WorldWideScience

Sample records for pre-operational safety appraisal

  1. Pre-operational safety appraisal Tritiated Scrap Recovery Facility, Mound facility

    Energy Technology Data Exchange (ETDEWEB)

    Dauby, J.J.; Flanagan, T.M.; Metcalf, L.W.; Rhinehammer, T.B.

    1996-07-01

    The purpose of this report is to identify, assess, and document the hazards which are associated with the proposed operation of the Tritiated Scrap Recovery Facility at Mound Facility. A Pre-operational Safety Appraisal is a requirement as stated in Department of Energy Order 5481.1, Safety Analysis and Review System. The operations to be conducted in the new Tritiated Scrap Waste Recovery Facility are not new, but a continuation of a prime mission of Mound`s i.e. recovery of tritium from waste produced throughout the DOE complex. The new facility is a replacement of an existing process started in the early 1960`s and incorporates numerous design changes to enhance personnel and environmental safety. This report also documents the safety of a one time operation involving the recovery of tritium from material obtained by the Department of Energy from the State of Arizona. This project will involve the processing of 240,000 curies of tritium contained in glass ampoules that were to be used in items such as luminous dial watches. These were manufactured by the now defunct American Atomics Corporation, Tucson, Arizona.

  2. Technical Safety Appraisal of the Rocky Flats Plant

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Blake P.

    1989-01-01

    This report provides the results of a Technical Safety Appraisal (TSA) of the Rocky Flats Plant (RFP) conducted November 14 to 18 and November 28 to December 9, 1988. This appraisal covered the effectiveness and improvements in the RFP safety program across the site, evaluating progress to date against standards of accepted practice. The appraisal included coverage of the timeliness and effectiveness of actions taken in response to the recommendations/concerns in three previous Technical Safety Appraisals (TSAs) of RFP Bldg. 707 conducted in July 1986, Bldgs. 771/774 conducted in October/November 1986, and Bldgs. 776/777 conducted in January/February 1988. Results of this appraisal are given in Section IV for each of 14 technical safety areas at RFP. These results include a discussion, conclusions and any new safety concerns for each technical safety area. Appendix A contains a description of the system for categorizing concerns, and the concerns are tabulated in Appendix B. Appendix C reports on the evaluation of the contractor's actions and the current status of each of the 230 recommendations and concerns contained in the three previous TSA reports.

  3. Technical Safety Appraisal of the Brookhaven National Laboratory

    Energy Technology Data Exchange (ETDEWEB)

    1990-12-01

    The purpose of the Technical Safety Appraisal (TSA) was to assess the effectiveness of representative safety and health programs at the Brookhaven National Laboratory (BNL) through the evaluation of activities at selected facilities and in selected safety disciplines. The TSA was conducted in accordance with established procedures. The following BNL safety and health program elements were reviewed as a part of this TSA: Organization and Administration, Operations, Maintenance, Training and Certification, Nuclear Criticality Safety, Auxiliary Systems, Technical Support, Site/Facility Safety Review, Emergency Preparedness, Radiological Protection, Industrial Hygiene, Occupational Safety, Fire Protection, Quality Verification, and Medical Services. The TSA was conducted from March 26--April 12, 1990. The evaluation was conducted by a team of experts assembled by EH, Office of Safety Appraisals (OSA). TSAs are operationally focused. As such, in terms of safety, health, and quality verification, the site and selected facilities were appraised relative to operations, and the condition of equipment and facilities. The evaluation thus addresses whether current operations are being conducted within the operational safety procedures established for specific facilities and activities.

  4. Pre-operative anaemia.

    Science.gov (United States)

    Clevenger, B; Richards, T

    2015-01-01

    Pre-operative anaemia is a relatively common finding, affecting a third of patients undergoing elective surgery. Traditionally associated with chronic disease, management has historically focused on the use of blood transfusion as a solution for anaemia in the peri-operative period. Data from large series now suggest that anaemia is an independent risk associated with poor outcome in both cardiac and non-cardiac surgery. Furthermore, blood transfusion does not appear to ameliorate this risk, and in fact may increase the risk of postoperative complications and hospital length of stay. Consequently, there is a need to identify, diagnose and manage pre-operative anaemia to reduce surgical risk. Discoveries in the pathways of iron metabolism have found that chronic disease can cause a state of functional iron deficiency leading to anaemia. The key iron regulatory protein hepcidin, activated in response to inflammation, inhibits absorption of iron from the gastrointestinal tract and further reduces bioavailability of iron stores for red cell production. Consequently, although iron stores (predominantly ferritin) may be normal, the transport of iron either from the gastrointestinal tract or iron stores to the bone marrow is inhibited, leading to a state of 'functional' iron deficiency and subsequent anaemia. Since absorption from the gastrointestinal tract is blocked, increasing oral iron intake is ineffective, and studies are now looking at the role of intravenous iron to treat anaemia in the surgical setting. In this article, we review the incidence and impact of anaemia on the pre-operative patient. We explain how anaemia may be caused by functional iron deficiency, and how iron deficiency anaemia may be diagnosed and treated.

  5. Technical Safety Appraisal of the Lawrence Livermore National Laboratory

    Energy Technology Data Exchange (ETDEWEB)

    1990-12-01

    This report documents the results of the Technical Safety Appraisal (TSA) of the Lawrence Livermore National Laboratory (LLNL) (including the Site 300 area), Livermore, California, conducted from February 26 to April 5, 1990. The purpose of the assessment was to provide the Secretary of Energy with the status of Environment, Safety and Health (ES H) Programs at LLNL. LLNL is operated by the University of California for the Department of Energy (DOE), and is a multi-program, mission-oriented institution engaged in fundamental and applied research programs that require a multidisciplinary approach. 1 fig.

  6. Technical safety appraisal of the Nevada Test Site

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1990-12-01

    This report presents the results of one of a series of Technical Safety Appraisals (TSAs) being conducted of Department of Energy (DOE) operations (nuclear and non-nuclear) by the Assistant Secretary of Environment, Safety and Health (ES&H), Office of Safety Appraisals. These TSAs are one of the initiatives announced by the Secretary of Energy on September 18, 1985, to enhance the DOE`s environment, safety, and health program. This TSA report focuses on the safety and health operations of the Nevada Operations Office (NV) at the Nevada Test Site (NTS), which was conducted concurrently, with and supporting a Tiger Team Assessment. The total effort of all the Tiger Team assessment, including environmental and manager evaluations, is reported in the Tiger Team Report, issued January 1990. The assessment of the NTS began November 5, 1989 with the briefing of the Tiger Team in Las Vegas at the Nevada Operations Office. The TSA team evaluation was conducted November 6--17, and November 26--December 1, 1989 at the NTS.

  7. Pre-operative antiseptic skin preparation.

    Science.gov (United States)

    Murkin, Claire Elizabeth

    Theatre nurses use antiseptic skin preparation products every day, but little thought seems to be given as to why a surgeon has a particular preference for one antiseptic skin preparation over another - whether it is for its efficacy, safety or application properties. Woodhead et al (2004) states that nurses still work in a ritualistic environment. Rituals are 'any action performed according to custom, without understanding the reasons why it is being practised'. Nursing practice should be evidence-based; nurses should understand the rationale behind the choice of a particular antiseptic, and be knowledgable about the clinical effectiveness of antiseptic's use pre-operatively, to achieve optimum results. This article focuses on the main types of antiseptic skin preparation while highlighting each product's activity and the relevant considerations for choosing the appropriate product for each patient. Theatre staff need to emphasize the importance of skin preparation and the correct application techniques, while educating the scrub team and surgeons with respect to skin preparation.

  8. Technical safety appraisal: Buildings 776/777 Rocky Flats Plant

    Energy Technology Data Exchange (ETDEWEB)

    Field, H C

    1988-03-01

    Buildings 776/777 at the Rocky Flats Plant are major components of the production complex at the plant site. They have been in operation since 1957. The operations taking place in the buildings are nuclear weapons production support, processing of weapons assemblies returned from Pantex, waste processing, research and development in support of production, special projects, and those generated by support groups, such as maintenance. The appraisal team identified nine deficiencies that it believed required prompt attention. DOE management for EH, the program office (Defense Programs), and the field office analyzed the information provided by the appraisal team and instituted compensatory measures for closer monitoring of contractor activities by knowledgeable DOE staff and staff from other sites. Concurrently, the contractor was requested to address both short-term and long-term remedial measures to correct the identified issues as well as the underlying problems. The contractor has provided his action plan, which is included. This plan was under evaluation by EH and the DOE program office at the time this report was prepared. In addressing the major areas of concern identified above, a well as the specific deficiencies identified by the appraisal team, the contractor and the field office are cautioned to search for the root causes for the problems and to direct corrective actions to those root causes rather than solely to the symptoms to assure the sustainability of the improvements being made. The results of prior TSAs led DOE to conclude that previous corrective actions were not sufficient in that a large number of the individual findings are recurrent. Pending completion of remedial actions over the next few months, enhanced DOE oversight of the contractor is warranted.

  9. An appraisal of meta-analysis guidelines: how do they relate to safety outcomes?

    Science.gov (United States)

    Bennetts, Meg; Whalen, Ed; Ahadieh, Sima; Cappelleri, Joseph C

    2016-09-09

    Although well developed to assess efficacy questions, meta-analyses and, more generally, systematic reviews, have received less attention in application to safety-related questions. As a result, many open questions remain on how best to apply meta-analyses in the safety setting. This appraisal attempts to: (i) summarize the current guidelines for assessing individual studies, systematic reviews, and network meta-analyses; (ii) describe several publications on safety meta-analytic approaches; and (iii) present some of the questions and issues that arise with safety data. A number of gaps in the current quality guidelines are identified along with issues to consider when performing a safety meta-analysis. While some work is ongoing to provide guidance to improve the quality of safety meta-analyses, this review emphasizes the critical need for better reporting and increased transparency regarding safety data in the systematic review guidelines. Copyright © 2016 John Wiley & Sons, Ltd.

  10. Pre-operative fasting guidelines: an update

    DEFF Research Database (Denmark)

    Søreide, E; Eriksson, L I; Hirlekar, G

    2005-01-01

    Liberal pre-operative fasting routines have been implemented in most countries. In general, clear fluids are allowed up to 2 h before anaesthesia, and light meals up to 6 h. The same recommendations apply for children and pregnant women not in labour. In children......Liberal pre-operative fasting routines have been implemented in most countries. In general, clear fluids are allowed up to 2 h before anaesthesia, and light meals up to 6 h. The same recommendations apply for children and pregnant women not in labour. In children...

  11. Pre-operative fasting guidelines: an update

    DEFF Research Database (Denmark)

    Søreide, E; Eriksson, L I; Hirlekar, G

    2005-01-01

    Liberal pre-operative fasting routines have been implemented in most countries. In general, clear fluids are allowed up to 2 h before anaesthesia, and light meals up to 6 h. The same recommendations apply for children and pregnant women not in labour. In children...

  12. Iron therapy for pre-operative anaemia.

    Science.gov (United States)

    Ng, Oliver; Keeler, Barrie D; Mishra, Amitabh; Simpson, Alastair; Neal, Keith; Brookes, Matthew J; Acheson, Austin G

    2015-12-22

    Pre-operative anaemia is common and occurs in up to 76% of patients. It is associated with increased peri-operative allogeneic blood transfusions, longer hospital lengths of stay and increased morbidity and mortality. Iron deficiency is one of the most common causes of this anaemia. Oral iron therapy has traditionally been used to treat anaemia but newer, safer parenteral iron preparations have been shown to be more effective in other conditions such as inflammatory bowel disease, chronic heart failure and post-partum haemorrhage. A limited number of studies look at iron therapy for the treatment of pre-operative anaemia. The aim of this Cochrane review is to summarise the evidence for use of iron supplementation, both enteral and parenteral, for the management of pre-operative anaemia. The objective of this review is to evaluate the effects of pre-operative iron therapy (enteral or parenteral) in reducing the need for allogeneic blood transfusions in anaemic patients undergoing surgery. We ran the search on 25 March 2015. We searched the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), EMBASE Classic and EMBASE (Ovid), CINAHL Plus (EBSCO), PubMed, clinical trials registries, conference abstracts, and we screened reference lists. We included all randomised controlled trials (RCTs) which compared pre-operative iron monotherapy to placebo, no treatment, standard of care or another form of iron therapy for anaemic adults undergoing surgery. Anaemia was defined by haemoglobin values less than 13 g/dL for males and 12 g/dL for non-pregnant females. Data were collected by two authors on the proportion of patients who receive a blood transfusion, amount of blood transfused per patient (units) and haemoglobin measured as continuous variables at pre-determined time-points: pre

  13. Appraisal of Risk Perception in Occupational Health and Safety Research in Developing Countries.

    Science.gov (United States)

    Hilhorst

    1996-10-01

    This paper addresses scientists in the field of occupational health and safety, with a special emphasis on research in developing countries. The article is based on findings of and a method used in a recent study of occupational health and safety in mines in Africa and Latin America. Dialog between technical experts and social scientists is needed to synthesize the values of society and the facts of nature into policy decisions that are both politically legitimate and consistent with the current state of technical knowledge. The author asks how researchers in the field of occupational health can take two axioms of the social sciences into account: 1) the concept of human agency, and 2) the notion that risk perception is socially constructed: rather than being determined by "real" risks, it is shaped by the adversarial context of, among other factors, the nature of labor relations, values in society, and personal histories. With regard to first axiom, it is shown why actors' risk perceptions and their context need indeed to be taken seriously. With regard to the second, a methodologic outline is given to complement technical research on occupational hygiene with risk-perception appraisal. The method is actor-oriented, building on the perceptions, views, and opinions of the different groups of relevant actors. Systematic integration of this method into technological studies could enrich them, contributing substantially to their applicability.

  14. Appraisal of work hazards and safety in the industrial estate of Jeddah.

    Science.gov (United States)

    Noweir, M H; Alidrisi, M M; Al-Jiffry, M S

    1993-08-01

    An environmental study for the appraisal of work hazards and safety in Jeddah Industrial Estate (JIE), Saudi Arabia has been conducted. The study is based upon a representative (stratified random) sample of 44 enterprises, including 52 plants and employing 5830 workers.Nearly 2/3 of the workers have heat exposure, orginating from climatic heat and heat dissipated from industrial operations, while exposure to noise is slightly less, and is attributed to noisy operations and machinery and to lack of meticulous maintenance; both exposures are mild in most of the plants and moderate in some. Mild exposures to nonionizing radiations (UV and IR) and to deficient illumination occur in 25% and 19.2% of the plants studied. Respiratory exposure to chemical agents (organic and inorganic dusts, metal fumes, gases and vapours - including asphyxiants, irritants, liver and nervous system offenders and acid and alkali mists) occurs in 75% of the plants, particularly in the medium-size enterprises plants; however, is mainly mild with a few moderate and severe exposures. Skin absorption contributes to absorption of chemical agents in 29% of the plants, and direct skin contact to chemicals (particularly to lubricating oils) occurs in 81% of the plants.Meanwhile, only eight plants, out of the 32 plants where controls for physical hazards are required (51.2%), apply engineering controls, and even in a few of these plants the efficiency of the control measures has been rated 'bad'. A few of them provide personal protective equipment, and even no maintenance to this equipment is provided.The level of safety is better in the large plants than in the small and medium-size plants; the safety score is the best in the recently established plants, while is the worst in the plastic industry, which is relatively old. The appraisal of fire protection is better than that of the safety, due to efficient supervision of the General Directorate of Civil Defense (GDCD). However, most of the safety

  15. Summary of Tiger Team Assessment and Technical Safety Appraisal recurring concerns in the Training Area. DOE Training Coordination Program

    Energy Technology Data Exchange (ETDEWEB)

    1993-01-01

    Fourteen Tiger Team Assessment and eight Technical Safety Appraisal (TSA) final reports have been received and reviewed by the DOE Training Coordination Program during Fiscal Year 1992. These assessments and appraisals included both reactor and non-reactor nuclear facilities in their reports. The Tiger Team Assessments and TSA reports both used TSA performance objectives, and list ``concerns`` as a result of their findings. However, the TSA reports categorized concerns into the following functional areas: (1) Organization and Administration, (2) Radiation Protection, (3) Nuclear Criticality Safety, (4) Occupational Safety, (5) Engineering/Technical Support, (6) Emergency Preparedness, (7) Safety Assessments, (8) Quality Verification, (9) Fire Protection, (10) Environmental Protection, and I (1) Energetic Materials Safety. Although these functional areas match most of the TSA performance objectives, not all of the TSA performance objectives are addressed. For example, the TSA reports did not include Training, Maintenance, and Operations as functional areas. Rather, they included concerns that related to these topics throughout the 11 functional areas identified above. For consistency, the Training concerns that were identified in each of the TSA report functional areas have been included in this summary with the corresponding TSA performance objective.

  16. Pre-operative investigations: yield and conformity to national guidelines.

    Science.gov (United States)

    Juliana, H; Lim, T A; Inbasegaran, K

    2003-03-01

    Routine ordering of pre-operative investigations yields a low true positive rate and is not cost effective. In this study, case notes of 251 adults who underwent elective surgery were reviewed. Pre-operative investigations were classified as 'indicated' or 'not indicated', based on the national guidelines. Only 56% of all tests done were indicated. The overall rates of expected and unexpected abnormal values from pre-operative blood investigations were 51.1% and 34.4% respectively. This study found that selective testing based on guidelines was beneficial. However, the results also suggest that the local guidelines need to be reviewed.

  17. Efficacy and Safety of Coronary Artery Bypass Grafting Without Stopping Pre-operative Aspirin Administration:A Meta Analysis%冠状动脉旁路移植术前不停用阿司匹林抗血小板治疗有效性和安全性的Meta分析

    Institute of Scientific and Technical Information of China (English)

    李俊红; 艾克拜尔; 木拉提; 艾克热木

    2015-01-01

    目的:系统评价冠状动脉旁路移植术(CABG)前不停用阿司匹林抗血小板治疗的有效性和安全性。方法:计算机检索The Cochrane Library(2014第2期)、PubMed、EMbase、CBM、CNKI、WanFang Data和VIP,收集有关CABG前停用或不停用抗血小板治疗的随机对照研究,检索时限均为从建库至2014-07。由两位评价者根据纳入、排除标准独立选择文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.2软件进行Meta分析。结果:最终纳入8个随机对照研究,共计1945例患者,Meta分析结果显示:与CABG前停用阿司匹林组相比,不停用阿司匹林组术后出血引流量[平均差(MD)=235.97,P=0.01]、二次开胸止血发生率[比值比(OR)=2.4,P=0.0005]及新鲜冰冻血浆输入量(MD=0.79,P<0.0001)明显增加;但在浓缩红细胞输入量(MD=0.66,P=0.05)、血小板输入量(MD=0.99,P=0.25)、术后心肌梗死发生率(OR=1.03,P=0.90)及术后死亡率(OR=1.24,P=0.56)方面,两组差异无统计学意义。结论: CABG前不停用阿司匹林会增加术后出血量、新鲜冰冻血浆输入量及二次开胸止血发生率。术前低剂量的阿司匹林可能有待于上述问题的解决。%Objective: To systemically evaluate the efifcacy and safety of coronary artery bypass grafting (CABG) without stopping pre-operative aspirin administration for anti-platelet therapy in relevant patients. Methods: The computer searching including Cochrane Library (Issue 2, 2014), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP was conducted to collect the randomized controlled trial (RCT) for CABG without stopping pre-operative aspirin administration from the data base establishment until 2014-07. There were 2 reviewers identiifed the literatures independently according to inclusion, exclusion criteria, and extracted the information, evaluated the quality of assessment methods, then meta

  18. Pre-operative pain and sensory function in groin hernia

    DEFF Research Database (Denmark)

    Aasvang, Eske K; Hansen, Jeanette B; Kehlet, Henrik

    2009-01-01

    mechanism. AIMS: To investigate the correlation between pre-operative pain intensity and sensory functions in the groin hernia area. METHODS: Patients with unilateral groin hernia were examined preoperatively by quantitative sensory testing (thermal, mechanical, and pressure [detection and pain thresholds...... pain is not related to findings of hyperalgesia or other changes in sensory function that may support pain-induced pre-operative neuroplasticity as a pathogenic mechanism for the development of persistent postherniotomy pain....

  19. An anaesthetic pre-operative assessment clinic reduces pre-operative inpatient stay in patients requiring major vascular surgery.

    LENUS (Irish Health Repository)

    O'Connor, D B

    2012-02-01

    BACKGROUND: Patients undergoing major vascular surgery (MVS) require extensive anaesthetic assessment. This can require extended pre-operative stays. AIMS: We investigated whether a newly established anaesthetic pre-operative assessment clinic (PAC) would reduce the pre-operative inpatient stay, avoid unnecessary investigations and facilitate day before surgery (DBS) admissions for patients undergoing MVS. PATIENT AND METHODS: One year following and preceding the establishment of the PAC the records of patients undergoing open or endovascular aortic aneurysm repair, carotid endarterectomy and infra-inguinal bypass were reviewed to measure pre-operative length of stay (LoS). RESULTS: Pre-operative LoS was significantly reduced in the study period (1.85 vs. 4.2 days, respectively, P < 0.0001). Only 12 out of 61 patients in 2007 were admitted on the DBS and this increased to 33 out of 63 patients (P = 0.0002). No procedure was cancelled for medical reasons. CONCLUSION: The PAC has facilitated accurate outpatient anaesthetic assessment for patients requiring MVS. The pre-operative in-patient stay has been significantly reduced.

  20. [Pre-operative smoking cessation does not always reduce the incidence of surgical site infection after gastrointestinal surgery].

    Science.gov (United States)

    Kuri, Michioki; Yamada, Terumasa; Nakagawa, Masashi; Tanigami, Hironobu; Kishi, Yoshihiko

    2011-02-01

    Centers for Disease Control (CDC) recommend pre-operative smoking cessation to reduce the risk of surgical site infection (SSI). However, whether pre-operative smoking cessation reduces the incidence of SSI for gastrointestinal surgery is unclear. We investigated whether pre-operative smoking cessation reduces the incidence of SSI among patients undergoing gastrointestinal surgery. The study subjects were 512 consecutive patients undergoing gastrointestinal surgery at Osaka Medical Center for Cancer and Cardiovascular Diseases. SSI occurrence was determined by the hospital SSI surveillance team. Pre-operative smoking status was obtained by interview, and the patients were divided into four groups. Information on age, sex, operation time, operational organ, American Society of Anesthesiologists physical status (ASA-PS), elective or emergency surgery, co-existing procedures, use of scopes, ileo-colostomy, properties of drain tube, use of floss, and wound contamination was obtained from the medical records. The relationship between smoking status and incidence of SSI, and risk factors associated with the incidence of SSI were investigated. SSI occurred in 83 patients. Pre-operative smoking status had no relation with the incidence of SSI. Operation time, gallbladder and pancreatic surgery, colon surgery, emergency surgery, co-existing procedures, ilea-colostomy, closed drain, usage of floss, and wound contamination were related significantly with SSI. Pre-operative smoking cessation does not reduce the incidence of SSI. However, since continuation of smoking has no benefits for the safety of surgery, anesthesiologists must advice patients to quit smoking before surgery.

  1. Posiva's application for a decision in principle concerning a disposal facility for spent nuclear fuel. STUK's statement and preliminary safety appraisal

    Energy Technology Data Exchange (ETDEWEB)

    Ruokola, E. [ed.

    2000-03-01

    In May 1999, Posiva Ltd submitted to the Government an application, pursuant to the Nuclear Energy Act, for a Decision in Principle on a disposal facility for spent nuclear fuel from the Finnish nuclear power plants. The Ministry of Trade and Industry requested the Radiation and Nuclear Safety Authority (STUK) to draw up a preliminary safety appraisal concerning the proposed disposal facility. In the beginning of this report, STUK's statement to the Ministry and Industry concerning the proposed disposal facility is given. In that statement, STUK concludes that the Decision in Principle is currently justified from the standpoint of safety. The statement is followed by a safety appraisal, where STUK deems, how the proposed disposal concept, site and facility comply with the safety requirements included in the Government's Decision (478/1999). STUK's preliminary safety appraisal was supported by contributions from a number of outside experts. A collective opinion by an international group of ten distinguished experts is appended to this report. (orig.)

  2. Safety appraisement on building natural gas pipeline over coal mining subsidence area

    Institute of Scientific and Technical Information of China (English)

    GUO Wei-jia; LIU Jin-xiao; WEN Xing-lin

    2007-01-01

    The target of the text is to scientifically appraise dynamic development of surface deformation in subsidence area and its influence on groundwork stability of natural pipe and then adopt some technological measures to ensure safe circulation of natural pipeline. Analysed the influence on natural pipeline from coal mining subsidence in the way of pipeline grade variation, vertical curve variation, transverse deformation, horizontal pull and compression deformation and pipe stress variation etc., and described detailed surface subsidence product and its used time among initial phase, active phase and decline phase in the course of surface movement deformation time. In the context of considering surface subsidence that doesn't reach basic latter end and residual subsidence quantity, the text confirmed the calculation method of residual deformation in surface subsidence area, and gave the technological measures about building natural gas pipeline in subsidence area finally.

  3. Dynamic Appraisal of Water-Soil Safety of Dump in Coal Field

    Institute of Scientific and Technical Information of China (English)

    MA Rui; HAN Wu-bo; BAI Zhong-ke

    2004-01-01

    Taking Pingshuo West Dump (247.91 hm2) for example, an evaluating model of water-soil safety was set up according to 8 disaster factors of soil erosion: 30 min rainfall intensity, surface material, landform and slope gradient, cover-degree, topographic, engineering measure grade of conservation of water-soil, volume weight and irregular subsidence. In new stage, early stage and later stage of reclamation, the degree of safety and the different site conditions were analyzed by the model. The results indicat that the dump belongs to middle danger, low danger and low safety in new stage, early stage and later stage of reclamation respectively. But at the same stage, different site conditions lead to different safety class because of the different disaster factors.

  4. Greater pre-operative anxiety, pain and poorer function predict a worse outcome of a total knee arthroplasty.

    Science.gov (United States)

    Alattas, Sharifah Adla; Smith, Toby; Bhatti, Maria; Wilson-Nunn, Daniel; Donell, Simon

    2016-10-12

    Around 10-30 % of patients are dissatisfied with the results of their total knee arthroplasty (TKA). This review aimed to identify and evaluate the predictors of outcome measured by the three domains of health-related quality of life (pain, stiffness and function). The focus was on pre-operative psychological factors as related to other patient-related variables. A systematic search was performed using the following databases: MEDLINE, PubMed, AMED, CINAHL, PsychINFO, SciFinder, Scopus, EMBASE, Cochrane, Lilacs, Web of Science and ScienceDirect. The quality of identified studies was assessed using the Critical Appraisal Skills Programme Cohort checklist. Ten studies met the eligibility criteria. From these, nine patient-related predictors of outcome were identified (depression, anxiety, age at surgery, gender (being female), medical co-morbidities, BMI, level of education, pre-operative pain severity and pre-operative knee function). Greater anxiety, pre-operative pain and function were the most significant factors to predict a poorer outcome of a TKA. The results of depression, gender (female), medical co-morbidities, BMI and level of education were variable among the included studies. There was very little evidence to support older age at operation as a predictor of poorer outcome. Patients experiencing high levels of pain before surgery should be informed of the chances of improvement by having a TKA. A validated psychological screening tool that separates depression and anxiety is recommended as part of the pre-operative assessment stage. Patients presenting with symptoms of depression and anxiety should be identified and consulted before a TKA. II.

  5. Deferasirox: appraisal of safety and efficacy in long-term therapy

    OpenAIRE

    2013-01-01

    Preeti Chaudhary, Vinod PullarkatJane Ann Nohl Division of Hematology, University of Southern California Keck School of Medicine, Los Angeles, CA, USAAbstract: Deferasirox is a once-daily, oral iron chelator that is widely used in the management of patients with transfusional hemosiderosis. Several Phase II trials along with their respective extension studies as well as a Phase III trial have established the efficacy and safety of this novel agent in transfusion-dependent patients with &b...

  6. Deferasirox: appraisal of safety and efficacy in long-term therapy.

    Science.gov (United States)

    Chaudhary, Preeti; Pullarkat, Vinod

    2013-01-01

    Deferasirox is a once-daily, oral iron chelator that is widely used in the management of patients with transfusional hemosiderosis. Several Phase II trials along with their respective extension studies as well as a Phase III trial have established the efficacy and safety of this novel agent in transfusion-dependent patients with β-thalassemia, sickle-cell disease and bone marrow-failure syndromes, including myelodysplastic syndrome and aplastic anemia. Data from various clinical trials show that a deferasirox dose of 20 mg/kg/day stabilizes serum ferritin levels and liver iron concentration, while a dose of 30-40 mg/kg/day reduces these parameters and achieves negative iron balance in red cell transfusion-dependent patients with iron overload. Across various pivotal clinical trials, deferasirox was well tolerated, with the most common adverse events being gastrointestinal disturbances, skin rash, nonprogressive increases in serum creatinine, and elevations in liver enzyme levels. Longer-term extension studies have also confirmed the efficacy and safety of deferasirox. However, it is essential that patients on deferasirox therapy are monitored regularly to ensure timely management for any adverse events that may occur with long-term therapy.

