by mutations in Methyl-CpG-binding protein 2 (MECP2). Despite distinct clinical features, the accumulation of clinical and molecular information in recent years has generated considerable confusion regarding the diagnosis of RTT. The purpose of this work was revise and clarify 2002 consensus criteria for the diagnosis of RTT in anticipation of treatment trials. Method RettSearch members, representing the majority of the international clinical RTT specialists, participated in an iterative process to come to a consensus on a revised and simplified clinical diagnostic criteria for RTT. Results The clinical criteria required for the diagnosis of classic and atypical RTT were clarified and simplified. Guidelines for the diagnosis and molecular evaluation of specific variant forms of RTT were developed. Interpretation These revised criteria provide clarity regarding the key features required for the diagnosis of RTT and reinforce the concept that RTT is a clinical diagnosis based on distinct clinical criteria, independent of molecular findings. We recommend that these criteria and guidelines be utilized in any proposed clinical research. PMID:21154482
Aull, Felice; Lewis, Bradley
In this paper, we propose analogies between medical discourse and Edward Said's "Orientalism." Medical discourse, like Orientalism, tends to favor institutional interests and can be similarly dehumanizing in its reductionism, textual representations, and construction of its subjects. To resist Orientalism, Said recommends that critics--"intellectuals"--adopt the perspective of exile. We apply Said's paradigm of intellectual-as-exile to better understand the work of key physician-authors who cross personal and professional boundaries, who engage with patients in mutually therapeutic relationships, and who take on the public responsibility of representation and advocacy. We call these physician-authors "medical intellectuals" and encourage others to follow in their path.
Allen Summer V
Full Text Available Abstract Background The purpose of the study was to examine patients’ understanding of the revised screening mammogram guidelines released by the United States Preventive Services Task Force (USPSTF in 2009 addressing age at initiation and frequency of screening mammography. Methods Patients from the Departments of Family Medicine, Internal Medicine, and Obstetrics and Gynecology (n = 150 at a tertiary care medical center in the United States completed a survey regarding their understanding of the revised USPSTF guidelines following their release, within four to six months of their scheduled mammogram (March 2010 to May 2010. Results Of the patients surveyed, 97/147 (67% indicated increased confusion regarding the age and frequency of screening mammography, 61/148 (41% reported increased anxiety about mammograms, and 58/146 (40% reported anxiety about their own health status following the release of the revised screening guidelines. Most of the patients surveyed, 111/148 (75%, did not expect to change their timing or frequency of screening mammograms in the future. Conclusion Results from this survey suggested increased confusion and possibly an increase in patients’ anxiety related to screening mammography and their own health status following the release of the revised USPSTF screening mammogram guidelines to the public and subsequent media portrayal of the revised guidelines. Although the study did not specifically address causality for these findings, the results highlight the need for improvements in the communication of guidelines to patients and the public. Development of shared decision-making tools and outcomes should be considered to address the communication challenge.
Wongpakaran, Nahathai; Wongpakaran, Tinakon
In order to ensure the construct validity of the three-factor model of the Multi-dimensional Scale of Perceived Social Support (MSPSS), and based on the assumption that it helps users differentiate between sources of social support, in this study a revised version was created and tested. The aim was to compare the level of model fit of the original version of the MSPSS against the revised version--which contains a minor change from the original. The study was conducted on 486 medical students who completed the original and revised versions of the MSPSS, as well as the Rosenberg Self-Esteem Scale (Rosenberg, 1965) and Beck Depression Inventory II (Beck, Steer, & Brown, 1996). Confirmatory factor analysis was performed to compare the results, showing that the revised version of MSPSS demonstrated a good internal consistency--with a Cronbach's alpha of .92 for the MSPSS questionnaire, and a significant correlation with the other scales, as predicted. The revised version provided better internal consistency, increasing the Cronbach's alpha for the Significant Others sub-scale from 0.86 to 0.92. Confirmatory factor analysis revealed an acceptable model fit: chi2 128.11, df 51, p < .001; TLI 0.94; CFI 0.95; GFI 0.90; PNFI 0.71; AGFI 0.85; RMSEA 0.093 (0.073-0.113) and SRMR 0.042, which is better than the original version. The tendency of the new version was to display a better level of fit with a larger sample size. The limitations of the study are discussed, as well as recommendations for further study.
Mowry, Marianne J; Gabel, Mollie A
Responding to the complex nature of critical care is imperative, as extensive clinical judgment is required during those vital moments when patients are experiencing complications related to open heart surgery, post-vessel bypass, or valve replacement. Critical care registered nurses must rely on evidence-based foundational knowledge and skills particular to cardiovascular pathophysiology, hemodynamic monitoring, and medications. This article reports on the critical care educator's revision of the immediate post-open heart surgery curriculum. Mixed educational methods within the plan were foundational to develop clinicians for competent care of these complex patients (within the first 8 hours). The revision included experiential learning and learner centeredness to bolster the learner's confidence, reduce the time to competence, and, most important, ensure positive patient outcomes. Kirkpatrick's classic four-level model provided the framework for evaluation. Lessons learned were discussed following the program initiation. Copyright 2015, SLACK Incorporated.
Cip, Johannes; Bach, Christian; Widemschek, Mark; Luegmair, Matthias; Martin, Arno
The articular surface replacement (ASR) total hip arthroplasty (THA) showed accelerated failure rates due to adverse-reaction to metal debris (ARMD). Literature correlating preoperative with intraoperative revision findings respectively post-revision outcome results are rare. 30 of 99 available ASR THA were revised due to ARMD. Mean post-revision follow-up term was 2.3 years. In part, preoperative data did not correlate with intraoperative revision findings. ARMD was even found in asymptomatic patients with non-elevated ion levels. Postoperative pain and metal ions decreased significantly (P ≤ 0.016). Cobalt decreased faster than chrome. Patients with intraoperative pseudotumors, osteolysis or bilateral THA did not have higher pre- or postoperative ion values (P ≥ 0.053). Females showed higher postoperative chrome levels (P=0.031). One major post-revision complication (femoral nerve palsy) and one re-revision (late onset infection) occurred. Copyright © 2015 Elsevier Inc. All rights reserved.
Johnson, William H; Fernanadez, Adolfo Z; Farrell, Timothy M; Macdonald, Kenneth G; Grant, John P; McMahon, Ross L; Pryor, Aurora D; Wolfe, Luke G; DeMaria, Eric J
The claim that the "mini"-gastric bypass (MGB) procedure with its loop gastrojejunostomy is safer and equally effective to the Roux-en-Y gastric bypass (RYGB) procedure has been promoted before validation. Rumors of unreported complications and the accuracy of follow-up are additional concerns. This study was undertaken to identify MGB patients who require or required revisional surgery at 5 hospitals within the region of the United States where the MGB procedure originated to assess the claim that revision to RYGB is rarely needed. The databases of 5 medical centers were retrospectively searched to identify patients undergoing surgical revision after a MGB procedure, all of which had been done elsewhere. A total of 32 patients were identified who presented with complications after undergoing an MGB procedure and required or require revisional surgery. The complications included gastrojejunostomy leak in 3, bile reflux in 20, intractable marginal ulcer in 5, malabsorption/malnutrition in 8, and weight gain in 2. Of the 32 patients, 21 required conversion to RYGB and an additional 5 have planned revisions in the future. Also, 2 patients were treated with Braun enteroenterostomies and 4 required 1 or more abdominal explorations. The results of this preliminary review have confirmed that MGB does require revision in some patients and that conversion to RYGB is a common form of revision. A national registry to record the complications and number of revisions is proposed to gain insight into the need for revision after MGB and other nontraditional bariatric procedures.
The winds of change world-wide have swept medical education in the last fifteen years. Today, Australia's medical students are older and drawn from more diverse socio-economic, ethnic and geographic backgrounds than twenty years ago, and there is now an equal mix of men and women in medical school. Admission policies have been rewritten to broaden access with a range of entry options now available including direct entry from high school and graduate entry following a first degree. Curricula have been revised and modes of learning transformed. This paper describes these changes and discusses the implications for medical schools and for planning the future workforce.
The practice of medical radiology. Diagnostics, radiotherapy, radiation protection. For physicians, medical students, and X-ray medical technicians. With a guide for radiation protection instructions for medical radiography. 6. completely rev. ed.
Laubenberger, T.; Laubenberger, J.
This book is intended for physicians, medical students, X-ray medical technicians, and medical technicians in general, and presents a concise but nevertheless comprehensive introduction to the practice of medical radiology. This 4th edition has been enriched by information on new imaging techniques and an outline of digital radiography and NMR imaging. The chapter on radiotherapy has been fully revised and extended to cover the current state of the art. Special attention has been given to the explanation of regulations and technical methods for better radiation protection. Physicians will find an introduction to radiation protection instructions. (orig.). 398 figs., 98 tabs [de
This book is intended for physicians, medical students, X-ray medical technicians, and medical technicians in general, and presents a concise but nevertheless comprehensive introduction to the practice of medical radiology. This 4th edition has been enriched by information on new imaging techniques and an outline of digital radiography and NMR imaging. The chapter on radiotherapy has been fully revised and extended to cover the current state of the art. Special attention has been given to the explanation of regulations and technical methods for better radiation protection. Physicians will find an introduction to radiation protection instructions. (orig./HP) [de
Toledo-Pereyra, Luis H
The Medical Renaissance started as the regular Renaissance did in the early 1400s and ended in the late 1600s. During this time great medical personalities and scholar humanists made unique advances to medicine and surgery. Linacre, Erasmus, Leonicello and Sylvius will be considered first, because they fit the early classic Renaissance period. Andreas Vesalius and Ambroise Paré followed thereafter, making outstanding anatomical contributions with the publication of the "Human Factory" (1543) by Vesalius, and describing unique surgical developments with the publication of the "The Apologie and Treatise of Ambroise Paré." At the end of the Renaissance and beginning of the New Science, William Harvey, noted British medical doctor and cardiovascular researcher, discovered the general circulation. He published his findings in "The Motu Cordis" in 1628 (Figure 1). The Medical Renaissance, in summary, included a great number of accomplished physicians and surgeons who made especial contributions to human anatomy; Vesalius assembled detailed anatomical information; Paré advanced surgical techniques; and Harvey, a medical genius, detailed the circulatory anatomy and physiology.
Koops, Willem J M; van der Vleuten, Cees P M; de Leng, Bas A; Snoeckx, Luc H E H
Medical students in clerkship are continuously confronted with real and relevant patient problems. To support clinical problem solving skills, students perform a Critical Appraisal of a Topic (CAT) task, often resulting in a paper. Because such a paper may contain errors, students could profit from discussion with peers, leading to paper revision. Active peer discussion by a Computer Supported Collaborative Learning (CSCL) environment show positive medical students perceptions on subjective knowledge improvement. High students' activity during discussions in a CSCL environment demonstrated higher task-focussed discussion reflecting higher levels of knowledge construction. However, it remains unclear whether high discussion activity influences students' decisions revise their CAT paper. The aim of this research is to examine whether students who revise their critical appraisal papers after discussion in a CSCL environment show more task-focussed activity and discuss more intensively on critical appraisal topics than students who do not revise their papers. Forty-seven medical students, stratified in subgroups, participated in a structured asynchronous online discussion of individual written CAT papers on self-selected clinical problems. The discussion was structured by three critical appraisal topics. After the discussion, the students could revise their paper. For analysis purposes, all students' postings were blinded and analysed by the investigator, unaware of students characteristics and whether or not the paper was revised. Postings were counted and analysed by an independent rater, Postings were assigned into outside activity, non-task-focussed activity or task-focussed activity. Additionally, postings were assigned to one of the three critical appraisal topics. Analysis results were compared by revised and unrevised papers. Twenty-four papers (51.6%) were revised after the online discussion. The discussions of the revised papers showed significantly higher
Bulski, Wojciech; Kukołowicz, Paweł; Skrzyński, Witold
This paper presents the situation of the profession of medical physicists in Poland. The official recognition of the profession of medical physicist in Polish legislation was in 2002. In recent years, more and more Universities which have Physics Faculties introduce a medical physics specialty. At present, there are about 15 Universities which offer such programmes. These Universities are able to graduate about 150 medical physicists per year. In 2002, the Ministry of Health introduced a programme of postgraduate specialization in medical physics along the same rules employed in the specialization of physicians in various branches of medicine. Five institutions, mostly large oncology centres, were selected as teaching institutions, based on their experience, the quality of the medical physics professionals, staffing levels, equipment availability, lecture halls, etc. The first cycle of the specialization programme started in 2006, and the first candidates completed their training at the end of 2008, and passed their official state exams in May 2009. As of January 2016, there are 196 specialized medical physicists in Poland. Another about 120 medical physicists are undergoing specialization. The system of training of medical physics professionals in Poland is well established. The principles of postgraduate training and specialization are well defined and the curriculum of the training is very demanding. The programme of specialization was revised in 2011 and is in accordance with EC and EFOMP recommendations. Copyright © 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.
Kurumop, Serah F; Pulford, Justin; Mueller, Ivo; Siba, Peter M; Hetzel, Manuel W
Papua New Guinea (PNG) introduced a revised national malaria treatment protocol (NMTP) in late 2011. Successful implementation of the revised protocol requires all health facilities in PNG to have reliable access to microscopy or malaria rapid diagnostic kits as well as a reliable supply of all recommended first-line medications. This paper presents findings from a study that sought to assess the availability of microscopy, malaria rapid diagnostic kits and recommended first-line antimalarial medication in Papua New Guinean health facilities across the country before the introduction of the revised treatment protocol. A country-wide cross-sectional survey of 79 randomly selected health centres, health subcentres and aid posts. Data were collected via an interviewer-administered questionnaire completed with the officer in charge of participating health facilities. Overall, 15% of surveyed health facilities had unexpired rapid diagnostic test (RDT) in stock or working microscopy available. A recommended first-line antimalarial for uncomplicated malaria was available in 85% of health facilities. The preferred first-line antimalarial combination for treating severe malaria was present in 42% of health facilities, although 68% had the capacity to provide either the preferred or recommended substitute first-line medication for severe malaria. The total number of health workers employed in the 79 surveyed health facilities was 443, only 3 of whom were medical doctors. Our findings indicate that diagnostic capacity was low in Papua New Guinean health facilities before the introduction of the new NMTP and that access to recommended first-line antimalarial medication was variable. Substantial improvements in diagnostic capacity and antimalarial procurement and distribution will need to be made if the revised protocol is to be adhered to.
Abdollahpour, Ibrahim; Nedjat, Saharnaz; Besharat, Mohammad Ali; Hosseini, Bayan; Salimi, Yahya
Emotional intelligence (EI) has recently been considered as one of the necessary elements for success and achievement in medical fields. The present study was conducted in Iran to compare the EI in medical and non-medical students adjusted for the other relevant factors. This cross-sectional study was conducted from October 2011 to January 2012 on 872 students of medicine, paramedical and non-medical groups in Tehran University and Tehran University of Medical Sciences, Tehran, Iran selected by multi-stage weighted cluster sampling. The Farsi version of revised Schutte Emotional Intelligence (FEIS) was used to estimate emotional intelligence. The mean of total EI was equal to 124.9 (SD=8.4) out of 205 and the means for its dimensions were as follows: regulation of emotions 39.3 (SD=5.1), utilization of emotions 26.7 (SD=3.6) and appraisal of emotions 33.5 (SD=5.3). While the paramedical and non-medical students' total EI score was significantly higher than the medical students', in the utilization of emotions dimension, the medical students scored significantly higher than the other two groups. The lower levels of the medical students' total EI score in comparison with paramedical and non-medical students in this study demands the relevant authorities to pay even more attention to the selection and training of medical students.
LaPlaca, Peter J.; Lindgreen, Adam; Vanhamme, Joelle
Most of the premier academic journals in all fields routinely have rejection rates of 80%, 95%, or higher. All journals prefer articles that make significant contributions to the field. Revising a manuscript and responding properly to the comments of reviewers and editors often is challenging....... This article discusses how to revise effectively a manuscript according to the (minor or major) comments of reviewers and editors for premier academic journals. We provide a series of tips for helping the authors in their endeavor, making the process less arduous and improving the possibility of a positive...
Mønsted, Troels Sune
’. Theoretically the project departs from Computer Supported Cooperative Work and Participatory Design and is informed by Medical Informatics, Design Research and Science and Technology Studies. Methodically the project is founded on collaborative prototyping, ethnographic studies, and design interventions...... philosophy and building on theory on narrative reasoning, the dissertation offers the notions of emplotment and re-emplotment to describe how physicians marshal information from various sources, including the medical record, the patient and coSummary to form a narrative, when making sense of patients...
The use of accelerators for medical applications has evolved from initial experimentation to turn-key devices commonly operating in hospitals. New applications are continuously being developed around the world, and the hadrontherapy facilities of the newest generation are placed at the frontier between industrial production and advanced R&D. An introduction to the different medical application accelerators is followed by a description of the hadrontherapy facilities, with special emphasis on CNAO, and the report closes with a brief outlook on the future of this field.
Biscari, C; Falbo, L
The use of accelerators for medical applications has evolved from initial experimentation to turn-key devices commonly operating in hospitals. New applications are continuously being developed around the world, and the hadrontherapy facilities of the newest generation are placed at the frontier between industrial production and advanced R&D. An introduction to the different medical application accelerators is followed by a description of the hadrontherapy facilities, with special emphasis on CNAO, and the report closes with a brief outlook on the future of this field
Holden, Elizabeth A
Leases for medical space can have far-reaching (and sometimes unintentional) consequences for the future of the practice and the costs of the business. In order to prevent hardship and expense down the line, it is especially important to review the lease to make sure that it reflects the practice's goals, needs, and structure. This article provides a number of provisions that are especially crucial to review and negotiate when leasing medical space, including use restrictions, assignment and subleasing clauses, build-out terms, and legal compliance requirements.
Of the 1603 civil liability cases filed between 2002 and 2012 related to upper-limb surgery, we found 20 proceedings (11 in court and 9 in front of the French CCI [commission for medical accidents]) that involved a total of 24 physicians: three proceedings involved multiple parties for a single patient and implicated two physicians in two cases and three physicians in one case. The grounds for liability being invoked varied greatly, but a good many of these cases concerned outcomes that were deemed unsatisfactory or insufficient in light of the initial injury. Information is always difficult to convey in an emergency setting, but is not generally disputed. However, the information process must be completed during the postoperative period and the patient informed of the injury assessment, expected results, potential complications and the possibility of surgical revision in the medium term. An expert found grounds for physician liability and breach of best practices in only three cases. In summary, this study shows that trauma-related flexor tendon injuries are rarely grounds for indictment of physicians before courts of civil jurisdiction (12 per 1000) and findings of liability for breach of best practices are even more rare (2 per 1000). Copyright © 2014. Published by Elsevier SAS.
Nicole Van Hoeck
Full Text Available The present study examines how children revise beliefs in the face of a new piece of information that they must accept as true and under what circumstances their belief-revision processes differ from college-aged adults. Results suggest that overall, 7-year-old children (children at Stage 2 reasoning; Moshman, 1990 revise beliefs as do adults, by rejecting particular beliefs in favour of more general ones. However, only adults adjust their revision strategy as a consequence of the logical structure of the initial belief set. Adults, but not children, tend to organise their revised beliefs to be consistent with general statements more often when the set of beliefs create a Modus Tollens logic structure than when they create a Modus Ponens structure. This difference in belief revision by the two age groups reflects their sensitivity to logical structure.
Horne, Zachary; Powell, Derek; Hummel, John
What kind of evidence will lead people to revise their moral beliefs? Moral beliefs are often strongly held convictions, and existing research has shown that morality is rooted in emotion and socialization rather than deliberative reasoning. In addition, more general issues-such as confirmation bias-further impede coherent belief revision. Here, we explored a unique means for inducing belief revision. In two experiments, participants considered a moral dilemma in which an overwhelming majority of people judged that it was inappropriate to take action to maximize utility. Their judgments contradicted a utilitarian principle they otherwise strongly endorsed. Exposure to this scenario led participants to revise their belief in the utilitarian principle, and this revision persisted over several hours. This method provides a new avenue for inducing belief revision. Copyright © 2015 Cognitive Science Society, Inc.
19. SA JOURNAL OF RADIOLOGY • August 2004. Abstract. The progress made in diagnostic and therapeutic medicine has resulted in an increase in the number of malprac- tice suits brought against medical practitioners. To constitute negligence it must be shown that the conduct of the accused did not measure up to the.
How should we assess the historical development of health care? Many historians are deeply reluctant to endorse ideas involving progress in human affairs, including the evolution of modern medicine. We tend to think either that our present situation is little better than in the past, or that most kinds of value judgments about history are subjective and inappropriate. A laudatory approach to medical history commonly adopted by "amateur" medical historians in the tradition of Sir William Osler has often been eschewed by "professionals" as faulty, feel-good history. But Osler was right in his belief that, on balance, the progress of medicine has been spectacular, that modern health care offers one of the finest examples of the possibility of "man's redemption of man." Written objectively, medical history is about progress and achievement, and can properly seen as inspiring. If we mordantly or relativistically dismiss the unprecedentedly high quality of modern health care, we lose the ability to understand why citizens value it so highly, and this distorts our understanding of current issues. We also lose our sense of the wonders of human and medical achievement.
Thomas, J T [ed.
The Nuclear Safety Guide was first issued in 1956 as classified AEC report LA-2063 and was reprinted the next year, unclassified, as TID-7016. Revision 1, published in 1961, extended the scope and refined the guiding information. The present revision of the Guide differs significantly from its predecessor in that the latter was intentionally conservative in its recommendations. Firmly based on experimental evidence of criticality, the original Guide and the first revision were considered to be of most value to organizations whose activities with fissionable materials were not extensive and, secondarily, that it would serve as a point of departure for members of established nuclear safety teams, experienced in the field. The reader will find a significant change in the character of information presented in this version. Nuclear Criticality Safety has matured in the past twelve years. The advance of calculational capability has permitted validated calculations to extend and substitute for experimental data. The broadened data base has enabled better interpolation, extension, and understanding of available information, especially in areas previously addressed by undefined but adequate factors of safety. The content has been thereby enriched in qualitative guidance. The information inherently contains, and the user can recapture, the quantitative guidance characteristic of the formerGuides by employing appropriate safety factors. In fact, it becomes incumbent on the Criticality Safety Specialist to necessarily impose safety factors consistent with the possible normal and abnormal credible contingencies of an operation as revealed by his evaluation. In its present form the Guide easily becomes a suitable module in any compendium or handbook tailored for internal use by organizations. It is hoped the Guide will continue to serve immediate needs and will encourage continuing and more comprehensive efforts toward organizing nuclear criticality safety information.