  7. Deferasirox: appraisal of safety and efficacy in long-term therapy

    Directory of Open Access Journals (Sweden)

    Chaudhary P

    2013-08-01

    Full Text Available Preeti Chaudhary, Vinod PullarkatJane Ann Nohl Division of Hematology, University of Southern California Keck School of Medicine, Los Angeles, CA, USAAbstract: Deferasirox is a once-daily, oral iron chelator that is widely used in the management of patients with transfusional hemosiderosis. Several Phase II trials along with their respective extension studies as well as a Phase III trial have established the efficacy and safety of this novel agent in transfusion-dependent patients with β-thalassemia, sickle-cell disease and bone marrow-failure syndromes, including myelodysplastic syndrome and aplastic anemia. Data from various clinical trials show that a deferasirox dose of 20 mg/kg/day stabilizes serum ferritin levels and liver iron concentration, while a dose of 30–40 mg/kg/day reduces these parameters and achieves negative iron balance in red cell transfusion-dependent patients with iron overload. Across various pivotal clinical trials, deferasirox was well tolerated, with the most common adverse events being gastrointestinal disturbances, skin rash, nonprogressive increases in serum creatinine, and elevations in liver enzyme levels. Longer-term extension studies have also confirmed the efficacy and safety of deferasirox. However, it is essential that patients on deferasirox therapy are monitored regularly to ensure timely management for any adverse events that may occur with long-term therapy.Keywords: deferasirox, iron overload, thalassemia, sickle-cell disease, myelodysplastic syndrome

  8. Deferasirox: appraisal of safety and efficacy in long-term therapy

    Science.gov (United States)

    Chaudhary, Preeti; Pullarkat, Vinod

    2013-01-01

    Deferasirox is a once-daily, oral iron chelator that is widely used in the management of patients with transfusional hemosiderosis. Several Phase II trials along with their respective extension studies as well as a Phase III trial have established the efficacy and safety of this novel agent in transfusion-dependent patients with β-thalassemia, sickle-cell disease and bone marrow-failure syndromes, including myelodysplastic syndrome and aplastic anemia. Data from various clinical trials show that a deferasirox dose of 20 mg/kg/day stabilizes serum ferritin levels and liver iron concentration, while a dose of 30–40 mg/kg/day reduces these parameters and achieves negative iron balance in red cell transfusion-dependent patients with iron overload. Across various pivotal clinical trials, deferasirox was well tolerated, with the most common adverse events being gastrointestinal disturbances, skin rash, nonprogressive increases in serum creatinine, and elevations in liver enzyme levels. Longer-term extension studies have also confirmed the efficacy and safety of deferasirox. However, it is essential that patients on deferasirox therapy are monitored regularly to ensure timely management for any adverse events that may occur with long-term therapy. PMID:23966805

  9. Appraisal on Rail Transit Development: A Review on Train Services and Safety

    Science.gov (United States)

    Nordin, Noor Hafiza binti; Masirin, Mohd Idrus Haji Mohd; Ghazali, Mohd Imran bin; Azis, Mohd Isom bin

    2017-08-01

    The ever increasing problems faced by population around the world have made demands that transportation need to be improved as an effective and efficient communication means. It is considered as a necessity especially when rapid development and economic growth of a country is the agenda. Among the transportation modes being focused as critical facilities are the bus system, rail system, road network, shipping system and air transportation system. Rail transport is a means of conveyance of passengers and goods by way of wheeled vehicles running on rail tracks. In Malaysia, the railway network has evolved tremendously since its inception in the early 19th century. It has grown proportionally with the national development. Railway network does not only mean for rural transportation, but it also considered as a solution to urban congestion challenges. Currently, urban rail transit is the most popular means of urban transportation system especially as big cities such as Kuala Lumpur. This paper presents the definition of rail transportation system and its role in urban or sub-urban operation. It also describes the brief history of world railway transportation including a discussion on Malaysian rail history perspective. As policy and standard are important in operating a railway system, this paper also illustrates and discusses some elements which have an impact on the effectiveness and efficiency of train operation. Towards the end, this paper also shares the importance of railway safety based on real case studies around the world. Thus, it is hoped that this paper will enable the public to understand the rail transit development and appreciate its existence as a public transportation system.

  10. Critical appraisal of efficacy and safety of abatacept in the treatment of refractory rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Augustine JM

    2012-02-01

    Full Text Available Lisa M Lundquist1, Sabrina W Cole2, Jill M Augustine11Mercer University College of Pharmacy and Health Sciences, Atlanta, GA, 2Wingate University School of Pharmacy, Wingate, NC, USAAbstract: Rheumatoid arthritis is a chronic, progressive, autoimmune disease that leads to significant disability and premature mortality. Various treatment options are available, but the foundation of treatment includes nonbiologic and biologic disease-modifying antirheumatic drugs. The incidence of patients with rheumatoid arthritis refractory to first-line agents is estimated to be at least 20%. Abatacept, a T cell costimulation modulator, is the first agent to interfere with full T cell activation by competing with CD28 for binding of CD80 and CD86, which results in decreased secretion of proinflammatory cytokines and autoantibody production. Current American College of Rheumatology treatment guidelines recommend abatacept for patients with at least moderate disease activity and a poor prognosis demonstrating an inadequate response to other agents. Several key Phase III trials have been conducted to evaluate the efficacy and safety of abatacept in patients with an inadequate response to methotrexate or anti-tumor necrosis factor alpha therapy. Response rates in all trials showed statistically significant improvements compared with placebo according to American College of Rheumatology criteria for disease improvement. The most common adverse event report in patients receiving abatacept was infection; however, the frequency of adverse events was similar to placebo. Abatacept is a safe and effective rheumatoid arthritis treatment for patients with an inadequate response to methotrexate or anti-tumor necrosis factor alpha therapy.Keywords: abatacept, rheumatoid arthritis, treatment refractory, biologic, disease-modifying antirheumatic drugs

  11. Statin therapy and hepatotoxicity: Appraisal of the safety profile of atorvastatin in hyperlipidemic patients

    Directory of Open Access Journals (Sweden)

    Saeed Kalantari

    2014-01-01

    Full Text Available Background: Statins are one of the most frequently prescribed medications to reduce the risk of cardiovascular events. Statins appear to be safe however, there are contradictory data regarding their adverse effects, which might be due to genetic variation in their metabolism. Hence, this prospective study was aimed to evaluate the effects of atorvastatin on liver transaminase changes in a clinical setting, in north Iran. Materials and Methods: This prospective semi-experimental study was performed on hyperlipidemic adults in 2010-2011. Patients received atorvastatin (5-40 mg/d based on the American National Cholesterol Education Program guidelines. Liver aminotransferases were measured in three occasions of baseline, 8 and 16 weeks period. Results: A total of 206 patients were included in the study. Of which 178 were female and 30 were male. Alanine aminotransferase (ALT and aspartate aminotransferase (AST were in normal range before intervention in the majority, except in 25 (12.1% and 16 (7.8% of patients, respectively. In general, ALT and AST remained in normal range over the study period (23.3 IU/L and 21.8 IU/L, respectively. There was found no relationship between different doses of atorvastatin prescribed and ALT/AST changes in the patients. The males′ ALT means at baseline (26.9 IU/L, 8 weeks (30 IU/L and 16 weeks (28.8 IU/L after statin therapy were significantly higher than females (22 IU/L, 22.2 IU/L and 22.1 IU/L, respectively; P < 0.05 for all. Conclusion: The absence of any hepatic adverse effect in the present study supports safety of atorvastatin and emerging opinion that routine screening of liver function tests is not necessary in patients on statins.

  12. Acute gallbladder torsion - a continued pre-operative diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Desrochers Randal

    2011-04-01

    Full Text Available Abstract Acute gallbladder volvulus continues to remain a relatively uncommon process, manifesting itself usually during exploration for an acute surgical abdomen with a presumptive diagnosis of acute cholecystitis. The pathophysiology is that of mechanical organo-axial torsion along the gallbladder's longitudinal axis involving the cystic duct and cystic artery, and with a pre-requisite of local mesenteric redundancy. The demographic tendency is septua- and octo-genarians of the female sex, and its overall incidence is increasing, this being attributed to increasing life expectancy. We discuss two cases of elderly, fragile women presenting to the emergency department complaining of sudden onset right upper quadrant abdominal pain. Their subsequent evaluation suggested acute cholecystitis. Ultimately both were taken to the operating room where the correct diagnosis of gallbladder torsion was made. Pre-operative diagnosis continues to be a major challenge with only 4 cases reported in the literature diagnosed with pre-operative imaging; the remainder were found intra-operatively. Consequently, a delay in diagnosis can have devastating patient outcomes. Herein we propose a necessary high index of suspicion for gallbladder volvulus in the outlined patient demographic with symptoms and signs mimicking acute cholecystitis.

  13. Pre-operative simulation of periacetabular osteotomy via a three-dimensional model constructed from salt

    Directory of Open Access Journals (Sweden)

    Fukushima Kensuke

    2017-01-01

    Full Text Available Introduction: Periacetabular osteotomy (PAO is an effective joint-preserving procedure for young adults with developmental dysplasia of the hip. Although PAO provides excellent radiographic and clinical results, it is a technically demanding procedure with a distinct learning curve that requires careful 3D planning and, above all, has a number of potential complications. We therefore developed a pre-operative simulation method for PAO via creation of a new full-scale model. Methods: The model was prepared from the patient’s Digital Imaging and Communications in Medicine (DICOM formatted data from computed tomography (CT, for construction and assembly using 3D printing technology. A major feature of our model is that it is constructed from salt. In contrast to conventional models, our model provides a more accurate representation, at a lower manufacturing cost, and requires a shorter production time. Furthermore, our model realized simulated operation normally with using a chisel and drill without easy breakage or fissure. We were able to easily simulate the line of osteotomy and confirm acetabular version and coverage after moving to the osteotomized fragment. Additionally, this model allowed a dynamic assessment that avoided anterior impingement following the osteotomy. Results: Our models clearly reflected the anatomical shape of the patient’s hip. Our models allowed for surgical simulation, making realistic use of the chisel and drill. Our method of pre-operative simulation for PAO allowed for the assessment of accurate osteotomy line, determination of the position of the osteotomized fragment, and prevented anterior impingement after the operation. Conclusion: Our method of pre-operative simulation might improve the safety, accuracy, and results of PAO.

  14. Pre-operative simulation of periacetabular osteotomy via a three-dimensional model constructed from salt

    Science.gov (United States)

    Fukushima, Kensuke; Takahira, Naonobu; Uchiyama, Katsufumi; Moriya, Mitsutoshi; Takaso, Masashi

    2017-01-01

    Introduction: Periacetabular osteotomy (PAO) is an effective joint-preserving procedure for young adults with developmental dysplasia of the hip. Although PAO provides excellent radiographic and clinical results, it is a technically demanding procedure with a distinct learning curve that requires careful 3D planning and, above all, has a number of potential complications. We therefore developed a pre-operative simulation method for PAO via creation of a new full-scale model. Methods: The model was prepared from the patient’s Digital Imaging and Communications in Medicine (DICOM) formatted data from computed tomography (CT), for construction and assembly using 3D printing technology. A major feature of our model is that it is constructed from salt. In contrast to conventional models, our model provides a more accurate representation, at a lower manufacturing cost, and requires a shorter production time. Furthermore, our model realized simulated operation normally with using a chisel and drill without easy breakage or fissure. We were able to easily simulate the line of osteotomy and confirm acetabular version and coverage after moving to the osteotomized fragment. Additionally, this model allowed a dynamic assessment that avoided anterior impingement following the osteotomy. Results: Our models clearly reflected the anatomical shape of the patient’s hip. Our models allowed for surgical simulation, making realistic use of the chisel and drill. Our method of pre-operative simulation for PAO allowed for the assessment of accurate osteotomy line, determination of the position of the osteotomized fragment, and prevented anterior impingement after the operation. Conclusion: Our method of pre-operative simulation might improve the safety, accuracy, and results of PAO. PMID:28186873

  15. Performance Appraisal.

    Science.gov (United States)

    Holloway, Mary Louise

    1988-01-01

    Reviews general facets of performance appraisal pointing out the similarities and differences in methods and instruments used to assess the performance of administrative, academic, and nonacademic personnel. Relates the concepts of merit pay and tenure to performance appraisal. (DMM)

  16. Pre-operative pain and sensory function in groin hernia

    DEFF Research Database (Denmark)

    Aasvang, Eske K; Hansen, Jeanette B; Kehlet, Henrik

    2009-01-01

    mechanism. AIMS: To investigate the correlation between pre-operative pain intensity and sensory functions in the groin hernia area. METHODS: Patients with unilateral groin hernia were examined preoperatively by quantitative sensory testing (thermal, mechanical, and pressure [detection and pain thresholds...... (rho=-0.413, p=0.049), indicating a paradoxical association between level of mechanical pain threshold and magnitude of spontaneous pain. No other sensory modality was significantly correlated to pain intensity. New/increased pain during repetitive pinprick stimulation (wind-up) was seen in 3 patients......]) and assessments were correlated to patients' reports of intensity and frequency of spontaneous pain in the groin area. RESULTS: Forty-two patients were examined, whereof one was excluded since no hernia was found intraoperatively. Mechanical pain threshold was inversely correlated with spontaneous pain intensity...

  17. Identifying and assessing anxiety in pre-operative patients.

    Science.gov (United States)

    Pritchard, Michael John

    Increasing demands for hospitals to be more efficient mean that patients attending for an operation are generally admitted on the day of surgery. As a result, healthcare professionals have little time to talk to the patient to ascertain his or her wellbeing, to check for any signs of anxiety and ask whether the patient requires further information about the forthcoming procedure. Healthcare professionals should be encouraged to use appropriate interventions to identify and assess anxious patients. There are several instruments available to measure the patient's level of pre-operative anxiety. This article reviews the Amsterdam Preoperative Anxiety and Information Scale, which is easy for patients to complete and may help to identify which individuals need extra support.

  18. A systematic review of pre-operative predictors of post-operative depression and anxiety in individuals who have undergone coronary artery bypass graft surgery.

    Science.gov (United States)

    McKenzie, Louise H; Simpson, Jane; Stewart, Marie

    2010-01-01

    In addition to the physical benefits, another important objective of coronary artery bypass graft (CABG) surgery is improvement of health-related quality of life. The aim of this systematic review is to provide an overview of the literature relating to the pre-operative prediction of post-operative depression and anxiety in individuals who have undergone CABG surgery. Forty-six studies were identified through a literature search of electronic databases conducted using explicit inclusion and exclusion criteria. The study characteristics, methodological features, and psychometric and clinical outcomes were summarised in a systematic manner. Collective appraisal of the studies indicated that symptoms of depression and anxiety exhibited after CABG surgery are best predicted by pre-operative measures of functioning in that area. Papers were inconclusive with respect to the predictive qualities of gender and age. Further research is required to clarify the predictive values of these and other factors, including pre-morbid ill health and socio-economic status. The findings of this review indicate a range of pre-operative predictors of post-operative depression and anxiety in patients with CABG. Chief among these are pre-operative depression and anxiety. These findings have clinical implications concerning the importance of pre and post-operative psychological assessment and intervention for individuals at risk of poor psychological recovery.

  19. Appraisal Report

    DEFF Research Database (Denmark)

    Schleimann, Finn; Enemark, Ulrika; Vagnby, Bo Hellisen

    Appraisal of continued support to Ghana's health sector for a third phase covering 2003 - 2007. Funding recommended with DKK 340 million over five years.......Appraisal of continued support to Ghana's health sector for a third phase covering 2003 - 2007. Funding recommended with DKK 340 million over five years....

  20. Pre-operative chemotherapy and radiotherapy in breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Goldhirsch, A. [Division of Medical Oncology, Istituto Europeo di Oncologia, Via Ripamonti 435, 20121 Milan (Italy); Viale, G. [Division of Pathology, Istituto Europeo di Oncologia, Via Ripamonti 435, 20121 Milan (Italy); Zurrida, S.; Veronesi, P. [Division of Senology, Istituto Europeo di Oncologia, Via Ripamonti 435, 20121 Milan (Italy); Orecchia, A. [Service of Radiology, Istituto Europeo di Oncologia, Via Ripamonti 435, 20121 Milan (Italy); Luini, A. [Division of Senology, Istituto Europeo di Oncologia, Via Ripamonti 435, 20121 Milan (Italy); Noberasco, C.; Minchella, I.; Nole' , F.; Colleoni, M. [Division of Medical Oncology, Istituto Europeo di Oncologia, Via Ripamonti 435, 20121 Milan (Italy)

    1998-04-01

    Primary systemic treatment of breast cancer with cytotoxics yields a high response rate and allows conservative surgical procedures in bulky tumours. In order to maximise local control of disease, two innovations were introduced in a pilot study. The first was to identify the good responders after three cycles of chemotherapy and to treat them with three additional cycles. The second was to also give this group of patients a full dose of radiotherapy before surgery with the aim of verifying the rate of pathological complete remissions in view of a possible treatment of breast primary with chemoradiotherapy only. Patients were treated with doxorubicin 60 mg/m{sup 2} and cyclophosphamide, 600 mg/m{sup 2} both intravenously on day 1, every 21 days for three courses. Partial or complete responders received three more courses followed by radiotherapy (50 Gy plus a 10 Gy boost). The others underwent immediate surgery. A total of 32 patients (median age, 50 years; range 28-69 years); performance status, 0-1; T{sub 2} 22, T{sub 3} 8, T{sub 4} 2) were enrolled and were evaluable for response and side-effects. 9 patients had only three cycles of chemotherapy due to absence of response and 23 patients had six cycles of chemotherapy. Overall, 7 patients had a complete remission, 16 a partial remission and 9 had stable disease, for an overall response rate of 72% (95% confidence interval 53-86%). In the group of patients that completed the programme, two complete pathological remissions were observed and 5 patients had only microfoci of tumour. No toxic death or grade III-IV toxicities were observed. Mild or moderate side-effects included mucositis, nausea/vomiting and leucopenia. In conclusion, our results indicate that the addition of radiotherapy to pre-operative chemotherapy did not significantly enhance the incidence of pathological complete remissions. New primary treatment approaches should be explored in this subset of patients in order to improve outcome. (Copyright (c

  1. Growth Hormone Safety Workshop Position Paper: a critical appraisal of recombinant human growth hormone therapy in children and adults

    DEFF Research Database (Denmark)

    Allen, David B; Backeljauw, Philippe; Bidlingmaier, Martin

    2015-01-01

    , the statement highlighted a number of areas for on-going surveillance of long-term safety, including cancer risk, impact on glucose homeostasis, and use of high dose pharmacological rhGH treatment. Over the intervening years, there have been a number of publications addressing the safety of rhGH with regard...

  2. 防汛墙的检测与安全鉴定%DETECTION AND SAFETY APPRAISAL METHOD OF FLOOD PROTECTION WALL

    Institute of Scientific and Technical Information of China (English)

    韩志强

    2012-01-01

    为了解某段防汛墙使用一段时期后的现状,通过多种检测技术在该段防汛墙安全鉴定中的应用,科学评价了该段防汛墙的安全性,总结了防汛墙安全鉴定工作经验,并为制订防汛墙的后续除险维修方案提供了依据.%In order to understand the use of a period after the current situation in a part of flood prevention wall .through a variety of detecting technology in this part of flood prevention wall, than appraise ihe scientific evaluation of the period of flood prevention wall safety,the authors summarized the experience of the safety evaluation on flood prevention wall, and propose the maintenance measures for preventing the disaster after a long period from construction.

  3. GH safety workshop position paper: a critical appraisal of recombinant human GH therapy in children and adults.

    Science.gov (United States)

    Allen, D B; Backeljauw, P; Bidlingmaier, M; Biller, B M K; Boguszewski, M; Burman, P; Butler, G; Chihara, K; Christiansen, J; Cianfarani, S; Clayton, P; Clemmons, D; Cohen, P; Darendeliler, F; Deal, C; Dunger, D; Erfurth, E M; Fuqua, J S; Grimberg, A; Haymond, M; Higham, C; Ho, K; Hoffman, A R; Hokken-Koelega, A; Johannsson, G; Juul, A; Kopchick, J; Lee, P; Pollak, M; Radovick, S; Robison, L; Rosenfeld, R; Ross, R J; Savendahl, L; Saenger, P; Toft Sorensen, H; Stochholm, K; Strasburger, C; Swerdlow, A; Thorner, M

    2016-02-01

    Recombinant human GH (rhGH) has been in use for 30 years, and over that time its safety and efficacy in children and adults has been subject to considerable scrutiny. In 2001, a statement from the GH Research Society (GRS) concluded that 'for approved indications, GH is safe'; however, the statement highlighted a number of areas for on-going surveillance of long-term safety, including cancer risk, impact on glucose homeostasis, and use of high dose pharmacological rhGH treatment. Over the intervening years, there have been a number of publications addressing the safety of rhGH with regard to mortality, cancer and cardiovascular risk, and the need for long-term surveillance of the increasing number of adults who were treated with rhGH in childhood. Against this backdrop of interest in safety, the European Society of Paediatric Endocrinology (ESPE), the GRS, and the Pediatric Endocrine Society (PES) convened a meeting to reappraise the safety of rhGH. The ouput of the meeting is a concise position statement.

  4. GH safety workshop position paper: a critical appraisal of recombinant human GH therapy in children and adults

    Science.gov (United States)

    Allen, D B; Backeljauw, P; Bidlingmaier, M; Biller, B M K; Boguszewski, M; Burman, P; Butler, G; Chihara, K; Christiansen, J; Cianfarani, S; Clayton, P; Clemmons, D; Cohen, P; Darendeliler, F; Deal, C; Dunger, D; Erfurth, E M; Fuqua, J S; Grimberg, A; Haymond, M; Higham, C; Ho, K; Hoffman, A R; Hokken-Koelega, A; Johannsson, G; Juul, A; Kopchick, J; Lee, P; Pollak, M; Radovick, S; Robison, L; Rosenfeld, R; Ross, R J; Savendahl, L; Saenger, P; Toft Sorensen, H; Stochholm, K; Strasburger, C; Swerdlow, A; Thorner, M

    2015-01-01

    Recombinant human GH (rhGH) has been in use for 30 years, and over that time its safety and efficacy in children and adults has been subject to considerable scrutiny. In 2001, a statement from the GH Research Society (GRS) concluded that ‘for approved indications, GH is safe’; however, the statement highlighted a number of areas for on-going surveillance of long-term safety, including cancer risk, impact on glucose homeostasis, and use of high dose pharmacological rhGH treatment. Over the intervening years, there have been a number of publications addressing the safety of rhGH with regard to mortality, cancer and cardiovascular risk, and the need for long-term surveillance of the increasing number of adults who were treated with rhGH in childhood. Against this backdrop of interest in safety, the European Society of Paediatric Endocrinology (ESPE), the GRS, and the Pediatric Endocrine Society (PES) convened a meeting to reappraise the safety of rhGH. The ouput of the meeting is a concise position statement. PMID:26563978

  5. A case of industrial safety appraisal for extension of service life of GTK-10-4 gas turbines used at gas transmission stations

    Science.gov (United States)

    Rybnikov, A. I.; Kovalev, A. G.; Kryukov, I. I.; Leont'ev, S. A.; Moshnikov, A. V.

    2017-04-01

    It is shown that the extended life and enhanced operational reliability of parts and subassemblies of the most popular GTK-10-4 gas transmission plants are determined by the enhanced efficiency of the control over technical condition and operational safety of turbine plants in conformity with industrial safety requirements imposed on gas pipeline compressor stations. It has been established that the materials of parts and subassemblies of gas turbine plants with different, especially with maximal operating time, shall be exposed to NDT for the purpose of determining the actual mechanical characteristics of these materials with different operating time and calculating residual life. The analysis of damageability and operating conditions has helped to identify parts and subassemblies for repair or replacement with the highest frequency of unacceptable defects. These parts and subassemblies have been shown to include base members of the axial compressor (AC), a turbine housing, an axial compressor rotor, high- and low-pressure turbine (HPT and LPT) discs, a 12-part holder, the housing of the holder of HPT and LPT guiding blades, a sealed baffler, and working and guiding AC, LPT and HPT blades. The most typical operational defects have been enumerated and analyzed. It has been determined that the primary task of the industrial safety appraisal for extending the life of GTK-10-4 with limit-exceeding operating time is to thoroughly examine HPT and LPT discs with more than 130,000 hours of operating time and establish by DT methods characteristics of materials for evaluation, taking account of their degradation, and residual life of critical turbine elements. In addition, it has been shown that the service life of HP turbine discs can be extended by replacing the disc material (EP-428 12% chromium steel) with a material with a higher linear expansion factor that somewhat exceeds the expansion factor of EI-893 nickel alloy used to melt out working blades.

  6. GH safety workshop position paper: A critical appraisal of recombinant human GH therapy in children and adults

    Science.gov (United States)

    Recombinant human Growth Hormone (rhGH) has been in use for 30 years, and over that time its safety and efficacy in children and adults has been subject to considerable scrutiny. In 2001, a statement from the GH Research Society (GRS) concluded that 'for approved indications, GH is safe'; however, t...

  7. Multidetector computed tomography (MDCT angiography of thoracic aortic coarctation in pediatric patients: Pre-operative evaluation

    Directory of Open Access Journals (Sweden)

    Mohamad Zakaryia Al-Azzazy

    2014-03-01

    Conclusion: We concluded that MDCT angiography with multiplanar and three dimensional techniques can be considered the modality of choice for pre-operative assessment of coarctation of the thoracic aorta in pediatric patients.

  8. [Pre-operative correction of severe scoliosis by halo and walking-frame system (author's transl)].

    Science.gov (United States)

    Durand, Y; Rigault, P; Pouliquen, J C; le Henaff, J C

    1980-01-01

    Ten cases of very severe scoliotic curves have been corrected pre-operatively by permanent traction with a halo suspended at a walking-frame device. The mean initial angulation was 110 degrees and the mean pre-operative correction was 48% for a mean use of two months. This procedure permits the patients a sub-normal activity, gives a good correction as "halo-cast" or "halo-pelvic" and avoids all cutaneous, neurological or psychological complications.

  9. The association between radiographic severity and pre-operative function in patients undergoing primary knee replacement for osteoarthritis

    DEFF Research Database (Denmark)

    Dowsey, Michelle M; Dieppe, Paul; Lohmander, Stefan

    2012-01-01

    To determine the association between radiographic osteoarthritis (OA) and pre-operative function in patients undergoing primary knee replacement.......To determine the association between radiographic osteoarthritis (OA) and pre-operative function in patients undergoing primary knee replacement....

  10. Quantification of respiratory depression during pre-operative administration of midazolam using a non-invasive respiratory volume monitor

    Science.gov (United States)

    Gonzalez Castro, Luis N.; Mehta, Jaideep H.; Brayanov, Jordan B.; Mullen, Gary J.

    2017-01-01

    Background Pre-operative administration of benzodiazepines can cause hypoventilation—a decrease in minute ventilation (MV)—commonly referred to as “respiratory compromise or respiratory depression.” Respiratory depression can lead to hypercarbia and / or hypoxemia, and may heighten the risk of other respiratory complications. Current anesthesia practice often places patients at risk for respiratory complications even before surgery, as respiratory monitoring is generally postponed until the patient is in the operating room. In the present study we examined and quantified the onset of respiratory depression following the administration of a single dose of midazolam in pre-operative patients, using a non-invasive respiratory volume monitor that reports MV, tidal volume (TV), and respiratory rate (RR). Methods Impedance-based Respiratory Volume Monitor (RVM) data were collected and analyzed from 30 patients prior to undergoing orthopedic or general surgical procedures. All patients received 2.0 mg of midazolam intravenously at least 20 minutes prior to the induction of anesthesia and the effects of midazolam on the patient's respiratory function were analyzed. Results Within 15 minutes of midazolam administration, we noted a significant decrease in both MV (average decrease of 14.3% ± 5.9%, pbenzodiazepines affect primarily TV rather than RR. Such respiratory monitoring data provide the opportunity for individualizing dosing and adjustment of clinical interventions, especially important in elderly patients. With additional respiratory data, clinicians may be able to better identify and quantify respiratory depression, reduce adverse effects, and improve overall patient safety. PMID:28235069

  11. Critical appraisal of the efficacy, safety, and patient acceptability of hydroxyprogesterone caproate injection to reduce the risk of preterm birth

    Directory of Open Access Journals (Sweden)

    Vidaeff AC

    2013-07-01

    Full Text Available Alex C Vidaeff, Michael A BelfortDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USAAbstract: Prevention of preterm delivery is a major desiderate in contemporary obstetrics and a societal necessity. The means to achieve this goal remain elusive. Progesterone has been used in an attempt to prevent preterm delivery since the 1970s, but the evidence initially accumulated was fraught by mixed results and was based on mostly underpowered studies with variable eligibility criteria, including history of spontaneous abortion as an indication for treatment. More recent randomized controlled clinical trials restimulated the interest in progesterone supplementation, suggesting that progesterone may favorably influence the rate of preterm delivery. Preterm delivery is a complex disorder and consequently it is unlikely that one generalized prevention strategy will be effective in all patients. Further, an additional impediment in accepting progesterone as the "magic bullet" in the prevention of preterm delivery is that its mechanism of action is not fully understood and the optimal formulations, route of administration, and dose have yet to be established. We have concerned ourselves in this review with the most recent status of 17 alpha-hydroxyprogesterone caproate (17OH-PC supplementation for prevention of preterm delivery. Our intention is to emphasize the efficacy, safety, and patient acceptability of this intervention, based on a comprehensive and unbiased review of the available literature. Currently there are insufficient data to suggest that 17OH-PC is superior or inferior to natural progesterone. Based on available evidence, we suggest a differential approach giving preferential consideration to either 17OH-PC or other progestins based on obstetric history and cervical surveillance. Progestin therapy for risk factors other than a history of preterm

  12. Critical appraisal of the safety and efficacy of insulin detemir in glycemic control and cardiovascular risk management in diabetics

    Directory of Open Access Journals (Sweden)

    Jean-Pierre Le Floch

    2010-06-01

    Full Text Available Jean-Pierre Le FlochDepartment of Diabetology, Medical Clinic, Villecresnes, FranceAbstract: Insulin detemir is an analog of human insulin designed to provide a long duration of basal insulin action. This is achieved by protracted absorption from the injection depot, which results in part from increased self-association of insulin detemir molecules and in part from reversible albumin binding. Subsequent albumin binding in the circulation is thought to buffer changes in the effects at target tissues that could otherwise arise from variability in absorption rate. In consequence, insulin detemir has shown a less variable pharmacodynamic profile than alternative basal insulins; this manifests as more consistent temporal glucose reduction profiles in repeat-clamp studies. In clinical trials, insulin detemir has been characterized by consistent risk reductions in hypoglycemia, as well as reduced weight gain in comparison with other basal insulins. Given some recent associations that have been made in prospective and epidemiologic studies between glucose variability and/or hypoglycemia and increased cardiovascular risk, and the long-known association between excess weight and cardiovascular risk, it is possible that the clinical profile of insulin detemir may carry prognostic value with regard to cardiovascular safety, although this is yet to be substantiated. There have also been some concerns raised recently over the use of insulin analogs and cancer risk, but available clinical data and the receptor interaction profile of insulin detemir suggest no excess in risk in comparison with human insulin therapy. Optimal approaches for the clinical use of insulin detemir have been emerging through an increasing clinical study base, and the analog is becoming established as a potentially valuable therapy option.Keywords: insulin detemir, type 2 diabetes, glucose variability, hypoglycemia, weight gain

  13. High-resolution CT: pre-operative assessment of chronic and recurrent rhinosinusitis

    Energy Technology Data Exchange (ETDEWEB)

    Ferrie, J.C. [Dept. of Radiology A, University Hospital, 86 Poitiers (France); Vandermarcq, P. [Dept. of Radiology A, University Hospital, 86 Poitiers (France); Azais, O. [Dept. of Radiology A, University Hospital, 86 Poitiers (France); Klossek, J.M. [Dept. of Oto-Rhino-Laryngology, University Hospital, 86 Poitiers (France); Drouineau, J. [Dept. of Radiology A, University Hospital, 86 Poitiers (France)

    1993-04-01

    The better understanding of chronic and recurrent rhinosinusitis and the advance in endoscopic endonasal surgery have modified the radiological pre-operative investigation of this condition. The ethmoid labyrinth, not accessible to the endoscope, may be explored by axial and coronal high-resolution thin section (2 mm) CT. We have reviewed 100 CT scans with endoscopic correlation in order to assess the accuracy of this pre-operative method. This anatomical study reveals the presence and extent of parasinus diseases which are usually concentrated in the area of the ostiomeatal unit. The anatomic variations of the lateral nasal wall that have been reporded as predisposing to sinusitis and the morphologic variations altering the relationships of the ethmoid with the orbits and the brain were also studied. This pre-operative radiological assessment is currently necessary for functional and safe surgery. (orig.)

  14. Pre-operative haematological investigations in paediatric orofacial cleft repair: Any relevance to management outcome?

    Directory of Open Access Journals (Sweden)

    Anthony T Adenekan

    2012-01-01

    Full Text Available Aim and Objectives: To determine the value of routine pre-operative haematologic investigations in children undergoing orofacial cleft repair. Background: Although routine pre-operative laboratory screening tests are carried out traditionally, some studies suggest that they are not absolutely necessary in the management of elective surgical patients. Materials and Methods: This is a prospective cohort study carried out at a tertiary health facility located in Nigeria. A review of the laboratory investigations in 116 paediatric orofacial cleft patients undergoing surgery during a 6-year period was undertaken. Pre-operative laboratory investigations and peri-operative transfusion records were analysed for the frequency and impact of abnormal results on treatment plan and outcome using the Statistical Packages for the Social Scientists 16.0. Results: All the children had pre-operative packed cell volume (PCV check on admission for surgery. The PCV ranged from 23% to 43%, mean was 32.9 (±3.7%. Twenty-two children (18.6% had sub-optimal PCV (<30%. Patients with the lowest PCV values (23% and 26% were transfused pre-operatively. The lowest post-operative PCV was 23%, mean 30.8 (±3.3%. There was no occasion of post-operative blood transfusion. Eighty-six patients (72.9% had full or partial serum electrolyte and urea analysis. Screening for sickle-cell disease was rarely done. Fourteen intra- and post-operative complications were recorded. None of these were predictable by the results of pre-operative screening tests carried out. All the children were discharged home in satisfactory condition. Conclusions: Routine laboratory testing has minimal impact on management and outcome of orofacial cleft surgeries. However, haematocrit screening may be appropriate, particularly in clinically pale patients.

  15. Relationship Between Pre-operative Anxiety and Post-operative Psychosomatic Adjustment and Its Related Factors and Nursing Strategies%术前焦虑与术后心身康复的相关性及其心理社会影响因素

    Institute of Scientific and Technical Information of China (English)

    沈晓红; 姜乾金

    2003-01-01

    Objective:To study the relationship between pre-operative anxiety and post-operative psychosomatic adjustment and the related psyehosoeial factors in upper- abdominal surgery patients. Methods: Forty patients undergoing upper- abdominalsurgery were assessed in this report. One day before surgery, the Medical Coping Mode Questionnaire (MCMQ), Perceived Social Support Scale (PSSS), Eysenek Personality Questionnaire (EPQ), State Anxiety Inventory (SAI) of State - Trait Arixiety Invento-ry (STAI) and a self- developed patients'' pre - operative appraisal questionnaire were used. In an hour before operation,the shift of the mean value of the pulse of every ease compared with the base line measured at his (or her ) admission was also recorded. Af-ter surgery, State Anxiety Inventory (SAI) of State- Trait Anxiety Inventory (STAI), a self-developed postoperative appraisal scale were used, and the indexes of somatic adjustment, including intestinal aerofluxus, total dosage of analgesia and so on were recorded. Results:Firstly, pre - operative anxiety was remarkably correlated to many indexes of post - operative psychosomatic adjustment. Secondly, hopelessness about operation, concern over sequela, resignation coping style and psychosis personality were the significant predictors of pre- operative anxiety. Conclusion: Post- operative psychosomatic adjustment could be handicapped by pre - operative anxiety which might be influenced by stress - related psyehosocial factors.

  16. Chronic pre-operative opioid use and acute pain after fast-track total knee arthroplasty

    DEFF Research Database (Denmark)

    Aasvang, E K; Lunn, T H; Hansen, T B;

    2016-01-01

    BACKGROUND: Pre-operative opioid use has been suggested to increase post-operative pain and opioid consumption after total knee arthroplasty (TKA), but previous studies are either retrospective or inhomogeneous with regard to surgical procedures or control of analgesic regimes, or with few opioid...

  17. Target motion predictions for pre-operative planning during needle-based interventions

    NARCIS (Netherlands)

    Buijs, op den Jorn; Abayazid, Momen; Korte, de Chris L.; Misra, Sarthak

    2011-01-01

    During biopsies, breast tissue is subjected to displacement upon needle indentation, puncture, and penetration. Thus, accurate needle placement requires pre-operative predictions of the target motions. In this paper, we used ultrasound elastography measurements to non-invasively predict elastic prop

  18. Predictive potential of pre-operative functional neuroimaging in patients treated with subthalamic stimulation

    Energy Technology Data Exchange (ETDEWEB)

    Sestini, Stelvio; Castagnoli, Antonio [Ospedale Misericordia e Dolce, Department of Diagnostic Imaging, Nuclear Medicine Unit, Prato (Italy); Pupi, Alberto; Sciagra, Roberto [University of Florence, Department of Clinical Physiopathology, Nuclear Medicine Unit, Florence (Italy); Ammannati, Franco; Ramat, Silvia; Sorbi, Sandro [University of Florence, Department of Neurological and Psychiatric Sciences, Florence (Italy); Mansi, Luigi [University II Naples, Department of Diagnostic Imaging, Nuclear Medicine Unit, Naples (Italy)

    2010-01-15

    The aim of this study was to investigate the predictive potential of pre-operative regional cerebral blood flow (rCBF) in the pre-supplementary motor area (pre-SMA) and clinical factors in Parkinson's disease (PD) patients treated with subthalamic nucleus (STN) stimulation. Ten patients underwent rCBF SPECT and motor Unified Parkinson's Disease Rating Scale (UPDRS) pre- and post-operatively during stimulation at 5 and 42 months. Statistical parametric mapping (SPM) was used to extract rCBF values in the pre-SMA because it is related with motor improvement. Post-operative outcomes included motor response to stimulation and percent improvement in UPDRS. Pre-operative predictors were explored by correlation test, linear regression and multivariate analyses. Higher pre-operative rCBF in the pre-SMA and younger age were associated with favourable outcomes at 5 and 42 months. Pre-operative rCBF results were significantly associated with baseline clinical factors. This study shows that PD patients with younger age have higher rCBF values in the pre-SMA and better outcome, thus giving the rationale to the hypothesis that STN stimulation could be considered early in the course of disease. (orig.)

  19. Pre-operative patient preparation in the prevention of surgical site infections.

    Science.gov (United States)

    McBride, Tara; Beamer, Jennifer

    2007-12-01

    In 1999 the Ontario Ministry of Health and Long-Term Care granted funding to St. Mary's General Hospital for a Regional Cardiac Care Center. In July 2003 the cardiac surgery program opened. During the program-planning phase, protocols and procedures related to patient preparation for cardiac surgery were developed. To share policies, protocols and patient teaching tools developed from research driven, evidenced based standards of practice. To complete a one-year review (January to December 2004) and assess the compliance rates with pre-operative patient preparation procedures on all Coronary Artery Bypass Graft (CABG) cardiac surgery patients. Retrospective chart review. 191 bed community-based Regional Cardiac Care Centre. All adult patients undergoing Coronary Artery Bypass Graft (CABG) surgery from January 1st 2004 to December 31st 2004. Compliance rate following patient education related to pre-operative washes, assessing completion of pre-operative washes, and location of clipping relative to the Cardiovascular Operating Room (CVOR). A team of Registered Nurses was able to effectively implement policies and protocols within a cardiac surgery program that meet the recommended standards of care of the Centers for Disease Control and Prevention (CDC), Operating Room Nurses Association of Canada (ORNAC) and Safer Health Care Now! Initiative. A retrospective chart review has demonstrated that staff consistently apply and document care in accordance with the developed pre-operative wash and hair clipping protocols.

  20. Quantification of respiratory depression during pre-operative administration of midazolam using a non-invasive respiratory volume monitor.

    Science.gov (United States)

    Gonzalez Castro, Luis N; Mehta, Jaideep H; Brayanov, Jordan B; Mullen, Gary J

    2017-01-01

    Pre-operative administration of benzodiazepines can cause hypoventilation-a decrease in minute ventilation (MV)-commonly referred to as "respiratory compromise or respiratory depression." Respiratory depression can lead to hypercarbia and / or hypoxemia, and may heighten the risk of other respiratory complications. Current anesthesia practice often places patients at risk for respiratory complications even before surgery, as respiratory monitoring is generally postponed until the patient is in the operating room. In the present study we examined and quantified the onset of respiratory depression following the administration of a single dose of midazolam in pre-operative patients, using a non-invasive respiratory volume monitor that reports MV, tidal volume (TV), and respiratory rate (RR). Impedance-based Respiratory Volume Monitor (RVM) data were collected and analyzed from 30 patients prior to undergoing orthopedic or general surgical procedures. All patients received 2.0 mg of midazolam intravenously at least 20 minutes prior to the induction of anesthesia and the effects of midazolam on the patient's respiratory function were analyzed. Within 15 minutes of midazolam administration, we noted a significant decrease in both MV (average decrease of 14.3% ± 5.9%, pmidazolam administration on clinically significant respiratory parameters (MV, TV and RR) using a non-invasive RVM, uncovering that the respiratory depressive effect of benzodiazepines affect primarily TV rather than RR. Such respiratory monitoring data provide the opportunity for individualizing dosing and adjustment of clinical interventions, especially important in elderly patients. With additional respiratory data, clinicians may be able to better identify and quantify respiratory depression, reduce adverse effects, and improve overall patient safety.

  1. The effect of pre-operative methylprednisolone on early endothelial damage after total knee arthroplasty

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Viktoria Oline; Ostrowski, S R; Lindberg-Larsen, M

    2017-01-01

    We wished to evaluate whether inhibition of the systemic inflammatory response by a single pre-operative dose of methylprednisolone reduced markers of early endothelial damage after fast-track total knee arthroplasty. We randomly allocated 70 patients undergoing elective unilateral total knee...... arthroplasty (1:1) to receive either pre-operative intravenous methylprednisolone 125 mg (methylprednisolone group) or isotonic saline (control group). All procedures were performed under spinal anaesthesia without a tourniquet, using a standardised multimodal analgesic regime. The outcomes included changes...... and 2 h, 6 h and 24 h after surgery, with complete sampling from 63 patients for analyses. Methylprednisolone significantly reduced markers of endothelial damage at 24 h following surgery compared with saline (methylprednisolone group vs. control group, adjusted means (SEM)) expressed by circulating...

  2. Decisional pathways in breast augmentation: how to improve outcomes through accurate pre-operative planning.

    Science.gov (United States)

    Nava, Maurizio B; Rocco, Nicola; Tunesi, Gianfranco; Catanuto, Giuseppe; Rancati, Alberto; Dorr, Julio

    2017-04-01

    Breast augmentation is the most commonly performed surgical procedure in aesthetic plastic surgery. Accurate pre-operative planning is crucial to obtain the best outcomes. We present our planning method deriving from a more than 30-year experience in aesthetic breast surgery, matching together patients tissues' characteristics and patients' wishes. We schematized our planning method in an easy-to-use flow diagram to help the decisional process in breast augmentation.

  3. Prognostic value of pre-operative serum CA 15.3 levels in breast cancer.

    Science.gov (United States)

    Martín, Arancha; Corte, Ma Daniela; Alvarez, Ana Ma; Rodriguez, Juan Carlos; Andicoechea, Alejandro; Bongera, Miguel; Junquera, Sara; Pidal, Diego; Allende, Teresa; Muñiz, José L García; Vizoso, Francisco

    2006-01-01

    CA15.3 (also known as MUCI) is the most widely used marker in breast cancer. The aim of the present work was the evaluation of the prognostic value of preoperative serum CA15.3 levels in patients with primary breast cancer. This study included 818 women with a histologically verified diagnosis of invasive breast cancer. The serum values of CA15.3 were investigated at the time of primary diagnosis by means of an immunoradiometric assay based on the "sandwich" principle. The median follow-up period of patients free of recurrence was 38 months. Pre-operative CA15.3 serum levels ranged from 6 to 452 U/ml. Elevated CA15.3 levels (>30 U/ml) were found in 15.2% of patients. Statistical analysis showed that pre-operative CA15.3 serum levels were significantly higher in patients with large size tumors (T3 or T4) (p = 0.0001), as well as in those with node-positive tumors (p = 0.0001). In the univariate analysis, high CA15.3 levels were significantly associated with a lower probability of both relapse-free and overall survival in the overall group of patients (p = 0.0001 and p = 0.004, respectively) and in the subgroup with node-positive breast cancer (p = 0.001 and p = 0.03, respectively). In addition, multivariate analysis demonstrated that pre-operative levels of the antigen were significantly and independently associated with relapse-free survival in the overall group of patients, as well as in the subgroup of patients with node-positive breast cancer (p = 0.02 and p = 0.01, respectively). These results show that high pre-operative CA15.3 levels correlate with large size tumors and the presence of lymph node metastases and suggest that this antigen could be used as an additional prognostic marker.

  4. Pre-operative echocardiogram in hip fracture patients with cardiac murmur- an audit

    Directory of Open Access Journals (Sweden)

    Talkhani Imtiyaz

    2011-09-01

    Full Text Available Abstract Background All hip fracture patients with a cardiac murmur have an echocardiogram as a part of their preoperative work-up in our unit. We performed a retrospective audit to assess the impact of obtaining a pre-operative echocardiogram on the management of hip fracture patients. Methods All hip fracture patients (N = 349 between 01/06/08 and 01/06/09 were included in the study. 29 patients had pre-operative echocardiogram (echo group. A computer generated randomised sample of 40 patients was generated from N, 'non-echo' group. Data was obtained from medical records and the Hospital Information Support System (HISS. The groups were compared using Student's t test. Approval was obtained locally from the clinical governance department for this project. Results Age and gender distribution were similar in both groups. Indication for echo was an acute cardiac abnormality in 4 cases. 25 patients had echo for no new cardiac problem (indication being cardiac murmur in 23 patients and extensive cardiac history in 2 cases. Cardiology opinion was sought in 5 cases. No patient required cardiac surgery or balloon angioplasty preoperatively. Patients having pre-operative echo had significant delay to surgery (average 2.7 days, range 0-6 days compared to 'non-echo' group (average 1.1 days, range 0-3 days, (p Conclusion We have developed departmental guidelines for expediting echo requests in hip fracture patients with cardiac murmur. A liaison has been established with our cardiology department to prioritise such patients on the Echocardiography waiting list, to prevent unnecessary avoidable delay. Careful patient selection for pre-operative echocardiography is important to avoid unnecessary delay to surgery.

  5. ROLE OF B - SCAN ULTRASONOGRAPHY IN EVALUATION OF PRE - OPERATIVE CATARACT P ATIENTS

    OpenAIRE

    Navneet

    2015-01-01

    The purpose of this study was to visualize the status of posterior segment with diagnostic toll of B - scan ultrasound in pre - operative dense cataract patients. METHOD S : Diagnostic B - scan ultrasound was done on 200 cataract patients from the age group of 10 to 80 years of both the sexes. The machine used for the a bove study was B - scan machine – (SONOMED, E - ZSCAN AB 5500 +) with frequency 10 MHz. RESULTS: Out...

  6. A study of a pre-operative intervention in patients with diabetes undergoing cardiac surgery.

    Science.gov (United States)

    Lee, G A; Wyatt, S; Topliss, D; Walker, K Z; Stoney, R

    2014-01-01

    Coronary heart disease is common in Type 2 diabetes and often requires cardiac surgery. However poorer outcomes have been reported including increased rates of post-operative infection and prolonged hospital stay. The aim of the study was to determine the feasibility and acceptability of a specialist consultation model (pre-operative medical and educational intervention) for type 2 diabetes in the cardiac surgery setting. Twenty four patients were assigned usual care or to the intervention group. The intervention group were assessed by a diabetes clinical nurse consultant, dietitian, and endocrinologist during a pre-operative visit. Specific diabetes questionnaires were administered, education was delivered, and protocol-driven changes to the medical regimen were instituted. Length of stay, incidence of post-operative complications, and number of post-operative inpatient review endocrinology visits required were recorded. Twenty four patients with a pre-operative HbA(1c) greater than 6.5% (48 mmol/mol) were studied (17 males and 7 females). In the usual care group (n = 15), HbA(1c) pre-operatively was 7.2% (55.2 mmol/mol) compared to 10.1% (86.9 mmol/mol) in the intervention group (n = 9). Six weeks post-operatively HbA(1c) fell significantly in the intervention group by 1.9% (to 8.2% [66.1 mmol/mol]) compared to a reduction of 1.2% (to 7.0% [53 mmol/mol]) in the usual care group (p cardiac surgery.

  7. Congenital hip disease in adults: terminology, classification, pre-operative planning and management.

    Science.gov (United States)

    Karachalios, T; Hartofilakidis, G

    2010-07-01

    This paper reviews the current knowledge relating to the management of adult patients with congenital hip disease. Orthopaedic surgeons who treat these patients with a total hip replacement should be familiar with the arguments concerning its terminology, be able to recognise the different anatomical abnormalities and to undertake thorough pre-operative planning in order to replace the hip using an appropriate surgical technique and the correct implants and be able to anticipate the clinical outcome and the complications.

  8. Scintigraphic techniques in primary hyperparathyroidism: from pre-operative localisation to intra-operative imaging

    Energy Technology Data Exchange (ETDEWEB)

    Rubello, Domenico [S. Maria della Misericordia Hospital, Service of Nuclear Medicine, Rovigo (Italy); Gross, Milton D. [Department of Veterans Affairs Health System, Nuclear Medicine Service, Ann Arbor, MI (United States); Mariani, Giuliano [University of Pisa, Regional Center of Nuclear Medicine, Pisa (Italy); Al-Nahhas, Adil [Hammersmith Hospital, Department of Nuclear Medicine, London (United Kingdom)

    2007-06-15

    Primary hyperparathyroidism (PHPT) is an increasingly diagnosed disease worldwide. In most cases, PHPT is related to the presence of a solitary parathyroid adenoma (PA). Fifty percent or more of newly diagnosed PHPT patients are asymptomatic, and there is debate among endocrinologists and endocrine surgeons about whether or not such patients should be treated. Usually, in a PHPT patient with a solitary PA that is well localised pre-operatively, a parathyroidectomy with limited or minimally invasive neck exploration is offered. The diffusion of minimally invasive neck exploration procedures is a consequence of the significant improvement in the accuracy of pre-operative imaging (mainly scintigraphic) techniques; these techniques have changed the surgical strategy to PHPT, from the wide traditional bilateral neck exploration to limited neck exploration. The present review considers developments during the past 10-15 years with regard to both the accuracy of pre-operative localising imaging techniques and intra-operative minimally invasive procedures in order to provide endocrinologists and endocrine surgeons with further information about the newly available diagnostic and therapeutic tools for use in PHPT patients with a solitary PA. (orig.)

  9. Pre-operative sestamibi-technetium subtraction scintigraphy in primary hyperparathyroidism: Experience with 156 consecutive patients

    Energy Technology Data Exchange (ETDEWEB)

    Jones, J. Mark; Russell, Colin F.J.; Ferguson, W. Rodney; Laird, James D

    2001-07-01

    AIM: The aim of this study was to assess the usefulness of pre-operative sestamibi-technetium subtraction scintigraphy in a large cohort of patients with primary hyperparathyroidism (HPT). MATERIALS AND METHODS: A group of 156 consecutive patients with biochemically proven HPT underwent sestamibi-technetium subtraction scintigraphy before cervical exploration. Images were interpreted and reported prospectively and influenced the extent of surgical exploration. The intraoperative findings were compared retrospectively with the pre-operative scintigram reports in 154 individuals with technically satisfactory scintigrams. RESULTS: Of the 154 patients with satisfactory scintigrams, 122 (78.2%) demonstrated a single focus of activity following subtraction, 31 (19.9%) had negative findings and the remaining scintigram showed four foci of activity. At operation 138 (89.6%) solitary adenomas were removed, 13 patients (8.4%) had multi-gland disease and in three individuals (2.0%) no abnormal parathyroid tissue was found. The pre-operative scintigram accurately localized 91 of 98 (92.9%) solitary tumours weighing > 500 mg but only 18 of 35 (51.4%) adenomas weighing < 500 mg, (P < 0.0001). Overall sensitivity of sestamibi-technetium scintigraphy for localizing single parathyroid adenomas was 83.7%. CONCLUSION: Sestamibi-technetium subtraction scintigraphy will accurately localize a high proportion of solitary parathyroid adenomas but its usefulness is diminished by its inability to consistently identify smaller tumours. Jones, J.M. et al. (2001)

  10. Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systematic review.

    Science.gov (United States)

    Ackerman, Ilana N; Bennell, Kim L

    2004-01-01

    A systematic review of randomised controlled trials was performed to evaluate the effectiveness of pre-operative physiotherapy programmes on outcome following lower limb joint replacement surgery. A search of relevant key terms was used to find suitable trials, with five papers meeting the inclusion criteria for the review. The methodological quality of the trials was rated using the PEDro scale. Estimates of the size of treatment effects were calculated for each outcome in each trial, with 95% confidence intervals calculated where sufficient data were provided. Of the three trials pertaining to total knee replacement, only very small mean differences were found between control and intervention groups for all of the outcome measures. Where confidence intervals could be calculated, these showed no clinically important differences between the groups. Two papers (one study) pertaining to total hip replacements found significant improvements in WOMAC scores, hip strength and range of movement, walking distance, cadence, and gait velocity for the intervention group, compared to a control group. Estimates of treatment effect sizes for these outcomes were larger than for the total knee replacement studies, with confidence intervals showing potentially clinically important differences between group means. However, as the intervention group also received an additional intensive post-operative physiotherapy program, these results cannot be attributed solely to the pre-operative program. This systematic review shows that pre-operative physiotherapy programmes are not effective in improving outcome after total knee replacement but their effect on outcome from total hip replacement cannot be adequately determined.

  11. Interpreting pre-operative mastoid computed tomography images: comparison between operating surgeon, radiologist and operative findings.

    Science.gov (United States)

    Badran, K; Ansari, S; Al Sam, R; Al Husami, Y; Iyer, A

    2016-01-01

    This study aimed to compare the interpretations of temporal bone computed tomography scans by an otologist and a radiologist with a special interest in temporal bone imaging. It also aimed to determine the usefulness of this imaging modality. A head and neck radiologist and an otologist separately reported pre-operative computed tomography images using a structured proforma. The reports were then compared with operative findings to determine their accuracy and differences in interpretations. Forty-eight patients who underwent pre-operative computed tomography scans in a 30-month period were identified. Six patients were excluded because complete operative findings had not been recorded. Positive and negative predictive values and accuracy of the anatomical and pathological findings were calculated for 42 patients by both reporters. The accuracy was found to be less than 80 per cent, except for identification of the tegmen and lateral semicircular canal erosion. Overall, there was no significant difference in interpretations of computed tomography scans between reporters. There was a slight difference in interpretation for tympanic membrane retraction, facial canal erosion and lateral semicircular canal fistula and/or erosion. Pre-operative computed tomography scanning of the temporal bone is useful for predicting anatomy for surgical planning in patients with chronic otitis media, but its reliability remains questionable.

  12. ROLE OF PRE-OPERATIVE NO HAIR REMOVAL ON SURGICAL S ITE INFECTION

    Directory of Open Access Journals (Sweden)

    Ashok Y.

    2013-05-01

    Full Text Available ABSTRACT: This prospective study evaluate the influence of p re-operative no hair removal on surgical site infection in all abdominal and groin surgeries. As there are very few articles about pre - operative no hair removal and its effect at surgica l site in all types of wound. We are presenting thi s original article. Prospective review of 417 patients operated in Kris hna Hospital and Research Center, Karad. Between JAN-2010 to JAN-2011. The study contains cl ean, clean contaminated and dirty wound with two type of skin preparation. All the endogenous an d exogenous factors affecting post-operative surgical site are kept constant except surgical sit e skin preparation like shaving by razor or no hair removal at surgical site. In this study, we are compared role of hair removal and it impact of SSI. We had 8.21 % SSI rate by using razor shaving as skin preparation whi ch is compared with pre-operative no hair removal. It had only 2.38% rate of SSI. The differe nce between standard error of two prospective is more than twice (P<0.05. So it is clear that preop erative no hair removal at surgical site is effecti ve procedure to prevent SSI in all wound type. We are using this pre-operative no hair removal practically for all surgical intervention in our ho spital.

  13. Impact of value based breast cancer care pathway implementation on pre-operative breast magnetic resonance imaging utilization

    Science.gov (United States)

    McCray, Devina K. S.; Grobmyer, Stephen R.

    2017-01-01

    Background Bilateral breast magnetic resonance imaging (MRI) is commonly used in the diagnostic workup of breast cancer (BC) to assess extent of disease and identify occult foci of disease. However, evidence for routine use of pre-operative MRI is lacking. Breast MRI is costly and can lead to unnecessary tests and treatment delays. Clinical care pathways (care paths) are value-based guidelines, which define management recommendations derived by expert consensus and available evidence based data. At Cleveland Clinic, care paths created for newly diagnosed BC patients recommend selective use of pre-operative MRI. We evaluated the number of pre-operative MRIs ordered before and after implementing an institution wide BC care paths in April 2014. Methods A retrospective review was conducted of BC cases during the years 2012, 2014, and part of 2015. Patient, tumor and treatment characteristics were collected. Pre-operative MRI utilization was compared before and after care path implementation. Results We identified 1,515 BC patients during the study period. Patients were more likely to undergo pre-operative MRI in 2012 than 2014 (OR: 2.77; Pcare path indications. Conclusions Implementation of online BC care paths at our institution was associated with a decreased use of pre-operative MRI overall and in patients without a BC care path indication, driving value based care through the reduction of pre-operative breast MRIs. PMID:28210553

  14. Pre-operative concurrent chemoradiotherapy for stage IIIA (N2) Non-Small cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyu Chan; Ahn, Yong Chan; Park, Keun Chil [College of Medicine, Sungkyunkwan Univ., Seoul (Korea, Republic of)] [and others

    1999-06-01

    This is to evaluate the acute complication, resection rate, and tumor down-staging after pre-operative concurrent chemoradiotherapy for stage IIIA (N2) non-small cell lung cancer. Fifteen patients with non-small cell lung cancer were enrolled in this study from May 1997 to June 1998 in Samsung Medical Center. The median age of the patients was 61 (range, 45-67) years and male to female ratio was 12:3. Pathologic types were squamous cell carcinoma (11) and adenocarcinoma (4). Pre-operative clinical tumor stages were cT1 in 2 patients, cT2 in 12, and cT3 in 1 and all were N2. Ten patients were proved to be N2 with mediastinoscopic biopsy and five had clinically evident mediastinal lymph node metastases on the chest CT scans. Pre-operative radiation therapy field included the primary tumor, the ipsilateral hilum, and the mediastinum. Total radiation dose was 45 Gy over 5 weeks with daily dose of 1.8 Gy. Pre-operative concurrent chemotherapy consisted of two cycles of intraventous cis-Platin (100 mg/m{sup 2}) on day 1 and oral Etoposide (50 mg/m{sup 2}/day) on days 1 through 14 with 4 weeks' interval. Surgery was followed after the pre-operative re-evaluation including chest CT scan in 3 weeks of the completion of the concurrent chemoradiotherapy if there was no evidence of disease progression. Full dose radiation therapy was administered to all the 15 patients. Planned two cycles of chemotherapy was completed in 11 patients and one cycle was given to four. One treatment related death of acute respiratory distress syndrome occurred in 15 days of surgery. Hospital admission was required in three patients including one with radiation pneumonitis and two with neutropenic fever. Hematologic complications and other acute complications including esophagitis were tolerable. Resection rate was 92.3% (12/13) in 13 patients excluding two patients who refused surgery. Pleural seeding was found in one patient after thoracotomy and tumor resection was not feasible. Post

  15. Pre-operative function, motivation and duration of symptoms predict sporting participation after total hip replacement.