... 416 RIN 0960-AH17 Consultative Examination--Annual Onsite Review of Medical Providers AGENCY: Social... triggers annual on-site reviews of medical providers who conduct consultative examinations (CEs) for our... in 1991. We expect the revised threshold amount will reestablish the level of oversight activity we...
Willer, Lasse; Jensen, R H; Juhler, M
To highlight the group of hydrocephalus patients known to have a long history of shunt revisions and refractory chronic headache. When a shunt in perfect working order has no effect on headache, other causes of headache should be investigated. In this paper, patients with medication overuse...... headache are identified and the positive effect of medication withdrawal are described....
Raburn, Daniel; Reiman, Allan; Monticello, Donald
A revised external numerical wrapper has been developed for the Princeton Iterative Equilibrium Solver (PIES code), which is capable of calculating 3D MHD equilibria with islands. The numerical wrapper has been demonstrated to greatly improve the rate of convergence in numerous cases corresponding to equilibria in the TFTR device where magnetic islands are present. The numerical wrapper makes use of a Jacobian-free Newton-Krylov solver along with adaptive preconditioning and a sophisticated subspace-restricted Levenberg-Marquardt backtracking algorithm. The details of the numerical wrapper and several sample results are presented.
This specification establishes requirements for design, testing, and quality assurance for electric heaters that will be used to maintain primary Sodium temperature in the Fast Test Facility (FFTF) reactor vessel. The Test Specification (WHC-SD-FF-SDS-003) has been revised to Rev. 1. This change modifies the fabrication of approximately 25 feet of the subject heater using ceramic insulators over the heater lead wire rather than compressed magnesium oxide. Also, 304 or 316 stainless steel can be used for the heater sheath. This change should simplify fabrication and improve the heater operational reliability
A new calibration of the Stroemgren (b-y),m_1 diagram in terms of iron abundance of red giants is presented. This calibration is based on a homogeneous sample of giants in the globular clusters omega Centauri, M22, and M55 as well as field giants from the list of Anthony-Twarog & Twarog (1998). Towards high metallicities, the new calibration is connected to a previous calibration by Grebel & Richtler (1992), which was unsatisfactory for iron abudances lower than -1.0 dex. The revised calibrat...
The decision by the European Court of Justice in the matter of the EEC's participation in international negotiations on safety problems of the nuclear fuel cycle is of basic importance, beyond the case to which it referred, in the interpretation of the respective provisions of the Euratom Treaty in the nuclear fuel sector. The reasoning of the European Court of Justice, which constitutes a reinforcement and advancement of the responsibilities and rights of the EEC, has made France ask for a revision of the Treaty. (orig.) [de
Roe, Sandra K
Use this single source to uncover the origin and development of the thesaurus! The Thesaurus: Review, Renaissance, and Revision examines the historical development of the thesaurus and the standards employed for thesaurus construction. This book provides both the history of thesauri and tutorials on usage to increase your understanding of thesaurus creation, use, and evaluation. This reference tool offers essential information on thesauri in the digital environment, including Web sites, databases, and software. For 50 years, the thesaurus has been a core reference book; The Thesaurus: Review,
Spurkeland, Johannes Svante; Jensen, Andreas Schmidt; Villadsen, Jørgen
Agents in a multiagent system may in many cases find themselves in situations where inconsistencies arise. In order to properly deal with these, a good belief revision procedure is required. This paper illustrates the usefulness of such a procedure: a certain belief revision algorithm is consider...... in order to deal with inconsistencies and, particularly, the issue of inconsistencies, and belief revision is examined in relation to the GOAL agent programming language....
Rambani, Rohit; Kepecs, David M; Mäkinen, Tatu J; Safir, Oleg A; Gross, Allan E; Kuzyk, Paul R
Total hip arthroplasty revision for a fractured ceramic bearing is rare but offers unique challenges. The purpose of this review was to provide a summary of existing literature on fractured ceramic bearings. Two authors performed a literature search of the MEDLINE OVID and PubMed databases with the following search terms: ceramic, fracture, total hip arthroplasty, and revision. The search identified 228 articles of which 199 were selected for review. It is mandatory to perform a complete synovectomy and thorough debridement of the fractured ceramic fragments. A well-fixed acetabular component should be removed if either the locking mechanism is damaged or the component is malpositioned. If the femoral stem taper is damaged, the femoral stem should be removed. However, if minimal damage is present, the femoral stem may be retained and revised using a fourth generation ceramic head with a titanium sleeve. Metal bearings should be avoided and revision with ceramic bearings should be performed whenever possible. Copyright © 2017 Elsevier Inc. All rights reserved.
Topcu, Çigdem; Erdur-Baker, Özgür
The aim of this study is to update the Turkish version of the Revised Cyber Bullying Inventory (RCBI) and eliminate specific technology names. Validity and reliability tests were carried out with 1,803 high school students. The updated version of the RCBI yields valid and reliable scores measuring cyberbullying and victimization.
Rodriguez Feijoo, Nelida
Investigations about attitudes toward mathematics carried out in the past decade were revised. The instruments used to measure attitudes toward mathematics were analysed as well as the attitudes toward different aspects of mathematics, their relation with other school subjects and their stability through time. Opinions about the influence of…
Under its Statute the International Atomic Energy Agency is empowered to provide for the application of standards of safety for protection against radiation to its own operations and to operations making use of assistance provided by it or with which it is otherwise directly associated. To this end authorities receiving such assistance are required to observe relevant health and safety measures prescribed by the Agency. As a first step, it was considered an urgent task to provide users of radioisotopes with a manual of practice for the safe handling of these substances. The first edition of such a manual was published in 1958 and represented the first of the 'Safety Series', a series of manuals and codes on health and safety published by the Agency. It was prepared after careful consideration of existing national and international codes of radiation safety by a group of international experts and in consultation with other international bodies. This edition presents the first revision. It incorporates in the Appendices the latest recommendations of the International Commission on Radiological Protection and extracts from the report of the Committee II of the I.C.R.P. on permissible dose for internal radiation. The Health Physics and Medical Addenda to this Manual, published as No. 2 and No. 3 in the Safety Series in 1960, give more complete advice to the user on specialized topics.
Full Text Available This study aims to investigate the effect of peer review training on the Iranian EFL students’ subsequent revision in an advanced writing class in Larestan Islamic Azad University. After 12 weeks class demonstration, teacher-reviewer conferences with 20 male and female students, the students’ first drafts, revisions, and reviewers’ comments were collected and compared the comments before and after peer review training. The findings revealed that the students incorporated significantly more comments into subsequent revisions after peer review training. Therefore, peer review training had a positive effect on the students’ subsequent revisions.
Full Text Available Surgery is indicated for symptomatic knee osteoarthritis (OA when conservative measures are unsuccessful. High tibial osteotomy (HTO, unicompartmental knee arthroplasty (UKA, and total knee arthroplasty (TKA are surgical options intended to relieve knee OA pain and dysfunction. The choice of surgical intervention is dependent on several factors such as disease location, patient age, comorbidities, and activity levels. Regardless of surgical treatment, complications such as infection, loosening or lysis, periprosthetic fracture, and postoperative pain are known risks and are indications for revision surgery. The clinical and economic implications for revision surgery are underappreciated. Over 55,000 revision surgeries were performed in 2010 in the US, with 48% of these revisions in patients under 65 years. Total costs associated with each revision TKA surgery have been estimated to be in excess of $49,000. The current annual economic burden of revision knee OA surgery is $2.7 billion for hospital charges alone. By 2030, assuming a 5-fold increase in the number of revision procedures, this economic burden will exceed $13 billion annually. It is appealing to envision a therapy that could delay or obviate the need for arthroplasty. From an actuarial standpoint, this would have the theoretical downstream effect of substantially reducing the number of revision procedures. Although no known therapies currently meet these criteria, such a breakthrough would have a tremendous impact in lessening the clinical and economic burden of knee OA revision surgery.
Due to the revision of the Radiation Protection Regulations in 2011 is this publication audited. The audit covers only changes of the sections, so that the references are in accordance with applicable regulations. The contents are the same. Sales and use of CBCT is subject to approval by the Norwegian Radiation Protection Authority. This means for example that businesses that want to take CBCT in clinical use, assign the specialist expertise in radiology, medical physicist, and that all users of CBCT must have relevant and documented expertise in radiation protection. (AG)
Full Text Available The genus Rubus L. in Taiwan is taxonomically revised based on morphological and phytogeographical patterns. Forty taxa (34 species, 3 varieties, and 3 hybrids of the genus are recognized, including two new hybrid species R. croceacanthus × corchorifolius and R. rosifolius × fraxinifolius. Among the Rubus taxa in Taiwan, R. croceacanthus H. Lév. exhibits tremendous variation and we do believe that more investigations are needed in the future. Several taxa described in the Flora of Taiwan, 2nd ed. are treated as synonyms of other species, and several taxa in Taiwan are revised. The existence of R. howii Merr. & Chun, R. linearifoliolus Hayata, and R. parvifraxinifolius Hayata in Taiwan are reconfirmed, we described R. howii fruit information which was absent in original literature; and the third taxon is treated as a natural hydrid R. × parvifraxinifolius Hayata which putatively derived from R. rosifolius Sm. and R. linearifoliolus based on intermediate morphology and the scarcity of fruit set. Rubus pseudoacer Makino ssp. flexuosus (Y.-C. Liu & F.-Y. Lu H. Ohashi & C.-F. Hsieh is treated as synonym of R. pseudoacer Makino and is excluded in Taiwan. A key to the taxa, synonyms and taxonomic descriptions of each taxon are presented. Moreover, information about phenology, chromosome number, distribution and specimens examined for each taxon are also provided.
The revision the Drinking Water Regulations will come into effect on 01.11.2011. Surveillance authorities and owners of drinking water supply systems had hoped for simplifications and reductions because of the new arrangements. According to the official statement for the revision the legislature intended to create more clarity, consider new scientific findings, to change regulations that have not been proved to close regulatory gaps, to deregulate and to increase the high quality standards. A detailed examination of the regulation text, however, raises doubts. The new classification of water supply systems requires different modalities of registration, water analyses and official observation, which will complicate the work of the authorities. In particular, the implementation of requirements of registration and examination for the owners of commercial and publicly-operated large hot-water systems in accordance with DVGW Worksheet W 551 requires more effort. According to the estimated 30 000 cases of legionellosis in Germany the need for a check of such systems for Legionella, however, is not called into question. Furthermore, the development of sampling plans and the monitoring of mobile water supply systems requires more work for the health authorities. © Georg Thieme Verlag KG Stuttgart · New York.
STREAM is an emergency response code that predicts downstream pollutant concentrations for releases from the SRS area to the Savannah River. The STREAM code uses an algebraic equation to approximate the solution of the one dimensional advective transport differential equation. This approach generates spurious oscillations in the concentration profile when modeling long duration releases. To improve the capability of the STREAM code to model long-term releases, its calculation module was replaced by the WASP5 code. WASP5 is a US EPA water quality analysis program that simulates one-dimensional pollutant transport through surface water. Test cases were performed to compare the revised version of STREAM with the existing version. For continuous releases, results predicted by the revised STREAM code agree with physical expectations. The WASP5 code was benchmarked with the US EPA 1990 and 1991 dye tracer studies, in which the transport of the dye was measured from its release at the New Savannah Bluff Lock and Dam downstream to Savannah. The peak concentrations predicted by the WASP5 agreed with the measurements within ±20.0%. The transport times of the dye concentration peak predicted by the WASP5 agreed with the measurements within ±3.6%. These benchmarking results demonstrate that STREAM should be capable of accurately modeling releases from SRS outfalls
Full Text Available Introduction: The porous coated cylindrical stem are one of the most popular option in the set of hip revison surgery. The poupose of this study is present the clinical and radiographic results of a group of patients treated with this stem. Material and Methods: Between 1997 and 2010, we retrospectively evaluated 150 stem in 148 patients. The indication for revisión was aseptic loosening in 88 cases (58.6%, septic loosening in 41 cases (27.3%, periprosthetic fracture in 14 cases (9.3%, failed hip ostesynthesis in 4 cases (2.6% and stem fracture in 3 cases (2%. We followed the patient on average for 7.7 years. Results: We achived bone-ingrowth fixation in 135 patients (90 %,, fibrous tissue fixation in 12 (8% and unstable fixation in 3 (2 %. The mean Harris hip score improved to 92 points at last follow-up. Three stem were revised (2%. One patient had revisión becouse of stem loosening. The other two becouse of deep infection required a 2 staged revision. Three patient (2% had dislocation and was treated succesfully with closed reduction. Conclusion: The porous coated cylindrical stem is a predictable technique with excellent survival rates in the set of revisión hip surgery.
Bensdorp, Alexandra J; van der Steeg, Jan Willem; Steures, Pieternel; Habbema, J Dik F; Hompes, Peter G A; Bossuyt, Patrick M M; van der Veen, Fulco; Mol, Ben W J; Eijkemans, Marinus J C
One of the aims in reproductive medicine is to differentiate between couples that have favourable chances of conceiving naturally and those that do not. Since the development of the prediction model of Hunault, characteristics of the subfertile population have changed. The objective of this analysis was to assess whether additional predictors can refine the Hunault model and extend its applicability. Consecutive subfertile couples with unexplained and mild male subfertility presenting in fertility clinics were asked to participate in a prospective cohort study. We constructed a multivariable prediction model with the predictors from the Hunault model and new potential predictors. The primary outcome, natural conception leading to an ongoing pregnancy, was observed in 1053 women of the 5184 included couples (20%). All predictors of the Hunault model were selected into the revised model plus an additional seven (woman's body mass index, cycle length, basal FSH levels, tubal status,history of previous pregnancies in the current relationship (ongoing pregnancies after natural conception, fertility treatment or miscarriages), semen volume, and semen morphology. Predictions from the revised model seem to concur better with observed pregnancy rates compared with the Hunault model; c-statistic of 0.71 (95% CI 0.69 to 0.73) compared with 0.59 (95% CI 0.57 to 0.61). Copyright © 2017. Published by Elsevier Ltd.
Full Text Available In conventional theoretical physics and its Standard Model the guiding principle is that the equations are symmetrical. This limitation leads to a number of difficulties, because it does not permit masses for leptons and quarks, the electron tends to “explode” un- der the action of its self-charge, a corresponding photon model has no spin, and such a model cannot account for the “needle radiation” proposed by Einstein and observed in the photoelectric e ff ect and in two-slit experiments. This paper summarizes a revised Lorentz and gauge invariant quantum electrodynamic theory based on a nonzero electric field divergence in the vacuum and characterized by linear intrinsic broken symmetry. It thus provides an alternative to the Higgs concept of nonlinear spontaneous broken sym- metry, for solving the difficulties of the Standard Model. New results are obtained, such as nonzero and finite lepton rest masses, a point-charge-like behavior of the electron due to a revised renormalization procedure, a magnetic volume force which counteracts the electrostatic eigen-force of the electron, a nonzero spin of the photon and of light beams, needle radiation, and an improved understanding of the photoelectric effect, two-slit ex- periments, electron-positron pair formation, and cork-screw-shaped light beams.
Full Text Available Nozomi Kinoshita, Ayumi Ota, Fumihiko Toyoda, Hiroko Yamagami, Akihiro KakehashiDepartment of Ophthalmology, Saitama Medical Center, Jichi Medical University, Saitama, JapanPurpose: To report a new technique of blunt needle revision with viscoelastic materials via the anterior chamber for the treatment of early failed filtering blebs and elevated intraocular pressure after trabeculectomy, in which digital ocular massage and laser suture lysis have been ineffective.Methods: A 27-gauge blunt needle attached to a syringe containing viscoelastic material was inserted into the anterior chamber from the inferior paracentesis. The needle tip was inserted into the subscleral flap space from the filtering fistula at the anterior chamber side, and the scleral flap was lifted bluntly. The needle tip was then inserted into the subconjunctival space where the viscoelastic agent was injected and the adhesion between the sclera and conjunctiva was separated bluntly. Blunt needle revision via the anterior chamber was performed 14 times in six eyes of six patients at Saitama Medical Center, Jichi Medical University from January 2007 to May 2009. All procedures were performed within 1 month after trabeculectomy.Results: The intraocular pressure remained 21 mmHg or lower for more than 6 months in three of six eyes. Slight bleeding from the iris occurred in one of the 14 procedures, and hypotony (intraocular pressure below 5 mmHg occurred in one of the 14 procedures. No serious complications developed.Conclusion: Blunt needle revision via the anterior chamber for early failed filtering blebs is a new, simple, and safe procedure.Keywords: glaucoma, trabeculectomy, filtering bleb, needle revision, blunt needle
Vinay BC; Nikhitha MK; Patel Sunil B
In this present review article, regarding medication errors its definition, medication error problem, types of medication errors, common causes of medication errors, monitoring medication errors, consequences of medication errors, prevention of medication error and managing medication errors have been explained neatly and legibly with proper tables which is easy to understand.
Full Text Available To compare the wear of conventional ultra-high molecular weight polyethylene (CUHMWPE and highly cross-linked polyethylene (HCLPE in hip revision with liner exchange fixed with original locking mechanism using analysis of history medical data.From Jan. 1, 2000, to Dec. 31, 2007, 26 patients (with 29 involved hips underwent liner exchange revision fixed with the original locking mechanism due to wear of CUHMWPE and/or osteolysis. The mean age was 53 ± 9 years at the time of the primary total hip arthroplasty (THA and 64 ± 9 years at the revision. The exchanged liners (Marathon, Depuy were made of HCLPE. Annual X-rays were used to measure linear wear and osteolysis. The annual linear penetration was measured using PolyWare® software (Draftware Inc.. Annual Harris Hip Scores(HSS were recorded.The mean follow-up time between the primary and revision THAs was 11 ± 2 years and 8 ± 2 years after revision. The mean Harris Hip Score(HHS before primary THA, 1 year after primary THA, before revision and 1 year after revision was 43±5, 85±5, 71±6, 83±7 individually. The mean penetration of the CUHMWPE and HCLPE liners occurring in the first year were 0.44 ± 0.28 mm and 0.38 ± 0.14 mm, respectively (p = 0.211. The mean annual linear penetration of CUHMWPE and HCLPE from the second year onward were 0.29±0.09 mm and 0.08 ± 0.03 mm respectively (p <0.01. All THAs with CUHMWPE showed osteolysis on acetabular and/or femoral side before revision. No HCLPE liner showed osteolysis at the last follow-up. Conclusion: The CUHMWPE liner had a significantly higher wear rate than did the HCLPE liner. The HCLPE liner showed a satisfactory liner penetration rate after revision with isolated liner exchange fixed with the original locking mechanism.
Townsend, David W
Since the introduction of the X-ray scanner into radiology almost 25 years ago, non-invasive imaging has become firmly established as an essential tool in the diagnosis of disease. Fully three-dimensional imaging of internal organs is now possible, b and for studies which explore the functional status of the body. Powerful techniques to correlate anatomy and function are available, and scanners which combine anatomical and functional imaging in a single device are under development. Such techniques have been made possible through r ecent technological and mathematical advances. This series of lectures will review both the physical basis of medical imaging techniques using X-rays, gamma and positron emitting radiosiotopes, and nuclear magnetic resonance, and the mathematical methods used to reconstruct three-dimentional distributions from projection data. The lectures will trace the development of medical imaging from simple radiographs to the present-day non-invasive measurement of in vivo biochemistry. They ...
Mønsted, Troels Sune
and by conceptualizing this as narrative reasoning, this PhD dissertation offers novel perspectives on design of health IT. The dissertation consists of five research articles and an extended synopsis that presents findings from three years of research within the project ‘Co-Constructing IT and Healthcare......’. Theoretically the project departs from Computer Supported Cooperative Work and Participatory Design and is informed by Medical Informatics, Design Research and Science and Technology Studies. Methodically the project is founded on collaborative prototyping, ethnographic studies, and design interventions...... philosophy and building on theory on narrative reasoning, the dissertation offers the notions of emplotment and re-emplotment to describe how physicians marshal information from various sources, including the medical record, the patient and coSummary to form a narrative, when making sense of patients...
Patterson, Diana C; Grelsamer, Ronald; Bronson, Michael J; Moucha, Calin S
As the number of total knee arthroplasties (TKAs) increases, the number of associated complications will also increase. Our goal with this study was to identify common causes of and financial trends relating to malpractice claims filed after TKA. We analyzed malpractice claims filed for alleged neglectful primary and revision TKA surgeries performed between 1982 and 2012 by orthopaedic surgeons insured by a large New York state malpractice carrier. We identified 69 primary and 8 revision TKAs in the malpractice carrier's database. All cases were performed between 1982 and 2012; all claims were closed between 1989-2015. The most frequent factor leading to lawsuits for primary TKA was chronic pain or dissatisfaction in 12 cases, followed by nerve palsy in 8, postoperative in-hospital falls in 5, and deep vein thrombosis or pulmonary embolism in 3. Medical complications included acute respiratory distress syndrome, cardiac arrest, and decubitus ulcers. Contracture was most common after revision TKA (three of eight cases). Mean indemnity was $325,369, and the largest single settlement was $2.42 million. The average expense relating to the defense of these cases was $66,365. Orthopaedic surgeons should continue to focus attention on prevention of complications and on preoperative patient education. Preoperative counseling regarding the risks of incomplete pain relief could reduce substantially the number of suits relating to primary TKAs.