    Science.gov (United States)

    Ollivier, M; Frey, S; Parratte, S; Flecher, X; Argenson, J N

    2014-08-01

    There is little in the literature on the level of participation in sports which patients undertake after total hip replacement (THR). Our aims in this study were to determine first, the level of sporting activity, second, the predictive factors for returning to sporting activity, and third, the correlation between participation in sports and satisfaction after THR. We retrospectively identified 815 patients who had undergone THR between 1995 and 2005. All were asked to complete a self-administered questionnaire regarding their sporting activity. A total of 571 patients (71%) met the inclusion criteria and completed the evaluation. At a mean follow-up of 9.8 years (sd 2.9), 366 patients (64%) returned to sporting activity as defined by a University of California at Los Angeles (UCLA) score of > 5. The main reasons that patients had for refraining from sports were fear of dislocation (65; 31.6%), avoiding wear (52; 25.4%), and the recommendation of the surgeon (34; 16.6%). There was a significant relationship between higher post-operative participation in sport in those patients with a higher pre-operative Harris hip score (HHS) (p = 0.0074), motivation to participate in sporting activities (p = 0.00022) and a shorter duration of symptoms (p = 0.0034). Finally, there was a correlation between age (p = 0.00013), UCLA score (p = 0.012) and pre-operative HHS (p = 0.00091) and satisfaction. In conclusion, we found that most patients participate in sporting activity after THR, regardless of the advice of their surgeon, and that there is a correlation between the level of participation and pre-operative function, motivation, duration of symptoms and post-operative satisfaction. ©2014 The British Editorial Society of Bone & Joint Surgery.

  16. Pre-operative Tei Index does not predict left ventricular function immediately after mitral valve repair

    Directory of Open Access Journals (Sweden)

    Chirojit Mukherjee

    2012-01-01

    Full Text Available Echocardiographic assessment of systolic left ventricular (LV function in patients with severe mitral regurgitation (MR undergoing mitral valve (MV repair can be challenging because the measurement of ejection fraction (EF or fractional area change (FAC in pathological states is of questionable value. The aim of our study was to evaluate the usefulness of the pre-operative Tei Index in predicting left ventricular EF or FAC immediately after MV repair. One hundred and thirty patients undergoing MV repair with sinus rhythm pre- and post-operatively were enrolled in this prospective study. Twenty-six patients were excluded due to absence of sinus rhythm post-operatively. Standard transesophageal examination(IE 33,Philips,Netherlands was performed before and after cardiopulmonary bypass according to the guidelines of the ASE/SCA. FAC was determined in the transgastric midpapillary short-axis view. LV EF was measured in the midesophageal four- and two-chamber view. For calculation of the Tei Index, the deep transgastric and the midesophageal four-chamber view were used. Statistical analysis was performed with SPSS 17.0. values are expressed as mean with standard deviation. LV FAC and EF decreased significantly after MV repair (FAC: 56±12% vs. 50±14%, P<0.001; EF: 58±11 vs. 50±12Έ P<0.001. The Tei Index decreased from 0.66±0.23 before MV repair to 0.41±0.19 afterwards (P<0.001. No relationship between pre-operative Tei Index and post-operative FAC or post-operative EF were found (FAC: r=−0.061, P=0.554; EF: r=−0.29, P=0.771. Conclusion: Pre-operative Tei Index is not a good predictor for post-operative FAC and EF in patients undergoing MV repair.

  17. The effect of pre-operative optimization on post-operative outcome in Crohn's disease resections

    DEFF Research Database (Denmark)

    El-Hussuna, Alaa; Iesalnieks, Igors; Horesh, Nir

    2017-01-01

    on the post-operative outcome in CD. METHOD: This is a multicentre retrospective cohort study. The primary outcome was 30-day post-operative complications. Secondary outcomes were intra-abdominal septic complications, surgical site infection (SSI), re-operation, length of post-operative stay in a hospital......BACKGROUND: The timing of surgical intervention in Crohn's disease (CD) may depend on pre-operative optimization (PO) which includes different interventions to decrease the risk for unfavourable post-operative outcome. The objective of this study was to investigate the effect of multi-model PO...

  18. Evaluation of pre-operative staging of renal cell cancer with cine MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Uematsu, Hidemasa; Inoue, Hiroshi; Hayashi, Koji; Kitagawa, Akane; Yamamori, Sanae; Ishitoya, Satoshi; Ogura, Keiji [Rakuwakai Otowa Hospital, Kyoto (Japan); Yamada, Hiroki; Ishii, Yasushi

    1994-12-01

    To assess the utility of single section cine MR images in evaluation of extrarenal invasion of renal cell cancer. Six patients who subsequently underwent definitive surgery were examined. Sequential twenty FLASH images were acquired in coronal and parasagittal single section during one respiratory cycle. These images were evaluated in cine-loop mode to assess tumoral movement with adjacent structures. Cine MR images showed that the tumor in one patient were fixed to the spleen and the tumors in five patients showed free movement. At pathologic examination, cine MR findings were proved correct in all patients. Cine MR images may be useful for pre-operative evaluation of extrarenal invasion. (author).

  19. Pre-operative history of depression and cognitive changes in bariatric surgery patients.

    Science.gov (United States)

    Alosco, Michael L; Spitznagel, Mary Beth; Strain, Gladys; Devlin, Michael; Cohen, Ronald; Crosby, Ross D; Mitchell, James E; Gunstad, John

    2015-01-01

    Obesity-associated cognitive impairments may be partially reversible through bariatric surgery. Depression, a prevalent comorbidity in bariatric surgery candidates, is linked with cognitive impairment and poorer surgical outcomes in other populations. No study has examined the effects of pre-operative depression on cognitive changes in bariatric surgery patients. Sixty-seven bariatric surgery patients completed a computerized cognitive test battery prior to surgery and 12 months post-operatively. The structured clinical interview for the DSM-IV Axis I disorders assessed major depressive disorder (MDD). Pre-surgery history of MDD was found in 47.8% of patients, but was not associated with greater baseline cognitive impairments. Repeated measures revealed improved cognitive abilities 12 months after surgery. Pre-surgery history of MDD did not influence post-operative cognitive function. Pre-operative history of MDD did not limit post-operative cognitive improvements. Larger studies with extended follow-ups are needed to clarify our findings and identify factors (e.g. older age) that may modify cognitive changes following surgery.

  20. CT pre-operative planning of a new semi-implantable bone conduction hearing device

    Energy Technology Data Exchange (ETDEWEB)

    Law, Eric K.C.; Bhatia, Kunwar S.S. [Prince of Wales Hospital, The Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Hong Kong, SAR (China); Tsang, Willis S.S.; Tong, Michael C.F. [Prince of Wales Hospital, The Chinese University of Hong Kong, Department of Otorhinolaryngology, Head and Neck Surgery, Hong Kong, SAR (China); Shi, Lin [The Chinese University of Hong Kong, Department of Medicine and Therapeutics, Hong Kong, SAR (China); The Chinese University of Hong Kong, Chow Yuk Ho Technology Center for Innovative Medicine, Hong Kong, SAR (China)

    2016-06-15

    Accommodating a novel semi-implantable bone conduction hearing device within the temporal bone presents challenges for surgical planning. This study describes the utility of CT in pre-operative assessment of such an implant. Retrospective review of pre-operative CT, clinical and surgical records of 16 adults considered for device implantation. Radiological suitability was assessed on CT using 3D simulation software. Antero-posterior (AP) dimensions of the mastoid bone and minimum skull thickness were measured. CT planning results were correlated with operative records. Eight and five candidates were suitable for device placement in the transmastoid and retrosigmoid positions, respectively, and three were radiologically unsuitable. The mean AP diameter of the mastoid cavity was 14.6 mm for the transmastoid group and 4.6 mm for the retrosigmoid group (p < 0.05). Contracted mastoid and/or prior surgery were predisposing factors for unsuitability. Four transmastoid and five retrosigmoid positions required sigmoid sinus/dural depression and/or use of lifts due to insufficient bone capacity. A high proportion of patients being considered have contracted or operated mastoids, which reduces the feasibility of the transmastoid approach. This finding combined with the complex temporal bone geometry illustrates the importance of careful CT evaluation using 3D software for precise device simulation. (orig.)

  1. Association between elevated pre-operative glycosylated hemoglobin and post-operative infections after non-emergent surgery

    Directory of Open Access Journals (Sweden)

    Joseph M. Blankush

    2016-09-01

    Conclusions: The risk factors of post-operative infection are multiple and likely synergistic. While pre-operative HbA1c level is not independently associated with risk of post-operative infection, there are scenarios and patient subgroups where pre-operative HbA1c is useful in predicting an increased risk of infectious complications in the post-operative period.

  2. Counterview: Pre-operative breast MRI (magnetic resonance imaging) is not recommended for all patients with newly diagnosed breast cancer.

    Science.gov (United States)

    Solin, Lawrence J

    2010-02-01

    For the woman with a newly diagnosed early stage breast cancer, the routine use of pre-operative breast MRI (magnetic resonance imaging) is not indicated beyond conventional breast imaging (i.e., mammography with correlation ultrasound as indicated). There is no consistent evidence that a pre-operative breast MRI confers a benefit to the patient by improving clinical outcomes or surgical procedures. In a meta-analysis of studies reporting on the use of pre-operative breast MRI for the patient with an established index cancer, multifocal or multicentric disease was found on breast MRI in 16% of the patients, a rate substantially higher than the rate of local recurrence after breast conserving surgery plus definitive radiation treatment. In the largest retrospective study of patients treated with breast conserving surgery plus radiation, no gain was found for adding a breast MRI to conventional breast imaging. No randomized clinical trial has been designed to evaluate long term clinical outcomes associated with adding a pre-operative breast MRI. Adding pre-operative breast MRI can alter clinical management in ways that are potentially harmful to patients, for example, increased ipsilateral mastectomies, increased contralateral prophylactic mastectomies, increased work-ups, and delay to definitive surgery. In summary, the routine use of pre-operative breast MRI is not warranted for the typical patient with a newly diagnosed early stage breast cancer.

  3. Using 3 Tesla magnetic resonance imaging in the pre-operative evaluation of tongue carcinoma.

    Science.gov (United States)

    Moreno, K F; Cornelius, R S; Lucas, F V; Meinzen-Derr, J; Patil, Y J

    2017-09-01

    This study aimed to evaluate the role of 3 Tesla magnetic resonance imaging in predicting tongue tumour thickness via direct and reconstructed measures, and their correlations with corresponding histological measures, nodal metastasis and extracapsular spread. A prospective study was conducted of 25 patients with histologically proven squamous cell carcinoma of the tongue and pre-operative 3 Tesla magnetic resonance imaging from 2009 to 2012. Correlations between 3 Tesla magnetic resonance imaging and histological measures of tongue tumour thickness were assessed using the Pearson correlation coefficient: r values were 0.84 (p Tesla magnetic resonance imaging had 83 per cent sensitivity, 82 per cent specificity, 82 per cent accuracy and a 90 per cent negative predictive value for detecting cervical lymph node metastasis. In this cohort, 3 Tesla magnetic resonance imaging measures of tumour thickness correlated highly with the corresponding histological measures. Further, 3 Tesla magnetic resonance imaging was an effective method of detecting malignant adenopathy with extracapsular spread.

  4. Routine pre-operative focused ultrasonography by anesthesiologists in patients undergoing urgent surgical procedures

    DEFF Research Database (Denmark)

    Bøtker, M T; Vang, M L; Grøfte, T;

    2014-01-01

    with focused ultrasonography in patients undergoing urgent surgical procedures. Methods We performed pre-operative focused cardiopulmonary ultrasonography in patients aged 18 years or above undergoing urgent surgical procedures at pre-defined study days. Known and unexpected cardiopulmonary pathology...... was recorded, and subsequent changes in the anesthesia technique or supportive actions were registered. Results A total of 112 patients scheduled for urgent surgical procedures were included. Their mean age (standard deviation) was 62 (21) years. Of these patients, 24% were American Society....... Unexpected pathology leading to changes in anesthesia technique or supportive actions was only disclosed in a group of patients above the age of 60 years and/or in ASA class ≥ 3. Conclusion Focused cardiopulmonary ultrasonography disclosed unexpected pathology in patients undergoing urgent surgical...

  5. ART THERAPY MANAGEMENT IN THE PRE-OPERATIVE PERIOD IN PEDIATRICS

    Directory of Open Access Journals (Sweden)

    Ana Cláudia Afonso Valladares

    2004-04-01

    Full Text Available Every child, particularly those who will be submitted to surgery, needs to express themselves, createand establish relationships with the world. This study was based on qualitative studies which were, in turn,substantiated on the behavioral changes of patients and their images. It was developed in the pediatric clinic of apublic hospital in the city of Goiânia/GO in a two years’ period (1998-2000. The target population consisted ofhospitalized children in the pre-operative process. It was concluded that great therapeutic benefit was achievedfrom the use of art therapy for this population as it helped the children to recover their mental balance, thusstrengthening a healthier side of the child which had been deadened by the illness, hospitalization and treatment.

  6. [Effectiveness of pre-operative education in reducing anxiety in surgical patients].

    Science.gov (United States)

    Díez-Álvarez, Esther; Arrospide, Arantzazu; Mar, Javier; Alvarez, Uzuri; Belaustegi, Alazne; Lizaur, Belen; Larrañaga, Aintzane; Arana, Jose M

    2012-01-01

    To evaluate the effectiveness of a structured pre-operative interview conducted by operating room nurses in order to reduce the pre-operative anxiety of patients, and to determine the profile of patients who can benefit from it. A randomised double-blind and prospective trial was conducted on a sample of 335 patients scheduled for surgery in two regional hospitals in the Basque Region of Spain, Alto Deba Hospital and Mendaro Hospital. We compared the alternative of using a structured briefing (test group) with the current situation without any formal intervention (control group). The effectiveness of the procedure was determined using the STAI state anxiety self-assessment questionnaire. The Chi-squared statistic was used to assess the differences in factors and the Student t-test for comparison of means in the continuous variables. The impact of the intervention on measures of state anxiety and trait anxiety was found to be not statistically significant, although the mean state anxiety state was slightly lower in the intervention group (18.96) than in the controls (20.03). Women undergoing surgery in the specialty of gynaecology showed the higher state anxiety compared with other specialties. As regards trait anxiety a higher ASA level is associated with higher anxiety. Furthermore, the consumption of psychotropic drugs is also related to a higher level of trait anxiety. The preoperative visit can be helpful when patients are selected according to specific characteristics: by type of anaesthesia, gender, or type of surgery. There may also be beneficial effects when preoperative education is tailored according to patient's anxiety risk. The time immediately before surgery may not be the best time for conducting the visit, as this may make the patients more anxious. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  7. ROLE OF PRE-OPERATIVE INVESTIGATIONS IN PREVENTING THE POST-OPERATIVE COMPLICATIONS OF THYROID SURGERY

    Directory of Open Access Journals (Sweden)

    Kamreddy Ashok

    2015-11-01

    Full Text Available Thyroid surgeries are performed worldwide for various indications. In the past complications of thyroid surgeries were reported more than 24%. With an increase in accuracy in Cytological reporting, non-invasive radiological investigations to know the extent of the tumor and infiltration of malignant tumors, the complications are reduced to less than 4%. AIM: To evaluate the predictability of pre-operative investigations in preventing the post-operative complications of thyroid surgery. MATERIALS AND METHODS: A prospective study conducted on 86 patients by investigating before thyroid surgeries with FNAC, ultrasonography, CT scan, X-ray Neck lateral view, MRI, 2D ECHO of Cardia, isotope scanning, video laryngoscopy and thyroid function tests. Demographic characteristics of the patients and indications for thyroid surgeries were used to predict the post-operative complications. Post-operative investigations included serum calcium levels, Thyroid function tests and serum Electrolyte levels to diagnose the complications. RESULTS: sensitivity of FNAC was 93.33%, ultra sound Neck was 92.83%, serum calcium was 89.16%, in thyroid function tests it was 77.66%. With X-Ray Neck the specificity was 57.66%, CT scan was 44.50%, MRI was 15%, and isotope study was 30.6%, Doppler study was 33.83% and 2DEcho was 27.83%. Pre-operative assessment was Airway obstruction 3.48%, hematoma formation 4.65%, RLN palsy 3.48%, Hypocalcaemia 33.72%, wound infection 4.65% were the complications encountered. CONCLUSIONS: Thorough investigations prior to surgery of thyroid, proper selection of the surgical procedure, tumor location knowledge, understanding the pathophysiology of the thyroid disease and type of anesthesia gives confidence to the surgeon and avoids complications. The methods applied in the present study had a definitive role in preventing hypocalcaemia with an incidence of 33.72% and RLN palsy 3.48%. These were added upon by the experience of the operating

  8. Attenuation of pressor response and dose sparing of opioids and anaesthetics with pre-operative dexmedetomidine

    Directory of Open Access Journals (Sweden)

    Sukhminder Jit Singh Bajwa

    2012-01-01

    Full Text Available Background and Aims: Alpha-2 agonists are being increasingly used as adjuncts in general anaesthesia, and the present study was carried out to investigate the ability of intravenous dexmedetomidine in decreasing the dose of opioids and anaesthetics for attenuation of haemodynamic responses during laryngoscopy and tracheal intubation. Methods: One hundred patients scheduled for elective general surgery were randomized into two groups: D and F (n=50 in each group. Group D were administered 1 μg/kg each of dexmedetomidine and fentanyl while group F received 2 μg/kg of fentanyl pre-operatively. Thiopental was given until eyelash reflex disappeared. Anaesthesia was maintained with 33:66 oxygen: nitrous oxide. Isoflurane concentration was adjusted to maintain systolic blood pressure within 20% of the pre-operative values. Haemodynamic parameters were recorded at regular intervals during induction, intubation, surgery and extubation. Statistical analysis was carried out using analysis of variance, chi-square test, Student′s t test and Mann-Whitney U test. Results: The demographic profile was comparable. The pressor response to laryngoscopy, intubation, surgery and extubation were effectively decreased by dexmedetomidine, and were highly significant on comparison (P50% by the administration of dexmedetomidine. The mean recovery time was also shorter in group D as compared with group F (P=0.014. Conclusions: Dexmedetomidine is an excellent drug as it not only decreased the magnitude of haemodynamic response to intubation, surgery and extubation but also decreased the dose of opioids and isoflurane in achieving adequate analgesia and anaesthesia, respectively.

  9. Pre-operative laboratory testing: A prospective study on comparison and cost analysis

    Directory of Open Access Journals (Sweden)

    Venkatesh H Keshavan

    2016-01-01

    Full Text Available Background and Aims : Pre-operative investigations are performed before any surgical intervention under anaesthesia. Many are considered as routine. However, there are no clear guidelines regarding these in India. We aim to look at the relevance of the laboratory investigations ordered routinely and their cost implications compared with the National Institute of Clinical Excellence (NICE guidelines. Methods: This prospective study was carried out at a tertiary care hospital. A total of 163 patients scheduled for elective surgical procedures were included in this study. Neither the surgeons nor anaesthesiologists involved in the case were aware of the study. The laboratory investigations of the patients who underwent surgery were noted. All values were categorised as normal or abnormal and they were assessed as indicated or unindicated based on NICE guidelines. Results: One hundred and sixty-three patients were subjected to a total of 984 tests. Forty three patients (26% were subjected to tests as per NICE guidelines. Of the 984 tests, 515 tests were unindicated (52%. Out of the 515 unindicated tests, 7 (1.3% were abnormal. None of these seven tests required any intervention or change of anaesthetic plan. The most common unindicated tests done were cardiac echocardiography and chest X-ray (92.5% and 93% respectively. The additional cost incurred towards unindicated tests was 63% of the total cost for the tests. Conclusion: Pre-operative laboratory investigations add to cost significantly. Patient premorbid conditions and surgical grade should guide the clinician to request for the relevant laboratory tests.

  10. Pre-operative therapeutic eyelid hygiene in the prevention of complications following excimer laser vision correction

    Directory of Open Access Journals (Sweden)

    V. V. Kurenkov

    2014-07-01

    Full Text Available Purpose: to assess the effectiveness of pre-operative therapeutic eyelid hygiene in the prevention and treatment of dry eye and meibomian glands dysfunction following excimer laser vision surgery.Methods: In enrolled 144 patients (288 eyes, ocular surface and meibomian glands functions were evaluated before and following refractive surgery (LASIK and REIK. In pre- and post-operative period, standard ophthalmological studies were performed, including best-corrected visual acuity determination, biomicroscopy, Schirmer’s test and Norn’s test (tear break-up time. In pre-operative pe- riod, ocular surface microbial profile was assessed. Subjective symptoms of impaired tear production were revealed via questioning. In study group (70 patients, 140 eyes, therapeutic eyelid hygiene using Blefarogel 1 or Blefarogel 2 (Ltd. Heltec-Medica, Moscow, Russia was prescribed one week before surgery. In control group, no therapeutic eyelid hygiene was prescribed. All patients were received antibacterial treatment including Vigamox (Alcon, Fort Worth, tX. In both groups, Natural tears and Systane Ultra (Alcon were used as tear replacement therapy.Results: Complex treatment, including therapeutic eyelid hygiene in study group, significantly improved tear film and ocular sur- face health as well as meibomian glands functions. Inflammatory complications rate was estimated as 5.7% in study group and 10.6% in control group.Conclusion: therapeutic eyelid hygiene is highly effective in the prophylaxis and treatment of post-operative complications duу to ocular surface pathology and meibomian glands dysfunction. the procedure is safe and can be recommended as a part of complex preventive treatment before excimer laser vision correction.

  11. Pre-operative therapeutic eyelid hygiene in the prevention of complications following excimer laser vision correction

    Directory of Open Access Journals (Sweden)

    V. V. Kurenkov

    2012-01-01

    Full Text Available Purpose: to assess the effectiveness of pre-operative therapeutic eyelid hygiene in the prevention and treatment of dry eye and meibomian glands dysfunction following excimer laser vision surgery.Methods: In enrolled 144 patients (288 eyes, ocular surface and meibomian glands functions were evaluated before and following refractive surgery (LASIK and REIK. In pre- and post-operative period, standard ophthalmological studies were performed, including best-corrected visual acuity determination, biomicroscopy, Schirmer’s test and Norn’s test (tear break-up time. In pre-operative pe- riod, ocular surface microbial profile was assessed. Subjective symptoms of impaired tear production were revealed via questioning. In study group (70 patients, 140 eyes, therapeutic eyelid hygiene using Blefarogel 1 or Blefarogel 2 (Ltd. Heltec-Medica, Moscow, Russia was prescribed one week before surgery. In control group, no therapeutic eyelid hygiene was prescribed. All patients were received antibacterial treatment including Vigamox (Alcon, Fort Worth, tX. In both groups, Natural tears and Systane Ultra (Alcon were used as tear replacement therapy.Results: Complex treatment, including therapeutic eyelid hygiene in study group, significantly improved tear film and ocular sur- face health as well as meibomian glands functions. Inflammatory complications rate was estimated as 5.7% in study group and 10.6% in control group.Conclusion: therapeutic eyelid hygiene is highly effective in the prophylaxis and treatment of post-operative complications duу to ocular surface pathology and meibomian glands dysfunction. the procedure is safe and can be recommended as a part of complex preventive treatment before excimer laser vision correction.

  12. Resident work hour restrictions do not improve patient safety in surgery: a critical appraisal based on 7 years of experience in Switzerland

    Directory of Open Access Journals (Sweden)

    Businger Adrian P

    2012-07-01

    Full Text Available Abstract In 2005 the Swiss government implemented new work-hour limitations for all residency programs in Switzerland, including a 50-hour weekly limit. The reduction in the working hours of doctors in training implicate an increase in their rest time and suggest an amelioration of doctors' clinical performance and consequently in patients' outcomes and safety - which was not detectable in a preliminary study at a large referral center in Switzerland. It remains elusive why work-hour restrictions did not improve patient safety. We are well advised to thoroughly examine and eliminate the known adverse effects of reduced work-hours to improve our patients' safety.

  13. An evaluation of factors influencing the assessment time in a nurse practitioner-led anaesthetic pre-operative assessment clinic.

    Science.gov (United States)

    Hawes, R H; Andrzejowski, J C; Goodhart, I M; Berthoud, M C; Wiles, M D

    2016-03-01

    Elective patients undergoing anaesthetic pre-operative assessment are usually allocated the same period of time with a nurse practitioner, leading to potential inefficiencies in patient flow through the clinic. We prospectively collected data on 8519 patients attending a pre-operative assessment clinic. The data set were split into derivation and validation cohorts. Standard multiple regressions were used to construct a model in the derivation cohort, which was then tested in the validation cohort. Due to missing data, 2457 patients were not studied, leaving 5892 for analysis (3870 in the derivation cohort and 2022 in the validation cohort). The mean (SD) pre-operative assessment time was 46 (12) min. Age, ASA physical status, nurse practitioner and surgical specialty all influenced the time spent in pre-operative assessment. The predictive equations calculated using the derivation cohort, based on age and ASA physical status, correctly estimated duration of consultation to within 20% of the maximum predicted time in 74.2% of the validation cohort. We conclude that if age and ASA physical status are known before the pre-operative assessment consultation, it could allow appointment times to be allocated more accurately.

  14. Improving Performance Appraisals

    Science.gov (United States)

    Lahti, Robert E.

    1975-01-01

    A positive and creative results-oriented management appraisal system is needed. This article reviews the benefits and requirements of such a system, lists the common pitfalls of shoddy evaluation attempts, describes the four basic kinds of performance appraisal systems, and offers suggestions for creating a successful system. (DC)

  15. Appraisal of Transport Projects

    DEFF Research Database (Denmark)

    Jensen, Anders Vestergaard

    be dealt with by the use of sensitivity analysis and robustness measures. This also calls for an appraisal methodology which is transparent and able to include the different preferences among experts, the public, and stakeholders. This PhD thesis has three main focuses concerning appraisal of transport...... papers written during the PhD study. The potential for transport appraisal demonstrated in this PhD study can be listed in the following main findings. • To reconcile socio-economic analysis and public acceptance it can be recommended to widen the appraisal methodology. • When widening the appraisal......The evaluation of transport projects has traditionally been based on quantitative descriptions of selected impacts by the use of cost-benefit analysis (CBA). However, environmental impacts are now taking into consideration when decisions have to be made, regarding which large transport projects...

  16. Pre-operative MRI of anorectal anomalies in the newborn period

    Energy Technology Data Exchange (ETDEWEB)

    McHugh, K. [Dept. of Radiology, John Radcliffe Hospital, Oxford (United Kingdom); Dudley, N.E. [Dept. of Paediatric Surgery, John Radcliffe Hospital, Oxford (United Kingdom); Tam, P. [Dept. of Paediatric Surgery, John Radcliffe Hospital, Oxford (United Kingdom)

    1995-11-01

    Nine infants (six boys, three girls) with anorectal anomalies were examined in the immediate newborn period, prior to corrective surgery, with MRI. Three high, one intermediate and five low anomalies were found at MRI - one patient with a `low` lesion was subsequently found at surgery 2 months later to have a high anorectal anomaly. This infant had passed meconium per urethram soon after the MRI study, prompting the need for a protective colostomy and stressing the importance of a thorough clinical examination of babies with anorectal malformations. The MRI results and findings at surgery were in agreement in all other patients (n=8). Hydronephrosis was evident in two and renal agenesis in one patient. Sacrococcygeal hypoplasia was found in two and two hemivertebrae in one infant. No spinal cord lesion was identified. One fistula was evident on MRI but four were later found at surgery. Uniformly hyperintense T1 signal meconium was seen in all nine newborns, allowing for easy differentiation of rectal contents from rectal wall and the adjacent musculature. MRI can provide useful information regarding the development of the puborectal and external anal sphincter muscles, can help guide the pull-through procedure and help predict future continence pre-operatively in the newborn period. (orig.)

  17. Superconducting Super Collider site environmental report for calendar year 1991. Pre-operational

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-05-01

    This is the first annual SER prepared for the SSC project. It is a pre-operational report, intended primarily to describe the baseline characterization of the Ellis County, Texas site that has been developed subsequent to the Environmental Impact Statement (EIS) and the Supplemental Environmental impact Statement (SEIS). As such, the emphasis will be on environmental compliance efforts, including monitoring and mitigation programs. The SER also reports on the measures taken to meet the commitments made in the EIS and SEIS. These measures are detailed in the Mitigation Action Plan (MAP) (Department of Energy (DOE), 1991), which was prepared following the signing of the Record of Decision (ROD) to construct the SSC in Texas. The SER will continue to be preoperational until the first high-energy (20 trillion electron volt or TeV) protons collisions are observed, at which point the SSC will become operational. At that time, the SER will place more emphasis on the radiological monitoring program. This SER will report on actions taken in 1991 or earlier and briefly mention some of those planned for calendar year 1992. AU actions completed in 1992 will be addressed in the SER for calendar year 1992.

  18. ROLE OF B - SCAN ULTRASONOGRAPHY IN EVALUATION OF PRE - OPERATIVE CATARACT P ATIENTS

    Directory of Open Access Journals (Sweden)

    Navneet

    2015-03-01

    Full Text Available The purpose of this study was to visualize the status of posterior segment with diagnostic toll of B - scan ultrasound in pre - operative dense cataract patients. METHOD S : Diagnostic B - scan ultrasound was done on 200 cataract patients from the age group of 10 to 80 years of both the sexes. The machine used for the a bove study was B - scan machine – (SONOMED, E - ZSCAN AB 5500 + with frequency 10 MHz. RESULTS: Out of total 200 patients, 23 (traumatic & non traumatic cataract were found having posterior segment lesions. Out of 23, 14 patients belong to non - traumatic cata ract group and 9 patients belong to traumatic cataract group. 5 Patients (25% had PVD and 2 patients (1% had asteroid hyalosis and 1(0.55 patient had intraocular foreign body, 2(1% had posterior staphyloma. In non - traumatic cataract group, 74.5% were i n the range of 50 - 60 years of age. In traumatic cataract group, 47.3% were in the age group 10 - 19 years. In non - traumatic cataract group, 72(39.7% were male and female were 109(60.2%. In traumatic cataract group, male were 14(73.6% and female were 3(26. 3% . CONCLUSION: It was concluded that B - scan ultrasound could be a useful tool for detection of hidden posterior segment lesions in dense cataract patients.

  19. Advance pre-operative chlorhexidine reduces the incidence of surgical site infections in knee arthroplasty.

    Science.gov (United States)

    Zywiel, Michael G; Daley, Jacqueline A; Delanois, Ronald E; Naziri, Qais; Johnson, Aaron J; Mont, Michael A

    2011-07-01

    Surgical site infections following elective knee arthroplasties occur most commonly as a result of colonisation by the patient's native skin flora. The purpose of this study was to evaluate the incidence of deep surgical site infections in knee arthroplasty patients who used an advance cutaneous disinfection protocol and who were compared to patients who had peri-operative preparation only. All adult reconstruction surgeons at a single institution were approached to voluntarily provide patients with chlorhexidine gluconate-impregnated cloths and a printed sheet instructing their use the night before and morning of surgery. Records for all knee arthroplasties performed between January 2007 and December 2008 were reviewed to determine the incidence of deep incisional and periprosthetic surgical site infections. Overall, the advance pre-operative protocol was used in 136 of 912 total knee arthroplasties (15%). A lower incidence of surgical site infection was found in patients who used the advance cutaneous preparation protocol as compared to patients who used the in-hospital protocol alone. These findings were maintained when patients were stratified by surgical infection risk category. No surgical site infections occurred in the 136 patients who completed the protocol as compared to 21 infections in 711 procedures (3.0%) performed in patients who did not. Patient-directed skin disinfection using chlorhexidine gluconate-impregnated cloths the evening before, and the morning of, elective knee arthroplasty appeared to effectively reduce the incidence of surgical site infection when compared to patients who underwent in-hospital skin preparation only.

  20. Pre-operative detection of thyroid pyramidal lobes by ultrasound and computed tomography.

    Science.gov (United States)

    Ryu, Ji Hwa; Kim, Dong Wook; Kang, Taewoo

    2014-07-01

    This study aimed to assess the diagnostic accuracy of pre-operative ultrasound (US) and computed tomography (CT) for detecting thyroid pyramidal lobe (TPL). A single radiologist prospectively performed thyroid US and retrospectively reviewed neck CT to detect TPLs in 135 consecutive patients scheduled for thyroid surgery. The location, size and superior extent of each TPL and its separation or continuity with the main thyroid gland were assessed by thyroid US, neck CT and surgery. The prevalence of TPLs as diagnosed by thyroid US, neck CT and surgery was 58.5% (79/135), 56.3% (76/135) and 60% (81/135), respectively. We compared US and CT detection of TPLs with surgical data to determine their sensitivity (85.2% and 91.4%), specificity (81.5% and 94.4%), positive (87.3% and 96.1%) and negative (78.6% and 87.9%) predictive values and accuracy (83.7% and 92.6%). For detecting TPLs, both neck CT and thyroid US have good diagnostic value, although neck CT is more accurate than thyroid US.

  1. Pre-operational monitor system of large inland lake water quality with MODIS imagery

    Science.gov (United States)

    Xiaoyu, Zhang; Dingtian, Yang; Xiaofeng, Zhang; Difeng, Wang; Shujing, Li; Delu, Pan

    2005-10-01

    EOS\\MODIS data have been proved a suitable and relative low-cost complementary tool to monitor large inland lake water quality for its re-visit frequency, moderate spatial and spectral resolution and appropriate channels designed for inversing water quality parameters. In this study, by the support of hi-tech research and development program of China, Lake water quality remote monitoring pre-operational system (LWQRMPS) was constructed aimed for practical monitoring of Taihu Lake water quality. The main water quality parameters including Chl-a and SPM, TN and TP inversion algorithm were developed. These parameters were obtained every month from time series fusion satellite data. With the routine trophic state evaluation system, the water quality was assessed every month based on the above retrieved MODIS water quality parameters, varied level of eutrophic area was computed. The obvious high reflectance in near-infrared spectrum caused by blue-green algal bloom support the application of 250m MODIS data in the algal bloom emergency monitor. Therefore, MODIS data were utilized successfully for inversing water quality parameters, evaluating eutrophication status, and detecting algal bloom in near real time. Standard thematic maps were produced and distributed to corresponding management departments. The accuracy of products and retrieve algorithm for operational use were tested with separate data sets. The result suggested that system is good enough for practical monitoring water quality of large size lakes and acquired identification.

  2. Incarcerated femoral hernia containing the right uterine tube. A pre-operative diagnosis is possible.

    Science.gov (United States)

    Engin, Omer; Cicek, Ebru; Oner, Soner Recai; Yildirim, Mehmet

    2011-01-01

    The incarcerated femoral hernia containing the right uterine tube is very rare to see. The case report is important to accumulate knowledge of very rare cases. The diagnosis of the case was established pre-operatively with abdominal computerized tomography (CT) On CT examination, the mass in the hernia sac was not connected with the intestines and a tubal structure on the right side of the uterus was shown to extend out of the abdomen. In the operation, the right uterine tube(RUT) was reduced into the abdomen after its blood supply was shown to be normal. A hernia repair was performed. Sometimes in obese patients, incarcerated femoral or inguinal hernias may not been noted. Ultrasonography, CT and magnetic resonance imaging (MRI) is used frequently to diagnose abdominal wall hernias. The organs in the incarcerated sac must be examined carefully and the viability must be checked. The surgeon must decide whether or not to resect the organs. In our case, strangulation was not found and polypropylene mesh was not used for hernia repair due to a fear of infection of the prosthesis. Incarceration of the uterine tube in the sac is traumatic and this condition may lead to infection. Such conditions may lead to ectopic pregnancy. The patient must be informed about ectopic pregnancy due to a previous incarceration of the tube because ectopic pregnancy may be fatal.

  3. SAFETY

    CERN Document Server

    Niels Dupont

    2013-01-01

    CERN Safety rules and Radiation Protection at CMS The CERN Safety rules are defined by the Occupational Health & Safety and Environmental Protection Unit (HSE Unit), CERN’s institutional authority and central Safety organ attached to the Director General. In particular the Radiation Protection group (DGS-RP1) ensures that personnel on the CERN sites and the public are protected from potentially harmful effects of ionising radiation linked to CERN activities. The RP Group fulfils its mandate in collaboration with the CERN departments owning or operating sources of ionising radiation and having the responsibility for Radiation Safety of these sources. The specific responsibilities concerning "Radiation Safety" and "Radiation Protection" are delegated as follows: Radiation Safety is the responsibility of every CERN Department owning radiation sources or using radiation sources put at its disposition. These Departments are in charge of implementing the requi...

  4. Program Facilitates CMMI Appraisals

    Science.gov (United States)

    Sweetser, Wesley

    2005-01-01

    A computer program has been written to facilitate appraisals according to the methodology of Capability Maturity Model Integration (CMMI). [CMMI is a government/industry standard, maintained by the Software Engineering Institute at Carnegie Mellon University, for objectively assessing the engineering capability and maturity of an organization (especially, an organization that produces software)]. The program assists in preparation for a CMMI appraisal by providing drop-down lists suggesting required artifacts or evidence. It identifies process areas for which similar evidence is required and includes a copy feature that reduces or eliminates repetitive data entry. It generates reports to show the entire framework for reference, the appraisal artifacts to determine readiness for an appraisal, and lists of interviewees and questions to ask them during the appraisal. During an appraisal, the program provides screens for entering observations and ratings, and reviewing evidence provided thus far. Findings concerning strengths and weaknesses can be exported for use in a report or a graphical presentation. The program generates a chart showing capability level ratings of the organization. A context-sensitive Windows help system enables a novice to use the program and learn about the CMMI appraisal process.

  5. Politicisation of performance appraisals

    Directory of Open Access Journals (Sweden)

    Sonia Swanepoel

    2014-02-01

    Full Text Available Orientation: Employees are a source of competitive advantage for organisations and human resource management seek to promote employee efficiency. One of the tools organisations utilise to achieve this goal is performance appraisals.Research purpose: The purpose of this study was to investigate the weaknesses in performance appraisal and to determine whether it is politicised in the North West Department of Health and Social Development in South Africa.Motivation for study: Many organisations either ignore the existence of politics in the appraisal process or assume that its impact can be minimised if they refine their appraisal instruments. Executives admit that, in appraising others, they often intentionally avoid meeting the goal of accuracy in favour of achieving goals that have more to do with exercising discretion and maintaining departmental effectiveness. Ironically, these same executives lament that the appraisals they receive often do not accurately represent their abilities and performance (Gioia & Longenecker, 1994.Research approach, design and method: Self-administered questionnaires were used as a means of collecting data and analysis was done through the use of the Statistical Package for the Social Sciences (SPSS.Main findings: The results of the study showed that respondents believe that performance appraisals are highly politicised.Practical/managerial implications: If used effectively, performance appraisals may improve employee productivity and efficiency as well as motivation and performance. However, if performance appraisal is perceived as unfair and political, it can diminish rather than enhance employee attitudes and performance.Contribution: Amongst others, it is recommended that managers should consider separating assessment for development and assessment for rewards.

  6. Efficacy of pre-operative progressive resistance training on post-operative outcomes in patients undergoing total knee arthroplasty

    DEFF Research Database (Denmark)

    Skoffer, Birgit; Maribo, Thomas; Mechlenburg, Inger;

    2015-01-01

    OBJECTIVE: To investigate the efficacy of 4 weeks of pre-operative and 4-week post-operative progressive resistance training (PRT) compared to 4 weeks of post-operative PRT only on functional performance, muscle strength and patient-reported outcomes in patients undergoing total knee arthroplasty...

  7. Safety

    CERN Multimedia

    2003-01-01

    Please note that the safety codes A9, A10 AND A11 (ex annexes of SAPOCO/42) entitled respectively "Safety responsibilities in the divisions" "The safety policy committee (SAPOCO) and safety officers' committees" and "Administrative procedure following a serious accident or incident" are available on the web at the following URLs: Code A9: http://edms.cern.ch/document/337016/LAST_RELEASED Code A10: http://edms.cern.ch/document/337019/LAST_RELEASED Code A11: http://edms.cern.ch/document/337026/LAST_RELEASED Paper copies can also be obtained from the TIS divisional secretariat, e-mail: tis.secretariat@cern.ch. TIS Secretariat

  8. Rescue pre-operative treatment with Lugol’s solution in uncontrolled Graves’ disease

    Science.gov (United States)

    Falhammar, Henrik

    2017-01-01

    Background Graves’ disease is a common cause of hyperthyroidism. Three therapies have been used for decades: pharmacologic therapy, surgery and radioiodine. In case of adverse events, especially agranulocytosis or hepatotoxicity, pre-treatment with Lugol’s solution containing iodine/potassium iodide to induce euthyroidism before surgery could be advocated, but this has rarely been reported. Methods All patients hospitalised due to uncontrolled hyperthyroidism at the Karolinska University Hospital 2005–2015 and treated with Lugol’s solution were included. All electronic files were carefully reviewed manually, with focus on the cause of treatment and admission, demographic data, and effects of iodine on thyroid hormone levels and pulse frequency. Results Twenty-seven patients were included. Lugol’s solution had been chosen due to agranulocytosis in 9 (33%), hepatotoxicity in 2 (7%), other side effects in 11 (41%) and poor adherence to medication in 5 (19%). Levels of free T4, free T3 and heart rate decreased significantly after 5–9 days of iodine therapy (free T4 53–20 pmol/L, P = 0.0002; free T3 20–6.5 pmol/L, P = 0.04; heart rate 87–76 beats/min P = 0.0007), whereas TSH remained unchanged. Side effects were noted in 4 (15%) (rash n = 2, rash and vomiting n = 1, swelling of fingers n = 1). Thyroidectomy was performed in 26 patients (96%) and one was treated with radioiodine; all treatments were without serious complications. Conclusion Treatment of uncontrolled hyperthyroidism with Lugol’s solution before definitive treatment is safe and it decreases thyroid hormone levels and heart rate. Side effects were limited. Lugol’s solution could be recommended pre-operatively in Graves’ disease with failed medical treatment, especially if side effects to anti-thyroid drugs have occurred. PMID:28325735

  9. Can pre-operative computed tomography predict the need for a thoracic approach for removal of retrosternal goitre?

    Science.gov (United States)

    Qureishi, Ali; Garas, George; Tolley, Neil; Palazzo, Fausto; Athanasiou, Thanos; Zacharakis, Emmanouil

    2013-01-01

    A best evidence topic was written according to a structured protocol. The question addressed was whether in patients with retrosternal goitre the need for a thoracic approach can be predicted using pre-operative CT. A total of 381 papers were identified using the reported search protocol of which 7 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group studied, study type, relevant outcomes and results are tabulated. The evidence on this subject is poor, none of the studies were randomised, only one used controls (historical) and all studies were retrospective. Despite these limitations, CT represents the gold-standard imaging modality in the pre-operative evaluation of patients with retrosternal goitre. CT is essential to define the extent and position of a retrosternal goitre. The literature suggests that CT is the single most valuable pre-operative investigation predicting whether a sternotomy or lateral thoracotomy will be necessary for removal of the retrosternal goitre. Although pre-operative CT does not have the precision to predict whether a thoracic approach is required in all cases, the presence of certain radiological features such as extension of the goitre below the aortic arch or into the posterior mediastinum, a dumbbell shape and a thoracic component that is wider than the thoracic inlet are all associated with the need for a thoracic approach. In some cases a pre-operative CT will not only determine that a thoracic approach is mandatory but it will also guide the surgeon upon the type of thoracic approach.

  10. From pre-operative cardiac modeling to intra-operative virtual environments for surgical guidance: an in vivo study

    Science.gov (United States)

    Linte, Cristian A.; Wierzbicki, Marcin; Moore, John; Wedlake, Christopher; Wiles, Andrew D.; Bainbridge, Daniel; Guiraudon, Gérard M.; Jones, Douglas L.; Peters, Terry M.

    2008-03-01

    As part of an ongoing theme in our laboratory on reducing morbidity during minimally-invasive intracardiac procedures, we developed a computer-assisted intervention system that provides safe access inside the beating heart and sufficient visualization to deliver therapy to intracardiac targets while maintaining the efficacy of the procedure. Integrating pre-operative information, 2D trans-esophageal ultrasound for real-time intra-operative imaging, and surgical tool tracking using the NDI Aurora magnetic tracking system in an augmented virtual environment, our system allows the surgeons to navigate instruments inside the heart in spite of the lack of direct target visualization. This work focuses on further enhancing intracardiac visualization and navigation by supplying the surgeons with detailed 3D dynamic cardiac models constructed from high-resolution pre-operative MR data and overlaid onto the intra-operative imaging environment. Here we report our experience during an in vivo porcine study. A feature-based registration technique previously explored and validated in our laboratory was employed for the pre-operative to intra-operative mapping. This registration method is suitable for in vivo interventional applications as it involves the selection of easily identifiable landmarks, while ensuring a good alignment of the pre-operative and intra-operative surgical targets. The resulting augmented reality environment fuses the pre-operative cardiac model with the intra-operative real-time US images with approximately 5 mm accuracy for structures located in the vicinity of the valvular region. Therefore, we strongly believe that our augmented virtual environment significantly enhances intracardiac navigation of surgical instruments, while on-target detailed manipulations are performed under real-time US guidance.

  11. Employee Satisfaction with Performance Appraisals and Appraisers: The Role of Perceived Appraisal Use.

    Science.gov (United States)

    Boswell, Wendy R.; Boudreau, John W.

    2000-01-01

    In a survey of 128 manufacturing employees, the perception that performance appraisal had developmental uses was associated with satisfaction with appraisals and appraisers. Reaction to the evaluation did not depend on the outcome of the appraisal or its perceived fairness. (SK)

  12. Females, younger patients and patients with high BMI have the highest pre-operative knee awareness measured using the Forgotten Joint Score.

    Science.gov (United States)

    Li, Dana; Troelsen, A; Ingelsrud, L; Husted, H; Gromov, K

    2017-02-16

    The Forgotten Joint Score (FJS) is a novel measurement for patients' awareness of their knee in daily life. By identifying factors that could explain pre-operative FJS levels, the clinician could better prioritize and single out patients who would benefit most from TKA. The aim of this study was to identify possible factors that may explain the variance of pre-operative FJS levels and evaluate the relationship between pre-operative FJS and pre-operative Oxford Knee Score (OKS). Four-hundred and six individual knees undergoing primary TKA between 2014 and 2016 were included in the study. Age, gender, body mass index (BMI), pre-operative FJS and pre-operative OKS were obtained maximum 2 weeks prior to surgery. Kellgren-Lawrence (K-L) grade, alignment and joint space width (JSW) were evaluated on pre-operative radiographs. Mean FJS was 21.1 ± 15.6. Females, younger patients and patients with high BMI had significantly the worst pre-operative FJS (p < 0.005). Females scored 6.5 FJS points lower than males. A 0.2-point increase in FJS for every added year indicated improvement in knee awareness with age. A 0.4-point decrease in FJS points for every added BMI point indicated worse knee awareness with higher BMI. There was a strong positive correlation between pre-operative FJS and pre-operative OKS according to the Spearman's rank order test (p < 0.005). Females, younger patients and patients with high BMI had significantly the worst pre-operative joint awareness. FJS had a strong positive correlation to OKS in pre-operative patients for primary TKA. This information can be used for improved patient selection; clinically continuous low FJS despite weight loss and/or the passing of time may be indication for TKA. Prospective cohort study, Level II.

  13. Novel application of pre-operative vertebral body embolization to reduce intraoperative blood loss during a three-column spinal osteotomy for non-oncologic spinal deformity.

    Science.gov (United States)

    Tuchman, Alexander; Mehta, Vivek A; Mack, William J; Acosta, Frank L

    2015-04-01

    Three column osteotomies (3CO) of the lumbar spine are powerful corrective procedures used in the treatment of kyphoscoliosis. Their efficacy comes at the cost of high reported complication rates, notably significant estimated blood loss (EBL). Previously reported techniques to reduce EBL have had modest efficacy. Here we describe a potential technique to decrease EBL during pedicle subtraction osteotomy (PSO) of the lumbar spine by means of pre-operative vertebral body embolization - a technique traditionally used to reduce blood loss prior to spinal column tumor resection. We present a 62-year-old man with iatrogenic kyphoscoliosis who underwent staged deformity correction. Stage 1 involved thoracolumbar instrumentation followed by transarterial embolization of the L4 vertebral body through bilateral segmental arteries. A combination of polyvinyl alcohol particles and Gelfoam (Pfizer, New York, NY, USA) were used. Following embolization there was decreased angiographic blood flow to the small vessels of the L4 vertebral body, while the segmental arteries remained patent. Stage 2 consisted of an L4 PSO and fusion. The EBL during the PSO procedure was 1L, which compared favorably to that during previous PSO at this institution as well as to quantities reported in previous literature. There have been no short term (5 month follow-up) complications attributable to the vertebral body embolization or surgical procedure. Although further investigation into this technique is required to better characterize its safety and efficacy in reducing EBL during 3CO, we believe this patient illustrates the potential utility of pre-operative vertebral embolization in the setting of non-oncologic deformity correction surgery.

  14. Physician Appraisals: Key Challenges

    Directory of Open Access Journals (Sweden)

    Klich Jacek

    2017-06-01

    Full Text Available The main purpose of the article is to identify key criteria being used for physician appraisals and to find how communication skills of physicians are valued in those appraisals. ScienceDirect and EBSCOhost databases were used for this search. The results show that a physician appraisal is underestimated both theoretically and empirically. The particular gap exists with respect to the communication skills of physicians, which are rarely present in medical training syllabi and physician assessments. The article contributes to the theoretical discourse on physician appraisals and points out at the inconsistency between the high status of physicians as a key hospital resource on the one hand and, on the other hand, at inadequate and poorly researched assessment of their performance with a special emphasis on communication skills. The article may inspire health managers to develop and implement up-to-date assessment forms for physicians and good managerial practices in this respect in hospitals and other health care units.

  15. Appraisal of efficacy and safety of intralesional injection of high concentration of bleomycin A5 for treatment of huge macrocystic lymphatic malformations in cervical region.

    Science.gov (United States)

    Xu, Da-Peng; Zhai, Qin-Kai; Cheng, Chen; Gong, He; Wang, Hong-Wei; Wang, Xu-Kai

    2014-09-01

    The objective of this study was to investigate the therapeutic effects and safety of intralesional injection of high concentration of bleomycin A5 for huge (more than 5 cm in diameter) macrocystic lymphatic malformations (LMs) in the cervical region. Thirty-two patients with huge macrocystic LMs were treated with percutaneous injection of bleomycin A5 in our department between 2006 and 2011. Among them, 13 patients had unilateral submandibular lesions, and 19 patients had lesions in anterior cervical regions. The age of patients ranged from 10 months to 29 years (mean age, 11.4 y). The concentration of the drug was as high as 2.7 mg/mL (8 mg/3 mL) with an addition of dexamethasone. The mean sessions of injection were 1.6 (1-3 sessions). Repeated injection interval was 4 to 6 weeks. The follow-up period was 6 months to 4 years after the last treatment, and the mean follow-up time was 18 months. The results were evaluated based on clinical examination and Doppler ultrasonography scan. The clinical follow-up showed excellent response in 28 of the 32 patients, whereas 4 of the 32 patients also had a satisfactory response. No serious complications were encountered. Intralesional injection of high concentration of bleomycin A5 was an effective and safe treatment of huge macrocystic LMs in the cervical region and can obtain satisfactory results esthetically and functionally without surgery.

  16. Appraising the safety and efficacy profile of left atrial appendage closure in 2016 and the future clinical perspectives. Results of the EAPCI LAAC survey.

    Science.gov (United States)

    Santucci, Andrea; Byrne, Robert A; Baumbach, Andreas; Colleran, Roisin; Haude, Michael; Windecker, Stephan; Valgimigli, Marco

    2016-05-17

    The aim of this study was to determine the opinion of the scientific community regarding percutaneous left atrial appendage closure (LAAC). The main focus of the survey was on concerns and expectations regarding the safety and efficacy profile of LAAC in clinical practice and on current and future clinical perspectives. A voluntary web-based survey was distributed by the European Association of Percutaneous Coronary Interventions (EAPCI) to all individuals registered on the EuroIntervention mailing list (n=21,800). A total of 724 physicians responded to the survey, of whom 31.8% had first operator experience with LAAC. Exclusive use of the Amulet (34.4%) or WATCHMAN (30.3%) was similar, but the former was the most frequently used device in Europe. The majority of respondents (59.3%) deemed LAAC to be as effective as, but safer than oral anticoagulants (OAC) in reducing stroke risk. Periprocedural complications (40.3%) and cost (28.8%) were the major concerns. Most practitioners did not consider novel oral anticoagulants (NOACs) to be a deterrent for performing LAAC procedures. Moreover, a history of serious haemorrhage was not deemed necessary to justify LAAC for 59.8% of physicians. The results of this survey reveal a high level of confidence in percutaneous LAAC amongst surveyed interventional cardiologists, with the majority believing it to be as effective as OAC in terms of stroke prevention and safer in terms of bleeding risk.

  17. Can EGFR mutation status be reliably determined in pre-operative needle biopsies from adenocarcinomas of the lung?

    DEFF Research Database (Denmark)

    Lindahl, Kim Hein; Sørensen, Flemming Brandt; Jonstrup, Søren Peter

    2015-01-01

    The identification of EGFR mutations in non-small-cell lung cancer is important for selecting patients, who may benefit from treatment with EGFR tyrosine kinase inhibitors. The analysis is usually performed on cytological aspirates and/or histological needle biopsies, representing a small fraction......-operative biopsies (131 histological and 70 cytological) and on the surgical specimens, using PCR. Samples with low tumour cell fraction were assigned to laser micro-dissection (LMD). We found nine (4.5%) patients with EGFR mutation in the lung tumour resections, but failed to identify mutation in one...... of the corresponding pre-operative, cytological specimens. Several (18.4%) analyses of the pre-operative biopsies were inconclusive, especially in case of biopsies undergoing LMD and regarding exon 21 analysis. Discrepancy of mutation status in one patient may reflect intra-tumoural heterogeneity or technical issues...

  18. Changes in biological markers, particularly hormone receptors, due to pre-operative chemotherapy (epirubicin/docetaxel in operable breast cancer

    Directory of Open Access Journals (Sweden)

    Rumiko Tashima

    2011-12-01

    Full Text Available We investigated the correlation between biological markers prior to pre-operative chemotherapy with epirubicin and docetaxel (ET therapy and the effect of treatment as well as the clinically significant changes in biological markers before and after chemotherapy. Since April 2002, 52 patients with tumors ≥3 cm in diameter or lymph node metastases have received pre-operative ET chemotherapy. The items investigated were ER/PgR, proliferative activity (MIB-1, etc. The correlation of changes in these factors between pre- and post-treatment status and the clinical and pathological responses was investigated. Clinical response was 82%, BCS rate was 67%. Pathological response was 31.4%. The ER/PgR positive cell rate significantly decreased from 48%/32% to 37%/14%. The MIB-1 decreased from 48% to 27%. The pathological response was significantly high in patients with low ER/PgR-positive rates and those with high MIB-1 values.

  19. Pre-operative renal arterial embolisation does not provide survival benefit in patients with radical nephrectomy for renal cell carcinoma.

    Science.gov (United States)

    May, M; Brookman-Amissah, S; Pflanz, S; Roigas, J; Hoschke, B; Kendel, F

    2009-08-01

    Currently, there is no widespread use of percutaneous renal artery embolisation (PRAE) as a pre-operative treatment in the management of renal cell carcinoma (RCC). There is also a scarcity of studies concerning the potential benefits of this procedure. All patients with RCC who underwent pre-operative PRAE before nephrectomy (n = 227) and all patients solely undergoing surgery (n = 607) at our institution from 1992 to 2006 were included. Information on techniques used, perioperative transfusion requirements, pathological and clinical variables, acute toxicity and complications were obtained from a retrospective review of medical records. Propensity modelling techniques were used to compare cancer-specific survival (CSS) and overall survival (OS) in both groups. Propensity scores were calculated from a logistic matching model including age, gender, clinical tumour size, grading, pN stage, cM stage, pT stage, histology and microvascular invasion. This resulted in 189 matches. The mean follow-up of the entire group of matched patients was 81 months. The 5-year actuarial CSS and OS for the total group of matched patients was 80.8% and 73.9%, respectively. CSS and OS did not show any significant differences between the matched treatment groups. There were no statistical differences in surgical complications between all patients treated with pre-operative PRAE (n = 227) and all patients without PRAE (n = 607), except for blood transfusion (61% vs 24%; ppost-embolization syndrome, including lumbar pain, fever, nausea, hypertension and macroscopic haematuria, were reported by 202 patients (89%), in most cases being mild and self-limited. There is no conclusive evidence that pre-operative PRAE provides survival benefits in the management of surgically resected RCC.

  20. Pre-operative use of anti-TNF-alpha agents and the risk of post-operative complications in patients with Crohn's disease--a nationwide cohort study

    DEFF Research Database (Denmark)

    Nørgård, Bente Mertz; Nielsen, J.; Qvist, N.

    2013-01-01

    BACKGROUND: A possible negative role of pre-operative use of antitumour necrosis factor-alpha (anti-TNF-alpha) agents on post-operative outcomes in Crohn's disease (CD) patients is still debated. AIM: To examine the impact of pre-operative anti-TNF-alpha agents on post-operative outcomes 30 and 6...

  1. Pre-operative use of anti-TNF-α agents and the risk of post-operative complications in patients with ulcerative colitis - a nationwide cohort study

    DEFF Research Database (Denmark)

    Nørgård, B M; Nielsen, J; Qvist, N;

    2012-01-01

    It is still controversial whether pre-operative anti-tumour necrosis factor-alpha (anti-TNF-α) agents increase post-operative complications in patients with ulcerative colitis (UC).......It is still controversial whether pre-operative anti-tumour necrosis factor-alpha (anti-TNF-α) agents increase post-operative complications in patients with ulcerative colitis (UC)....