Stedman, Roman C; Lim, Daniel; Husain, Adeel; Courtney, Paul M; Nelson, Charles L
Dislocation is the most frequent complication following revision total hip arthroplasty (THA). Although several risk factors for dislocation in revision THA have been described, many cannot be modified at the time of surgery. Identifying modifiable risk factors for subsequent dislocation after revision THA provides opportunity for orthopedic surgeons to decrease instability. A retrospective analysis of 203 consecutive revision THA procedures performed by a single surgeon with a minimum 2-year follow-up between May 2003 and June 2012 was performed. 2 (1.0%) died and 14 (6.9%) were lost to follow-up leaving 187 (92%) revision procedures in 123 men and 64 women. Univariate and multivariate logistic regression was used to identify risk factors for dislocation. 9 (4.8%) of all patients reviewed experienced a dislocation episode. Of those, 8 (89%) had a single component revised, 6 (67%) were women, and 4 (44%) had a history of recurrent dislocation. 2 of 14 (14%) patients with a constrained liner dislocated. Univariate analysis demonstrated that single-component revisions were at higher risk for dislocation after the surgery (p value = 0.033). Identifying modifiable risk factors for dislocation after revision THA provide opportunity to decrease rates of instability. Based on our data, single-component revision THA is a risk factor for subsequent dislocation.
A near-peer teaching program designed, developed and delivered exclusively by recent medical graduates for final year medical students sitting the final objective structured clinical examination (OSCE
Full Text Available Abstract Background The General Medical Council states that teaching doctors and students is important for the care of patients. Our aim was to deliver a structured teaching program to final year medical students, evaluate the efficacy of teaching given by junior doctors and review the pertinent literature. Methods We developed a revision package for final year medical students sitting the Objective Structured Clinical Examination (OSCE. The package was created and delivered exclusively by recent medical graduates and consisted of lectures and small group seminars covering the core areas of medicine and surgery, with a focus on specific OSCE station examples. Students were asked to complete a feedback questionnaire during and immediately after the program. Results One hundred and eighteen completed feedback questionnaires were analysed. All participants stated that the content covered was relevant to their revision. 73.2% stated that junior doctors delivered teaching that is comparable to that of consultant - led teaching. 97.9% stated the revision course had a positive influence on their learning. Conclusions Our study showed that recent medical graduates are able to create and deliver a structured, formal revision program and provide a unique perspective to exam preparation that was very well received by our student cohort. The role of junior doctors teaching medical students in a formal structured environment is very valuable and should be encouraged.
Pascarella, Luigi; Shortell, Cynthia K
Venous disease is the most common cause of chronic leg ulceration and represents an advanced clinical manifestation of venous insufficiency. Due to their frequency and chronicity, venous ulcers have a high socioeconomic impact, with treatment costs accounting for 1% of the health care budget in Western countries. The evaluation of patients with venous ulcers should include a thorough medical history for prior deep venous thrombosis, assessment for an hypercoagulable state, and a physical examination. Use of the CEAP (clinical, etiology, anatomy, pathophysiology) Classification System and the revised Venous Clinical Severity Scoring System is strongly recommended to characterize disease severity and assess response to treatment. This venous condition requires lifestyle modification, with affected individuals performing daily intervals of leg elevation to control edema; use of elastic compression garments; and moderate physical activity, such as walking wearing below-knee elastic stockings. Meticulous skin care, treatment of dermatitis, and prompt treatment of cellulitis are important aspects of medical management. The pharmacology of chronic venous insufficiency and venous ulcers include essentially two medications: pentoxifylline and phlebotropic agents. The micronized purified flavonoid fraction is an effective adjunct to compression therapy in patients with large, chronic ulceration. Copyright © 2015 Elsevier Inc. All rights reserved.
In the market of medical devices, non-Japanese products hold a large part even in Japan. To overcome this situation, the Japanese government has been announcing policies to encourage the medical devices industry, such as the 5-year strategy for medical innovation (June 6, 2012). The Division of Medical Devices has been contributing to rapid marketing of medical devices by working out the standards for approval review and accreditation of medical devices, guidances on evaluation of medical devices with emerging technology, and test methods for biological safety evaluation of medical devices, as a part of practice in the field of regulatory science. The recent outcomes are 822 standards of accreditation for Class II medical devices, 14 guidances on safety evaluation of medical devices with emerging technology, and the revised test methods for biological safety evaluation (MHLW Notification by Director, OMDE, Yakushokuki-hatsu 0301 No. 20 "Basic Principles of Biological Safety Evaluation Required for Application for Approval to Market Medical Devices").
Wouthuyzen-Bakker, Marjan; Tornero, Eduard; Claret, Guillem; Bosch, Jordi; Martinez-Pastor, Juan Carlos; Combalia, Andreu; Soriano, Alex
A significant amount of patients undergoing revision surgery of a prosthetic joint turn out to have an infection. Withholding preoperative antibiotic prophylaxis in these patients to optimize culture yield during revision surgery remains a matter of debate. The aim of our study was to determine (1) the rate of positive intraoperative cultures with or without preoperative antibiotic prophylaxis and (2) the incidence of a prosthetic joint infection (PJI) during the follow-up in the 2 groups. Medical files of patients in whom preoperative antibiotic prophylaxis was withheld until culture samples were taken (2007-2010, n = 284) and in whom antibiotic prophylaxis was given during the induction of anesthesia (2010-2013, n = 141) were retrospectively reviewed. The percentage of ≥1 positive cultures was the same in the group without (26%) and with preoperative prophylaxis (27%; P value, .7). PJI was diagnosed during revision surgery according to the Musculoskeletal Infection Society criteria in 6.7% patients not receiving preoperative prophylaxis and in 7.0% receiving it (P value, .79). We found no important differences in the type of microorganisms that were isolated in both groups. During a 3-month follow-up, an early PJI developed in patients undergoing total revision surgery in 6.4% of the nonpreoperative prophylaxis group vs 1.6% in the preoperative prophylaxis group (P value, .1). Preoperative antibiotic prophylaxis does not reduce culture yield in patients undergoing knee revision surgery. Our data show a trend toward a higher PJI rate in the postoperative period of total revision surgery when preoperative prophylaxis is withheld. Copyright © 2017 Elsevier Inc. All rights reserved.
Leitao, Jordana; Chandramohan, Daniel; Byass, Peter; Jakob, Robert; Bundhamcharoen, Kanitta; Choprapawon, Chanpen; de Savigny, Don; Fottrell, Edward; França, Elizabeth; Frøen, Frederik; Gewaifel, Gihan; Hodgson, Abraham; Hounton, Sennen; Kahn, Kathleen; Krishnan, Anand; Kumar, Vishwajeet; Masanja, Honorati; Nichols, Erin; Notzon, Francis; Rasooly, Mohammad Hafiz; Sankoh, Osman; Spiegel, Paul; AbouZahr, Carla; Amexo, Marc; Kebede, Derege; Alley, William Soumbey; Marinho, Fatima; Ali, Mohamed; Loyola, Enrique; Chikersal, Jyotsna; Gao, Jun; Annunziata, Giuseppe; Bahl, Rajiv; Bartolomeus, Kidist; Boerma, Ties; Ustun, Bedirhan; Chou, Doris; Muhe, Lulu; Mathai, Matthews
Objective Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems. Methods A literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification. Findings A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach. Conclusions The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians. PMID
Full Text Available Objective: Verbal autopsy (VA is a systematic approach for determining causes of death (CoD in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS systems. Methods: A literature review of existing VA instruments was undertaken. The World Health Organization (WHO then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC. In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10 CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification. Findings: A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach. Conclusions: The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving
Leitao, Jordana; Chandramohan, Daniel; Byass, Peter; Jakob, Robert; Bundhamcharoen, Kanitta; Choprapawon, Chanpen; de Savigny, Don; Fottrell, Edward; França, Elizabeth; Frøen, Frederik; Gewaifel, Gihan; Hodgson, Abraham; Hounton, Sennen; Kahn, Kathleen; Krishnan, Anand; Kumar, Vishwajeet; Masanja, Honorati; Nichols, Erin; Notzon, Francis; Rasooly, Mohammad Hafiz; Sankoh, Osman; Spiegel, Paul; AbouZahr, Carla; Amexo, Marc; Kebede, Derege; Alley, William Soumbey; Marinho, Fatima; Ali, Mohamed; Loyola, Enrique; Chikersal, Jyotsna; Gao, Jun; Annunziata, Giuseppe; Bahl, Rajiv; Bartolomeus, Kidist; Boerma, Ties; Ustun, Bedirhan; Chou, Doris; Muhe, Lulu; Mathai, Matthews
Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems. A literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification. A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach. The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians.
de Thomasson, E; Guingand, O; Terracher, R; Mazel, C
The Exeter technique opened new perspectives for the treatment of femoral bone stock loss in revision hip arthroplasty. Implant migration in the cement sheath is, however, a frequent finding. According to the promoters of the technique, this would favor transformation of the allograft into living bone. For others it is a worrisome problem since it alters the heterogeneous cement sheath, leading to loosening and final surgical revision, with an incidence up to 20%. We propose an analysis of the mid-term results of the modified Exeter technique with the objective of cementing the distal part of the implant directly into the recipient bone in order to achieve satisfactory primary stability. The purpose of this work was to analyze the consequences of this method on the long-term evolution of the allograft. After preparing the femur, a specific gun is filled with allograph dough obtained from frozen femoral heads fragmented with an acetabular reamer. The Mersilene mesh enables the deposit of a tube of graft material at the desired level. The implant is sealed after impaction of the graft to enable direct distal cementing in contact with the recipient bone. Partial weight bearing is allowed as early as the fifth day and increased progressively to complete weight bearing at three months. Forty-five patients (46 hips) were treated between June 1996 and January 2002. Six patients were not retained for analysis due to insufficient follow-up. For three patients, graft outcome could not be properly assessed due to a major complication. In addition, two patients died and one was lost to follow-up. In all 39 patients (40 hips) were analyzed at mean follow-up of 84 months (range 48-110). There were no cases of revision for femoral loosening. Femoral bone loss was mainly moderate to severe type II and III hips (Sofcot classification) but limited in height (no grade IV in the Endo-Klinik classification). Clinical outcome was excellent in 13 hips, good in 16, fair in nine and poor
Merenmies, Jussi; Niemi-Murola, Leila; Pyörälä, Eeva
Medical education is facing changes in order to improve young doctors' competency to respond better to current needs of the patients and the society. Both curriculum content and teaching methods are revised. In addition to vibrant research in academic medical education, teachers are supported by the improved web-based learning environments and novel technical tools. Flipped classroom, a new paradigm that benefits from technical development, provides many opportunities for medical education. This teaching method always consists of two mutually complementary parts. The first part of the learning action takes place independently off classroom with video lectures or other stimuli for learning. The second part takes place in conjunction with the teacher and other students, and requires student group interactions.
... DEPARTMENT OF THE INTERIOR National Park Service [NPS-PWR-YOSE-13178; PS.SPWLA0028.00.1] Minor Boundary Revision at Yosemite National Park AGENCY: National Park Service, Interior. ACTION: Notification of Boundary Revision. SUMMARY: The boundary of Yosemite National Park is modified to include 80 acres...
Young, Chase; Stover, Katie
This study helped the researchers to determine if blogging as a revision strategy in a second grade classroom was beneficial. Nineteen second grade students wrote expository essays and made revisions and edits based on peer feedback in a blogging environment. Six elementary school teachers independently rated the students' writing samples using…
Smith, J. David
The Division on Mental Retardation and Developmental Disabilities (MRDD) of the Council for Exceptional Children adopted this position statement concerning the revised American Association on Mental Retardation (AAMR) definition of mental retardation. The position statement views the revised mental retardation definition and classification as a…
... PRACTITIONER DATA BANK FOR ADVERSE INFORMATION ON PHYSICIANS AND OTHER HEALTH CARE PRACTITIONERS Reporting of Information § 60.6 Reporting errors, omissions, and revisions. (a) Persons and entities are responsible for... 45 Public Welfare 1 2010-10-01 2010-10-01 false Reporting errors, omissions, and revisions. 60.6...
Pham, Vu Phi Ho; Usaha, Siriluck
Few studies have been conducted to see how blog-based peer response helps students to improve their writing revisions. The present study investigates peer comments made through blogs, the nature of the comments and their areas of focus, and the ratios of students incorporating suggestions made through blog-based comments into revisions of their…
This edition of the Carlsbad Area Office Strategic Plan captures the US Department of Energy's (DOE's) new focus, and supersedes the edition issued previously (DOE, 1993a). This revision reflects: a revised strategy designed to demonstrate compliance with environmental regulations earlier than the previous course of action; and a focus on establishment of standardized transuranic waste characterization and acceptance criteria for disposal facilities
Suyama, Kenya; Mochizuki, Hiroki [Department of Fuel Cycle Safety Research, Nuclear Safety Research Center, Tokai Research Establishment, Japan Atomic Energy Research Institute, Tokai, Ibaraki (Japan); Kiyosumi, Takehide [The Japan Research Institute, Ltd., Tokyo (Japan)
SWAT is an integrated burnup code system developed for analysis of post irradiation examination, transmutation of radioactive waste, and burnup credit problem. This report shows an outline and a user's manual of revised SWAT. This revised SWAT includes expansion of functions, increasing supported machines, and correction of several bugs reported from users of previous SWAT. (author)
Curriculum revision is an important part of academic work. Despite theoretical literature on curriculum development and design, there is a scarcity of literature available for either academic staff or novice educational developers on the initiation of this curriculum revision process. This study, therefore, set out to explore the practices of…
... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Budget revision: Airport development. 152... TRANSPORTATION (CONTINUED) AIRPORTS AIRPORT AID PROGRAM Accounting and Reporting Requirements § 152.323 Budget... change in the budget estimates, the sponsor shall submit a request for budget revision on a form...
... 45 Public Welfare 1 2010-10-01 2010-10-01 false Budget revisions and minor deviations. 63.19 Section 63.19 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION GRANT PROGRAMS... Budget revisions and minor deviations. Pursuant to § 74.102(d) of this title, paragraphs (b)(3) and (b)(4...
The species of Microterys Thomson from China are revised. Forty-three species are described and illustrated, of which 17 are new to science. Seventeen new species are described and illustrated, 26 species of the genus are revised and redescribed. The hosts of 33 species of the genus Microterys are
... Management and Budget (OMB) a request for clearance of a revised information collection, Standard Form (SF... [email protected] . U. S. Office of Personnel Management. Elaine Kaplan, Acting Director. BILLING... MANAGEMENT Notice of Revision of Standard Form 15 AGENCY: U.S. Office of Personnel Management. ACTION: Notice...
Middleton, David J.
The genus Alyxia is revised for Australia and the islands of the Pacific Ocean as the second and final part of a complete revision of the genus. 39 species are recognised for this area of which three are new to science, two are new combinations and one is a new name. 14 species are found in
Suyama, Kenya; Mochizuki, Hiroki; Kiyosumi, Takehide
SWAT is an integrated burnup code system developed for analysis of post irradiation examination, transmutation of radioactive waste, and burnup credit problem. This report shows an outline and a user's manual of revised SWAT. This revised SWAT includes expansion of functions, increasing supported machines, and correction of several bugs reported from users of previous SWAT. (author)
Vollema, MG; Ormel, J
We investigated the reliability of the Structured Interview for Schizotypy-Revised (SIS-R). The original interview (SIS) was developed by Kendler, We revised the SIS, primarily by standardizing the rating procedures. Operational definitions and explicit criteria for rating were given. We introduced
Nickelsen, T N; Erenbjerg, M; Retpen, J B
component revision for aseptic loosening was performed on 100 hips. In 14 cases (14%) an intraoperative fracture occurred and 7 patients (7%) had other postoperative complications. Seventeen patients (17%) required further revision, 10 because of aseptic loosening. Of 50 surviving patients with retained...
Philippakos, Zoi A.; MacArthur, Charles A.
Revision is a challenging step of the writing process and students often focus their attention to mechanics or grammar instead of making organizational and meaning changes. It is important for students to critically read and independently evaluate their work when revising. This practitioner article discusses the importance of genre-specific…
Lindberg-Larsen, Martin; Pitter, Frederik Taylor; Voldstedlund, Marianne
one case (1.4%) of methicillin-resistance was registered. Coagulase-negative staphylococci (CoNS) were frequent, sole pathogen in 65 revisions and in polymicrobial cultures in 28 revisions with a total frequency of 29.5%. A pre-operative knee aspiration was performed in 50% and preoperative blood...
Teruggi, Lilia A.; Gutiérrez-Cáceres, Rafaela
In this study we explored the revision process and strategies implemented by deaf and hearing students who attend the same bilingual school context (LIS and Italian). For that we analysed and compared the types and quality of revisions made by deaf and hearing participants to their first draft of a narrative text ("Frog, Where Are You?")…
Thompson, Britta M.; Searle, Nancy S.; Gruppen, Larry D.; Hatem, Charles J.; Nelson, Elizabeth A.
Purpose The purpose of our study was to determine the prevalence, focus, time commitment, graduation requirements and programme evaluation methods of medical education fellowships throughout the United States. Medical education fellowships are defined as a single cohort of medical teaching faculty who participate in an extended faculty development programme. Methods A 26-item online questionnaire was distributed to all US medical schools (n=127) in 2005 and 2006. The questionnaire asked each school if it had a medical education fellowship and the characteristics of the fellowship programme. Results Almost half (n=55) of the participating schools (n=120, response rate 94.5 %) reported having fellowships. Duration (10–584 hours) and length (teaching skills, scholarly dissemination and curriculum design, and required the completion of a scholarly project. A majority collected participant satisfaction; few used other programme evaluation strategies. Conclusions The number of medical education fellowships increased rapidly during the 1990s and 2000s. Across the US, programmes are similar in participant characteristics and curricular focus but unique in completion requirements. Fellowships collect limited programme evaluation data, indicating a need for better outcome data. These results provide benchmark data for those implementing or revising existing medical education fellowships. PMID:21475643
In this book, we present medical robotics, its evolution over the last 30 years in terms of architecture, design and control, and the main scientific and clinical contributions to the field. For more than two decades, robots have been part of hospitals and have progressively become a common tool for the clinician. Because this domain has now reached a certain level of maturity it seems important and useful to provide a state of the scientific, technological and clinical achievements and still open issues. This book describes the short history of the domain, its specificity and constraints, and
Tsai, Ya-Chin; Chuang, Min-Tun
This quasi-experimental study investigated the effect of structured peer assessment on revision of an argumentative writing. Two intact classes (N = 22, 26) were randomly assigned to be the trained and control groups. The latter received no facilitative resources, while the former participated in structured peer assessment based on Calibrated Peer Review, a web-based program purposefully designed for students to receive peer-assessment training, assess their peers' writing, and make written commentary online. At the end of the treatment, both groups revised their writing. The trained group revised their writing more extensively, outperforming the control group on frequency and type of revision, as well as the holistic quality of argumentative writing. After structured peer assessment, participants of the trained group became critical of their own work and invested more effort in spontaneous revision to produce higher-quality argumentative writing.
Pelt, Christoper E; Madsen, Wes; Erickson, Jill A; Gililland, Jeremy M; Anderson, Mike B; Peters, Christopher L
We retrospectively reviewed 123 patients who underwent cementless THA with modular femoral stem designs for revision THA or conversion of failed ORIF and found 75 patients available for analysis. The Harris Hip Score (HHS) improved from 52 ± 14 to 86 ± 11 (P revised in eight patients (11%). The mean time to re-revision was 1.1years (0.13-2.54). Reasons for re-revision included infection (n = 5, 7%), aseptic loosening (n = 2, 3%) and significant pain (n = 1, 1%). There were no failures of the modular junctions. PC stems had an increased rate of intraoperative fractures (PC 28% vs. STS 9%, P = 0.04). Modular cementless femoral stems provide acceptable mid-term results in revision THA. Copyright © 2014 Elsevier Inc. All rights reserved.
...: Final Authorization of State Hazardous Waste Management Program Revision AGENCY: Environmental... hazardous waste management program. We authorized the following revisions: Oklahoma received authorization... its program revision in accordance with 40 CFR 271.21. The Oklahoma Hazardous Waste Management Act...
Ettl, V.; Kirschner, S.; Krauspe, R.
Relapse rates of surgically treated clubfeet are about 25%. We reviewed 43 patients (57 feet) treated for relapsed clubfoot deformity between 1992 and 2001 in our department. The average age of the patients at the time of revision surgery was 5.1 years, the mean follow-up was 6.6 years. Surgical therapy was performed using an algorithm according to age groups. The mean Atar score at follow-up was 77 points, representing a good outcome. Out of 57 feet, 20 (35%) were rated excellent, 24 (42%) good, 5 (9%) fair, and 8 (14%) poor. The number of previous surgical interventions had no influence on the outcome. Using an age related surgical algorithm, good postoperative results could be achieved in most of our patients, thus improving their functional situation. This emphasises the usefulness of the proposed algorithm in the difficult situation of recurrent clubfoot, while thorough analysis of the underlying deformity remains essential. PMID:18094969
Thomas P. McLaughlin; Shean P. Monahan; Norman L. Pruvost; Vladimir V. Frolov; Boris G. Ryazanov; Victor I. Sviridov
Criticality accidents and the characteristics of prompt power excursions are discussed. Sixty accidental power excursions are reviewed. Sufficient detail is provided to enable the reader to understand the physical situation, the chemistry and material flow, and when available the administrative setting leading up to the time of the accident. Information on the power history, energy release, consequences, and causes are also included when available. For those accidents that occurred in process plants, two new sections have been included in this revision. The first is an analysis and summary of the physical and neutronic features of the chain reacting systems. The second is a compilation of observations and lessons learned. Excursions associated with large power reactors are not included in this report.
Full Text Available Llavea Lag. is a genus of Cryptogrammoideae (Pteridaceae, whose only species is distributed from southern United States and Mexico to Guatemala and Costa Rica, although it lives mainly in Mesoamerica, inhabiting preferably calcicolous habitats associated with forests and mountains. The genus is easily recognized by the presence of fertile leaves hemi-dimorphic, with the fertile apical portion with longer and narrower segments than the sterile ones, with strongly revolute margin, and rhizome scales bicolorous, shiny, and black. This paper presents a revision of the genus, nomenclatural issues are resolved, and and palynological morphological diversity are reviewed, as well as its distribution, phenology, ecology, and applications, based on field and herbarium specimens studies. In addition, two names related to Llavea, Allosorus karwinskii Kunze and Ceratodactylis osmundioides J. Sm., were lectotypified.