  2. Minor elective surgical procedures using general anesthesia in children with sickle cell anemia without pre-operative blood transfusion.

    Science.gov (United States)

    Fu, Teresa; Corrigan, Nicole J; Quinn, Charles T; Rogers, Zora R; Buchanan, George R

    2005-07-01

    Pre-operative red blood cell (RBC) transfusions are often recommended for patients with sickle cell disease (SCD) who require elective surgery under general anesthesia. However, definitive randomized studies demonstrating the benefit of transfusions in this setting have not been conducted. In particular, the merits of transfusion prior to minor or low-risk surgical procedures in children with SCD have not been demonstrated. We hypothesized that children with sickle cell anemia (Hb SS) who have minor elective surgical procedures develop few complications even without pre-operative transfusion. We accessed our Comprehensive Sickle Cell Program's Database to identify all such procedures performed during a 13-year period. Medical records were reviewed to characterize the surgical procedure, the use of transfusions, and perioperative complications. Twenty-eight children with Hb SS had a total of 38 minor surgical procedures. No perioperative transfusions were given in 34 of the cases (85%). Five of these 34 surgeries (15%) were associated with minor post-operative complications (fever or transient pain). No post-operative acute chest syndrome was encountered. Minor or low-risk elective surgical procedures in children with Hb SS may not routinely require pre-operative transfusion. A randomized clinical trial to compare transfusion with no transfusion for minor surgical procedures is needed.

  3. Do pre-operative knee laxity values influence post-operative ones after anterior cruciate ligament reconstruction?

    Science.gov (United States)

    Signorelli, C; Bonanzinga, T; Lopomo, N; Marcheggiani Muccioli, G M; Bignozzi, S; Filardo, G; Zaffagnini, S; Marcacci, M

    2013-08-01

    The objective of this study was to verify whether pre-reconstruction laxity condition effects post-reconstruction outcome. A total of 100 patients who underwent navigated Anterior Cruciate Ligament (ACL) reconstruction were included in the study and knee laxity analysed retrospectively. The knee was assessed in six different laxity tests before and after ACL reconstruction, namely antero-posterior (AP) and internal-external (IE) at 30° and 90°, and varus-valgus (VV) rotations at 0° and 30° of flexion. For each test, the least square (LS) fitting line based on pre-operative-to-post-operative laxity value was calculated. To what degree the post-operative laxity value is explainable by the corresponding pre-operative condition was evaluated by the LS line slope. Post-operatively, for each single patient, the grade of laxity decreased at any evaluated test. The strongest influence of pre-operative-to-post-operative laxity values was found during IE30 and IE90 tests. While AP30 and VV0 tests seem to be those in which the post-reconstruction laxity was barely affected by the pre-surgery condition. The analysis of the global laxity reduction confirms the previous results. Following this hypothesis, our study remarks on the importance of combined lesions to secondary restraints and the importance of fully understanding the residual laxity to optimize the surgical technique.

  4. Role of routine pre-operative screening venous duplex ultrasound in morbidly obese patients undergoing bariatric surgery

    Directory of Open Access Journals (Sweden)

    P Praveen Raj

    2017-01-01

    Full Text Available Background/Aims: It is well established that obesity is a strongly associated risk factor for post-operative deep vein thrombosis (DVT. Physical effects and pro-thrombotic, pro-inflammatory and hypofibrinolytic effects of severe obesity may predispose to idiopathic DVT (pre-operatively because of which bariatric patients are routinely screened before surgery. The aim of this study was to audit the use of routine screening venous duplex ultrasound in morbidly obese patients before undergoing bariatric surgery. Methods: We retrospectively reviewed 180 patients who underwent bariatric surgery from August 2013 to August 2014 who had undergone pre-operative screening bilateral lower-extremity venous duplex ultrasound for DVT. Data were collected on patient's demographics, history of venous thromboembolism, prior surgeries and duplex ultrasound details of the status of the deep veins and superficial veins of the lower limbs. Results: No patients had symptoms or signs of DVT pre-operatively. No patient gave history of DVT. No patient was found to have iliac, femoral or popliteal vein thrombosis. Superficial venous disease was found in 17 (8%. One patient had a right lower limb venous ulcer. Conclusion: Thromboembolic problems in the morbidly obese before bariatric surgery are infrequent, and screening venous duplex ultrasound can be done in high-risk patients only.

  5. Pre-operative testing for pregnancy in Dublin day surgery units.

    LENUS (Irish Health Repository)

    Wong, L F A

    2013-06-01

    The safety of anaesthetic agents in early pregnancy cannot be guaranteed. Certain types of surgery, particularly gynaecological, may also be dangerous. It is therefore important to ensure that, female patients are not inadvertently pregnant when undergoing elective surgery. Different hospitals have different policies and guidelines in place to determine female patients\\' pregnancy status prior to elective surgery.

  6. Real estate surfaces appraisal

    Directory of Open Access Journals (Sweden)

    Marina Ciuna

    2014-07-01

    Full Text Available In the appraisal of the market value of the properties are applied two important surface indexes: the market surface ratio of the secondary surfaces and the ratio of the site value to total value (allocation method. The measure of both these indexes can be revealed difficult: the data collection of the surface trade ratio in the market can get different results and in practice often the valuer refolds on the fixed coefficients brought in the handbooks and in the circulars of the public administration; the appraisal of the ratio of the site, especially in the central zones and for ancient buildings, where besides the incidence is higher, is developed extrapolating the ratios from the peripheral zones for new building or falling back on the publications of real estate sector.For the market comparison methods are proposed a series of test of surface trade ratio and land value ratio to foresee the effect on the appraisal result.

  7. Apixaban, an oral, direct, selective factor Xa inhibitor, in combination with antiplatelet therapy after acute coronary syndrome: results of the Apixaban for Prevention of Acute Ischemic and Safety Events (APPRAISE) trial.

    Science.gov (United States)

    Alexander, John H; Becker, Richard C; Bhatt, Deepak L; Cools, Frank; Crea, Filippo; Dellborg, Mikael; Fox, Keith A A; Goodman, Shaun G; Harrington, Robert A; Huber, Kurt; Husted, Steen; Lewis, Basil S; Lopez-Sendon, Jose; Mohan, Puneet; Montalescot, Gilles; Ruda, Mikhail; Ruzyllo, Witold; Verheugt, Freek; Wallentin, Lars

    2009-06-09

    After an acute coronary syndrome, patients remain at risk of recurrent events. Apixaban, an oral direct factor Xa inhibitor, is a novel anticoagulant that may reduce these events but also poses a risk of bleeding. Apixaban for Prevention of Acute Ischemic and Safety Events (APPRAISE) was a phase 2, double-blind, placebo-controlled, dose-ranging study. Patients (n=1715) with recent ST-elevation or non-ST-elevation acute coronary syndrome were randomized to 6 months of placebo (n=611) or 1 of 4 doses of apixaban: 2.5 mg twice daily (n=317), 10 mg once daily (n=318), 10 mg twice daily (n=248), or 20 mg once daily (n=221). Nearly all patients received aspirin; 76% received clopidogrel. The primary outcome was International Society of Thrombosis and Hemostasis major or clinically relevant nonmajor bleeding. A secondary outcome was cardiovascular death, myocardial infarction, severe recurrent ischemia, or ischemic stroke. At the recommendation of the Data Monitoring Committee, the 2 higher-dose apixaban arms were discontinued because of excess total bleeding. Compared with placebo, apixaban 2.5 mg twice daily (hazard ratio, 1.78; 95% confidence interval, 0.91 to 3.48; P=0.09) and 10 mg once daily (hazard ratio, 2.45; 95% confidence interval, 1.31 to 4.61; P=0.005) resulted in a dose-dependent increase in major or clinically relevant nonmajor bleeding. Apixaban 2.5 mg twice daily (hazard ratio, 0.73; 95% confidence interval, 0.44 to 1.19; P=0.21) and 10 mg once daily (hazard ratio, 0.61; 95% confidence interval, 0.35 to 1.04; P=0.07) resulted in lower rates of ischemic events compared with placebo. The increase in bleeding was more pronounced and the reduction in ischemic events was less evident in patients taking aspirin plus clopidogrel than in those taking aspirin alone. We observed a dose-related increase in bleeding and a trend toward a reduction in ischemic events with the addition of apixaban to antiplatelet therapy in patients with recent acute coronary syndrome

  8. Pre-operative stroke and neurological disability do not independently affect short- and long-term mortality in infective endocarditis patients.

    Science.gov (United States)

    Diab, Mahmoud; Guenther, Albrecht; Sponholz, Christoph; Lehmann, Thomas; Faerber, Gloria; Matz, Anna; Franz, Marcus; Witte, Otto W; Pletz, Mathias W; Doenst, Torsten

    2016-10-01

    Infective endocarditis (IE) is still associated with high morbidity and mortality. The impact of pre-operative stroke on mortality and long-term survival is controversial. In addition, data on the severity of neurological disability due to pre-operative stroke are scarce. We analysed the impact of pre-operative stroke and the severity of its related neurological disability on short- and long-term outcome. We retrospectively reviewed our data from patients operated for left-sided IE between 01/2007 and 04/2013. We performed univariate (Chi-Square and independent samples t test) and multivariate analyses. Among 308 consecutive patients who underwent cardiac surgery for left-sided IE, pre-operative stroke was present in 87 (28.2 %) patients. Patients with pre-operative stroke had a higher pre-operative risk profile than patient without it: higher Charlson comorbidity index (8.1 ± 2.6 vs. 6.6 ± 3.3) and higher incidence of Staphylococcus aureus infection (43 vs. 17 %) and septic shock (37 vs. 19 %). In-hospital mortality was equal but 5-year survival was significantly worse with pre-operative stroke (33.1 % vs. 45 %, p = 0.006). 5-year survival was worst in patients with severe neurological disability compared to mild disability (19.0 vs. 0.58 %, p = 0.002). However, neither pre-operative stroke nor the degree of neurological disability appeared as an independent risk factor for short or long-term mortality by multivariate analysis. Pre-operative stroke and the severity of neurological disability do not independently affect short- and long-term mortality in patients with infective endocarditis. It appears that patients with pre-operative stroke present with a generally higher risk profile. This information may substantially affect decision-making.

  9. 12 CFR 34.43 - Appraisals required; transactions requiring a State certified or licensed appraiser.

    Science.gov (United States)

    2010-01-01

    ..., DEPARTMENT OF THE TREASURY REAL ESTATE LENDING AND APPRAISALS Appraisals § 34.43 Appraisals required; transactions requiring a State certified or licensed appraiser. (a) Appraisals required. An appraisal performed by a State certified or licensed appraiser is required for all real estate-related...

  10. GlobVolcano pre-operational services for global monitoring active volcanoes

    Science.gov (United States)

    Tampellini, Lucia; Ratti, Raffaella; Borgström, Sven; Seifert, Frank Martin; Peltier, Aline; Kaminski, Edouard; Bianchi, Marco; Branson, Wendy; Ferrucci, Fabrizio; Hirn, Barbara; van der Voet, Paul; van Geffen, J.

    2010-05-01

    The GlobVolcano project (2007-2010) is part of the Data User Element programme of the European Space Agency (ESA). The project aims at demonstrating Earth Observation (EO) based integrated services to support the Volcano Observatories and other mandate users (e.g. Civil Protection) in their monitoring activities. The information services are assessed in close cooperation with the user organizations for different types of volcano, from various geographical areas in various climatic zones. In a first phase, a complete information system has been designed, implemented and validated, involving a limited number of test areas and respective user organizations. In the currently on-going second phase, GlobVolcano is delivering pre-operational services over 15 volcanic sites located in three continents and as many user organizations are involved and cooperating with the project team. The set of GlobVolcano offered EO based information products is composed as follows: Deformation Mapping DInSAR (Differential Synthetic Aperture Radar Interferometry) has been used to study a wide range of surface displacements related to different phenomena (e.g. seismic faults, volcanoes, landslides) at a spatial resolution of less than 100 m and cm-level precision. Permanent Scatterers SAR Interferometry method (PSInSARTM) has been introduced by Politecnico of Milano as an advanced InSAR technique capable of measuring millimetre scale displacements of individual radar targets on the ground by using multi-temporal data-sets, estimating and removing the atmospheric components. Other techniques (e.g. CTM) have followed similar strategies and have shown promising results in different scenarios. Different processing approaches have been adopted, according to data availability, characteristic of the area and dynamic characteristics of the volcano. Conventional DInSAR: Colima (Mexico), Nyiragongo (Congo), Pico (Azores), Areanal (Costa Rica) PSInSARTM: Piton de la Fournaise (La Reunion Island

  11. Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests

    Science.gov (United States)

    2012-01-01

    Background Routine pre-operative tests for anesthesia management are often ordered by both anesthesiologists and surgeons for healthy patients undergoing low-risk surgery. The Theoretical Domains Framework (TDF) was developed to investigate determinants of behaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists’ and surgeons’ perceptions of ordering routine tests for healthy patients undergoing low-risk surgery. Methods Sixteen clinicians (eleven anesthesiologists and five surgeons) throughout Ontario were recruited. An interview guide based on the TDF was developed to identify beliefs about pre-operative testing practices. Content analysis of physicians’ statements into the relevant theoretical domains was performed. Specific beliefs were identified by grouping similar utterances of the interview participants. Relevant domains were identified by noting the frequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence on the performance of the behaviour under investigation. Results Seven of the twelve domains were identified as likely relevant to changing clinicians’ behaviour about pre-operative test ordering for anesthesia management. Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity); inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences); and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources). Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences). There were also conflicting comments about the potential consequences associated with

  12. Anesthesiologists' and surgeons' perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians' decisions to order pre-operative tests.

    Science.gov (United States)

    Patey, Andrea M; Islam, Rafat; Francis, Jill J; Bryson, Gregory L; Grimshaw, Jeremy M

    2012-06-09

    Routine pre-operative tests for anesthesia management are often ordered by both anesthesiologists and surgeons for healthy patients undergoing low-risk surgery. The Theoretical Domains Framework (TDF) was developed to investigate determinants of behaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists' and surgeons' perceptions of ordering routine tests for healthy patients undergoing low-risk surgery. Sixteen clinicians (eleven anesthesiologists and five surgeons) throughout Ontario were recruited. An interview guide based on the TDF was developed to identify beliefs about pre-operative testing practices. Content analysis of physicians' statements into the relevant theoretical domains was performed. Specific beliefs were identified by grouping similar utterances of the interview participants. Relevant domains were identified by noting the frequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence on the performance of the behaviour under investigation. Seven of the twelve domains were identified as likely relevant to changing clinicians' behaviour about pre-operative test ordering for anesthesia management. Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity); inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences); and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources). Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences). There were also conflicting comments about the potential consequences associated with reducing testing, from negative

  13. Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF to identify factors that influence physicians’ decisions to order pre-operative tests

    Directory of Open Access Journals (Sweden)

    Patey Andrea M

    2012-06-01

    Full Text Available Abstract Background Routine pre-operative tests for anesthesia management are often ordered by both anesthesiologists and surgeons for healthy patients undergoing low-risk surgery. The Theoretical Domains Framework (TDF was developed to investigate determinants of behaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists’ and surgeons’ perceptions of ordering routine tests for healthy patients undergoing low-risk surgery. Methods Sixteen clinicians (eleven anesthesiologists and five surgeons throughout Ontario were recruited. An interview guide based on the TDF was developed to identify beliefs about pre-operative testing practices. Content analysis of physicians’ statements into the relevant theoretical domains was performed. Specific beliefs were identified by grouping similar utterances of the interview participants. Relevant domains were identified by noting the frequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence on the performance of the behaviour under investigation. Results Seven of the twelve domains were identified as likely relevant to changing clinicians’ behaviour about pre-operative test ordering for anesthesia management. Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity; inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences; and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources. Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences. There were also conflicting comments about the potential

  14. Appraising Party Cadres

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    An efficient cadre appraisal system guarantees cadres of the Communist Party of China will serve the people wholeheartedly According to the Progress in A China’s Human Rights in 2009 white paper,there were more than 2.9 million ethnic-minority cadres in China,accounting for 7.4 percent

  15. An initial radiation safety needs assessment of Costa Rica: the South Texas Chapter of the Health Physics Society's strategic planning appraisal for participation in the "Radiation Safety Without Borders" initiative.

    Science.gov (United States)

    Emery, Robert J; Felknor, S A

    2002-05-01

    In response to the Health Physics Society's recent 'radiation safety without borders" initiative, the South Texas Chapter of the Health Physics Society selected Costa Rica as its partner country of choice. To develop an understanding of the radiation safety needs of this country, the fall 2001 University of Texas Health Science Center at Houston School of Public Health Environmental Radiation and Radioactivity class was tasked with the assignment of assessing the possible radiation safety needs and concerns for this country. The assignment culminated in a class presentation to the membership of the South Texas Chapter during its annual fall meeting. Using library and web based resources, tile students reviewed a number of public health and radiation-related topics. Life expectancies were found to be equivalent to the United States, even though significant differences in per capita health expenditures were noted. Costa Rica exhibited lower population mortality rates from major causes such as cardiovascular diseases, neoplasms, and external sources. Maternal and infant mortality rates were found to be much higher in Costa Rica than in the United States. Naturally occurring radiation sources such as uranium deposits were not identified as apparent major radiation issues of concern, although ultraviolet radiation exposures are consistently high. Several recent events in the country and the region involving patient overexposures suggest that concerns are likely focused on ensuring the proper use and maintenance of healing arts radiation equipment. The lack of available information on radioactive waste disposal suggests that waste handling also may be an issue warranting attention. The exercise proved to be very educational for the students, and the information gathered will serve to focus the Chapter's efforts when technical exchanges are initiated. The importance of linking this initiative to other existing programs within the country is also discussed.

  16. Pre-operative flexion contracture determines the functional outcome of haemophilic arthropathy treated with total knee arthroplasty.

    Science.gov (United States)

    Atilla, B; Caglar, O; Pekmezci, M; Buyukasik, Y; Tokgozoglu, A M; Alpaslan, M

    2012-05-01

    End-stage haemophiliac arthropathy can be successfully treated with total knee arthroplasty. However, the functional results may not be as good as anticipated and certain pre-op knee characteristics may alter the functional results. The purpose of this study was to evaluate the functional outcome of TKA in haemophilic patients with specific attention to final range of motion and residual flexion contracture of the joint. Twenty-one consecutive patients were retrospectively reviewed. The average age was 34 years with an average follow-up of 5.7 years. Functional status was evaluated with Hospital for Special Surgery Knee Score. Receiving Operating Characteristics analysis was used to determine the threshold of pre-operative flexion contracture degree to avoid residual knee contracture. The range of motion was increased in 16 joints and unchanged in three joints and decreased in the remaining two. Preoperative average range of motion was 37.6°, improved to 57.1° post-operatively. The average knee score increased from 27.85 (15-30) points pre-operatively to 79.42 (12-94) points at the last follow-up. The degree of pre-operative flexion contracture was found to be a good predictor for residual flexion contracture. (Specificity: 85.7%, sensitivity: 100%, cut-off: 27.5°). Total knee replacement improves the quality of life in patients with advanced haemophilic arthropathy. Statistical analysis revealed that pre-op flexion contracture of 27.5° is an important threshold. Patients should be operated before that stage to gain maximum benefit with minimal gait abnormalities. © 2011 Blackwell Publishing Ltd.

  17. Surgical bleeding after pre-operative unfractionated heparin and low molecular weight heparin for coronary bypass surgery.

    Science.gov (United States)

    Renda, Giulia; Di Pillo, Raffaele; D'Alleva, Alberto; Sciartilli, Adolfo; Zimarino, Marco; De Candia, Erica; Landolfi, Raffaele; Di Giammarco, Gabriele; Calafiore, Antonio; De Caterina, Raffaele

    2007-03-01

    Since the impairment of platelet function may cause excess peri-operative bleeding, pre-operative discontinuation of aspirin and heparin bridging are common for cardiac surgery. We evaluated the impact of pre-operative administration of enoxaparin and unfractionated heparin (UFH) on coagulation parameters and peri-operative bleeding in patients undergoing elective coronary artery bypass grafting (CABG) surgery after discontinuation of aspirin. Forty-three patients with three-vessel coronary artery disease undergoing elective CABG surgery discontinued aspirin and were randomized to receive either UFH 180 UI/Kg x 2/day s.c. or enoxaparin 100 UI/Kg x 2/day s.c. until 12 h before surgery (median pre-operative treatment 8 days, range 6-12 days). Surgery was performed as usual with UFH. Neither UFH nor any low molecular weight heparin was given in the immediate post-operative period. The effects of UFH and enoxaparin were monitored by the activated partial thromboplastin time (aPTT) and the Enox-test (sensitive to factor Xa inhibition) using a Rapidpoint Coagulation Analyzer. aPTT and factor Xa activity were also measured by standard methods. Peri-operative bleeding and the nadirs of hemoglobin concentration, hematocrit and platelet count were monitored post-operatively. Patients in the two groups were similar for number of bypasses, on-pump time, total surgery time, and time from the last heparin administration. Coagulation parameters increased significantly and similarly at 30 min and 6 h with both treatments, but returned within the normal range at 12 h. Hemoglobin, hematocrit and platelet counts significantly decreased to the same extent after CABG and re-normalized at the same time. Transfusional requirements of blood and plasma units were similar in the two groups. From the kinetics of coagulation parameters and the evaluation of bleeding, enoxaparin is a safe alternative to UFH as a bridging therapy to CABG after discontinuation of aspirin.

  18. Pre-operative and early post-operative factors associated with surgical site infection after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Oller, Inmaculada; Llavero, Carolina; Arroyo, Antonio; Muñoz, Jose Luis; Calero, Alicia; Diez, María; Zubiaga, Lorea; Calpena, Rafael

    2013-08-01

    Surgical procedures on obese patients are expected to have a high incidence of surgical site infection (SSI). The identification of pre-operative or early post-operative risk factors for SSI may help the surgeon to identify subjects in risk and adequately optimize their status. We conducted a study of the association of comorbidities and pre- and post-operative analytical variables with SSI following laparoscopic sleeve gastrectomy for the treatment of morbid obesity. We performed a prospective study of all morbidly obese patients undergoing laparoscopic sleeve gastrectomy as a bariatric procedure between 2007 and 2011. An association of clinical and analytical variables with SSI was investigated. The study included 40 patients with a mean pre-operative body mass index (BMI) of 51.2±7.9 kg/m(2). Surgical site infections appeared in three patients (7.5%), of whom two had an intra-abdominal abscess located in the left hypochondrium and the third had a superficial incisional SSI. Pre-operatively, a BMI >45 kg/m(2) (OR 8.7; p=0.008), restrictive disorders identified by pulmonary function tests (OR 10.0; p=0.012), a serum total protein concentration 30 mcg/dL (OR 13.0; p=0.003), and a mean corpuscular volume (MCV) 128 mg/dL (OR 4.7; p=0.012) and hemoglobin <11g/dL (OR 7.5; p=0.002) were associated with SSI. The study supports the role of restrictive lung disorders and the values specified above for preoperative BMI, serum total protein and cortisol concentrations, and MCV, and of post-operative anemia and hyperglycemia as risk factors for SSI. In these situations, the surgeon must be aware of and seek to control these risk factors.

  19. [Impact of pre-operative uric acid on acute kidney injury after cardiac surgery in elderly patients].

    Science.gov (United States)

    Xu, Jiaqi; Chen, Yuanhan; Liang, Xinling; Hu, Penghua; Cai, Lu; An, Shengli; Li, Zhilian; Shi, Wei

    2014-11-01

    To investigate the impact of pre-operative uric acid on acute kidney injury (AKI) after cardiac surgery in elderly patients. Clinical data were collected from 936 elderly patients (age ≥ 60 years) undergoing cardiac surgery with cardiopulmonary bypass in Guangdong General Hospital between January 2005 and May 2011. The baseline serum creatinine was defined as the latest serum creatinine before surgery, and AKI was diagnosed according to RIFLE criteria. Patients were divided into three groups according to the sex-specific cutoff values of serum uric acid tertiles (group A: ≤ 384.65 µmol/L in men, and ≤ 354.00 µmol/L in women; group B:384.66-476.99 µmol/L in men and 354.01-437.96 µmol/L in women; group C: ≥ 477.00 µmol/L in men and ≥ 437.97 µmol/L in women). Multivariate logistic regression analysis was used to analyze the independent risk factors for AKI. Among 936 elderly patients, 576 cases (61.5%) developed AKI. Mean uric acid concentration was higher in AKI patients than in Non-AKI patients ( (436.6 ± 119.1) µmol/L vs. (398.0 ± 107.2) µmol/L, P cardiac surgery, eGFRsurgery, cardiopulmonary bypass operation time, aortic cross-clamping time, pre-operative angiotensin converting enzyme inhibitor or angiotensin II receptor blockers and lipid-lowering drugs use, early postoperative angiotensin converting enzyme inhibitor or angiotensin II receptor blockers, diuretics and digoxin use, post-operation central venous pressure, risk of post operative AKI was significantly higher in group C than in group A (OR:1.897, 95%CI: 1.270-2.833, P = 0.002). Pre-operative elevated uric acid is an independent risk factor of AKI after cardiac surgery in elderly patients.

  20. Promotional literature: How do we critically appraise?

    Directory of Open Access Journals (Sweden)

    Shetty V

    2008-01-01

    Full Text Available There has been a tremendous increase in the number of new and generic drugs coming into the market. The busy practitioner obtains the information from various sources, of which promotional literature forms an important source. The promotional literature provided by the pharmaceutical companies cannot be entirely relied upon; moreover, very few physicians are equipped with the skills of critically appraising it. The new drug should be relevant to the clinician′s practice in terms of population studied, the disease and the need for new treatment. The methodology of the study should be carefully judged to determine the authenticity of the evidence. The new drug should be preferred over the existing one if it offers clear advantages in terms of safety, tolerability, efficacy and price. Critical appraisal of promotional literature can provide valuable information to the busy physician to practice evidence-based medicine.

  1. The prognostic value of pre-operative predicted forced vital capacity in corrective spinal surgery for Duchenne's muscular dystrophy.

    Science.gov (United States)

    Harper, C M; Ambler, G; Edge, G

    2004-12-01

    The majority of patients with Duchenne's muscular dystrophy require corrective spinal surgery for scoliosis to maintain seated balance and to slow the progression of respiratory compromise, thereby facilitating nursing and enhancing their quality of life. Traditionally patients with a pre-operative forced vital capacity (PFVC) of 30% or below predicted have been denied this surgery as it was thought that the incidence of postoperative complications was unacceptably high. We present data collected prospectively from 45 consecutive operations undertaken in our unit. These cases indicate that there is no clinically significant difference in operative and postoperative outcomes between patients with PFVC > 30% and vital.

  2. Pre-operative Identification and Surgical Management of the Appendiceal Mucocele: A Case Report.

    Science.gov (United States)

    Lynch, Kevin; Cho, Sung; Andres, Robert; Knight, Jennifer; Con, Jorge

    2016-01-01

    An appendiceal mucocele (AM) is an uncommon differential in the patient being evaluated for acute appendicitis. Although often asymptomatic, AMs can clinically mimic acute appendicitis, and preoperative distinction between these processes facilitates optimal management. We report the case of a 60-year-old male with an AM presenting with nausea and periumbilical pain radiating to the right lower quadrant. Literature relevant to the diagnosis and treatment of AMs is reviewed, with emphasis on diagnosis through radiographic imaging and surgical management. Abdominal CT scan or ultrasound are useful in identifying AMs preoperatively. A decision to perform a right hemicolectomy should be influenced by the criteria reported by Gonzalez-Moreno. The safety of the laparoscopic resection relative to an open appendectomy is debated.

  3. SAFETY

    CERN Multimedia

    M. Plagge, C. Schaefer and N. Dupont

    2013-01-01

    Fire Safety – Essential for a particle detector The CMS detector is a marvel of high technology, one of the most precise particle measurement devices we have built until now. Of course it has to be protected from external and internal incidents like the ones that can occur from fires. Due to the fire load, the permanent availability of oxygen and the presence of various ignition sources mostly based on electricity this has to be addressed. Starting from the beam pipe towards the magnet coil, the detector is protected by flooding it with pure gaseous nitrogen during operation. The outer shell of CMS, namely the yoke and the muon chambers are then covered by an emergency inertion system also based on nitrogen. To ensure maximum fire safety, all materials used comply with the CERN regulations IS 23 and IS 41 with only a few exceptions. Every piece of the 30-tonne polyethylene shielding is high-density material, borated, boxed within steel and coated with intumescent (a paint that creates a thick co...

  4. SAFETY

    CERN Multimedia

    C. Schaefer and N. Dupont

    2013-01-01

      “Safety is the highest priority”: this statement from CERN is endorsed by the CMS management. An interpretation of this statement may bring you to the conclusion that you should stop working in order to avoid risks. If the safety is the priority, work is not! This would be a misunderstanding and misinterpretation. One should understand that “working safely” or “operating safely” is the priority at CERN. CERN personnel are exposed to different hazards on many levels on a daily basis. However, risk analyses and assessments are done in order to limit the number and the gravity of accidents. For example, this process takes place each time you cross the road. The hazard is the moving vehicle, the stake is you and the risk might be the risk of collision between both. The same principle has to be applied during our daily work. In particular, keeping in mind the general principles of prevention defined in the late 1980s. These principles wer...

  5. Development of BIM Execution Plan for BIM Model Management during the Pre-Operation Phase: A Case Study

    Directory of Open Access Journals (Sweden)

    Yu-Cheng Lin

    2016-02-01

    Full Text Available Building information modeling (BIM technologies use precise geometry and relevant data to enhance and improve the maintenance performance of facilities integrated with 3D object-oriented computer aided design (CAD. Although most owners agree on the potential benefits of integrating BIM technologies with facility management (FM, they must overcome many problems to plan and develop effective BIM execution plans for FM implementation. This study proposes and develops a BIM execution plan for BIM model management for FM during the pre-operation phase. Through the application of the proposed BIM execution plan, BIM can be effectively implemented during the operation and maintenance phases. In order to verify the proposed methodology and demonstrate its effectiveness in practice, the BIM execution plan is then applied in a selected case study of a building project in Taiwan. The combined results demonstrate that the proposed BIM execution plan is an effective approach for operation and maintenance management. The advantage of the proposed BIM execution plan lies not only in improving the efficiency of maintenance management work when integrated with BIM technologies, but also in maximizing the value and benefits of BIM to support maintenance management. Finally, limitations, difficulties, and suggestions are summarized for further development of the BIM execution plan for BIM model management during the pre-operation phase.

  6. Appraisal of Transport Projects

    DEFF Research Database (Denmark)

    Jensen, Anders Vestergaard

    The evaluation of transport projects has traditionally been based on quantitative descriptions of selected impacts by the use of cost-benefit analysis (CBA). However, environmental impacts are now taking into consideration when decisions have to be made, regarding which large transport projects...... complexity. Optimisation has been replaced with satisficing, where satisficing is defined as finding an acceptable or satisfactory solution to a problem instead of a socio-economical optimal solution. This calls for new approaches of appraising transport projects that goes beyond what the classical CBA......, seems suitable for. As a result of the above mentioned issues regarding conflict of interests, multiple impacts, participation of stakeholders, and sustainability, additional approaches for appraisal have been suggested. Multi-criteria decision analysis (MCDA) has been introduced in the transport...

  7. Present situation analysis on pre-operation fasting for patients undergoing selective non-abdominal operation%择期非经腹手术患者术前禁饮禁食的现状分析

    Institute of Scientific and Technical Information of China (English)

    朱红芳; 葛昕; 乔世娜; 朱雅凤; 吕鹰

    2013-01-01

    Objective To study the present situation on pre - operation lasting for patients undergoing selective non - abdominal operation and provide evidence for improving pre-operation intervention. Method Investigate 102 adult patients undergoing selective non - abdominal orthopedic operation by self-designed questionnaire, including general information, lasting time and discomfort reaction. Result The average time of fasting is 17. 3 h and fasting in liquid is 14. 6 h. Patients suffer from different degrees of thirsty, hunger and fidget. Conclusion Too long pre-operation fasting time is related to medical staffs and patients. Measures should be taken to ensure the safety of patients in perioperative period.%目的 了解择期非经腹手术患者术前禁饮禁食的现状,为改进术前干预措施提供依据.方法 自行设计调查问卷,内容包括患者一般资料、禁饮禁食时间、不适反应等,对102例骨科择期手术的成年患者进行调查.结果 患者实际禁食时间平均17.3 h,禁饮时间平均14.6 h,存在不同程度的口渴、饥饿、心烦感.结论 患者术前实际禁饮禁食时间普遍过长,与医护人员及患者本身有关,必须采取改进措施,以保证患者围手术期安全.

  8. Pre-operative urinary tract infection: is it a risk factor for early surgical site infection with hip fracture surgery? A retrospective analysis.

    Science.gov (United States)

    Yassa, Rafik Rd; Khalfaoui, Mahdi Y; Veravalli, Karunakar; Evans, D Alun

    2017-03-01

    The aims of the current study were to determine whether pre-operative urinary tract infections in patients presenting acutely with neck of femur fractures resulted in a delay to surgery and whether such patients were at increased risk of developing post-operative surgical site infections. A retrospective review of all patients presenting with a neck of femur fracture, at a single centre over a one-year period. The hospital hip fracture database was used as the main source of data. UK University Teaching Hospital. All patients (n = 460) presenting across a single year study period with a confirmed hip fracture. The presence of pre-operative urinary tract infection, the timing of surgical intervention, the occurrence of post-operative surgical site infection and the pathogens identified. A total of 367 patients were operated upon within 24 hours of admission. Urinary infections were the least common cause of delay. A total of 99 patients (21.5%) had pre-operative urinary tract infection. Post-operatively, a total of 57 (12.4%) patients developed a surgical site infection. Among the latter, 31 (54.4%) did not have a pre-operative urinary infection, 23 (40.4%) patients had a pre-operative urinary tract infection, 2 had chronic leg ulcers and one patient had a pre-operative chest infection. Statistically, there was a strong relationship between pre-operative urinary tract infection and the development of post-operative surgical site infection (p-value: 0.0005). The results of our study indicate that pre-operative urinary tract infection has a high prevalence amongst those presenting with neck of femur fractures, and this is a risk factor for the later development of post-operative surgical site infection.

  9. Prediction of Long-term Post-operative Testosterone Replacement Requirement Based on the Pre-operative Tumor Volume and Testosterone Level in Pituitary Macroadenoma

    OpenAIRE

    Cheng-Chi Lee; Chung-Ming Chen; Shih-Tseng Lee; Kuo-Chen Wei; Ping-Ching Pai; Cheng-Hong Toh; Chi-Cheng Chuang

    2015-01-01

    Non-functioning pituitary macroadenomas (NFPAs) are the most prevalent pituitary macroadenomas. One common symptom of NFPA is hypogonadism, which may require long-term hormone replacement. This study was designed to clarify the association between the pre-operative tumor volume, pre-operative testosterone level, intraoperative resection status and the need of long-term post-operative testosterone replacement. Between 2004 and 2012, 45 male patients with NFPAs were enrolled in this prospective...

  10. Pre-operational environmental monitoring plan for the Device Assembly Facility at the Nevada Test Site

    Energy Technology Data Exchange (ETDEWEB)

    Ferate, F.D.

    1995-01-01

    Nuclear explosives operations have been and may continue to be an important component of the DOE mission at the NTS. This mission has been to conduct the nation`s nuclear testing program in a safe, secure, and efficient manner while assuring full compliance with state and federal regulations, and DOE order`s and directives. These operations have generally included assembly, disassembly or modification, staging, transportation, and tesbng of nuclear explosive devices. They may also include maintenance, repair, retrofit, and surveillance. The Device Assembly Facility (DAF) was constructed to provide a dedicated facility in which to prepare nuclear explosives assemblies for their intended disposition. This facility will provide for combined operations (replacing two separate facilities) and incorporates state-of-the-art safety and security features while minimizing the risks of environmental impacts. The facility has been completed but not yet operated, so the impacts to be considered will b e based on normal operations and not on the impacts of construction activities. The impacts will arise from nuclear explosives operations that require the handling of high explosives in combination with special nuclear materials. Wastes from operation of the earlier device assembly facilities have included grams of epoxies, pints of solvents, and small quantities of waste explosives. These are hazardous (includes radioactive) wastes and are disposed of in accordance with state and federal regulations. Assuming similar operations at the DAF, non-hazardous (includes non-radioactive) solid waste would be transported to a permitted landfill. Waste explosives would be sent to the Area 11 Explosive Ordnance Disposal Unit. Other hazardous waste would be sent to the Area 5 Radioactive Waste.Management Site for shipment or burial.

  11. 12 CFR 564.3 - Appraisals required; transactions requiring a State certified or licensed appraiser.

    Science.gov (United States)

    2010-01-01

    ... SUPERVISION, DEPARTMENT OF THE TREASURY APPRAISALS § 564.3 Appraisals required; transactions requiring a State certified or licensed appraiser. (a) Appraisals required. An appraisal performed by a State certified or..., pooled loan, or real property interest met OTS regulatory requirements for appraisals at the time...

  12. Performance appraisal: dimensions and determinants

    OpenAIRE

    2012-01-01

    The determinants of the dimensions that shape a formal system of performance appraisal are studied in relation to a sample of Spanish manufacturing establishments. In particular, the factors that influence the measures used to evaluate performance, the person who carries out such appraisal and its frequency are analysed. Our results show that the characteristics of the establishment exert a significant influence on the configuration of performance appraisal. Specifically, we find that the use...

  13. Ratee Preferences Concerning Performance Management and Appraisal.

    Science.gov (United States)

    Gosselin, Alain; Werner, Jon M.; Halle, Nicole

    1997-01-01

    Employees surveyed (265 responses from 344) expressed the following performance appraisal preferences: appraisal by immediate supervisors; prior knowledge of expectations; ongoing informal feedback; semiannual formal appraisals; and developmental evaluation focused on the results of work. (SK)

  14. Clinical and pathological response to pre-operative crizotinib in a patient with ALK-translocated NSCLC

    Directory of Open Access Journals (Sweden)

    Catania C

    2016-11-01

    Full Text Available A 65-year-old non-smoker female was diagnosed with lung adenocarcinoma clinically staged as IV M1a because of bilateral pulmonary lesions. After a differential response to chemotherapy, further analyses allowed us to re-stage the tumor as a synchronous bilateral local disease with unilateral ALK (Anaplastic lymphoma kinase rearrangement. Combined treatment with chemotherapy, crizotinib and surgery, with clinical and pathological tumor-response to pre-operative crizotinib, obtained complete tumors remission, and the patient is still disease free after 11 months since the last tumor resection. As far as we know this is the first report of a clinical and pathological regression of an early-stage ALK-rearranged NSCLC treated with neo-adjuvant crizotinib. This report supports further studies to assess activity and efficacy of ALK–inhibitors in neoadjuvant setting.

  15. Pre-operative embolization facilitating a posterior approach for the surgical resection of giant sacral neurogenic tumors.

    Science.gov (United States)

    Chen, Kangwu; Zhou, Ming; Yang, Huilin; Qian, Zhonglai; Wang, Genlin; Wu, Guizhong; Zhu, Xiaoyu; Sun, Zhiyong

    2013-07-01

    The present study aimed to assess a posterior approach for the surgical resection of giant sacral neurogenic tumors, and to evaluate the oncological and functional outcomes. A total of 16 patients with giant sacral neurogenic tumors underwent pre-operative embolization and subsequent posterior sacral resection between January 2000 and June 2010. Benign tumors were identified in 12 cases, while four cases exhibited malignant peripheral nerve sheath tumors (MPNSTs). An evaluation of the operative techniques used, the level of blood loss, any complications and the functional and oncological outcomes was performed. All tumor masses were removed completely without intra-operative shock or fatalities. The mean tumor size was 17.5 cm (range, 11.5-28 cm) at the greatest diameter. The average level of intra-operative blood loss was 1,293 ml (range, 400-4,500 ml). Wound complications occurred in four patients (25%), including three cases of cutaneous necrosis and one wound infection. The mean follow-up time was 59 months (range, 24-110 months). Tumor recurrence or patient mortality as a result of the disease did not occur in any of the patients with benign sacral neurogenic tumors. The survival rate of the patients with malignant lesions was 75% (3/4 patients) since 25 % (1/4 patients) had multiple local recurrences and succumbed to the disease. The patients with benign tumors scored an average of 92.8% on the Musculoskeletal Tumor Society (MSTS) score functional evaluation, while the patients with malignant tumors scored an average of 60.3%. A posterior approach for the surgical resection of giant sacral neurogenic tumors, combined with pre-operative embolization may be safely conducted with satisfactory oncological and functional outcomes.

  16. The role of pre-operative and post-operative glucose control in surgical-site infections and mortality.

    Directory of Open Access Journals (Sweden)

    Christie Y Jeon

    Full Text Available BACKGROUND AND OBJECTIVE: The impact of glucose control on surgical-site infection (SSI and death remains unclear. We examined how pre- and post-operative glucose levels and their variability are associated with the risk of SSI or in-hospital death. METHODS: This retrospective cohort study employed data on 13,800 hospitalized patients who underwent a surgical procedure at a large referral hospital in New York between 2006 and 2008. Over 20 different sources of electronic data were used to analyze how thirty-day risk of SSI and in-hospital death varies by glucose levels and variability. Maximum pre- and post-operative glucose levels were determined for 72 hours before and after the operation and glucose variability was defined as the coefficient of variation of the glucose measurements. We employed logistic regression to model the risk of SSI or death against glucose variables and the following potential confounders: age, sex, body mass index, duration of operation, diabetes status, procedure classification, physical status, emergency status, and blood transfusion. RESULTS: While association of pre- and post-operative hyperglycemia with SSI were apparent in the crude analysis, multivariate results showed that SSI risk did not vary significantly with glucose levels. On the other hand, in-hospital deaths were associated with pre-operative hypoglycemia (OR = 5.09, 95% CI (1.80, 14.4 and glucose variability (OR = 1.14, 95% CI (1.03, 1.27 for 10% increase in coefficient of variation. CONCLUSION: In-hospital deaths occurred more often among those with pre-operative hypoglycemia and higher glucose variability. These findings warrant further investigation to determine whether stabilization of glucose and prevention of hypoglycemia could reduce post-operative deaths.

  17. Comparison of 3D reconstruction of mandible for pre-operative planning using commercial and open-source software

    Science.gov (United States)

    Abdullah, Johari Yap; Omar, Marzuki; Pritam, Helmi Mohd Hadi; Husein, Adam; Rajion, Zainul Ahmad

    2016-12-01

    3D printing of mandible is important for pre-operative planning, diagnostic purposes, as well as for education and training. Currently, the processing of CT data is routinely performed with commercial software which increases the cost of operation and patient management for a small clinical setting. Usage of open-source software as an alternative to commercial software for 3D reconstruction of the mandible from CT data is scarce. The aim of this study is to compare two methods of 3D reconstruction of the mandible using commercial Materialise Mimics software and open-source Medical Imaging Interaction Toolkit (MITK) software. Head CT images with a slice thickness of 1 mm and a matrix of 512x512 pixels each were retrieved from the server located at the Radiology Department of Hospital Universiti Sains Malaysia. The CT data were analysed and the 3D models of mandible were reconstructed using both commercial Materialise Mimics and open-source MITK software. Both virtual 3D models were saved in STL format and exported to 3matic and MeshLab software for morphometric and image analyses. Both models were compared using Wilcoxon Signed Rank Test and Hausdorff Distance. No significant differences were obtained between the 3D models of the mandible produced using Mimics and MITK software. The 3D model of the mandible produced using MITK open-source software is comparable to the commercial MIMICS software. Therefore, open-source software could be used in clinical setting for pre-operative planning to minimise the operational cost.

  18. Pre-operative sequential chemo- and radiochemotherapy in locally advanced carcinomas of the lower oesophagus and gastro-oesophageal junction

    Energy Technology Data Exchange (ETDEWEB)

    Wilke, H.; Mueller, C. [Department of Internal Medicine (Cancer Research), Essen University Medical School, D-45 122 Essen (Germany); Walz, M.K. [Department of General Surgery, Essen University Medical School, D-45 122 Essen (Germany); Stuschke, M. [Department of Radiotherapy, Essen University Medical School, D-45 122 Essen (Germany); Vanhoefer, U.; Stahl, M. [Department of Internal Medicine (Cancer Research), Essen University Medical School, D-45 122 Essen (Germany)

    1998-04-01

    The purpose of this trial was to examine the feasibility of intensive, sequential chemo- and radiochemotherapy followed by surgery in patients with locally advanced carcinomas of the lower oesophagus and the gastro-oesophageal junction (GO junction). The chemotherapy consisted of two courses of 6 weekly administrations of 5-fluorouracil (5-FU) (2.0 g/m{sup 2}, 24 h infusion) and folinic acid (FA) (500 mg/m{sup 2}, 2 h infusion) combined with twice weekly cisplatin (50 mg/m{sup 2}, 1 h infusion). Irradiation of 30 Gy was given concurrently with one course of cisplatin and etoposide. 25 patients with locally advanced (T3-T4 NX M0) squamous cell or adenocarcinoma of the lower oesophagus and GO junction were included and evaluated. Toxicity was usually mild to moderate (WHO grade 1 and 2) with mucositis as the most important side-effect of the pre-operative treatment. Of the patients, 94 and 88% completed the chemo- and radiochemotherapy according to the protocol, respectively. A major response (=partial remission with subjective improvement) to chemotherapy was achieved in 6/10 patients with squamous cell carcinoma and 10/15 with adenocarcinoma. 19 patients had subsequent surgery and complete resection was achieved in 16 (3 patients had intra-abdominal metastases observed at laparotomy). The operative mortality rate was 16% (3/19). 10 of the 16 patients with tumour resection had a pathological complete response. 15 patients (43%) remain alive at a median follow-up of 20 months and the median survival exceeds 16+ months. Our data suggest that this intensive pre-operative chemoradiotherapy programme is feasible and remarkably effective in patients with locally advanced carcinomas of the lower oesophagus or GO junction. (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

  19. Role of Pre-Operative Blood Transfusion and Subcutaneous Fat Thickness as Risk Factors for Surgical Site Infection after Posterior Thoracic Spine Stabilization.

    Science.gov (United States)

    Osterhoff, Georg; Burla, Laurin; Werner, Clément M L; Jentzsch, Thorsten; Wanner, Guido A; Simmen, Hans-Peter; Sprengel, Kai

    2015-06-01

    Surgical site infections (SSIs) increase morbidity and mortality rates and generate additional cost for the healthcare system. Pre-operative blood transfusion and the subcutaneous fat thickness (SFT) have been described as risk factors for SSI in other surgical areas. The purpose of this study was to assess the impact of pre-operative blood transfusion and the SFT on the occurrence of SSI in posterior thoracic spine surgery. In total, 244 patients (median age 55 y; 97 female) who underwent posterior thoracic spine fusions from 2008 to 2012 were reviewed retrospectively. Patient-specific characteristics, pre-operative hemoglobin concentration/hematocrit values, the amount of blood transfused, and the occurrence of a post-operative SSI were documented. The SFT was measured on pre-operative computed tomography scans. Surgical site infection was observed in 26 patients (11%). The SFT was 13 mm in patients without SSI and 14 mm in those with infection (p=0.195). The odds ratio for patients with pre-operative blood transfusion to present with SSI was 3.1 (confidence interval [CI] 1.4-7.2) and 2.7 (CI 1.1-6.4) when adjusted for age. There was no difference between the groups with regard to pre-operative hemoglobin concentration (p=0.519) or hematocrit (p=0.908). The SFT did not differ in the two groups. Allogeneic red blood cell transfusion within 48 h prior to surgery was an independent risk factor for SSI after posterior fusion for the fixation of thoracic spine instabilities. Pre-operative blood transfusion tripled the risk, whereas SFT had no influence on the occurrence of SSI.

  20. Performance Appraisal Applied to Leadership

    Science.gov (United States)

    Jefferson, Anne L.

    2010-01-01

    Performance appraisal is a measurement process of how well an individual is doing her or his job. In most organisations, this appraisal is an annual event. Generally, it is done to encourage job performance, to flag areas that need attention, to inform both parties as to expectations. Much of the literature speaks to this process in terms of the…

  1. Prediction of Long-term Post-operative Testosterone Replacement Requirement Based on the Pre-operative Tumor Volume and Testosterone Level in Pituitary Macroadenoma.

    Science.gov (United States)

    Lee, Cheng-Chi; Chen, Chung-Ming; Lee, Shih-Tseng; Wei, Kuo-Chen; Pai, Ping-Ching; Toh, Cheng-Hong; Chuang, Chi-Cheng

    2015-11-05

    Non-functioning pituitary macroadenomas (NFPAs) are the most prevalent pituitary macroadenomas. One common symptom of NFPA is hypogonadism, which may require long-term hormone replacement. This study was designed to clarify the association between the pre-operative tumor volume, pre-operative testosterone level, intraoperative resection status and the need of long-term post-operative testosterone replacement. Between 2004 and 2012, 45 male patients with NFPAs were enrolled in this prospective study. All patients underwent transsphenoidal surgery. Hypogonadism was defined as total serum testosterone levels of testosterone to patients with defined hypogonadism or clinical symptoms of hypogonadism. Hormone replacement for longer than 1 year was considered as long-term therapy. The need for long-term post-operative testosterone replacement was significantly associated with larger pre-operative tumor volume (p = 0.0067), and lower pre-operative testosterone level (p = 0.0101). There was no significant difference between the gross total tumor resection and subtotal resection groups (p = 0.1059). The pre-operative tumor volume and testosterone level impact post-operative hypogonadism. By measuring the tumor volume and the testosterone level and by performing adequate tumor resection, surgeons will be able to predict post-operative hypogonadism and the need for long-term hormone replacement.

  2. A qualitative study of the pre-operative preparation of children, young people and their parents' for planned continence surgery: experiences and expectations.

    Science.gov (United States)

    Bray, Lucy; Callery, Peter; Kirk, Sue

    2012-07-01

    The aim of this study is to explore children's, young people's and parents' pre-operative experiences of continent stoma formation. Current research investigating continent stoma surgery focuses on surgical outcomes including complication rates, adherence to management regimes, self-management practices and levels of continence achieved. Despite reports of pre-operative anxiety in families undergoing continent stoma surgery, there has been a lack of research exploring pre-operative experiences, information needs or decision-making processes in this group. A qualitative study. Forty-nine semi-structured interviews were conducted with 17 children, young people and their parents. Data were collected at key points in the surgical process that aimed to represent a longitudinal perspective of continent stoma formation. The interviews suggested that children's, young people's and parents' information needs in relation to the long-term implications of surgery and for their day-to-day lives were not being adequately met. The preparation process was described as being positively influenced by contact with a nurse specialist, being given time to make the decision and having access to different sources of information. Decisions regarding life-long planned surgery can be challenging. The individual involvement and information needs of children, young people and their parents need to be recognised during pre-operative preparation. Health professionals need to discuss the holistic implications of continent stoma surgery and provide families with the time and opportunity to consider surgery and access relevant sources of information pre-operatively. © 2012 Blackwell Publishing Ltd.

  3. Variations in the pre-operative status of patients coming to primary hip replacement for osteoarthritis in European orthopaedic centres

    Directory of Open Access Journals (Sweden)

    Puhl Wofhart

    2009-02-01

    Full Text Available Abstract Background Total hip joint replacement (THR is a high volume, effective intervention for hip osteoarthritis (OA. However, indications and determinants of outcome remain unclear. The 'EUROHIP consortium' has undertaken a cohort study to investigate these questions. This paper describes the variations in disease severity in this cohort and the relationships between clinical and radiographic severity, and explores some of the determinants of variation. Methods A minimum of 50 consecutive, consenting patients coming to primary THR for primary hip OA in each of the 20 participating orthopaedic centres entered the study. Pre-operative data included demographics, employment and educational attainment, drug utilisation, and involvement of other joints. Each subject completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC – Likert version 3.1. Other data collected at the time of surgery included the prosthesis used and American Society of Anaesthesiologists (ASA status. Pre-operative radiographs were read by the same three readers for Kellgren and Lawrence (K&L grading and Osteoarthritis Research Society International (OARSI atlas features. Regression analyses were carried out. Results Data from 1327 subjects has been analysed. The mean age of the group was 65.7 years, and there were more women (53.4% than men. Most (79% were ASA status 1 or 2. Reported disease duration was 5 years or less in 69.2%. Disease in other joint sites was common. Radiographs were available in 1051 subjects and the K&L grade was 3 or 4 in 95.8%. There was much more variation in clinical severity (WOMAC score; the mean total WOMAC score was 59.2 (SD 16.1. The radiographic severity showed no correlation with WOMAC scores. Significantly higher WOMAC scores (worse disease were seen in older people, women, those with obesity, those with worse general health, and those with lower educational attainment. Conclusion 1. Clinical disease severity

  4. Variations in the pre-operative status of patients coming to primary hip replacement for osteoarthritis in European orthopaedic centres.

    Science.gov (United States)

    Dieppe, Paul; Judge, Andrew; Williams, Susan; Ikwueke, Ifeoma; Guenther, Klaus-Peter; Floeren, Markus; Huber, Joerg; Ingvarsson, Thorvaldur; Learmonth, Ian; Lohmander, L Stefan; Nilsdotter, Anna; Puhl, Wofhart; Rowley, David; Thieler, Robert; Dreinhoefer, Karsten

    2009-02-10

    Total hip joint replacement (THR) is a high volume, effective intervention for hip osteoarthritis (OA). However, indications and determinants of outcome remain unclear. The 'EUROHIP consortium' has undertaken a cohort study to investigate these questions. This paper describes the variations in disease severity in this cohort and the relationships between clinical and radiographic severity, and explores some of the determinants of variation. A minimum of 50 consecutive, consenting patients coming to primary THR for primary hip OA in each of the 20 participating orthopaedic centres entered the study. Pre-operative data included demographics, employment and educational attainment, drug utilisation, and involvement of other joints. Each subject completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC - Likert version 3.1). Other data collected at the time of surgery included the prosthesis used and American Society of Anaesthesiologists (ASA) status. Pre-operative radiographs were read by the same three readers for Kellgren and Lawrence (K&L) grading and Osteoarthritis Research Society International (OARSI) atlas features. Regression analyses were carried out. Data from 1327 subjects has been analysed. The mean age of the group was 65.7 years, and there were more women (53.4%) than men. Most (79%) were ASA status 1 or 2. Reported disease duration was 5 years or less in 69.2%. Disease in other joint sites was common.Radiographs were available in 1051 subjects and the K&L grade was 3 or 4 in 95.8%. There was much more variation in clinical severity (WOMAC score); the mean total WOMAC score was 59.2 (SD 16.1). The radiographic severity showed no correlation with WOMAC scores.Significantly higher WOMAC scores (worse disease) were seen in older people, women, those with obesity, those with worse general health, and those with lower educational attainment. 1. Clinical disease severity varies widely at the time of THR for OA. 2. In advanced hip OA

  5. Appraising Adaptive Management

    Directory of Open Access Journals (Sweden)

    Kai N. Lee

    1999-12-01

    Full Text Available Adaptive management is appraised as a policy implementation approach by examining its conceptual, technical, equity, and practical strengths and limitations. Three conclusions are drawn: (1 Adaptive management has been more influential, so far, as an idea than as a practical means of gaining insight into the behavior of ecosystems utilized and inhabited by humans. (2 Adaptive management should be used only after disputing parties have agreed to an agenda of questions to be answered using the adaptive approach; this is not how the approach has been used. (3 Efficient, effective social learning, of the kind facilitated by adaptive management, is likely to be of strategic importance in governing ecosystems as humanity searches for a sustainable economy.

  6. MAPS Appraisal Report Form

    CERN Multimedia

    HR Department

    2005-01-01

    As announced in Weekly Bulletin 48/2004, from now onwards, the paper MAPS appraisal report form has been replaced by an electronic form, which is available via EDH (on the EDH desktop under Other Tasks / HR & Training) No changes have been made to the contents of the form. Practical information will be available on the web page http://cern.ch/ais/projs/forms/maps/info.htm, and information meetings will be held on the following dates: 18 January 2005: MAIN AUDITORIUM (500-1-001) from 14:00 to 15:30. 20 January 2005: AB AUDITORIUM II (864-1-D02) from14:00 to 15:30. 24 January 2005: AT AUDITORIUM (30-7-018) from 10:00 to 11:30. Human Resources Department Tel. 73566

  7. 12 CFR 34.45 - Appraiser independence.

    Science.gov (United States)

    2010-01-01

    ... staff appraiser, that appraiser must be independent of the lending, investment, and collection functions... perform an appraisal are involved in the lending, investment, or collection functions of the regulated institution, the regulated institution shall take appropriate steps to ensure that the appraisers exercise...

  8. 12 CFR 323.5 - Appraiser independence.

    Science.gov (United States)

    2010-01-01

    ... appraiser, that appraiser must be independent of the lending, investment, and collection functions and not... appraisal are involved in the lending, investment, or collection functions of the regulated institution, the regulated institution shall take appropriate steps to ensure that the appraisers exercise independent...

  9. 36 CFR 254.9 - Appraisals.

    Science.gov (United States)

    2010-07-01

    ... requirements that meet the intent of Title XI, Financial Institutions Reform, Recovery, and Enforcement Act of... appraiser(s) shall provide to the authorized officer appraisals estimating the market value of Federal and... meeting the requirements of FIRREA. (b) Market value. (1) In estimating market value, the appraiser...

  10. 7 CFR 761.7 - Appraisals.

    Science.gov (United States)

    2010-01-01

    ... section describes Agency requirements for: (1) Real estate and chattel appraisals made in connection with... loans. (b) Appraisal standards. (1) Real estate appraisals, technical appraisal reviews and their... State Office) or other format containing the same information. (c) Use of an existing real...

  11. 7 CFR 762.127 - Appraisal requirements.

    Science.gov (United States)

    2010-01-01

    ... appraisals. A current real estate appraisal is required when real estate will be primary security. Agency... market or on the subject real estate and the appraisal was either completed within the past 12 months or... interest through the closing date, the appraisal must be completed by a State certified general...

  12. Training Supervisors in Employee Performance Appraisals.

    Science.gov (United States)

    Sims, Ronald R.

    1988-01-01

    The author presents a training program for supervisors designed to improve an organization's performance appraisal system. Legal issues surrounding performance appraisal are discussed. Course topics include (1) definition and purpose of performance appraisal, (2) how appraisals can improve performance, (3) negative reactions and how to overcome…

  13. 4 CFR 4.2 - Performance appraisal.

    Science.gov (United States)

    2010-01-01

    ... 4 Accounts 1 2010-01-01 2010-01-01 false Performance appraisal. 4.2 Section 4.2 Accounts... appraisal. (a) The GAO shall develop one or more performance appraisal systems which provide for periodic appraisals of job performance of employees; encourages employee participation in establishing...