Full Text Available KARTONEGORO, A. & VELDKAMP, J. F. 2010. A revision of Dissochaeta (Melastomataceae in Java. Reinwardtia13(2: 125–145. There are 12 species of Dissochaeta (Melastomataceae in Java, Indonesia: D. bakhuizenii, D. bracteata,D. decipiens, D. fallax, D. gracilis, D. inappendiculata, D. intermedia, D. leprosa, D. monticola, D. reticulata, D.sagittata and D. vacillans. Diplectria and Macrolenes are regarded as separate genera and species traditionally classifiedwithin the latter have not been included. Dissochaeta leprosa, D. reticulata, and D. sagittata are reinstated as species.Dissochaeta gracilis is the most common species of Dissochaeta and D. bracteata is the rarest one. There are noendemics for the island. Each taxon is provided with literature references, synonymy, morphological descriptions, distribution,ecological habitat, collector’s notes, and notes. An identification key and a list of collections seen are included.
Safe, efficient operation of waste tank farm facilities is dependent in part upon the availability of accurate, up-to-date plant drawings. Accurate plant drawings are also required in support of facility upgrades and future engineering remediation projects. This supporting document establishes the procedure for performing a visual field verification of engineering drawings, the degree of visual observation being performed and documenting the results. A copy of the drawing attesting to the degree of visual observation will be paginated into the released Engineering Change Notice (ECN) documenting the field verification for future retrieval and reference. All waste tank farm essential and support drawings within the scope of this program will be converted from manual to computer aided drafting (CAD) drawings. A permanent reference to the field verification status will be placed along the right border of the CAD-converted drawing, referencing the revision level, at which the visual verification was performed and documented
Newport, M L; Stuchin, S A; Frankel, V H; Zuckerman, J
Thirteen patients (14 hips) underwent revision from conventional cemented total hip arthroplasty to uncemented acetabular threaded screw-in components and cementless femoral press-fit stems by means of the Autophor, Biofit, and Ti-Thread designs. The patients suffered from all forms of primary hip disease except rheumatoid arthritis; their average age was 34 years. The average preoperative Harris hip score was 39.4; the average postoperative score was 71.2 at six months, 90.6 at one year, and 91.6 at two years. Complications included two femoral shaft fractures, one femoral nerve palsy, and one dislocation. No signs have been observed of loosening or migration as of an early (6-24 months) follow-up.
Couvreur, Thomas L P
The genus Uvariastrum (Annonaceae) is restricted to continental Africa and is characterized by sepals with folded margins, few carpels and numerous stamens. The genus is mainly found in the tropical lowland rain forests of Africa, with one species growing in a drier woodland habitat. The species name Uvariastrum pynaertii De Wild is reduced into synonymy with Uvariastrum zenkeri Engl. & Diels. Uvaraistrum neglectum Paiva and Uvariastrum modestum Dielsare transferred to the genus Uvaria leading to two new combinations: Uvaria modesta (Diels) Couvreur, comb. nov. and Uvaria paivana Couvreur, nom. nov. Five species are currently recognized in Uvariastrum. The present revision, the first of the genus for over 100 years, provides an overview of previously published information and discussions on morphology, taxonomy and palynology. Preliminary conservation status assessments are provided for each species, as well as diagnostic keys for fruiting and flowering material as well as detailed species descriptions. Furthermore, all species are illustrated by line drawings and all species are mapped.
This directory (NUREG/BR-0088, Revision 7) lists local public document rooms (LPDRs) for commercial nuclear power plants with operating or possession-only licenses or under construction, plus the LPDRs for potential high-level radioactive waste repository sites, gaseous diffusion plants, certain fuel cycle facilities, certain low-level waste disposal facilities, and any temporary LPDRs established for the duration of licensing proceedings. In some instances, the LPDR libraries maintain document collections for more than one licensed facility. The library staff members listed are the persons most familiar with the LPDR collections. Reference librarians in the NRC Headquarters Public Document Room (PDR) are also available to assist the public in locating NRC documents
McLaughlin, Thomas P.; Monahan, Shean P.; Pruvost, Norman L.; Frolov, Vladimir V.; Ryazanov, Boris G.; Sviridov, Victor I.
Criticality accidents and the characteristics of prompt power excursions are discussed. Sixty accidental power excursions are reviewed. Sufficient detail is provided to enable the reader to understand the physical situation, the chemistry and material flow, and when available the administrative setting leading up to the time of the accident. Information on the power history, energy release, consequences, and causes are also included when available. For those accidents that occurred in process plants, two new sections have been included in this revision. The first is an analysis and summary of the physical and neutronic features of the chain reacting systems. The second is a compilation of observations and lessons learned. Excursions associated with large power reactors are not included in this report
As the prime contractor to the Department of Energy Idaho Operations Office (DOE-ID), Lockheed Martin Idaho Technologies Company (LMITCO) provides comprehensive waste management services to all contractors at the Idaho National Engineering and Environmental Laboratory (INEEL) through the Waste Management (WM) Program. This Program Management Plan (PMP) provides an overview of the Waste Management Program objectives, organization and management practices, and scope of work. This document will be reviewed at least annually and updated as needed to address revisions to the Waste Management's objectives, organization and management practices, and scope of work. Waste Management Program is managed by LMITCO Waste Operations Directorate. The Waste Management Program manages transuranic, low-level, mixed low-level, hazardous, special-case, and industrial wastes generated at or transported to the INEEL
G. M. Kavalersky
Full Text Available In recent years, there is a trend of increasing demand for revision hip arthroplasty. Among these patients there are many with complex acetabular defects, including patients with pelvic discontinuity. To ensure stability for revised acetabular components in such cases becomes a challenging or unachievable task. Such defects give indications for printing customized tri-flange acetabular component. The authors analysed own experience of creating and applying custom made acetabular components in 3 patients with complex acetabular defects. Material and methods. Among the patients there were 2 women and 1 man. Average age was 60,3±19,4 years (38 to 78 years. Two patients had III B defects with pelvic discontinuity and one patient had III A defect by Paprosky classification. As the first step, the authors in collaboration with engineers printed a plaster full size pelvic 3D model, as the second step a customized tri-flange acetabular component was designed and printed. Harris Hip Score was evaluated preoperatively and 3 months postoperatively. Results. Average follow-up period was 5,3±2,5 months (3 to 8 months. The authors observed no cases of implant loosening, dislocation or deep periprosthetic infection. Average Harris Hip Score before surgery was 27,13 and after surgery – 74,1 indicating a significant improvement in 3 months postoperatively. Conclusion. Indications for use of individual acetabular components in reported patients correspond to indications formulated by Berasi et al. The authors obtained encouraging early follow-up outcomes that correspond to data of other authors. In one patient certain difficulties were reported due to insufficient pelvic distraction. Component’s flanges prevented achieving adequate pelvic distraction. Nevertheless, good primary stability was achieved. Modern software and 3D metal printers can significantly reduce the production cost of customized acetabular components. Application of this technology can be
The present revision of TID-7016 Nuclear Safety Guide is discussed. This Guide differs significantly from its predecessor in that the latter was intentionally conservative in its recommendations. Firmly based on experimental evidence of criticality, the original Guide and the first revision were considered to be of most value to organizations whose activities with fissionable materials were not extensive and, secondarily, that it would serve as a point of departure for members of established nuclear safety teams, experienced in the field. The reader will find a significant change in the character of information presented in this version. Nuclear Criticality Safety has matured in the past twelve years. The advance of calculational capability has permitted validated calculations to extend and substitute for experimental data. The broadened data base has enabled better interpolation, extension, and understanding of available, information, especially in areas previously addressed by undefined but adequate factors of safety. The content has been thereby enriched in qualitative guidance. The information inherently contains, and the user can recapture, the quantitative guidance characteristic of the former Guides by employing appropriate safety factors. In fact, it becomes incumbent on the Criticality Safety Specialist to necessarily impose safety factors consistent with the possible normal and abnormal credible contingencies of an operation as revealed by his evaluation. In its present form the Guide easily becomes a suitable module in any compendium or handbook tailored for internal use by organizations. It is hoped the Guide will continue to serve immediate needs and will encourage continuing and more comprehensive efforts toward organizing nuclear criticality safety information
Wirström, E. S.; Charnley, S. B.
Nitrogen-bearing molecules in cold molecular clouds exhibit a range of isotopic fractionation ratios and these molecules may be the precursors of 15N enrichments found in comets and meteorites. Chemical model calculations indicate that atom-molecular ion and ion-molecule reactions could account for most of the fractionation patterns observed. However, recent quantum-chemical computations demonstrate that several of the key processes are unlikely to occur in dense clouds. Related model calculations of dense cloud chemistry show that the revised 15N enrichments fail to match observed values. We have investigated the effects of these reaction rate modifications on the chemical model of Wirström et al. (2012) for which there are significant physical and chemical differences with respect to other models. We have included 15N fractionation of CN in neutral-neutral reactions and also updated rate coefficients for key reactions in the nitrogen chemistry. We find that the revised fractionation rates have the effect of suppressing 15N enrichment in ammonia at all times, while the depletion is even more pronounced, reaching 14N/15N ratios of >2000. Taking the updated nitrogen chemistry into account, no significant enrichment occurs in HCN or HNC, contrary to observational evidence in dark clouds and comets, although the 14N/15N ratio can still be below 100 in CN itself. However, such low CN abundances are predicted that the updated model falls short of explaining the bulk 15N enhancements observed in primitive materials. It is clear that alternative fractionating reactions are necessary to reproduce observations, so further laboratory and theoretical studies are urgently needed.
Asrar, G.; Wolf, J.; West, T. O.
Livestock play an important role in agricultural carbon cycling through consumption of biomass and emissions of methane. Quantification and spatial distribution of methane and carbon dioxide produced by livestock is needed to develop bottom-up estimates for carbon monitoring. These estimates serve as stand-alone international emissions estimates, as input to global emissions modeling, and as comparisons or constraints to flux estimates from atmospheric inversion models. Recent results for the US suggest that the 2006 IPCC default coefficients may underestimate livestock methane emissions. In this project, revised coefficients were calculated for cattle and swine in all global regions, based on reported changes in body mass, quality and quantity of feed, milk production, and management of living animals and manure for these regions. New estimates of livestock methane and carbon dioxide emissions were calculated using the revised coefficients and global livestock population data. Spatial distribution of population data and associated fluxes was conducted using the MODIS Land Cover Type 5, version 5.1 (i.e. MCD12Q1 data product), and a previously published downscaling algorithm for reconciling inventory and satellite-based land cover data at 0.05 degree resolution. Preliminary results for 2013 indicate greater emissions than those calculated using the IPCC 2006 coefficients. Global total enteric fermentation methane increased by 6%, while manure management methane increased by 38%, with variation among species and regions resulting in improved spatial distributions of livestock emissions. These new estimates of total livestock methane are comparable to other recently reported studies for the entire US and the State of California. These new regional/global estimates will improve the ability to reconcile top-down and bottom-up estimates of methane production as well as provide updated global estimates for use in development and evaluation of Earth system models.
Ferrigno, Giancarlo; Baroni, Guido; Casolo, Federico; De Momi, Elena; Gini, Giuseppina; Matteucci, Matteo; Pedrocchi, Alessandra
Information and communication technology (ICT) and mechatronics play a basic role in medical robotics and computer-aided therapy. In the last three decades, in fact, ICT technology has strongly entered the health-care field, bringing in new techniques to support therapy and rehabilitation. In this frame, medical robotics is an expansion of the service and professional robotics as well as other technologies, as surgical navigation has been introduced especially in minimally invasive surgery. Localization systems also provide treatments in radiotherapy and radiosurgery with high precision. Virtual or augmented reality plays a role for both surgical training and planning and for safe rehabilitation in the first stage of the recovery from neurological diseases. Also, in the chronic phase of motor diseases, robotics helps with special assistive devices and prostheses. Although, in the past, the actual need and advantage of navigation, localization, and robotics in surgery and therapy has been in doubt, today, the availability of better hardware (e.g., microrobots) and more sophisticated algorithms(e.g., machine learning and other cognitive approaches)has largely increased the field of applications of these technologies,making it more likely that, in the near future, their presence will be dramatically increased, taking advantage of the generational change of the end users and the increasing request of quality in health-care delivery and management.
Johnston, James; Mahadevan, Murali; Douglas, Richard G
Adenoidectomy is one of the most commonly performed pediatric operations worldwide. There are a proportion of children who require revision adenoidectomy. Yet there is little in the literature about the incidence, associated factors and etiology of adenoidal regrowth. The aim of this retrospective cohort study was to determine incidence and factors associated with revision adenoidectomy. An extraction of all hospital morbidity records belonging to patients under the age of 18 years who underwent one or more adenoidectomy procedures (with or without tonsillectomy) between January 1, 2000 and June 2016 at a tertiary care children's hospital was performed. Demographic, diagnostic, and procedural data were included in the analysis. Community prescribing information was examined for the number of courses of antibiotics prescribed to each patient prior to initial adenoidectomy. There were 8260 patients under the age of 18 years who underwent primary adenoidectomy from 2000 to 2016 at a tertiary pediatric hospital. 2.5% (n = 212) of patients underwent revision adenoidectomy in our cohort during the same time period. A higher proportion of females underwent revision adenoidectomy when compared to male counterparts (p = 0.007). Patients who were prescribed more than five courses of antibiotics prior to initial adenoidectomy were more likely to undergo revision adenoidectomy (p = 0.003). Patients with a diagnosis of otitis media with effusion were more likely to undergo revision adenoidectomy (p=revision adenoidectomy. An age of over 4 years at the time of initial adenoidectomy was associated with revision adenoidectomy (p=revision adenoidectomy in this cohort (p=revision adenoidectomy. Copyright © 2017 Elsevier B.V. All rights reserved.
Ballarin, V L; Isoardi, R A
The paper discusses the major Argentineans contributors, medical physicists and scientists, in medical imaging and the development of medical imaging in Argentina. The following are presented: history of medical imaging in Argentina: the pioneers; medical imaging and medical revolution; nuclear medicine imaging; ultrasound imaging; and mathematics, physics, and electronics in medical image research: a multidisciplinary endeavor.
Tsai, Chun-Hao; Muo, Chih-Hsin; Hung, Chih-Hung; Lin, Tsung-Li; Wang, Ta-Ii; Fong, Yi-Chin; Hsu, Horng-Chaung
The choice of primary hip hemiarthroplasty or total hip arthroplasty for displaced femoral neck fracture is still controversial. Revision hip arthroplasty not only increases risk and cost but also could result in worse outcome. Determining the risk factors for revision can help inform medical decision-making and aid in risk stratification of publicly reported outcomes. Therefore, we conducted a nationwide population-based study to identify the disease-related risk factors and construct a risk score nomogram to predict revision surgery. Records of all 68,030 femoral neck fracture patients receiving partial hemiarthroplasty (HA) in 2000-2010, with no total hip arthroplasty (THA) or revision HA history, were collected from the National Health Insurance Research Database. Cox proportional hazard regression was used to estimate the risk of revision hip replacement (RHA). The score of each risk factor was the quotient of the regression coefficient of the variable by the regression coefficient for a 10-year increase in age. The predictive accuracy was tested using the area under the receiver operating characteristic curve (AUROC). The revision risk for hemiarthroplasty increased in male, those with schizophrenia and end-stage renal disease patients had 1.58-, 1.88-, and 1.74-fold revision HA risk (95 % confidence interval (CI) = 1.40-1.78, 1.26-2.79, and 1.29-2.34, respectively). In a predictive model, the cumulative risk score ranged from 0 to 13 with a 5.08 to 91.82 % 10-year predicted RHA risk. The percentage of AUROC for 10-year RHA risk in nomogram was 61.9 (95 % CI = 60.0-63.4). Males, schizophrenia and end-stage renal disease patients have higher risk of revision surgery after hemiarthroplasty for femoral neck fracture.
Mowder, Barbara A.; Shamah, Renee
This study evaluated the test-retest reliability of two parenting measures: the Parent Behavior Importance Questionnaire-Revised (PBIQ-R) and Parent Behavior Frequency Questionnaire-Revised (PBFQ-R). These self-report parenting behavior assessment measures may be utilized as pre- and post-parent education program measures, with parents as well as…
Fraile Suari, A; Gil González, S; Pérez Prieto, D; León García, A; Mestre Cortadellas, C; Tey Pons, M; Marqués López, F
Subsidence is one of the potential complications in femoral stem revision total hip arthroplasty surgery, and can affect stability and osseointegration. A retrospective study was conducted on the outcomes at one year and 5 years (specifically subsidence and clinical relevance) of 40 consecutive femoral total hip arthroplasty revisions, comparing two modular cementless revision stems, Straight vs. Curved, with 20 patients in each group. No mechanical failure was observed, and there was an improvement in functional outcomes. Mean radiological subsidence was 9.9±4.9mm (straight=10.75mm vs. curved=9.03mm), with no statistically significant difference between groups (p=0,076). Fourteen patients (35%) had ≥10mm of subsidence, up to a maximum of 22mm. The subsidence found in this study is similar to published series, with no short-term clinical manifestations, or an increased number of complications or stem loosening in either the Straight or Curved group. No differences in subsidence were observed at one year and 5 years after surgery between the 2 types of stems. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.
The European Commission is currently developing a modified European Basic Safety Standards Directive covering two major objectives: the consolidation of existing European Radiation Protection legislation, and the revision of the European Basic Safety Standards. The consolidation will merge the following five Directives into one single Directive: the Basic Safety Standards Directive, the Medical Exposures Directive, the Public Information Directive, the Outside Workers Directive, and the Directive on the Control of high-activity sealed radioactive sources and orphan sources. The revision of the European Basic Safety Standards will take account of the latest recommendations by the International Commission on Radiological Protection (ICRP) and shall improve clarity of the requirements where appropriate. It is planned to introduce more binding requirements on natural radiation sources, on criteria for clearance, and on the cooperation between Member States for emergency planning and response, as well as a graded approach for regulatory control. One additional goal is to achieve greater harmonisation between the European BSS and the international BSS. Following a recommendation from the Article 31 Group of Experts, the current draft of the modified BSS will highlight the importance of education and training by dedicating a specific title to radiation protection education, training and information. This title will include a general requirement on the Member States to ensure the establishment of an adequate legislative and administrative framework for providing appropriate radiation protection education, training and information. In addition, there will be specific requirements on training in the medical field, on information and training of workers in general, of workers potentially exposed to orphan sources, and to emergency workers. The revised BSS directive will include requirements on the competence of a radiation protection expert (RPE) and of a radiation protection
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Adams, Krystyna; Snyder, Jeremy; Crooks, Valorie A; Johnston, Rory
Medical tourism, the practice of persons intentionally travelling across international boundaries to access medical care, has drawn increasing attention from researchers, particularly in relation to potential ethical concerns of this practice. Researchers have expressed concern for potential negative impacts to individual safety, public health within both countries of origin for medical tourists and destination countries, and global health equity. However, these ethical concerns are not discussed within the sources of information commonly provided to medical tourists, and as such, medical tourists may not be aware of these concerns when engaging in medical tourism. This paper describes the methodology utilized to develop an information sheet intended to be disseminated to Canadian medical tourists to encourage contemplation and further public discussion of the ethical concerns in medical tourism. The methodology for developing the information sheet drew on an iterative process to consider stakeholder feedback on the content and use of the information sheet as it might inform prospective medical tourists' decision making. This methodology includes a literature review as well as formative research with Canadian public health professionals and former medical tourists. The final information sheet underwent numerous revisions throughout the formative research process according to feedback from medical tourism stakeholders. These revisions focused primarily on making the information sheet concise with points that encourage individuals considering travelling for medical tourism to do further research regarding their safety both within the destination country, while travelling, and once returning to Canada, and the potential impacts of their trip on third parties. This methodology may be replicated for the development of information sheets intending to communicate ethical concerns of other practices to providers or consumers of a certain service.
Lamiani, Giulia; Setti, Ilaria; Barlascini, Luca; Vegni, Elena; Argentero, Piergiorgio
Moral distress is a common experience among critical care professionals, leading to frustration, withdrawal from patient care, and job abandonment. Most of the studies on moral distress have used the Moral Distress Scale or its revised version (Moral Distress Scale-Revised). However, these scales have never been validated through factor analysis. This article aims to explore the factorial structure of the Moral Distress Scale-Revised and develop a valid and reliable scale through factor analysis. Validation study using a survey design. Eight medical-surgical ICUs in the north of Italy. A total of 184 clinicians (64 physicians, 94 nurses, and 14 residents). The Moral Distress Scale-Revised was translated into Italian and administered along with a measure of depression (Beck Depression Inventory-Second Edition) to establish convergent validity. Exploratory factor analysis was conducted to explore the Moral Distress Scale-Revised factorial structure. Items with low (less than or equal to 0.350) or multiple saturations were removed. The resulting model was tested through confirmatory factor analysis. The Italian Moral Distress Scale-Revised is composed of 14 items referring to four factors: futile care, poor teamwork, deceptive communication, and ethical misconduct. This model accounts for 59% of the total variance and presents a good fit with the data (root mean square error of approximation = 0.06; comparative fit index = 0.95; Tucker-Lewis index = 0.94; weighted root mean square residual = 0.65). The Italian Moral Distress Scale-Revised evinces good reliability (α = 0.81) and moderately correlates with Beck Depression Inventory-Second Edition (r = 0.293; p moral distress total score between physicians and nurses. However, nurses scored higher on futile care than physicians (t = 2.051; p = 0.042), whereas physicians scored higher on deceptive communication than nurses (t = 3.617; p Moral distress was higher for those clinicians considering to give up their position
Largy, Pierre; Dédéyan, Alexandra; Hupet, Michel
Writing is a complex activity involving various cognitive processes in the planning, the transcription and the revision of written texts. The present study focused on the revision of written texts within a developmental approach. The study aimed to examine whether children and adults use different procedures to detect and revise erroneous grammatical agreements. It was predicted that children would use a slow algorithmic procedure while adults would use a fast automatized procedure. One hundred and twenty participants from 5th grade to undergraduate levels (24 per level) participated in the study. The participants were asked to decide as quickly as possible whether a visually presented sentence had any agreement error. The French experimental sentences were of the type 'The N1 of the N2 + Verb', in which N2 was either a plausible subject of the following verb (e. g., The guard of the prisoners watches) or an implausible subject (e. g., The guard of the safes watches). Correctness and latency of the responses were recorded. The main results showed that only the younger participants were affected by the subject-role plausibility of N2, and that there was no difference in response latency between their correct and incorrect responses. These observations support the hypothesis that the younger participants systematically apply a time-consuming algorithmic procedure to verify the agreement; since one step of this procedure consists in searching for the subject of the verb, these participants were frequently misled by the subject-role plausibility of N2. On the contrary, the older participants were not affected by the plausibility of N2, but were frequently misled by erroneous agreements between N2 and the verb. These observations support the view that these older participants use a fast decision strategy based on the co-occurrence of formal indices. Their correct answers, however, were slower than their incorrect ones; this suggests that they also sometimes use a time
Ferrell, Trinidad L.; Crilly, P. B.; Smith, S. F.; Wintenberg, Alan L.; Britton, Charles L., Jr.; Morrison, Gilbert W.; Ericson, M. N.; Hedden, D.; Bouldin, Donald W.; Passian, A.; Downey, Todd R.; Wig, A. G.; Meriaudeau, Fabrice
Medical telesensors are self-contained integrated circuits for measuring and transmitting vital signs over a distance of approximately 1-2 meters. The circuits are unhoused and contain a sensor, signal processing and modulation electronics, a spread-spectrum transmitter, an antenna and a thin-film battery. We report on a body-temperature telesensor, which is sufficiently small to be placed on a tympanic membrane in a child's ear. We also report on a pulse-oximeter telesensor and a micropack receiver/long- range transmitter unit, which receives form a telesensor array and analyzes and re-transmits the vital signs over a longer range. Signal analytics are presented for the pulse oximeter, which is currently in the form of a finger ring. A multichip module is presented as the basic signal-analysis component. The module contains a microprocessor, a field=programmable gate array, memory elements and other components necessary for determining trauma and reporting signals.
The cannabis plant has been known to humanity for centuries as a remedy for pain, diarrhea and inflammation. Current research is inspecting the use of cannabis for many diseases, including multiple sclerosis, epilepsy, dystonia, and chronic pain. In inflammatory conditions cannabinoids improve pain in rheumatoid arthritis and:pain and diarrhea in Crohn's disease. Despite their therapeutic potential, cannabinoids are not free of side effects including psychosis, anxiety, paranoia, dependence and abuse. Controlled clinical studies investigating the therapeutic potential of cannabis are few and small, whereas pressure for expanding cannabis use is increasing. Currently, as long as cannabis is classified as an illicit drug and until further controlled studies are performed, the use of medical cannabis should be limited to patients who failed conventional better established treatment.
Barbara E. C. Knollmann-Ritschel MD
Full Text Available Current medical school curricula predominantly facilitate early integration of basic science principles into clinical practice to strengthen diagnostic skills and the ability to make treatment decisions. In addition, they promote life-long learning and understanding of the principles of medical practice. The Pathology Competencies for Medical Education (PCME were developed in response to a call to action by pathology course directors nationwide to teach medical students pathology principles necessary for the practice of medicine. The PCME are divided into three competencies: 1 Disease Mechanisms and Processes, 2 Organ System Pathology, and 3 Diagnostic Medicine and Therapeutic Pathology. Each of these competencies is broad and contains multiple learning goals with more specific learning objectives. The original competencies were designed to be a living document, meaning that they will be revised and updated periodically, and have undergone their first revision with this publication. The development of teaching cases, which have a classic case-based design, for the learning objectives is the next step in providing educational content that is peer-reviewed and readily accessible for pathology course directors, medical educators, and medical students. Application of the PCME and cases promotes a minimum standard of exposure of the undifferentiated medical student to pathophysiologic principles. The publication of the PCME and the educational cases will create a current educational resource and repository published through Academic Pathology .
Abdel, Matthew P
Dislocation after revision total hip arthroplasty (THA) continues to be one of the most common and concerning complications after the procedure. As with every hip arthroplasty, it is essential to optimize component positioning, minimize impingement, and maintain the integrity of the abductor complex during the revision THAs. However, in several revision circumstances, additional strategies are required to mitigate the risk of dislocation, particularly those being revised for instability or those with cognitive or neuromuscular disorders. In such revision THAs, dual-mobility constructs offer lower rates of dislocations and re-revisions for dislocations in the midterm. However, it is important to note that dual-mobility constructs should not be considered as compensation for poor surgical technique or technical errors such as poor cup orientation or inappropriate restoration of soft-tissue tension. While intraprosthetic dislocations are a unique complication to dual-mobility constructs, they are exceedingly rare. Furthermore, additional follow-up is required with modular dual-mobility constructs utilized with increasing frequency during revision THAs in North America. Copyright © 2018 Elsevier Inc. All rights reserved.
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Reitsma, S. M. S.
The financial security to be provided to victims of an incident at a nuclear installation is the main objective of international nuclear liability conventions. As from the introduction of the Paris Convention on Third Party Liability in the Field of Nuclear Energy in 1960 and the Vienna Convention on Liability for Nuclear Damage in 1963 insurers have been prepared to provide the financial capacity needed to cover the liability under both conventions. They did so in close co-operation with the competent national and international authorities, which has resulted in the insurability of as much of the nuclear liability under the conventions as possible. This tradition of co-operation between authorities and insurers was extended to include the revision negotiations regarding the above conventions, which were concluded in 1997 and 2004 respectively. This has resulted in the insurability of by far the largest part of the convention based liability. However, some heads of damage have been introduced about which insurers had expressed concerns as to their likelihood to attract insurance support. In view of the explicit choice by Convention States to include the uninsurable heads of damage into the revised conventions one would expect that liability for them would fall upon national Governments. This would reflect practice in a number of States, which already assume liability for uninsurable mandatory liabilities for a long time. Nonetheless some other States now seem reluctant to do so, the resulting deadlock having a tendency to manifest itself in a negative perception of the insurance industry. Insurers are therefore appreciative of the forum provided by the CNS to once again explain the areas where problems as regards insurability have arisen and why this is the case. This presentation will show that those areas are few in number and notably relate to a limited number of environmental damages as well as the extension of prescription periods. Furthermore, thoughts will
The primary changes that have been made to this revision reflect the relocation of the Waste Certification Official (WCO) organizationally from the Quality Services Division (QSD) into the Laboratory Waste Services (LWS) Organization. Additionally, the responsibilities for program oversight have been differentiated between the QSD and LWS. The intent of this effort is to ensure that those oversight functions, which properly belonged to the WCO, moved with that function; but retain an independent oversight function outside of the LWS Organization ensuring the potential for introduction of organizational bias, regarding programmatic and technical issues, is minimized. The Waste Certification Program (WCP) itself has been modified to allow the waste certification function to be performed by any of the personnel within the LWS Waste Acceptance/Certification functional area. However, a single individual may not perform both the technical waste acceptance review and the final certification review on the same 2109 data package. Those reviews must be performed by separate individuals in a peer review process. There will continue to be a designated WCO who will have lead programmatic responsibility for the WCP and will exercise overall program operational oversite as well as determine the overall requirements of the certification program. The quality assurance organization will perform independent, outside oversight to ensure that any organizational bias does not degrade the integrity of the waste certification process. The core elements of the previous WCP have been retained, however, the terms and process structure have been modified.. There are now two ''control points,'' (1) the data package enters the waste certification process with the signature of the Generator Interface/Generator Interface Equivalent (GI/GIE), (2) the package is ''certified'', thus exiting the process. The WCP contains three steps, (1) the technical review for waste acceptance, (2) a review of the
Dankner, Rachel; Gabbay, Uri; Leibovici, Leonard; Sadeh, Maya; Sadetzki, Siegal
There is increasing agreement among medical educators regarding the importance of improving the integration between public health and clinical education, understanding and implementation of epidemiological methods, and the ability to critically appraise medical literature. The Sackler School of Medicine at Tel-Aviv University revised its public health and preventive medicine curriculum, during 2013-2014, according to the competency-based medical education (CBME) approach in training medical students. We describe the revised curriculum, which aimed to strengthen competencies in quantitative research methods, epidemiology, public health and preventive medicine, and health service organization and delivery. We report the process undertaken to establish a relevant 6-year longitudinal curriculum and describe its contents, implementation, and continuous assessment and evaluation. Central competencies included: epidemiology and statistics for appraisal of the literature and implementation of research; the application of health promotion principles and health education strategies in disease prevention; the use of an evidence-based approach in clinical and public health decision making; the examination and analysis of disease trends at the population level; and knowledge of the structure of health systems and the role of the physician in these systems. Two new courses, in health promotion, and in public health, were added to the curriculum, and the courses in statistics and epidemiology were joined. Annual evaluation of each course results in continuous revisions of the syllabi as needed, while we continue to monitor the whole curriculum. The described revision in a 6 year-medical school training curriculum addresses the currently identified needs in public health. Ongoing feedback from students, and re-evaluation of syllabus by courses teams are held annually. Analysis of student's written feedbacks and courses evaluations of "before and after" the implementation of this
Full Text Available Abstract Background There is increasing agreement among medical educators regarding the importance of improving the integration between public health and clinical education, understanding and implementation of epidemiological methods, and the ability to critically appraise medical literature. The Sackler School of Medicine at Tel-Aviv University revised its public health and preventive medicine curriculum, during 2013–2014, according to the competency-based medical education (CBME approach in training medical students. We describe the revised curriculum, which aimed to strengthen competencies in quantitative research methods, epidemiology, public health and preventive medicine, and health service organization and delivery. Methods We report the process undertaken to establish a relevant 6-year longitudinal curriculum and describe its contents, implementation, and continuous assessment and evaluation. Results Central competencies included: epidemiology and statistics for appraisal of the literature and implementation of research; the application of health promotion principles and health education strategies in disease prevention; the use of an evidence-based approach in clinical and public health decision making; the examination and analysis of disease trends at the population level; and knowledge of the structure of health systems and the role of the physician in these systems. Two new courses, in health promotion, and in public health, were added to the curriculum, and the courses in statistics and epidemiology were joined. Annual evaluation of each course results in continuous revisions of the syllabi as needed, while we continue to monitor the whole curriculum. Conclusions The described revision in a 6 year-medical school training curriculum addresses the currently identified needs in public health. Ongoing feedback from students, and re-evaluation of syllabus by courses teams are held annually. Analysis of student’s written feedbacks
Harris, Paul B; Houston, John M
This study examined the reliability of the Revised Competitiveness Index by investigating the test-retest reliability, interitem reliability, and factor structure of the measure based on a sample of 280 undergraduates (200 women, 80 men) ranging in age from 18 to 28 years (M = 20.1, SD = 2.1). The findings indicate that the Revised Competitiveness Index has high test-retest reliability, high inter-item reliability, and a stable factor structure. The results support the assertion that the Revised Competitiveness Index assesses competitiveness as a stable trait rather than a dynamic state.
Lenguerrand, E.; Whitehouse, M. R.; Beswick, A. D.; Jones, S. A.; Porter, M. L.
Objectives We used the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) to investigate the risk of revision due to prosthetic joint infection (PJI) for patients undergoing primary and revision hip arthroplasty, the changes in risk over time, and the overall burden created by PJI. Methods We analysed revision total hip arthroplasties (THAs) performed due to a diagnosis of PJI and the linked index procedures recorded in the NJR between 2003 and 2014. The cohort analysed consisted of 623 253 index primary hip arthroplasties, 63 222 index revision hip arthroplasties and 7585 revision THAs performed due to a diagnosis of PJI. The prevalence, cumulative incidence functions and the burden of PJI (total procedures) were calculated. Overall linear trends were investigated with log-linear regression. Results We demonstrated a prevalence of revision THA due to prosthetic joint infection of 0.4/100 procedures following primary and 1.6/100 procedures following revision hip arthroplasty. The prevalence of revision due to PJI in the three months following primary hip arthroplasty has risen 2.3-fold (95% confidence interval (CI) 1.3 to 4.1) between 2005 and 2013, and 3.0-fold (95% CI 1.1 to 8.5) following revision hip arthroplasty. Over 1000 procedures are performed annually as a consequence of hip PJI, an increase of 2.6-fold between 2005 and 2013. Conclusions Although the risk of revision due to PJI following hip arthroplasty is low, it is rising and, coupled with the established and further predicted increased incidence of both primary and revision hip arthroplasty, this represents a growing and substantial treatment burden. Cite this article: E. Lenguerrand, M. R. Whitehouse, A. D. Beswick, S. A. Jones, M. L. Porter, A. W. Blom. Revision for prosthetic joint infection following hip arthroplasty: Evidence from the National Joint Registry. Bone Joint Res 2017;6:391–398. DOI: 10.1302/2046-3758.66.BJR-2017-0003.R1. PMID:28642256
Full Text Available Background. Due to restrictions imposed on a clinical freedom, interest for professionalism in healthcare has been getting bigger not only in medicine literature and various mass media but also in teaching and organisation of healthcare. Professionalism stands not only for a medicine’s contract with society, recognition of a physician status, privilege and monopoly but also for a genuine physician’s commitment to professional responsibilities.Analysis. In 2002 European and American associations approved a document on medical professionalism in the new millenium, so-called Physician Charter. This document includes fundamental principles of professionalism such as altruism, patient autonomy and social justice. In particular, it analyses a physician’s professional competency, honesty with patients, patient confidentiality, appropriate relations with patients, improvements regarding a healthcare quality, healthcare access, just distribution of finite funds, commitment to scientific knowledge, trust maintenance by managing conflicts of interest and a professional responsibility.Conclusions. Physician’s professionalism means philosophycal and sociological analysis of his/her profession and its position in a society. It includes a concern for improvements of his/ her own scientific knowledge, skills, a genuine ethic interest for an individual patient bearing in mind principles of equality and justice in society. Whether performing an organisational and public work or participating in professional health organizations, physician’s interest for a patient must prevail.
Whitty, Rachel; Porter, Sandra; Battu, Kiran; Bhatt, Pranjal; Koo, Ellen; Kalocsai, Csilla; Wu, Peter; Delicaet, Kendra; Bogoch, Isaac I; Wu, Robert; Downar, James
Many seriously ill and frail inpatients receive potentially inappropriate or harmful medications and do not receive medications for symptoms of advanced illness. We developed and piloted an interprofessional Medication Rationalization (MERA) approach to deprescribing inappropriate medications and prescribing appropriate comfort medications. We conducted a single-centre pilot study of inpatients at risk of 6-month mortality from advanced age or morbidity. The MERA team reviewed the patients' medications and made recommendations on the basis of guidelines. We measured end points for feasibility, acceptability, efficiency and effectiveness. We enrolled 61 of 115 (53%) eligible patients with a mean age of 79.6 years (standard deviation [SD] 11.7 yr). Patients were taking an average of 11.5 (SD 5.2) medications before admission and had an average of 2.1 symptoms with greater than 6/10 severity on the revised Edmonton Symptom Assessment System. The MERA team recommended 263 medication changes, of which 223 (85%) were accepted by both the medical team and the patient. MERA team's recommendations resulted in the discontinuation of 162 medications (mean 3.1 per patient), dose changes for 48 medications (mean 0.9 per patient) and the addition of 13 medications (mean 0.2 per patient). Patients who received the MERA intervention stopped significantly more inappropriate medications than similar non-MERA comparison patients for whom data were collected retrospectively (3.1 v. 0.9 medications per patient, p < 0.01). The MERA approach was highly acceptable to patients and medical team members. The MERA intervention is feasible, acceptable, efficient and possibly effective for changing medication use among seriously ill and frail elderly inpatients. Scalability and effectiveness may be improved through automation and integration with medication reconciliation programs. Copyright 2018, Joule Inc. or its licensors.
Toriumi, Dean M; Bared, Anthony
The short nose deformity may arise from multiple etiologies including iatrogenic following rhinoplasty. The weakening of the cartilaginous support and the contractile forces imposed by the healing soft tissue envelope may result in the short nose deformity. The focus of this article is to present the senior author's approach to this nasal deformity. Copyright © 2012 by Thieme Medical Publishers, Inc.
Full Text Available A revised Lorentz invariant electromagnetic theory leading beyond Maxwell’s equations, and to a form of extended quantum electrodynamics, has been elaborated on the basis of a nonzero electric charge density and a nonzero electric field divergence in the vacuum state. Among the applications of this theory, there are steady electromagnetic states having no counterpart in conventional theory and resulting in models of electrically charged and neutral leptons, such as the electron and the neutrino. The analysis of the electron model debouches into a point-charge-like geometry with a very small characteristic radius but having finite self-energy. This provides an alternative to the conventional renormalization procedure. In contrast to conventional theory, an integrated radial force balance can further be established in which the electron is prevented from “exploding” under the action of its net self-charge. Through a combination of variational analysis and an investigation of the radial force balance, a value of the electronic charge has been deduced which deviates by only one percent from that obtained in experiments. This deviation requires further investigation. A model of the neutrino finally reproduces some of the basic features, such as a small but nonzero rest mass, an angular momentum but no magnetic moment, and long mean free paths in solid matter.
The Human Computer Interface Guide, SSP 30540, is a reference document for the information systems within the Space Station Freedom Program (SSFP). The Human Computer Interface Guide (HCIG) provides guidelines for the design of computer software that affects human performance, specifically, the human-computer interface. This document contains an introduction and subparagraphs on SSFP computer systems, users, and tasks; guidelines for interactions between users and the SSFP computer systems; human factors evaluation and testing of the user interface system; and example specifications. The contents of this document are intended to be consistent with the tasks and products to be prepared by NASA Work Package Centers and SSFP participants as defined in SSP 30000, Space Station Program Definition and Requirements Document. The Human Computer Interface Guide shall be implemented on all new SSFP contractual and internal activities and shall be included in any existing contracts through contract changes. This document is under the control of the Space Station Control Board, and any changes or revisions will be approved by the deputy director.
Plodinec, M.J.; Marra, S.L.
The Department of Energy currently has over 100 million liters of high-level radioactive waste in storage at the Savannah River Site (SRS). In the late 1970's, the Department of Energy recognized that there were significant safety and cost advantages associated with immobilizing the high-level waste in a stable solid form. Several alternative waste forms were evaluated in terms of product quality and reliability of fabrication. This evaluation led to a decision to build the Defense Waste Processing Facility (DWPF) at SRS to convert the easily dispersed liquid waste to borosilicate glass. In accordance with the NEPA (National Environmental Policy Act) process, an Environmental Impact Statement was prepared for the facility, as well as an Environmental Assessment of the alternative waste forms, and issuance of a Record of Decision (in December, 1982) on the waste form. The Department of Energy, recognizing that start-up of the DWPF would considerably precede licensing of a repository, instituted a Waste Acceptance Process to ensure that these canistered waste forms would be acceptable for eventual disposal at a federal repository. This report is a revision of the DWPF compliance plan
Michael S. Caterino
Full Text Available We revise the genus Prespelea Park, redefining and redescribing the two previously known species, P. copelandi Park and P. quirsfeldi Park, and adding ten new species: P. parki Caterino & Vásquez-Vélez, sp. n., P. minima Caterino & Vásquez-Vélez, sp. n., P. morsei Caterino & Vásquez-Vélez, sp. n., P. divergens Caterino & Vásquez-Vélez, sp. n., P. carltoni Caterino & Vásquez-Vélez, sp. n., P. myersae Caterino & Vásquez-Vélez, sp. n., P. georgiensis Caterino & Vásquez-Vélez, sp. n., P. enigma Caterino & Vásquez-Vélez, sp. n., P. wagneri Caterino & Vásquez-Vélez, sp. n., and P. basalis Caterino & Vásquez-Vélez, sp. n.. The genus is still only known from a relatively small area in the southern Appalachian Mountains, but the diversity is much greater than previously suspected. The new species exhibit considerable diversity in male secondary sexual characters. A preliminary phylogenetic analysis cannot conclusively resolve the polarity of eye and wing reduction across Speleobamini, but the monophyly of Park’s subgenus Fusjugama, if expanded to include all species with full-eyed and winged males, is not supported, and we therefore synonymize it with Prespelea s. str.
Title 44 US Code, ``Public Printing and Documents,`` regulations issued by the General Service Administration (GSA) in 41 CFR Chapter 101, Subchapter B, ``Management and Use of Information and Records,`` and regulations issued by the National Archives and Records Administration (NARA) in 36 CFR Chapter 12, Subchapter B, ``Records Management,`` require each agency to prepare and issue a comprehensive records disposition schedule that contains the NARA approved records disposition schedules for records unique to the agency and contains the NARA`s General Records Schedules for records common to several or all agencies. The approved records disposition schedules specify the appropriate duration of retention and the final disposition for records created or maintained by the NRC. NUREG-0910, Rev. 3, contains ``NRC`s Comprehensive Records Disposition Schedule,`` and the original authorized approved citation numbers issued by NARA. Rev. 3 incorporates NARA approved changes and additions to the NRC schedules that have been implemented since the last revision dated March, 1992, reflects recent organizational changes implemented at the NRC, and includes the latest version of NARA`s General Records Schedule (dated August 1995).
Full Text Available The genus Uvariastrum (Annonaceae is restricted to continental Africa and is characterized by sepals with folded margins, few carpels and numerous stamens. The genus is mainly found in the tropical lowland rain forests of Africa, with one species growing in a drier woodland habitat. The species name U. pynaertii De Wild is reduced into synonymy with U. zenkeri Engl. & Diels. Uvaraistrum neglectum Paiva and U. modestum Diels are transferred to the genus Uvaria leading to two new combinations: Uvaria modesta (Diels Couvreur, comb. nov. and Uvaria paivana Couvreur, nom. nov.. Five species are currently recognized in Uvariastrum. The present revision, the first of the genus for over 100 years, provides an overview of previously published information and discussions on morphology, taxonomy and palynology. Preliminary conservation status assessments are provided for each species, as well as diagnostic keys for fruiting and flowering material as well as detailed species descriptions. Furthermore, all species are illustrated by line drawings and all species are mapped.
Title 44 US Code, ''Public Printing and Documents,'' regulations issued by the General Service Administration (GSA) in 41 CFR Chapter 101, Subchapter B, ''Management and Use of Information and Records,'' and regulations issued by the National Archives and Records Administration (NARA) in 36 CFR Chapter 12, Subchapter B, ''Records Management,'' require each agency to prepare and issue a comprehensive records disposition schedule that contains the NARA approved records disposition schedules for records unique to the agency and contains the NARA's General Records Schedules for records common to several or all agencies. The approved records disposition schedules specify the appropriate duration of retention and the final disposition for records created or maintained by the NRC. NUREG-0910, Rev. 3, contains ''NRC's Comprehensive Records Disposition Schedule,'' and the original authorized approved citation numbers issued by NARA. Rev. 3 incorporates NARA approved changes and additions to the NRC schedules that have been implemented since the last revision dated March, 1992, reflects recent organizational changes implemented at the NRC, and includes the latest version of NARA's General Records Schedule (dated August 1995)
Alex P. Schmid
Full Text Available Terrorism is a contested concept. While there are many national and regional definitions, there is no universal legal definition approved by the General Assembly of the United Nations (the one proposed by the Security Council in Res. 1566 (2004 is non-binding, lacking legal authority in international law. The Ad Hoc Committee on Terrorism of the 6th (legal Committee of the General Assembly has, with some interruptions, been trying to reach a legal definition since 1972 - but in vain. In the absence of a legal definition, attempts have been made since the 1980s to reach agreement on an academic consensus definition. The latest outcome is the revised definition reprinted below. It is the result of three rounds of consultations among academics and other professionals. A description how it was arrived at can be found on pp. 39 - 98 of Alex P. Schmid (Ed.. The Routledge Handbook of Terrorism Research. London and New York: Routledge, 2011. The same volume also contains 260 other definitions compiled by Joseph J. Easson and Alex P. Schmid on pp. 99 -200.
Full Text Available ABSTRACT The taxonomy of Galeocharax, a genus of freshwater fishes distributed in most South American cis-Andean river systems, except the rio Negro, rio São Francisco and rio Xingu basins and the eastern drainages of Brazil, is herein revised. A total of 1229 specimens were examined from which 680 had meristic and morphometric data taken. Osteological and morphological features were also examined through radiographs, scanning electron microscopy and in cleared and stained specimens. Three of the four species previously considered as valid are herein recognized: Galeocharax humeralis from rio Paraguay and lower rio Paraná basins; Galeocharax goeldii, from rio Madeira basin, with records of geographical distribution expanded to the río Madre de Dios, río Beni, rio Mamoré and rio Guaporé basins and Galeocharax gulo, which is widespread throughout rio Amazonas, río Orinoco, rio Tocantins, and upper rio Paraná basins. Galeocharax knerii is herein considered a junior synonym of Galeocharax gulo. A key to species of Galeocharax is presented.
Hector M.O. Gonzalez-Filho
Full Text Available The Neotropical Sasoninae Neodiplothele Mello-Leitão, 1917 is revised and now includes eight species. Neodiplothele can be distinguished from other Sasoninae by the absence of the posterior median spinnerets and differs Neotropical relatives as Cosmopelma by the absence of cuspules on coxae of leg I and Paracenobiopelma by the absence of cuspules on the labium. The male of N. irregularis Mello-Leitão, 1917 and N. picta Vellard, 1924 are described and illustrated for the first time. Neodiplothele leonardosi Mello-Leitão, 1939 is considered a junior synonym of N. irregularis. Five new species are described from Brazil: N. aureus sp. nov. from the states of Ceará, Rio Grande do Norte, Paraíba, and Minas Gerais, N. itabaiana sp. nov. from Sergipe, N. martinsi sp. nov. from Bahia, Espírito Santo, and Minas Gerais, N. indicattii sp. nov. from Espírito Santo, Minas Gerais, Rio de Janeiro, and São Paulo, N. caucaia sp. nov. from Ceará, Goiás, and Mato Grosso do Sul. Two informal groups are proposed based on genitalia morphology: irregularis group and picta group. An identification key and new distribution records for all known species are given.
Van Tuyle, G.J.; Slovik, G.C.; Chan, B.C.; Aronson, A.L.; Kennett, R.J.
Analyses of the 1990 version of the PRISM Advanced Liquid Metal Reactor (ALMR) design are presented and discussed. Most of the calculations were performed using BNL computer codes, particularly SSC and MINET. In many cases, independent BNL calculations were compared against analyses presented by General Electric when they submitted the PRISM design revisions for evaluation by the Nuclear Regulatory Commission (NRC). The current PRISM design utilizes the metallic fuel developed by Argonne National Laboratory (ANL) which facilitates the passive/''inherent'' shutdown mechanism that acts to shut down reactor power production whenever the system overheats. There are a few vulnerabilities in the passive shutdown, with the most worrisome being the positive feedback from sodium density decreases or sodium voiding. Various postulated unscrammed events were examined by GE and/or BNL, and much of the analysis discussed in this report is focused on this category of events. For the most part, the BNL evaluations confirm the information submitted by General Electric. The principal areas of concern are related to the performance of the ternary metal fuel, and may be resolved as ANL continues with its fuel development and testing program
Boiling water reactors (BWRs) have experienced stress corrosion cracking in the reactor cooling system piping resulting in adverse impacts on plant availability and personnel radiation exposure. The BWR Owners Group and EPRI have sponsored a major research and development program to provide remedies for this stress corrosion cracking problem. This work shows that the likelihood of cracking depends on the plant's water chemistry performance (environment) as well as on material condition and stress level. Plant experience and other research demonstrate that water quality also affects fuel performance and radiation field buildup in BWRs. This report,''BWR Normal Water Chemistry Guidelines: 1986 Revision,'' presents suggested generic water chemistry specifications, justifies the proposed water chemistry limits, suggests responses to out-of-specification water chemistry, discusses available chemical analysis methods as well as data management and surveillance schemes, and details the management philosophy required to successfully implement a water chemistry control program. An appendix contains recommendations for water quality of auxiliary systems. 73 refs., 20 figs., 9 tabs
This report contains a revised version of the Environmental Monitoring Programme for the Swedish Nuclear Facilities. The revision is based on earlier experiences and evaluations. Some samples have been excluded. Some have been added, for example spruce cone and the food products apple and currant. The sediment samples of 2 cm length have been completed with samples of 10 cm length every fourth year to follow the migration of radio nuclides down the sediment layers over time. The revised Environmental Monitoring Programme is valid from the 1st of January 2005.
The design requirements, subsystem characteristics, environmental requirements, and cost and performance evaluation techniques are defined for the Line Focus Solar Central Power Systems. Specific passages revised are enumerated. (LEW)
Borges, T.; Stafford, R.S.; Lu, P.Y.; Carter, D.
NUREG/CR-6204 is a collection of questions and answers that were originally issued in seven sets and which pertain to revised 10 CFR Part 20. The questions came from both outside and within the NRC. The answers were compiled and provided by NRC staff within the offices of Nuclear Reactor Regulation, Nuclear Material Safety and Safeguards, Nuclear Regulatory Research, the Office of State Programs, and the five regional offices. Although all of the questions and answers have been reviewed by attorneys in the NRC Office of the General Counsel, they do not constitute official legal interpretations relevant to revised 10 CFR Part 20. The questions and answers do, however, reflect NRC staff decisions and technical options on aspects of the revised 10 CFR Part 20 regulatory requirements. This NUREG is being made available to encourage communication among the public, industry, and NRC staff concerning the major revisions of the NRC's standards for protection against radiation
Full Text Available Logical theories in reasoning about actions may also evolve and knowledge engineers need revision tools to incorporate new incoming laws about the dynamic environment. Researchers here fill this gap by providing an algorithmic approach for action...
... Measure (SCM) titled, ``Suggested Control Measure for Automotive Coatings.'' SJVUAPCD Rule 4653 is revised... Region 9, August 21, 2001 (the Little Bluebook). 4. CARB's Suggested Control Measure (SCM) titled...
Nielsen, Kamilla; Johansson, Pär I; Dahl, Benny
BACKGROUND: Transfusion with red blood cells (RBC) may be needed during hip revision surgery but the appropriate haemoglobin concentration (Hb) threshold for transfusion has not been well established. We hypothesized that a higher transfusion threshold would improve ambulation after hip revision...... surgery. METHODS: The trial was registered at Clinicaltrials.gov ( NCT00906295). Sixty-six patients aged 18 years or older undergoing hip revision surgery were randomized to receive RBC at a Hb threshold of either 7.3 g/dL (restrictive group) or 8.9 g/dL (liberal group). Postoperative ambulation...... received RBC. CONCLUSIONS: A Hb transfusion threshold of 8.9 g/dL was associated with a statistically significantly faster TUG after hip revision surgery compared to a threshold of 7.3 g/dL but the clinical importance is questionable and the groups did not differ in Hb at the time of testing....
The Fast Flux Test Facility (FFTF) Transition Project Plan, Revision 2, provides changes to the major elements and project baseline for the deactivation activities necessary to transition the FFTF to a radiologically and industrially safe shutdown condition.
Borges, T.; Stafford, R.S.; Lu, P.Y. [Oak Ridge National Lab., TN (United States); Carter, D. [Nuclear Regulatory Commission, Washington, DC (United States)
NUREG/CR-6204 is a collection of questions and answers that were originally issued in seven sets and which pertain to revised 10 CFR Part 20. The questions came from both outside and within the NRC. The answers were compiled and provided by NRC staff within the offices of Nuclear Reactor Regulation, Nuclear Material Safety and Safeguards, Nuclear Regulatory Research, the Office of State Programs, and the five regional offices. Although all of the questions and answers have been reviewed by attorneys in the NRC Office of the General Counsel, they do not constitute official legal interpretations relevant to revised 10 CFR Part 20. The questions and answers do, however, reflect NRC staff decisions and technical options on aspects of the revised 10 CFR Part 20 regulatory requirements. This NUREG is being made available to encourage communication among the public, industry, and NRC staff concerning the major revisions of the NRC`s standards for protection against radiation.
These examination standards are intended to assist NRC examiners and facility licensees to better understand the processes associated with initial and requalification examinations. The standards also ensure the equitable and consistent administration of examinations for all applicants. These standards are for guidance purposes and are not a substitute for the operator licensing regulations (i.e., 10 CFR Part 55), and they are subject to revision or other changes in internal operator licensing policy. This interim revision permits facility licensees to prepare their initial operator licensing examinations on a voluntary basis pending an amendment to 10 CFR Part 55 that will require facility participation. The NRC intends to solicit comments on this revision during the rulemaking process and to issue a final Revision 8 in conjunction with the final rule
Vapor Intrusion Characterization Report (Revision 1) - February 5, 2015: This report, which was approved by the EPA on February 18, 2015, documents the results from implementation of the Final Vapor Intrusion Characterization Work Plan.
Fishel, C C; Graham, K E; Greer, D M; Gupta, A D; Lockwood, D K; Prime, E E
The rationale and methods for revising the thesaurus of one of the major health sciences indexing tools are discussed. Computer production of the Cumulative Index to Nursing & Allied Health Literature and the possibility of online access mandated a revision of the list of subject headings. CINAHL has maintained a policy of responding to user needs and to changes in the nursing and allied health literature, and user input was encouraged during revision of the thesaurus. The methods of structural revision are described, and major changes in the thesaurus are detailed. Modification of the thesaurus is expected to have a far-reaching impact on the retrieval of information in nursing and allied health. Nursing and Allied Health (CINAHL) is now available online through DIALOG (file 218) and BRS (access code NAHL).
Crouse, William H.; Anglin, Donald L.
Today's automotive technology curriculum is changing; curriculum revisions are being made in response to both the changing automobile and to the latest social trends and laws affecting students and teachers alike. (Author)
... regulations. CEQ has revised Section 1515.10(c) to make this intention clear. One commenter stated that CEQ's..., CEQ has adhered to the regulatory philosophy and the applicable principles of regulation as set forth...
Polak, B.C.P.; Hartstra, W.W.; Ringens, P.J.; Scholten, R.J.
The revised evidence-based guideline 'Diabetic retinopathy: screening, diagnosis and treatment' contains important recommendations concerning screening, diagnosis and treatment of diabetic retinopathy. Regular screening and the treatment of risk factors, such as hyperglycemia, hypertension,
US International Trade Commission — This dataset is the 2015 Harmonized Tariff Schedule Revision 1 effective July 1, 2015. It provides the applicable tariff rates and statistical categories for all...
The Fast Flux Test Facility (FFTF) Transition Project Plan, Revision 2, provides changes to the major elements and project baseline for the deactivation activities necessary to transition the FFTF to a radiologically and industrially safe shutdown condition
... the exception of editorial changes, and the changes described above, this rule is the same as that... upward from 700 feet or more above the surface of the earth. * * * * * AAL AK E5 Platinum, AK [Revised...
Solid state lasers are the real highlight of my talk today, and were really the star of the year. In every application area I can think of, people have tried with some success to introduce corturiercial solid state products. I'll go into more detail, but aside from solid state, a very significant event happened in Deceniber when one of the laser angioplasty companies (Advanced Interventional Systens) received FDA clearance to begin marketing the excimer for coronary applications (Figure 1) . This is the first time to my knowledge that an excimer has ever been cleared for a medical application in the United States. It's an event that we didn't really expect to happen so soon. It's extremely significant and we'll see where it goes from here. The system needs to be road-tested a bit but to get past the FDA is the major obstacle. Looking back to solid state laser the importance of solid state lasers is as researchers become more involved with the excimer and conduct more clinical studies in ophthalmology, they realize that it's not going to be a panacea for all refractive surgery or other ophthalmolic applications. In many cases it looks like the solid state laser may be the laser of choice in certain types of surgery; most notably perhaps in refractive surgery. We've all read about the success of the excimer at least in capturing the press's attention for corneal sculpting and vision correction. Well, it could be that actually the next generation will be a solid state laser, so let's keep an open mind here.
Cucchi, Davide; Gathen, Martin; Streicher, Robert; Wirtz, Dieter Christian
The use of Ceramic-on-Ceramic (CoC) bearings in primary total hip arthroplasty (THA) is increasing and has been intensively analysed. This bearing plays a particularly relevant role in young, active patients and shows advantages over other bearings in biocompatibility, wear rate and lubrication properties. On the contrary, CoC bearings in revision THA are seldom used and scarcely analysed. The aim of this study is to systematically review the available literature on CoC bearings in revision THA. A systematic research in the English literature was performed to identify all studies reporting results of THA revisions using ceramic-on-ceramic bearing. The initial search strategy revealed 555 articles for consideration. On the basis of eligibility criteria, 26 studies were included in this review. Twenty-six studies, accounting for 1846 procedures, were eligible and included in the review. No studies of Level I were identified. Eighteen studies reported on revisions of CoC implants for various reasons, performed either with CoC or different bearings. In 111 patients a CoC bearing was used for the revision. Six studies consistently reported outcome measures for CoC bearing THA revisions, so that a quantitative synthesis of the data was possible. The range of follow-up across the six studies varied between 2.1 and 19 years, with a cumulative avearage follow-up of 9.3 years. A good functional result was documented, with a cumulative weighted mean for postoperative Harris Hip Score (HHS) of 87 points. The rate of dislocation in this group was 3.45% and the risk of fracture of an alumina ceramic head was 0.35% (1 study). Squeaking was reported as complication of CoC bearing THA revisions in three studies, with a calculated incidence of 0.52%. Modern CoC bearings show advantages in preclinical and retrospective studies over other bearings also in revision cases and are therefore to be considered a promising alternative for this kind of operation. Reasonable indications for Co
Cho, Samuel K; Bridwell, Keith H; Lenke, Lawrence G; Yi, Jin-Seok; Pahys, Joshua M; Zebala, Lukas P; Kang, Matthew M; Cho, Woojin; Baldus, Christine R
Retrospective cohort comparative study. To determine the prevalence of major complications, identify risk factors, and assess long-term clinical benefit after revision adult spinal deformity surgery. No study has analyzed risk factors for major complications in long revision fusion surgery and whether or not occurrence of a major complication affects ultimate clinical outcome. Analysis of consecutive adult patients who underwent multilevel revision surgery for spinal deformity with a minimum 2-year follow-up was performed. All complications were classified as either major or minor. Outcome analysis was conducted with the Scoliosis Research Society and Oswestry Disability Index scores. A total of 166 patients (mean age = 53.8 years) were identified with a mean follow-up of 3.5 years (range: 2-7). Primary diagnoses included idiopathic/de novo scoliosis (107), degenerative (35), trauma (7), neuromuscular scoliosis (6), congenital deformity (5), ankylosing spondylitis (2), tumor (2), Scheuermann kyphosis (1), and rheumatoid arthritis (1). Most common secondary diagnoses that necessitated revision surgery were adjacent segment disease, fixed sagittal imbalance, and pseudarthrosis. Overall, 34.3% of patients developed major complications (19.3% perioperative; 18.7% follow-up). Associated risk factors for perioperative complications were patient- (age > 60 years, medical comorbidities, obesity) and surgery-related (pedicle subtraction osteotomy). Performance of a 3-column osteotomy and postoperative radiographic changes that suggested progressive loss of sagittal correction were recognized as risk factors for follow-up complications. Equivalent outcome scores were reported by patients preoperatively, but those experiencing follow-up complications reported lower scores at the final follow-up. Overall, 34.4% of patients experienced major complications after long revision fusion surgery. Different risk factors were identified for perioperative versus follow-up complications
Seibert, J Anthony; Clements, Jessica B; Halvorsen, Per H; Herman, Michael G; Martin, Melissa C; Palta, Jatinder; Pfeiffer, Douglas E; Pizzutiello, Robert J; Schueler, Beth A; Shepard, S Jeff; Fairobrent, Lynne A
The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States.The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner.Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized.The following terms are used in the AAPM practice guidelines:Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline.Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.
Kroll, Judith F.; van Hell, Janet G.; Tokowicz, Natasha; Green, David W.
Brysbaert and Duyck (2009) suggest that it is time to abandon the Revised Hierarchical Model (Kroll and Stewart, 1994) in favor of connectionist models such as BIA+ (Dijkstra and Van Heuven, 2002) that more accurately account for the recent evidence on nonselective access in bilingual word recognition. In this brief response, we first review the history of the Revised Hierarchical Model (RHM), consider the set of issues that it was proposed to address, and then evaluate the evidence that supp...
Myers, L.B.; Bell, A.J.
In response to the Three Mile Island (TMI) accident, the US Nuclear Regulatory Commission (NRC) has published the TMI Action Plan. The TMI Action Plan Item I.C.1 called for the upgrading of Emergency Operating Procedures (EOPs) at nuclear power plants. The program developed from this Action Plan item has resulted in utility efforts to: (1) revise EOPs; (2) train personnel in the use of the EOPs; and (3) implement the revised EOPs. The NRC supported the study presented in this report to identify factors which influence the effectiveness of training and implementation of revised EOPs. The NRC's major concern was the possible effects of negative transfer of training. The report includes a summary of existing methods for implementing revisions to procedures based on interviews of plant personnel, a review of the training literature applicable to the effect of previously learned procedures on the learning of and performance with revised procedures (i.e., negative transfer) and recommendations of methods and schedules for implementing revised EOPs. While the study found that the concern over negative transfer of training was not as great as anticipated, several recommendations were made. These include: (1) overtraining of operators to reduce the effect of observed negative transfer; and (2) implementation of the revised EOPs as soon as possible after training to minimize the time operators must rely upon the old EOPs after having been trained on the revised EOPs. The results of the study should be useful both to the utilities and the NRC in the development and review of EOP implementation programs
Mancuso, Francesco; Beltrame, Arianna; Colombo, Elia; Miani, Enrick; Bassini, Fabrizio
Revision total knee arthroplasty (TKA) is usually made more complex by the presence of bone defects, which may be caused by periprosthethic infection, polyethylene wear, implant loosening or fractures. The main aim of the present work is to review the available literature to understand the current options to manage with the bone loss during knee revisions. Available English literature for bone defects in revision TKAs has been evaluated looking at treatment options and their results in terms of clinical and radiological outcomes and failure rates. Anderson Orthopaedic Research Institute (AORI) classification is the most frequently used because it helps in the choice of the most suitable treatment. Several options are available in the management of metaphyseal bone loss in revision knee arthroplasty. For small and contained defects (AORI type 1) cement with or without screws and auto- or allograft morcellized bone are available. In uncontained but mild defects (AORI type 2A) metal augments should be use while large and uncontained defects (AORI type 2B and 3) are best addressed with structural allograft or metal filling devices (cones and sleeves). Stemmed components, either cemented or cementless, are recommended to reduce the strain at the interface implant-host. The treatment of bone defects in revision TKAs has evolved during the last years providing different options with good results at a short/medium term follow up. With the increasing revision burden, further scientific evidence is requested to identify the best approach for each patient. Long-term clinical outcome as well as implant survival after revision TKA are still sub-optimal and depend upon many factors including cause for revision, surgical approach, type of implants used and various patient factors.
The revised edition of the model Regulations for the safe transport of radioactive materials (1973, Vienna, International Atomic Energy Agency Safety Series no.6) has acted as the basis for the conditions of carriage and regulatory requirements in Great Britain. The changes introduced in this revised edition are discussed, and the current Regulations and Codes of Practice covering U.K. and international transport by road, sea, rail and air reviewed. (U.K.)
Tack, C J; Plasschaert, A J M
As part of a revised dental curriculum, a 3(rd) year module on medical subjects was developed based on a mixture of self-study and problem-oriented approach using cases. Pairs of students had to select a specific medical problem and solve a paper patient case using a problem-solving cycle. Results were presented in working groups and by writing an essay. The quality of the presentations was assessed by colleague students and by the teacher supervisor; the expert teacher in the field graded the essay. The results contributed for 40% to the overall grade of the module. A questionnaire filled out by 94% of the participating students showed that 85% of the students agreed in preferring this way of handling medical problems as compared with conventional, lecture-based education. Almost all of them enjoyed the provided opportunity to give a case presentation. The problem-oriented model was assessed as useful by 73% of the students. Knowledge concerning the topic chosen turned out to be higher than knowledge of other topics. Although this study cannot prove that this mode of education actually results in a better ability to cope with medical problems, it may contribute in several ways to the final competences in the area of general medicine in the undergraduate dental curriculum.
Yoshimoto, Kensei; Nakashima, Yasuharu; Yamamoto, Takuaki; Fukushi, Jun-Ichi; Motomura, Goro; Ohishi, Masanobu; Hamai, Satoshi; Iwamoto, Yukihide
Dislocation is a leading cause of failure after revision total hip arthroplasty (THA). This study was conducted to examine the risk factors for dislocation as well as their recurrence after revision THA. We retrospectively reviewed 178 revision THAs in 162 patients between 1998 and 2013. The mean patient age was 65.2 years at operation and the mean follow-up period was 6.7 years. Multivariate logistic regression was performed to identify risk factors for dislocation, and further comparison was made between patients with single and recurrent dislocations. Sixteen hips in 15 patients (9.0 %) dislocated at a mean of 9.1 months (range, 0-83 months) after revision THA. Multivariate analysis identified advanced age (odds ratio [OR] = 2.94/10 years) and osteonecrosis of the femoral head (OR = 7.71) as the independent risk factors for any dislocations. Risk factors for recurrent dislocations, which were observed in eight hips (50 %), were later dislocations (≥4 months) and lower BMI. Dislocation is a serious problem after revision THA with multiple risk factors. Although our findings were limited to revision THAs done through posterolateral approach, recognition of these factors is helpful in patient education and surgical planning.
Ijaz, Tazvin; Nasir, Attikah; Sarfraz, Naema; Ijaz, Shirmeen
To revise conversion disorder scale and to establish the psychometric properties of the revised scale. This case-control study was conducted from February to June, 2014, at the Government College University, Lahore, Pakistan, and comprised schoolchildren and children with conversion disorder. In order to generate items for revised version of conversion disorder scale, seven practising mental health professionals were consulted. A list of 42 items was finalised for expert ratings. After empirical validation, a scale of 40 items was administered on the participants and factor analysis was conducted. Of the240 participants, 120(50%) were schoolchildren (controls group) and 120(50%)were children with conversion disorder (clinical group).The results of factor analysis revealed five factors (swallowing and speech symptoms, motor symptoms, sensory symptoms, weakness and fatigue, and mixed symptoms) and retention of all 40 items of revised version of conversion disorder scale. Concurrent validity of the revised scale was found to be 0.81 which was significantly high. Similarly, discriminant validity of the scale was also high as both clinical and control groups had significant difference (pconversion disorder scale was 76% sensitive to predicting conversion disorder while specificity showed that the scale was 73% accurate in specifying participants of the control group. The revised version of conversion disorder scale was a reliable and valid tool to be used for screening of children with conversion disorder.
Davidge, Kristen M; Ebersole, Gregory C; Mackinnon, Susan E
The purpose of this study was to determine pain and functional outcomes following revision cubital tunnel surgery and to identify predictors of poor postoperative outcome. A retrospective cohort study was conducted of all patients undergoing revision cubital tunnel surgery over a 5-year period at a high-volume peripheral nerve center. Intraoperative findings, demographic and injury factors, and outcomes were reviewed. Average pain, worst pain, and impact of pain on self-perceived quality of life were each measured using a 10-cm visual analog scale (VAS). Function was evaluated using pinch and grip strength, as well as the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Differences in preoperative and postoperative pain, strength, and DASH were analyzed using nonparametric tests. Predictors of postoperative average pain were evaluated using odds ratios and linear regression analyses. The final cohort consisted of 50 patients (mean age: 46.3 ± 12.5 years; 29 [68%] male) undergoing 52 revision ulnar nerve transpositions (UNTs). Pain VAS scores decreased significantly following revision UNT. Strength and DASH scores demonstrated nonsignificant improvements postoperatively. Worse preoperative pain and greater than 1 prior cubital tunnel procedure were significant predictors of worse postoperative average pain VAS scores. Patients can and do improve following revision cubital tunnel surgery, particularly as it relates to pain. Intraoperative findings during the revision procedure suggest that adherence to specific principles in the primary operation is key to prevention of secondary cubital tunnel syndrome.
Pashinian, G A; Tuchik, E S
In order to improve the cooperation between medical criminology departments of the organs of home affairs and forensic medical service in personality identification of unidentified corpses, the authors propose amendments to the routine procedure regulated by documents of the Ministry of Home Affairs of the Russian Federation, for these documents are in need of serious correction and revision, so that they conform to the judicial legislation and other documents.
Full Text Available This paper presents the revised aeromagnetic anomaly map of Italy and its surrounding seas, projected at reference altitude of 2500 m and geomagnetic epoch 1979.0. The magnetic data set used for the map compilation is composed of the total intensity field data acquired partly during the aeromagnetic surveys performed by the Italian National Oil Company (Agip - Direzione Esplorazione Idrocarburi between 1971 and 1980, and during the new surveys committed by the Geophysical Corporate Services of Eni Spa - Exploration & Production Division in the years 2001-2002. In both campaigns the recorded data were very dense and uniformly distributed over the examined area. A detailed re-processing of this data set and a re-organization into a new digital database were carried out. The re-processing was done using modern adequate techniques, obtaining a remarkable exploitation of the data information content. The result is a colour shaded relief map that shows on a large scale many of the structural lineaments of the Italian area. The inclusion of a larger number of data and the subtraction of an appropriate magnetic reference field are the main reasons of an enhancement in the anomaly definition. This new map replaces the previous Agip version, and aims to become the reference aeromagnetic cartography of the Italian area. We think this work will be useful both for researchers interested in large scale tectonic studies, and for anyone interested in the investigation of smaller scale structures, such as volcanic complexes or infra-sedimentary magnetic bodies, as well as for mining research.
China is the world's largest carbon emitter and takes the lion's share of new increased emission since 2000, China's carbon emissions and mitigation efforts have received global attentions (Liu et al., Nature 500, 143-145)1. Yet China's emission estimates have been approved to be greatly uncertain (Guan et al., Nature Climate Change 2, 672-675)2. Accurate estimation becomes even crucial as China has recently pledged to reach a carbon emission peak by 2030, but no quantitative target has been given, nor is it even possible to assess without a reasonable baseline. Here we produced new estimates of Chinese carbon emissions for 1950-2012 based on a new investigation in energy consumption activities and emission factors using extensively surveyed and experimental data from 4243 mines and 602 coal samples. We reported that the total energy consumption is 10% higher than the nationally published value. The investigated emission factors used in China are significantly (40%) different from the IPCC default values which were used in drawing up several previous emission inventories. The final calculated total carbon emissions from China are 10% different than the amount reported by international data sets. The new estimate provides a revision of 4% of global emissions, which could have important implications for global carbon budgets and burden-sharing of climate change mitigation. 1 Liu, Z. et al. A low-carbon road map for China. Nature 500, 143-145 (2013). 2 Guan, D., Liu, Z., Geng, Y., Lindner, S. & Hubacek, K. The gigatonne gap in China's carbon dioxide inventories. Nature Climate Change, 672-675 (2012).
De Ridder, W.; Wesselink, L.G.
The current EU strategy for sustainable development comprises three separate components. Collectively, these comprise a broad spectrum of sustainable development goals, ranging from economic growth and more jobs to halting biodiversity loss and attaining millennium development goals such as poverty reduction. On paper, the entire EU Sustainable Development Strategy (EU SDS) reflects the different views on sustainable development. In reality, however, it is the so-called Lisbon strategy, whose goal it is to transform Europe into the most competitive area of the world by 2010, that dominates policy development in the EU. This focus on the Lisbon strategy is motivated by the assumption that competitiveness is a precondition for sustainable development. However, historical trends show that more growth has thus far not contributed to attaining the sustainable development goals for protection of the world's climate and biodiversity. The current EU SDS is not clear about the extent to which such trade-offs are accepted or about how further trade-offs will be avoided. There are also indications that large groups of EU citizens do not necessarily desire the EU to focus on the Lisbon strategy in favour to the other components of the EU SDS. Revising the EU SDS provides an opportunity to explicitly subordinate the Lisbon strategy to the EU SDS by creating one single document, endorsed and monitored by the EU Council, in which all goals for sustainable development are presented integrally. This document should then describe how the focus on Lisbon will contribute to sustainable development and how tradeoffs are dealt with. Trade-offs should ideally be scientifically underpinned and choices based on broad societal consultation
Vargas, Paul R.
The purpose of this document is to define, document, and allocate the Human Research Program (HRP) requirements to the HRP Program Elements. It establishes the flow-down of requirements from Exploration Systems Mission Directorate (ESMD) and Office of the Chief Health and Medical Officer (OCHMO) to the various Program Elements of the HRP to ensure that human research and technology countermeasure investments are made to insure the delivery of countermeasures and technologies that satisfy ESMD's and OCHMO's exploration mission requirements. Requirements driving the HRP work and deliverables are derived from the exploration architecture, as well as Agency standards regarding the maintenance of human health and performance. Agency human health and performance standards will define acceptable risk for each type and duration of exploration mission. It is critical to have the best available scientific and clinical evidence in setting and validating these standards. In addition, it is imperative that the best available evidence on preventing and mitigating human health and performance risks is incorporated into exploration mission and vehicle designs. These elements form the basis of the HRP research and technology development requirements and highlight the importance of HRP investments in enabling NASA's exploration missions. This PRD defines the requirements of the HRP which is comprised of the following major Program Elements: Behavioral Health and Performance (BHP), Exploration Medical Capability (ExMC), Human Health Countermeasures (HHC), ISS Medical Project (ISSMP), Space Human Factors and Habitability (SHFH), and Space Radiation (SR).
Fabio Rocha Lima
Full Text Available OBJECTIVE: Dengue is a worldwide public health problem with approximately 50 million cases reported annually. The World Health Organization proposed a revised classification system in 2008 to more effectively identify the patients who are at increased risk of complications from dengue. Few studies have validated this new classification system in clinical practice. We conducted a cross-sectional study of patients hospitalized for dengue in Dourados, Mato Grosso do Sul, Brazil, to evaluate the capacity of the two classification systems for detecting severe cases of dengue. MATERIALS AND METHODS: We conducted a cross-sectional study of survey data from the medical records of patients admitted to the University Hospital of the Federal University of Grande Dourados under clinical suspicion of dengue during an epidemic from September 2009 to April 2010. RESULTS: The distribution of patients according to the traditional classification system was as follows: dengue fever, 150/181 (82.9%; dengue hemorrhagic fever, 27/181 (14.9%; and dengue hemorrhagic shock, 4/181 (2.2%. Using the revised classification system, the distribution was as follows: dengue without warning signs, 45/181 (24.3%; dengue with warning signs, 107/181 (59.1%; and severe dengue, 29/181 (15.6%. Of the 150 patients classified as having dengue fever, 105 (70% were reclassified as having dengue with warning signs or severe dengue. CONCLUSION: These data demonstrate that the revised classification system has greater discriminatory power for detecting patients at risk of progression to severe disease and those needing hospitalization.
Lim, Jun Wei; Ridley, David; Johnston, Linda R; Clift, Benedict A
The coexistence of a stable femoral and a loose acetabular component may pose a clinical dilemma for the surgeon. Our study aims at comparing the intermediate functional outcomes and survivorship of acetabulum-only revision total hip arthroplasty (ArTHA) with an age-matched and gender-matched total revision THA (TrTHA) group. We retrospectively reviewed prospectively collected data on the pain, function, and total Harris Hip Scores (HHS) and complication profile for ArTHA and TrTHA cohorts from our regional arthroplasty database. Kaplan-Meier survivorship, with the need for repeat revision surgery as the end point, was used for survival analysis. Among 538 cases, there were fewer acute medical complications in ArTHA and a similar dislocation rate for both cohorts. Preoperative HHS for pain, function, and total were better in the ArTHA cohort, but only the function score reached statistical significance. No significant differences in subsequent years for all aspects of HHS, except the function score was significantly better in the ArTHA cohort at year 1. And 10.0% of ArTHAs and 7.8% of TrTHAs had required rerevision. The 5-year survivorship was 90.3% (95% confidence interval ± 2.1%) for the ArTHA cohort and 92.7% (95% confidence interval ± 1.8%) for the TrTHA cohort (P = .394). The ArTHA with posterior approach (n = 118) group had the lowest dislocation rate and the best trend of functional outcomes. ArTHA can provide similar functional outcomes and dislocation rate to TrTHA, with an acceptable rerevision rate. The posterior approach in this study was not associated with a significant dislocation rate. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.
National Aeronautics and Space Administration — Gridded Population of the World, Version 4 (GPWv4) Population Count Adjusted to Match 2015 Revision of UN WPP Country Totals, Revision 10 consists of estimates of...
National Aeronautics and Space Administration — Gridded Population of the World, Version 4 (GPWv4) Population Density Adjusted to Match 2015 Revision of UN WPP Country Totals, Revision 10 consists of estimates of...
... proposed 3.00M (What is chronic pulmonary hypertension, and how do we evaluate it?) to reflect current... definition of disability before they get their transplants. This section would clarify that we may decide... Chronic pulmonary pulmonary vascular hypertension. hypertension due to any cause 3.10 Sleep-related...
... children. We are requesting your comments as part of our ongoing effort to ensure that our listings reflect...-- Internet, fax, or mail. Do not submit the same comments multiple times or by more than one method.... Internet: We strongly recommend that you submit your comments via the [[Page 53701
McGuire, Frederick L.; Friedmann, Claude T. H.
The new teaching format of a behavioral science course at the University of California, Irvine, College of Medicine is described. Specific objectives were to present an introduction of life's developmental cycles, the nature of mind-body relationships, and dynamics of the doctor-patient relationship, and to develop interviewing skills. (MLW)
... dental) which replace all or part of an internal body organ (including colostomy bags and supplies... intraocular lens.'' Other examples of prosthetic devices include cardiac pacemakers, cochlear implants...
... section 1861(s)(8) of the Act. Prosthetic devices are defined as devices (other than dental) which replace... examples of prosthetic devices include cardiac pacemakers, cochlear implants, electrical continence aids...
... situations in which positive surgical margins would not indicate unresectable cancer. We [[Page 76509... positive surgical margins. Proposed Section 13.00K--How do we evaluate specific cancers? We propose several... change in response to questions we have received from our adjudicators. We would remove the word...
... catastrophic congenital disorders, such as anencephaly, cyclopia, chromosome 13 trisomy (Patau syndrome or... existence of non-mosaic Down syndrome and other congenital disorders that affect multiple body systems under... and childhood listing 110.06 for non-mosaic Down syndrome; and Make editorial changes in childhood...
... catastrophic congenital disorders, such as anencephaly, cyclopia, chromosome 13 trisomy (Patau syndrome or... listings 10.06 and 110.06 Non-mosaic Down syndrome. The commenter suggested that an individual be found to meet the criteria of the listings unless chromosomal analysis shows a diagnosis of mosaic Down syndrome...
Przelaskowski, A.; Jóźwiak, R.; Krzyżewski, T.; Wróblewska, A.
A concept of diagnostic accuracy progression for embedded coding of medical images was presented. Implementation of JPEG2000 encoder with a modified PCRD optimization algorithm was realized and initially verified as a tool for accurate medical image streaming. Mean square error as a distortion measure was replaced by other numerical measures to revise quality progression according to diagnostic importance of successively encoded image information. A faster increment of image diagnostic importance during reconstruction of initial packets of code stream was reached. Modified Jasper code was initially tested on a set of mammograms containing clusters of microcalcifications and malignant masses, and other radiograms. Teleradiologic applications were considered as the first area of interests.
Cheema, S. A.; Asim, M.
Objective: To analyze the secondary cleft lip deformities and the possible causes in a cohort of cases. Study Design: A case series. Place and Duration of Study: Services Institute of Medical Sciences and WAPDA Teaching Hospital Complex, Lahore, from September 2008 to March 2012. Methodology: Consecutive cases of secondary unilateral cleft lip deformities were selected for the study. These cases were interviewed and deformities recorded. Pre and postoperative photographs were taken for comparison. Per operative photographs were taken, after marking of the incisions, to keep a record of the intervention needed to correct the deformities. These cases were then further analyzed to know the deformities and interventions needed for correction of these deformities. Results: Study subjects comprised 114 males and 75 females. Secondary correction was the most common in second decade of life with 82 cases in this group. The most common deformity was unfavorable scar in 150 cases followed by notch at the vermilion border in 124 cases. Short lip was found in 119 cases. Complete revision of the repair was required in 158 cases and 25 cases required partial redo of the initial repair. In other 6 cases, only scar revision was carried out. Conclusion: Unfavorable scar followed by vermilion notch and short lip were the most common secondary cleft lip deformities. Better technique helps favorable scar. Vermilion notch and short lip can be overcome by switching from rotation advancement repair to the triangular flap repair of Noordhoff. (author)
D'Allest, Frederic; Arets, Jean; Baker, Phillip J.; Balmino, Georges; Barth, Hans; Benson, Robert H.
A comprehensive and intensively illustrated development history is presented for spaceflight, ranging over its basic concepts' speculative and fictional origins, the historical roots of rocket-related technologies, and the scientific accomplishments of earth orbit and interplanetary missions to date. Attention is given to propulsion systems, spaceflight launch centers, satellite systems, and solar system exploration by the U.S. and the Soviet Union. Current space-related activities encompass the meteorology, remote sensing, telecommunications and direct broadcasting, and navigation functions of unmanned satellites, as well as such manned spacecraft roles as medical and materials science research. The military uses of space, and increasingly important space industrialization concepts, are discussed as well.
Gittins, John; Harmer, Robin E.
The term "ferrocarbonatite" has been in use for about twenty years but is not adequately defined. The IUGS system of igneous rock nomenclature defines it mineralogically as a carbonatite in which "the main carbonate mineral is iron rich" and chemically as a carbonatite in which (in weight percent) CaO:CaO + MgO + FeO + Fe 2O 3 + MnOrocks that have been called ferrocarbonatites do not have a high proportion of an Fe-rich carbonate mineral and it is clear from their chemical analyses that most are calcite-hematite rocks or magnesian calcite-hematite rocks. Because the IUGS system treats FeO, Fe 2O 3 and MnO as a single component it is unable to distinguish between calcite or dolomite carbonatites that contain hematite or magnetite, and carbonatites that are composed largely of Fe-rich ankerite, or of calcite and siderite. A modified chemical classification is proposed using molar rather than weight proportions in which the ferrocarbonatite field of the IUGS system is divided into two parts so as to recognise a group of rocks to be known as ferruginous calciocarbonatites, and to restrict the term ferrocarbonatite to much more Fe-rich rocks. The revised classification is as follows: calciocarbonatite: CCMF > 0.75, magnesiocarbonatite: CCMF 1.0, ferruginous calcicarbonatite: 0.5 < CCMF < 0.75; MgO/FeO ∗ < 1.0, ferrocarbonatite: CCMF < 0.5; MgO/FeO ∗ < 1.0 where CCMF is the molar ratio CaO/(CaO + MgO + FeO ∗ + MnO) and FeO ∗ refers to molar FeO if FeO and Fe 2O 3 are both determined and total Fe as FeO if not. It is proposed that the term ferrocarbonatite only be used in this modified chemical sense: carbonatites in which the main carbonatite is Fe rich are adequately described using the modal mineralogy.
Simpson, G.; Rankine, A. [UKAEA, Dounreay, Thurso, Scotland (United Kingdom)
is recognised and was simplified using a nonogram. The STARBURST arrangements were successfully demonstrated to the Nuclear Installations Inspectorate in April 1999. These revised arrangements are now in line with the best practice in the industry and well suited for our future requirements. (author)
reviewed, medical and health science journal published three times a year in January-April, May-August and September – December, by the Medical Association of Tanzania (MAT). The journal publishes any contribution that advances medical ...
People with diabetes should always wear a medical alert bracelet or necklace that emergency medical workers will be able to find. Medical identification products can help ensure proper treatment in an ...
... this? Submit What's this? Submit Button Past Emails Medication Use During Pregnancy Recommend on Facebook Tweet Share ... are taking only medications that are necessary. What Medications Can Cause Birth Defects? We know that taking ...
Full Text Available ... J. Lembo, MD, Instructor of Medicine, Harvard Medical School; Division of Gastroenterology, Beth Israel Deaconess Medical Center, ... IBS Medications Probiotics and Antibiotics Psychological Treatments Understanding Stress Cognitive Behavioral Therapy Relaxation Techniques for IBS Take ...
... Training Home Conditions Medication/Drug Allergy Medication/Drug Allergy Make an Appointment Find a Doctor Ask a ... risk for adverse reactions to medications. Facts about Allergies The tendency to develop allergies may be inherited. ...
Full Text Available ... Agents Antidiarrheal Agents Antidepressant Medications Newer IBS Medications Probiotics and Antibiotics Pharmacologic, or drug, therapy is best ... Agents Antidiarrheal Agents Antidepressant Medications Newer IBS ... Antibiotics Psychological Treatments Understanding Stress Cognitive Behavioral ...
Buelow, Amanda K; Haggard, Robbie; Gatchel, Robert J
The present study represents the next stage in the development of a psychometrically sound, self-report screening tool used for assessing the potential pain-medication-misuse risk. A revised Pain Medication Questionnaire (PMQ) was initially designed to successfully evaluate such risk. A subsequent series of two additional studies further documented the clinical utility of the PMQ. A new shortened version of the PMQ was developed, and its psychometric properties, along with its predictive accuracy in identifying risk for medication misuse, were evaluated. Results revealed that the new version maintained the strong psychometric properties of the original PMQ. Moreover, its predictive accuracy was found to be high (85.5% accuracy). Thus, this revised, shortened PMQ can aid physicians in assessing for potential medication misuse, allowing them to more closely monitor at-risk patients during pain management treatment.
Marmor, Michael F; Kellner, Ulrich; Lai, Timothy Y Y; Melles, Ronald B; Mieler, William F
The American Academy of Ophthalmology recommendations on screening for chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy are revised in light of new information about the prevalence of toxicity, risk factors, fundus distribution, and effectiveness of screening tools. Although the locus of toxic damage is parafoveal in many eyes, Asian patients often show an extramacular pattern of damage. DOSE: We recommend a maximum daily HCQ use of ≤5.0 mg/kg real weight, which correlates better with risk than ideal weight. There are no similar demographic data for CQ, but dose comparisons in older literature suggest using ≤2.3 mg/kg real weight. The risk of toxicity is dependent on daily dose and duration of use. At recommended doses, the risk of toxicity up to 5 years is under 1% and up to 10 years is under 2%, but it rises to almost 20% after 20 years. However, even after 20 years, a patient without toxicity has only a 4% risk of converting in the subsequent year. High dose and long duration of use are the most significant risks. Other major factors are concomitant renal disease, or use of tamoxifen. A baseline fundus examination should be performed to rule out preexisting maculopathy. Begin annual screening after 5 years for patients on acceptable doses and without major risk factors. The primary screening tests are automated visual fields plus spectral-domain optical coherence tomography (SD OCT). These should look beyond the central macula in Asian patients. The multifocal electroretinogram (mfERG) can provide objective corroboration for visual fields, and fundus autofluorescence (FAF) can show damage topographically. Modern screening should detect retinopathy before it is visible in the fundus. Retinopathy is not reversible, and there is no present therapy. Recognition at an early stage (before any RPE loss) is important to prevent central visual loss. However, questionable test results should be repeated or validated with additional procedures to avoid
Abdel, Matthew P; Cottino, Umberto; Larson, Dirk R; Hanssen, Arlen D; Lewallen, David G; Berry, Daniel J
Modular fluted tapered stems have become the most commonly employed category of femoral component in revision hip arthroplasty in North America as a result of favorable early results and simplicity of use. Despite wide adoption, the majority of published data are limited to relatively small series with modest follow-up. The goal of the current study was to determine the success rate and factors associated with success, failure, and complications of the use of modular fluted tapered stems in aseptic revision total hip arthroplasties (THAs) in a large patient cohort. We identified 519 aseptic femoral revisions during which a modular fluted tapered stem was utilized. Clinical outcomes, Kaplan-Meier survivorship, radiographic outcomes, and complications were assessed. The mean age at revision arthroplasty was 70 years, the mean body mass index (BMI) was 29 kg/m, and the mean duration of follow-up was 4.5 years (range, 2 to 14 years). The mean Harris hip score (HHS) improved significantly from 51 points preoperatively to 76 points at 2 years (p revisions had been performed: 6 because of aseptic loosening, 4 because of infection, 3 because of instability, 2 because of periprosthetic fracture, and 1 because of stem fracture. The 10-year survivorship was 96% with revision for any reason as the end point and 90% with any reoperation as the end point. Of the patients who were alive and had not undergone revision at the time of final follow-up, 12 had stem subsidence but all but 1 of these stems had stabilized after subsiding. Postoperative complications were noted in 12% of the cases. Repeat revision due to femoral component loosening was not correlated with the preoperative bone-loss category or patient demographic factors. In this large series, femoral revision with a modular fluted tapered stem provided a high rate of osseointegration and sustained improvement in clinical scores at the time of the last follow-up. There was also a high rate of successful implant fixation
Full Text Available Background. Weight regain secondary to VBG pouch dilation is a typical referral for Bariatric surgeons. In this study we compare an endoluminal pouch reduction (Stomaphyx to RYGB for revision. Methods. A retrospective review was completed for patients with a previous VBG presenting with weight regain between 2003–2010. Results. Thirty patients were identified for study 23 RYGB, 14 StomaphyX. Significant post procedure BMI loss was seen in each cohort (RYGB, 47.7 ± 7 kg/m2 to 35 ± 7 kg/m2; StomaphyX 43 ± 10 kg/m2 to 40 ± 9 kg/m2, P=0.0007. Whereas nausea and headache were the only complications observed in StomaphyX patients, the RYGB group had a 43.5% complication rate and 1 mortality. Complications following RYGB include: incisional hernia (13%, anastomotic leak (8.7%, respiratory failure (8.7%, fistula (8.7%, and perforation (4.35%. The median length of stay following RYGB was 6 days compared to 1.5 ± 0.5 days following StomaphyX. Conclusion. This study suggests that while RYGB revision may achieve greater weight loss, the complication rates and severity is discouraging. StomaphyX may be a safe alternative. Further technical modifications of the device and longer follow-up may clarify the role of this approach.
Schulz, Christian; Wenzel-Meyburg, Ursula; Karger, Andr?; Scherg, Alexandra; in der Schmitten, J?rgen; Trapp, Thorsten; Paling, Andreas; Bakus, Simone; Schatte, Gesa; Rudolf, Eva; Decking, Ulrich; Ritz-Timme, Stephanie; Gr?newald, Matthias; Schmitz, Andrea
Background: By means of the revision of the Medical Licensure Act for Physicians (ÄAppO) in 2009, undergraduate palliative care education (UPCE) was incorporated as a mandatory cross sectional examination subject (QB13) in medical education in Germany. Its implementation still constitutes a major challenge for German medical faculties. There is a discrepancy between limited university resources and limited patient availabilities and high numbers of medical students. Apart from teaching theor...
Medicalization appears to be an issue that is both ubiquitous and unquestionably problematic as it seems to signal at once a social and existential threat. This perception of medicalization, however, is nothing new. Since the first main writings in the 1960s and 1970s, it has consistently been used to describe inappropriate or abusive instances of medical authority. Yet, while this standard approach claims that medicalization is a growing problem, it assumes that there is simply one "medical model" and that the expanding realm of "the medical" can be more or less clearly delineated. Moreover, while intended to establish the reality of this growing threat, this research often requires making arbitrary or unjustified distinctions between different practices. To better clarify the concept of medicalization, I will focus more on capturing the variety of medical practices than on the sociological aspects of medical discourse. In doing so, I will explore the distinction between medicalization and pathologization, a distinction that is often overlooked and that brings with it many conceptual and practical implications. After defining these terms, I will use some examples to show that while pathologizing is closely tied to medicalizing, both can occur independently. I will then further develop this distinction in terms of the different individual and social effects of these practices.
Landor, I; Vavrík, P; Jahoda, D; Pokorný, D; Popelka, S; Sosna, A
A prerequisite for the successful implantation of an acetabular component in a defective bone tissue is, in addition to providing sufficient primary fixation of the implant, reconstruction of the acetabular bone bed. To achieve this, one of the options involves the use of an oblong implant. Data published on this topic are sparse and therefore the aim of this study was to gain a deeper insight into this issue. In addition, we wanted to compare the results achieved with the oblong component with those obtained using its original model. One group comprised 111 patients with 133 sides who underwent acetabular revision for aseptic loosening or extraction of an infected acetabular component with subsequent implantation of an oblong cup (Langs-Ovale Revisionspfanne [L.O.R.], Allopro, Switzerland). The average age of this group at the time of surgery was 62.2 (range, 31-83) years, and average follow-up was 9.7 (range, 0.6-13.9) years. The other group consisted of 134 patients with 152 sides who for the same indications as the L.O.R. group received a Walter Oval cup (Medin Orthopaedics, Czech Republic). The average age at the time of surgery was 64.6 (22-86) years, and average follow-up was 7.3 (range, 1.1-9.8) years. The proportion and nature of defects and underlying clinical diagnoses in the two groups were statistically comparable. The patients requiring replacement or removal of the acetabular component were not included in clinical evaluation, but their data were used for survival analysis. The clinical evaluation included: in the L.O.R. group, 115 hip joints at an average follow-up of 10.8 (range, 4.5-13.9) years and, in the Walter Oval group, 144 hip joints at an average follow-up of 7.5 (range, 2.3-9.8) years. The data of patients who died during ;the study (L.O.R., 7 Walter Oval, 11) were included in the clinical evaluation as of the date of the final follow-up. The results for each group were evaluated using the Kaplan-Meier survival analysis, with a simple
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Full Text Available The development of efficient and flexible agent-based medical diagnosis systems represents a recent research direction. Medical multiagent systems may improve the efficiency of traditionally developed medical computational systems, like the medical expert systems. In our previous researches, a novel cooperative medical diagnosis multiagent system called CMDS (Contract Net Based Medical Diagnosis System was proposed. CMDS system can solve flexibly a large variety of medical diagnosis problems. This paper analyses the increased intelligence of the CMDS system, which motivates its use for different medical problem’s solving.
Lee, Hyun Chul; Lee, Yong Hee; Oh, In Seok; Lee, Jung Woon; Cha, Woo Chang; Lee, Dhong Ha
The Application of Human Factors to the design of Man-Machine Interfaces System(MMIS) in the nuclear power plant is essential to the safety and productivity of the nuclear power plants, human factors standards and guidelines as well as human factors analysis methods and experiments are weightily used to the design application. A Korean engineering company has developed a human factors engineering guideline, so-call HF-010, and has used it for human factors design, however the revision of HF-010 is necessary owing to lack of the contents related to the advanced MMI(Man-Machine Interfaces). As the results of the reviews of HF-010, it is found out that the revision of Section 9. Computer Displays of HF-010 is urgent, thus the revision was drafted on the basis of integrated human factors design guidelines for VDT, human factors design guidelines for PMAS SPADES display, human factors design guidelines for PMAS alarm display, and human factors design guidelines for electronic displays developed by the surveillance and operation support project of KOICS. The draft revision of HF-010 Section 9 proposed in this report can be utilized for the human factors design of the advanced MMI, and the high practical usability of the draft can be kept up through the continuous revision according to the advancement of digital technology
Lee, Y. E.; Lee, S. H.; Chang, H. S.; Choi, K. S.; Jung, S. J.
Nuclear safety policy in Korea is currently declared in the Nuclear Safety Charter as the highest tier document and safety principles and directions are announced in the Nuclear Safety Policy Statement. As the circumstances affecting on the nuclear safety policy change, it needs to revise the Statement. This study aims to develop the revised Nuclear Safety Policy Statement to declare that securing safety is a prerequisite to the utilization of nuclear energy, and that all workers in nuclear industry and regulatory body must adhere to the principle of priority to safety. As a result, two different types of revision are being prepared as of August. One is based on the spirit of Nuclear Safety Charter as well as the direction of future-oriented safety policies including the changes in the environment after declaration of the Statement. The other is to declare the fundamental safety objective and safety principles as the top philosophy of national nuclear safety policy by adopting the '10 Safety Principles in IAEA Safety Fundamental' instead of the current Charter. Both versions of revision are subject to further in-depth discussion. However once the revision is finalized and declared, it would be useful to accomplish effectively the organizational responsibilities and to enhance the public confidence in nuclear safety by performing the regulatory activities in a planned and systematic manner and promulgating the government's dedication to priority to safety
Wei, Pengfei; Lu, Zhenzhou; Ruan, Wenbin; Song, Jingwen
The variance ratio function, derived from the contribution to sample variance (CSV) plot, is a regional sensitivity index for studying how much the output deviates from the original mean of model output when the distribution range of one input is reduced and to measure the contribution of different distribution ranges of each input to the variance of model output. In this paper, the revised mean and variance ratio functions are developed for quantifying the actual change of the model output mean and variance, respectively, when one reduces the range of one input. The connection between the revised variance ratio function and the original one is derived and discussed. It is shown that compared with the classical variance ratio function, the revised one is more suitable to the evaluation of model output variance due to reduced ranges of model inputs. A Monte Carlo procedure, which needs only a set of samples for implementing it, is developed for efficiently computing the revised mean and variance ratio functions. The revised mean and variance ratio functions are compared with the classical ones by using the Ishigami function. At last, they are applied to a planar 10-bar structure
Ehni, Hans-Jöerg; Wiesing, Urban
On December 6, 2016, the Council of International Organisations of Medical Sciences published a new version of its guidelines with the title "International Ethical Guidelines for Health-related Research Involving Humans." In this article we briefly describe the revision process and the structure and content of these guidelines. We outline some of its main guidelines such as the ones on social value, post-trial access, and risk-benefit ratio. In our overall evaluation we come to the conclusion that the CIOMS guidelines manage to strike a balance between the protection of human participants in health-related research and the promotion of such research activities in an exemplary way. The guidelines combine key principles with a guide to their application based on the state of the art in research ethics. Thus they represent a timely and indispensable orientation for researchers, ethics committees, and other stakeholders in health-related research.
Conclusion: Life and work experience improve the accuracy of medical staff in providing hospice palliative care. A culture-based, case-oriented continuing education program and a timely revision of the Hospice Palliative Care Article are recommended to increase the consistency between the principle and the practice of hospice palliative care.
... Safety and Health Administration Mine Rescue Teams and Arrangements for Emergency Medical Assistance and... teams for underground coal mines on February 8, 2008. The United Mine Workers of America challenged the... revised its requirements for mine rescue teams for underground coal mines on June 17, 2009. The 2008 mine...
Willer, Lasse; Jensen, R H; Juhler, M
To highlight the group of hydrocephalus patients known to have a long history of shunt revisions and refractory chronic headache. When a shunt in perfect working order has no effect on headache, other causes of headache should be investigated. In this paper, patients with medication overuse...
Knight, Vernon; And Others
Principal features of Baylor's course are annually-revised lecture handouts, medically-oriented laboratory sessions with a manual written especially for the course, and clinical demonstrations of infectious disease. Improvement in student performance seems to be related to the course format, increased teaching proficiency, and allocations of hours…
Silber, Michael H; Becker, Philip M; Earley, Christopher; Garcia-Borreguero, Diego; Ondo, William G
Restless legs syndrome (RLS)/Willis-Ekbom disease (WED) is a common disorder, occurring at least twice a week and causing at least moderate distress in 1.5% to 2.7% of the population. It is important for primary care physicians to be familiar with this disorder and its management. Much has changed in its management since our previous algorithm was published in 2004, including the availability of several new drugs. This revised algorithm was written by members of the Medical Advisory Board of the Willis-Ekbom Disease Syndrome Foundation based on scientific evidence and expert opinion. It considers the management of RLS/WED under intermittent RLS/WED, chronic persistent RLS/WED, and refractory RLS/WED. Nonpharmacological approaches, including mental alerting activities, avoiding substances or medications that may exacerbate RLS, and the role of iron supplementation, are outlined. Chronic persistent RLS/WED should be treated with either a nonergot dopamine agonist or a calcium channel α-2-δ ligand. We discuss the available drugs, the factors determining which to use, and their adverse effects. We define refractory RLS/WED and describe management approaches, including combination therapy and the use of high-potency opioids. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
Shin, Jeong Eun; Jung, Hye-Kyung; Lee, Tae Hee; Jo, Yunju; Lee, Hyuk; Song, Kyung Ho; Hong, Sung Noh; Lim, Hyun Chul; Lee, Soon Jin; Chung, Soon Sup; Lee, Joon Seong; Rhee, Poong-Lyul; Lee, Kwang Jae; Choi, Suck Chei; Shin, Ein Soon
The Korean Society of Neurogastroenterology and Motility first published guidelines for chronic constipation in 2005 and was updated in 2011. Although the guidelines were updated using evidence-based process, they lacked multidisciplinary participation and did not include a diagnostic approach for chronic constipation. This article includes guidelines for diagnosis and treatment of chronic constipation to realistically fit the situation in Korea and to be applicable to clinical practice. The guideline development was based upon the adaptation method because research evidence was limited in Korea, and an organized multidisciplinary group carried out systematical literature review and series of evidence-based evaluations. Six guidelines were selected using the Appraisal of Guidelines for Research & Evaluation (AGREE) II process. A total 37 recommendations were adopted, including 4 concerning the definition and risk factors of chronic constipation, 8 regarding diagnoses, and 25 regarding treatments. The guidelines are intended to help primary physicians and general health professionals in clinical practice in Korea, to provide the principles of medical treatment to medical students, residents, and other healthcare professionals, and to help patients for choosing medical services based on the information. These guidelines will be updated and revised periodically to reflect new diagnostic and therapeutic methods. PMID:27226437
Cano-Guitierrez, Carlos; Samper-Ternent, Rafael; Cabrera, Javier; Rosselli, Diego
To determine the frequency and types of medication used by older adults living in the Colombian capital, Bogota, and to identify the use of potentially inappropriate medications according to the revised Beers criteria. Data were obtained from the health, welfare, and aging (SABE, Spanish: salud, bienestar y envejecimiento) study conducted in both urban and rural areas of Bogota in 2012. The Mann-Whitney U test was used to analyze sex-related differences in the number of medications used among age-stratified subgroups. Of 2 000 subjects, 1,268 (63.4%) were women; furthermore, 1,514 (75.7%) of the total participants had ≤5 years of basic education. The self-reported prevalence rates of hypertension and diabetes were 56.9% and 17.5%, respectively. The average number of medications per subject was 3.24, and it was higher in women (3.50) than in men (2.79). A total of 549 subjects (27.4%) reported using ≥5 medications. Only 311 subjects (15.6%) reported not using any medication. According to the Beers criteria, 443 (6.9%) of the medications were potentially inappropriate. The use of inappropriate medications is a major problem among older adults in Bogota. Further studies should identify factors that increase the risks of polypharmacy and inappropriate medication use and design interventions that would allow older adults to avoid these risks.
Virag, Ioan; Stoicu-Tivadar, Lăcrămioara; Crişan-Vida, Mihaela
The paper presents an application related to collaborative medicine using a browser based medical visualization system with focus on the medical image colorization process and the underlying open source web development technologies involved. Browser based systems allow physicians to share medical data with their remotely located counterparts or medical students, assisting them during patient diagnosis, treatment monitoring, surgery planning or for educational purposes. This approach brings forth the advantage of ubiquity. The system can be accessed from a any device, in order to process the images, assuring the independence towards having a specific proprietary operating system. The current work starts with processing of DICOM (Digital Imaging and Communications in Medicine) files and ends with the rendering of the resulting bitmap images on a HTML5 (fifth revision of the HyperText Markup Language) canvas element. The application improves the image visualization emphasizing different tissue densities.
Medicine has encountered unprecedented problems associated with changes in nature, society, and environment, as well as with new human quests for survival, longevity, and health. In the meantime, the development of medicine is facing challenges that resulted from the over-division and specialization of disciplines and the fragmentation of medical knowledge. To construct a new medical system that is more suitable for human health and disease treatment, holistic integrative medicine (HIM), which regards the human body as a holistic entity, organically integrates the most advanced knowledge and theories in each medical field and the most effective practices in various clinical specialties to revise and adjust on the basis of social, environmental, and psychological conditions. HIM is the inevitable and necessary direction for the future development of medicine. In this article, we illustrated the connotation of HIM, the differences between HIM and other medical conceptions, and the practice of HIM in recent years.
Maeda, Shoichi; Kamishiraki, Etsuko; Starkey, Jay
Abstract Background Patient safety education, including error prevention strategies and management of adverse events, has become a topic of worldwide concern. The importance of the patient safety is also recognized in Japan following two serious medical accidents in 1999. Furthermore, educational curriculum guideline revisions in 2008 by relevant the Ministry of Education includes patient safety as part of the core medical curriculum. However, little is known about the patient safety educatio...
Established are allowable maximum levels for personnel occupationally exposed to ionizing radiation in the ININ and for the public, in accordance with the international standards; defined are categories of radiation facilities, requirements and operating conditions that must be met. Demarcated are the kinds of placards to be posted in controlled and restricted areas and the signs, symbols and tags to be used, defined and established is environmental dosimetric and medical radiation monitoring. Regulated are methods for handling sealed and unsealed sources of radiation, work clothes, closing of radiation installations, storage, transfer and transport of radioactive material; classified are types of possible radiation accidents, action to be taken upon the occurrence and subsequent clean up. (corporate author)
Renilson José MENEGASSI
Full Text Available The text discuss how the concepts and the methodological orientations about text revision and rewriting processes, in teaching context, are conceived, presented and guide the Portuguese Language teacher’s work. To this end, the concepts of revision and rewriting are characterized in four Brazilian official documents, two from national scope and two from Paraná state. The information was organized from what the documents show about the teacher and student attitude face to the investigated concepts, which determine the methodological orientations to the text production work. The results show irregularities in these processes handling, highlighting one of the official documents, from national scope, as the one that presents more suitable methodological and conceptual orientations. It shows that the documents which guide the mother language teaching in the country are still not appropriately discussing the writing text production process, specifically the revision and rewriting, even in more recent documents.
Münch, Henrik J; Jacobsen, Stig; Olesen, Jens T
BACKGROUND AND PURPOSE: It is unclear whether delayed-type hypersensitivity reactions against implanted metals play a role in the etiopathogenesis of malfunctioning total knee arthroplasties. We therefore evaluated the association between metal allergy, defined as a positive patch test reaction...... to common metal allergens, and revision surgery in patients who underwent knee arthroplasty. PATIENTS AND METHODS: The nationwide Danish Knee Arthroplasty Register, including all knee-implanted patients and revisions in Denmark after 1997 (n = 46,407), was crosslinked with a contact allergy patch test......, the prevalence of cobalt and chromium allergy was markedly higher. Metal allergy that was diagnosed before implant surgery appeared not to increase the risk of implant failure and revision surgery. INTERPRETATION: While we could not confirm that a positive patch test reaction to common metals is associated...
Haker, Ayala; Aderka, Idan M; Marom, Sofi; Hermesh, Haggai; Gilboa-Schechtman, Eva
Interpersonal relations are markedly impaired in social anxiety. Yet, little is known about the ways social anxiety affects social cognition. We examined impression formation and impression revision among individuals with social anxiety disorder (SAD, n = 26) and non-anxious individuals (n = 29). Participants read initial descriptions of protagonists depicted as dominant, neutral or submissive and rated them on social rank and affiliation dimensions. Next, participants were presented with behavioral acts that were either congruent, incongruent or irrelevant to the initial descriptions, and re-rated the protagonists. Individuals with SAD (a) rated others as more extreme on social rank dimension, (b) rated others as lower on the affiliation dimension, and (c) revised their impressions of others to a greater extent than did the non-anxious individuals. Understanding the ways social anxiety affects the formation and revision of perceptions of others can improve our understanding of maintaining processes in SAD. Copyright © 2013 Elsevier Ltd. All rights reserved.
Ahmadi, Shahryar; Lawrence, Thomas M; Sahota, Shawn; Schleck, Cathy D; Harmsen, William S; Cofield, Robert H; Sperling, John W
The purposes of this study were to determine the incidence of blood transfusion after revision shoulder arthroplasty and to assess risk factors associated with an increased risk of transfusion. Between 1994 and 2008, 566 consecutive revision shoulder procedures were performed at our institution, which formed the basis of this study. The patient's age, sex, body mass index, comorbidities, preoperative and postoperative hemoglobin level, details of the surgery, operative time, and transfusion details were documented retrospectively from medical records. Overall, 11.3% of patients (64 of 566) required a transfusion. An increased transfusion rate was associated with age (odds ratio [OR] per 10 years, 1.5 [95% confidence interval (CI), 1.2 to 2.0]; P = .002), operative time (≤ 5 hours vs >5 hours) (OR, 3.3 [95% CI, 1.9 to 5.8]; P revision surgery are associated with higher postoperative transfusion rates. These factors should be taken into consideration to more accurately predict the need for transfusion and modify preoperative blood-ordering protocols. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.