  14. Research on coal mine safety production management decision system based on VB

    Institute of Scientific and Technical Information of China (English)

    ZHAO Zhong-ling; FENG Xi-wen; FANG Heng-fu; YUAN Qing-he

    2007-01-01

    Based on safety management appraisal theory, the decision system was divided into 5 function menu module, including system control module, mining coal and the tunneling working surface security evaluation module, the entire ore safety production condition appraisal module, the safety management level appraisal module of main production work area, the withdrawal system module and so on. The system operates through the constitutive procedure, outputs the main operation results by graph and form,and realizes the main function of safety evaluation.

  15. Females, younger patients and patients with high BMI have the highest pre-operative knee awareness measured using the Forgotten Joint Score

    DEFF Research Database (Denmark)

    Li, Dana; Troelsen, A; Ingelsrud, L

    2017-01-01

    PURPOSE: The Forgotten Joint Score (FJS) is a novel measurement for patients' awareness of their knee in daily life. By identifying factors that could explain pre-operative FJS levels, the clinician could better prioritize and single out patients who would benefit most from TKA. The aim of this s......PURPOSE: The Forgotten Joint Score (FJS) is a novel measurement for patients' awareness of their knee in daily life. By identifying factors that could explain pre-operative FJS levels, the clinician could better prioritize and single out patients who would benefit most from TKA. The aim...

  16. Is Tc99m-MIBI scintigraphy a predictor of response to pre-operative neoadjuvant chemotherapy in Osteosarcoma?

    Directory of Open Access Journals (Sweden)

    Vahidreza Dabbagh Kakhki

    2013-10-01

    Full Text Available Objectives: Multidrug resistance (MDR, which may be due to the over expression of P-glycoprotein (Pgp and/or MRP, is a major problem in neoadjuvant chemotherapy of osteosarcoma. The aim of this study was to investigate the role of Tc-99m MIBI scan for predicting the response to pre-operative chemotherapy. Materials and Methods: Twenty-five patients (12 males and 13 females, aged between 8 and 52y with osteosarcoma were studied. Before the chemotherapy, planar 99mTc-MIBI anterior and posterior images were obtained 10-min [tumor-to-background ratio: (T1/B110min] and 3-hr after tracer injection. After completion of chemotherapy, again 99mTc-MIBI scan was performed at 10-min after tracer injection. In addition to calculation of decay corrected tumor to background (T/B ratios ,  using the 10-min and 3-hr images of the pre-chemotherapy scintigraphy , percent wash-out rate (WR% of 99mTc-MIBI was calculated. Using the 10-min images of the pre- and post-chemotherapy scans, the percent reduction in uptake at the tumor site after treatment (Red% was also calculated. Then after surgical resection, tumor response was assessed by percentage of necrosis. Results: All patients showed significant 99mTc-MIBI uptake in early images. Only 9 patients showed good response to chemotherapy (necrosis≥90% while 16 patients were considered as non-responder (necrosis

  17. Image analysis of the inner ear with CT and MR imaging; Pre-operative assessment for cochlear implant surgery

    Energy Technology Data Exchange (ETDEWEB)

    Kumakawa, Kohzoh; Takeda, Hidehiko; Mutoh, Naoko; Miyakawa, Kohichi (Toranomon Hospital, Tokyo (Japan)); Yukawa, Kumiko; Funasaka, Sohtaro

    1992-06-01

    Recent progress in magnetic resonance imaging (MRI) has made it possible to obtain detailed images of the inner ear by delineating the lymphatic fluid within the labyrinth. We analyzed CT scans and MR imaging in 70 ears manifesting profound deafness owing to inner ear lesions and compared their detective ability for inner ear lesions. The following results were obtained. CT scan examination showed slight to extensive ossification of the labyrinth in six ears (9%), whereas MRI examination revealed low to absent signal intensity of the inner ear in nine ears (13%). Therefore, it was concluded that MRI is more sensitive in detecting abnormalities of the inner ear than CT scan. MRI provided useful information as to whether the cochlear turn is filled with lymphatic fluid or obstructed. This point was one of the greatest advantages of MRI over CT scan. Abnormal findings in either or both the CT scan and the MRI were detected in suppurative labyrinthitis occurring secondary to chronic otitis media, bacterial meningitis and in inner ear trauma. However, such abnormal findings were not detected in patients with idiopathic progressive sensorineural hearing loss, ototoxity or sudden deafness. These findings should be taken into consideration in pre-operative assessment of cochlear implant candidates. (author).

  18. Radioguided surgery and the GOSTT concept: From pre-operative image and intraoperative navigation to image-assisted excision.

    Science.gov (United States)

    Bowles, H; Sánchez, N; Tapias, A; Paredes, P; Campos, F; Bluemel, C; Valdés Olmos, R A; Vidal-Sicart, S

    Radio-guided surgery has been developed for application in those disease scheduled for surgical management, particularly in areas of complex anatomy. This is based on the use of pre-operative scintigraphic planar, tomographic and fused SPECT/CT images, and the possibility of 3D reconstruction for the subsequent intraoperative locating of active lesions using handheld devices (detection probes, gamma cameras, etc.). New tracers and technologies have also been incorporated into these surgical procedures. The combination of visual and acoustic signals during the intraoperative procedure has become possible with new portable imaging modalities. In daily practice, the images offered by these techniques and devices combine perioperative nuclear medicine imaging with the superior resolution of additional optical guidance in the operating room. In many ways they provide real-time images, allowing accurate guidance during surgery, a reduction in the time required for tissue location and an anatomical environment for surgical recognition. All these approaches have been included in the concept known as (radio) Guided intraOperative Scintigraphic Tumour Targeting (GOSTT). This article offers a general view of different nuclear medicine and allied technologies used for several GOSTT procedures, and illustrates the crossing of technological frontiers in radio-guided surgery. Copyright © 2016 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  19. PRA in Design: Increasing Confidence in Pre-Operational Assessments of Risks (Results of a Joint NASA/NRC Workshop)

    Science.gov (United States)

    Youngblood, Robert; Dezfuli, Homayoon; Siu, Nathan

    2010-01-01

    In late 2009, the National Aeronautics and Space Administration (NASA) and the U.S. Nuclear Regulatory Commission (NRC) jointly organized a workshop to discuss technical issues associated with application of risk assessments to early phases of system design. The workshop, which was coordinated by the Idaho National Laboratory, involved invited presentations from a number of PRA experts in the aerospace and nuclear fields and subsequent discussion to address the following questions: (a) What technical issues limit decision-makers' confidence in PRA results, especially at a pre-operational phase of the system life cycle? (b) What is being done to address these issues'? (c) What more can be done ? The workshop resulted in participant observations and suggestions on several technical issues, including the pursuit of non-traditional approaches to risk assessment and the verification and validation of risk models. The workshop participants also identified several important non-technical issues, including risk communication with decision makers, and the integration of PRA into the overall design process.

  20. Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery

    Directory of Open Access Journals (Sweden)

    Bates Tom

    2007-06-01

    Full Text Available Abstract Background The decision on whether to operate on a sick elderly person with an intra-abdominal emergency is one of the most difficult in general surgery. A predictive risk-score would be of great value in this situation. Methods A Medline search was performed to identify those predictive risk-scores relevant to sick elderly patients in whom emergency surgery might be life-saving. Results Many of the risk scores for surgical patients include the operative findings or require tests which are not available in the acute situation. Most of the relevant studies include younger patients and elective surgery. The Glasgow Aneurysm Score and Hardman Index are specific to ruptured aortic aneurysm while the Boey Score and the Hacetteppe Score are specific to perforated peptic ulcer. The Reiss Index and Fitness Score can be used pre-operatively if the elements of the score can be completed in time. The ASA score, which includes a significant element of subjective clinical judgement, can be augmented with factors such as age and urgency of surgery but no test has a negative predictive value sufficient to recommend against surgical intervention without clinical input. Conclusion Risk scores may be helpful in sick elderly patients needing emergency abdominal surgery but an experienced clinical opinion is still essential.

  1. The impact of actual and perceived disease severity on pre-operative psychological well-being and illness behaviour in adult congenital heart disease patients.

    Science.gov (United States)

    Callus, Edward; Utens, Elisabeth M W J; Quadri, Emilia; Ricci, Cristian; Carminati, Mario; Giamberti, Alessandro; Chessa, Massimo

    2014-04-01

    The purpose of this study was to investigate whether the objective medical parameters related to congenital heart disease and patients' ratings of cardiac disease severity were related to psychological well-being and illness behaviour during the pre-operative period. A total of 143 patients (63 male patients; 16-73 years old) with congenital heart disease evaluated the severity of their cardiac condition using a numerical rating scale ranging from 0, indicating the least severe condition, to 100, indicating the most severe condition. Psychological well-being was assessed using the Psychological General Well-Being Index (total score ≤ 60 indicating severe distress) and illness behaviour using the Illness Behavior Questionnaire. Pre-operative psychological well-being was not related to the objective medical parameters reflecting cardiac disease severity. In contrast, total psychological well-being scores correlated significantly with patients' subjective ratings of disease severity (p Illness Behavior Questionnaire, the scores on denial were higher and those on hypochondria were lower compared with other hospitalised patients. This study shows that the perception of cardiac disease severity, and not the medical parameters in congenital heart disease, is related to the patients' pre-operative psychological state. Thus, more importance needs to be given to assessing the patients' pre-operative perception and psychological state independently of cardiac severity. Targeted interventions with regard to the cardiac condition are recommended.

  2. A 20-year retrospective analysis of CT-based pre-operative identification of pulmonary metastases in patients with osteosarcoma: A single-center review.

    Science.gov (United States)

    Heaton, Todd E; Hammond, William J; Farber, Benjamin A; Pallos, Valerie; Meyers, Paul A; Chou, Alexander J; Price, Anita P; LaQuaglia, Michael P

    2017-01-01

    Cooperative studies support complete metastasectomy in osteosarcoma (OS). Pre-operative CT is used to identify and quantify metastases and can facilitate minimally invasive techniques. Here we assess the accuracy of pre-operative CT compared to findings at thoracotomy and its change over time. We reviewed OS thoracotomies performed at our institution from 1996 to 2015. The number of metastases identified on pre-operative chest CT was compared to the number of metastases seen on pathology (both metastases with viable cells and non-viable, osteoid-only metastases). Eighty-eight patients underwent 161 thoracotomies with a median of 14days (range, 1-85) between CT and surgery, a median of 2 CT-identified lesions (range, 0-15), and a median of 4 resected lesions (range, 1-25). In 56 (34.8%) cases, more metastases were found surgically than were seen on CT, and among these, 34 (21.1%) had a greater number of viable metastases. There was poor overall correlation between CT and pathology findings (Kendall Tau-b=0.506), regardless of CT slice thickness, decade of thoracotomy, or total number of CT-identified lesions. CT accuracy in pre-operatively quantifying OS pulmonary metastases has not improved in recent decades. Consequently, we recommend an open technique with direct lung palpation for complete identification and resection of OS pulmonary metastases. Level IV, retrospective study with no comparison group. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Effect of investments on fundamentals and market reaction on pre-operational and operational Brazilian companies for the period 2006-2012

    Directory of Open Access Journals (Sweden)

    Marco Antonio Pereira

    2016-03-01

    Full Text Available ABSTRACT This paper provides evidence on the market reaction to corporate investment decisions whose shareholder value is largely attributed to growth options. The exploratory research raised pre-operational companies and their operational pairs on the same economy segments. It had the purpose of investigating the existence of statistical differentiation from financial indicators that reflect the installed assets and growth assets, and then study the market reaction to changes in fixed assets as a signaling element about investment decisions. The formation process of operational assets and shareholder value almost exclusively dependent on asset growth stands out in the pre-operational companies. As a result, differentiation tests confirmed that the pre-operational companies had their value especially derived on growth options. The market reaction was particularly bigger in pre-operational companies with abnormal negative stock returns, while the operational companies had positive returns, which may indicate that the quality of the investment is judged based on the financial disclosure. Additionally, operational companies' investors await the disclosure to adjust their prices. We conclude that the results are consistent with the empirical evidence and the participants in financial markets to long-term capital formation investments should give that special attention.

  4. Fear of movement in pre-operative patients with a lumbar stenosis and or herniated disc : Factor structure of the Tampa scale for kinesiophobia

    NARCIS (Netherlands)

    van Wilgen, C. Paul; Stewart, Roy; Stegeman, P. T. Patrick; Coppes, Maarten; van Wijhe, Marten

    2010-01-01

    The presence of fear of movement is related to higher disability rates in several patient groups. The purpose of this study was first to analyze fear of movement and the relation with pain and disability in pre-operative patients with low back pain and radiculopathy and secondly to analyze the

  5. INFLUENCE OF PRE OPERATIVE PHYSICAL THERAPY EDUCATION AND EXERCISE ON POST OPERATIVE SHOULDER RANGE OF MOTION AND FUNCTIONAL ACTIVITES IN SUBJECTS WITH MODIFIED RADICAL MASTECTOMY

    Directory of Open Access Journals (Sweden)

    Y. Lokapavani

    2014-10-01

    Full Text Available Background: Modified radical mastectomy is a frequent surgery employed as a therapeutic procedure in patients with breast carcinoma with involvement of axillary lymph nodes. Many patients suffer from severe shoulder complaints after axillary lymph node dissection even with postoperative rehabilitation. Pre-operative exercise and education are recommended to reduce the incidence of breast cancer related upper limb dysfunction; it will shorten the recovery time. The objectives of the study are to determine the influence of pre-operative physiotherapy on shoulder ROM using goniometer in subjects with modified radical mastectomy and to determine the influence of pre-operative physiotherapy on functional activities using shoulder pain and disability index (SPADI in subjects with modified radical mastectomy. Methods: 30 Subjects of adult women included in the study who met the inclusion criteria, divided into 2 groups. Experimental Group received preoperative physical therapy education and exercises 1-2 weeks before surgery and routine physical therapy protocol after surgery. Control Group received standard education brochure preoperatively and routine physical therapy post operatively. Measurements included shoulder ROM and functional evaluation using goniometer and SPADI. Measurements were taken at baseline i.e., pre operatively, post operatively at 4th day after removal of drains, and 1month after surgery. Results: All measures were significantly reduced after surgery, but most recovered after 1month of surgery and attained functional level in experimental Group. Conclusion: This study provides experimental evidence that preoperative education and exercise influence the postoperative shoulder ROM and functional activities after modified radical mastectomy.

  6. Pre-operative assessment of cancer in the elderly (PACE) : A comprehensive assessment of underlying characteristics of elderly cancer patients prior to elective surgery

    NARCIS (Netherlands)

    Pope, D.; Ramesh, H.; Gennari, R.; Corsini, G.; Maffezzini, M.; Hoekstra, H. J.; Mobarak, D.; Sunouchi, K.; Stotter, A.; West, C.; Audisio, R. A.

    2006-01-01

    Background: Cancer is a disease that particularly affects the elderly and, although surgery is the first treatment choice, many elderly cancer patients do not receive standard surgery because they are considered unfit for treatment due to an inaccurate estimation of operative risk. Pre-operative Ass

  7. Axillary fine needle aspiration cytology for pre-operative staging of patients with screen-detected invasive breast carcinoma.

    LENUS (Irish Health Repository)

    Hayes, Brian D

    2012-02-01

    INTRODUCTION: Fine needle aspiration cytology (FNAC) of radiologically abnormal axillary lymph nodes in patients with breast cancer can identify patients suitable for primary axillary clearance (AC) rather than sentinel node biopsy, enabling surgical axillary staging by a single operation. This study assessed the accuracy of FNAC in predicting positive axillary lymph nodes. METHODS: 161 patients with screen-detected invasive carcinoma and who had pre-operative FNAC of a radiologically abnormal axillary lymph node were identified from two screening units, The axillary FNAC reports were correlated with sentinel node biopsy and AC reports, and sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated. RESULTS: FNAC had a moderate sensitivity (66.3%) and NPV (71.8%), and a high specificity (98.7%) and PPV (98.3%). Most patients (86%) had a single axillary operation. The sensitivity was highest in grade 3 (81.8%) and ductal type (77.8%) tumours. The sensitivity was lower in tumours of special type (34.8%), grade 1 tumours (50%) and those without lymphovascular invasion (LVI) (55.9%). The NPV was highest in pT1 (86.7%) and in grade 1 (84.5%) tumours, and lowest (44%) in tumours with LVI. The PPV was 100% in grade 1 and 3 tumours, stage pT2 and pT3 tumours and those without LVI, and was high (>96%) in all other groups. In lymph-node-positive patients, the mean number of lymph nodes involved was higher in the case of a positive (6.4) than negative FNAC (4.4). CONCLUSIONS: FNAC of ultrasonically abnormal axillary lymph nodes achieved surgical staging by a single operation in most patients with screen-detected invasive breast carcinoma, with moderate sensitivity and high specificity.

  8. Effect of pre-operative neoadjuvant chemo-radiotherapy and surgical treatment on resectable esophageal cancer: a Meta-analysis

    Directory of Open Access Journals (Sweden)

    Wei ZHU

    2011-08-01

    Full Text Available Objective To explore the effect of pre-operative adjuvant chemo-radiotherapy and surgical treatment on resectable esophageal cancer.Methods By searching Medline,CENTRAL(the Cochrane Central Register of Controlled trials,EMBASE,CBM(China Biology Medicine and CNKI(China National Knowledge Infrastructure by computer,the data of randomized controlled trials(RCTs of neoadjuvant chemoradiotherapy and surgical treatment for resectable esophageal cancer were selected and analyzed using Stata 11.0 statistical software.The study population was patients with resectable early or medium stage esophageal cancer,the intervention was neoadjuvant chemoradiotherapy(include sequential chemoradiotherapy and concurrent chemoradiotherapy followed with surgical resection,the outcome indices were 1-and 3-year survival rates and local recurrence rate.The combined odds ratio(OR,relative risk(RR and their 95% confidence interval(CI were calculated to estimate the results.Results Nine articles including a total of 1156 patients were finally analyzed in the Meta-analysis.Among all the patients,579 received neoadjuvant chemoradiotherapy(study group and 577 received surgical treatment only(control group.Compared the study group and control group,the OR of 1-and 3-year survival rate was 1.06(95%CI=0.94-1.19,Z=0.97,P=0.33 and 1.30(95%CI=1.07.-1.57,Z=2.67,P=0.008,respectively,and the RR of local recurrence rate was 0.75(95%CI=0.50-1.12,Z=1.40,P=0.162.Conclusions Neoadjuvant chemoradiotherapy could improve the 3-year survival rate of patients with resectable esophageal cancer,but could not decrease the local recurrence rate.

  9. Effect of Pre-Operative Use of Medications on the Risk of Surgical Site Infections in Patients Undergoing Cardiac Surgery.

    Science.gov (United States)

    Eton, Vic; Sinyavskaya, Liliya; Langlois, Yves; Morin, Jean François; Suissa, Samy; Brassard, Paul

    2016-10-01

    Median sternotomy, the most common means of accessing the heart for cardiac procedures, is associated with higher risk of surgical site infections (SSIs). A limited number of studies reporting the impact of medication use prior to cardiac surgery on the subsequent risk of SSIs usually focused on antibacterial prophylaxis. The objective of the current study was to evaluate the effect of medications prescribed commonly to cardiac patients on the risk of incident SSIs. The study analyzed data on consecutive cardiac surgery patients undergoing median sternotomy at a McGill University teaching hospital between April 1, 2011 and October 31, 2013. Exposure of interest was use of medications for heart disease and cardiovascular conditions in the seven days prior to surgery and those for comorbid conditions. The main outcome was SSIs occurring within 90 d after surgery. Univariate and multivariate logistic regression (adjusted odds ratio [AOR]) was used to evaluate the effect. The cohort included 1,077 cardiac surgery patients, 79 of whom experienced SSIs within 90 d of surgery. The rates for sternal site infections and harvest site infections were 5.8 (95% confidence interval [CI]: 4.4-7.3) and 2.5 (95% CI: 1.4-3.7) per 100 procedures, respectively. The risk of SSI was increased with the pre-operative use of immunosuppressors/steroids (AOR 3.47, 95% CI: 1.27-9.52) and α-blockers (AOR 3.74, 95% CI: 1.21-1.47). Our findings support the effect of immunosuppressors/steroids on the risk of SSIs and add evidence to the previously reported association between the use of anti-hypertensive medications and subsequent development of infection/sepsis.

  10. Focused parathyroidectomy without intraoperative parathormone testing is safe after pre-operative localization with (18)F-Fluorocholine PET/CT.

    Science.gov (United States)

    Hocevar, M; Lezaic, L; Rep, S; Zaletel, K; Kocjan, T; Sever, M J; Zgajnar, J; Peric, B

    2017-01-01

    A focused surgical approach based on pre-operative localization replaced the classical four-gland exploration in patients with primary hyperparathyroidism (PHP). Sestamibi scanning and ultrasound are most often used localization modalities with reported sensitivity of 54-100% for identification of single gland disease. The aim of this study was to analyze the results of pre-operative localization with (18)F-Fluorocholine PET/CT (FCh-PET) in patients with PHP. A retrospective review of 151 patients with PHP who underwent surgery after pre-operative localization with FCh-PET was performed. Only a focused parathyroidectomy without ioPTH testing had been done in patients with single adenoma on FCh-PET. Primary outcome was operative failure, defined as persistent PHP. According to pre-operative FCh-PET 126 (83,4%) patients had single adenoma, 22 (14,5%) multiglandular disease and the test was negative in only two patients. Intraoperative failure experienced 4/126 patients (3,3%) with single adenoma. Removed parathyroid glands were normal in three and hyperplastic in one patient with intraoperative failure. A limited bilateral neck exploration with ioPTH testing was used in 14/22 patients with double adenoma and a classical four-gland exploration without ioPTH testing was used in 8/22 patients with more than two pathological glands according to pre-operative FCh-PET. Intraoperative failure experienced 2/22 patients (9,1%). In two patients with negative FCh-PET a classical four-gland exploration without ioPTH testing was used and one experienced intraoperative failure. A preoperative localization with FCh-PET is a reliable test in patients with PHP. Patients with a single adenoma on FCh-PET can safely undergo a focused parathyroidectomy without ioPTH testing.

  11. HOW APPRAISERS DEVELOP FAIR VALUE

    Directory of Open Access Journals (Sweden)

    MIROSLAV ŠKODA

    2012-01-01

    Full Text Available Management is responsible for its own financial decisions. If we take into account, that fair value concept was shown in financial crisis as something that does not work anymore in this way; there is a big need to develop it for the future. Non-professional readers of financial statements believe, however, that company financials are the work of the public accounting firm that had signed the audit certificate. The main reason for bringing this point up is that when companies disclose Fair Value (FV information in their financial statements, they are taking responsibility for the values disclosed. Management may often be encouraged to utilize the services of an outside professional, but at the end of the day, the outside appraiser is a hired gun. Although the appraiser has to take responsibility for his own work, hiring the appraiser does not absolve management of its ultimate responsibility. The obverse of this is also true. Management does not have to hire the appraiser to develop any fair value disclosures made in the financial statements. Developing FV information is not recommended as a do-it yourself undertaking, there is nothing in Generally Accepted Accounting Principles (GAAP or Securities Exchange Commission (SEC regulations, however, that requires an outside appraiser.

  12. Is Tc99m-MIBI scintigraphy a predictor of response to pre-operative neoadjuvant chemotherapy in Osteosarcoma?

    Directory of Open Access Journals (Sweden)

    Mohammad Gharehdaghi

    2013-10-01

    Full Text Available Introduction: Multidrug resistance (MDR, which may be due to the over expression of P-glycoprotein (Pgp and/or MRP, is a major problem in neoadjuvant chemotherapy of osteosarcoma. The aim of this study was to investigate the role of Tc-99m MIBI scan for predicting the response to pre-operative chemotherapy. Materials and Methods: Twenty-five patients (12 males and 13 females, aged between 8 and 52y with osteosarcoma were studied. Before the chemotherapy, planar 99mTc-MIBI anterior and posterior images were obtained 10-min [tumor-to-background ratio: (T1/B110min] and 3-hr after tracer injection. After completion of chemotherapy, again 99mTc-MIBI scan was performed at 10-min after tracer injection. In addition to calculation of decay corrected tumor to background (T/B ratios , using the 10-min and 3-hr images of the pre-chemotherapy scintigraphy , percent wash-out rate (WR% of 99mTc-MIBI was calculated. Using the 10-min images of the pre- and post-chemotherapy scans, the percent reduction in uptake at the tumor site after treatment (Red% was also calculated. Then after surgical resection, tumor response was assessed by percentage of necrosis. Results: All patients showed significant 99mTc-MIBI uptake in early images. Only 9 patients showed good response to chemotherapy (necrosis≥90% while 16 patients were considered as non-responder (necrosis<90%. There was no statistical significant difference between non-responders and responders in (T1/B110min.There was a significant negative correlation between WR% and percentage of necrosis (P=0.001. On the other hand, there was a significant correlation between Red% and percentage of necrosis (P<0.001.There was also statistical significant difference in WR% and Red% between non-responders and responders (both P< 0.001. Conclusion: Washout rate of 99mTc-MIBI in pre-chemotherapy scintigraphy as well as Red% using pre- and post-chemotherapy MIBI scintigraphy are useful methods for predicting response to

  13. Pre-operative radiochemotherapy of primarily non-resectable rectal cancer; Praeoperative Radiochemotherapie bei primaer inoperablen Rektumkarzinomen

    Energy Technology Data Exchange (ETDEWEB)

    Keilholz, L. [Erlangen-Nuernberg Univ., Erlangen (Germany). Strahlentherapeutische Klinik; Dworak, O. [Erlangen-Nuernberg Univ., Erlangen (Germany). Abt. fuer Pathologie; Dunst, J. [Erlangen-Nuernberg Univ., Erlangen (Germany). Strahlentherapeutische Klinik; Koeckerling, F. [Erlangen-Nuernberg Univ., Erlangen (Germany). Chirurgische Klinik; Schwarz, B. [Erlangen-Nuernberg Univ., Erlangen (Germany). Abt. fuer Pathologie; Sauer, R. [Erlangen-Nuernberg Univ., Erlangen (Germany). Strahlentherapeutische Klinik

    1995-02-01

    Twenty patients with non-resectable rectal cancer (Mason CS III-VI) have been irradiated from September 1989 through February 1994. The total dose, calculated at the isocenter, was 50,4 Gy with 5 fractions of 1.8 Gy per week with a small volume boost in selected cases. Chemotherapy was administered on 5 consecutive days in week 1 and 5 with 1000 mg/m{sup 2} 5-FU per day as continuous infusion over 120 hours. The treatment was well tolerated. Acute toxicity included 1 grade III-dermatitis, 7 grade II-enteritis, 1 grade III- and 3 grade II-leucopenia. Seventeen out of 20 patients were resected 6 weeks after radiochemotherapy, 3 patients had no surgery (1 toxic death due to septicemia, 1 refusal of surgery after complete remission, 1 thrombocytopenia due to liver cirrhosis), all 3 had at least partial remission of their tumors. Fourteen out of 17 (82%) resections were curative (R0) with 1 additional R1- and 2 R2-resections. Ten out of 14 (71%) curative resected patients had no lymph node metastasis. A detailed histological examination showed regression in 15/16 tumors with fibrosis and vascular wall changes. Nine out of 16 patients had only minimal residual tumor. In this pilot study, pre-operative radiochemotherapy was well tolerated. (orig.) [Deutsch] An der Strahlentherapeutischen Klinik haben wir im Zeitraum September 1989 bis Februar 1994 20 Patienten mit primaer nicht resektablen Rektumkarzinomen (CS III-IV nach Mason) praeoperativ bestrahlt (fuenf Fraktionen pro Woche, Einzeldosis 1,8 Gy im Isozentrum, Gesamtdosis 50,4 Gy grossvolumig, in Einzelfaellen Boost bis maximal 68 Gy). Simultan erfolgte in der ersten und fuenften Therapiewoche eine 120-Stunden-Dauerinfusion mit 1000 mg/m{sup 2} 5-FU pro Tag. Die Radiochemotherapie wurde gut toleriert. Es traten bei einem Patienten eine Grad-III-Dermatitis, bei sieben eine Grad-II-Enteritis, bei einem Patienten eine Grad-III- und bei drei Patienten eine Grad-II-Leukozytopenie auf. 17/20 Patienten wurden etwa sechs

  14. Adenoid and tonsil surgeries in children: How relevant is pre-operative blood grouping and cross-matching?

    Directory of Open Access Journals (Sweden)

    Lucky Onotai

    2013-01-01

    Full Text Available Background: As a part of pre-operative evaluation, several otolaryngologists group and cross-match blood routinely for children undergoing adenoid and tonsil surgeries. This practice has generated several debates either in support or against this practice. The aim of this study is to critically evaluate the incidence of post-tonsillectomy (with or without adenoidectomy bleeding and blood transfusions in otherwise healthy children with adenoid/tonsil pathologies conducted in the University of Port Harcourt Teaching Hospital (UPTH. Patients and Methods: A descriptive retrospective study of children who underwent adenoid and tonsil surgeries in the Department of Ear, Nose and Throat (ENT surgery of UPTH from January 2003 to December 2012. Children with family history of bleeding disorders and derangement of clotting profile as well as different co-morbidity like sickle cell disease were excluded from this study. The patients′ data were retrieved from the registers of ENT out-patient clinics, theatre registers and patients case notes. Demographic data, indications for surgery, preoperative investigations, complications and management outcomes were recorded and analyzed. Results: Out of 145 children that had adenoid and tonsil surgeries; only 100 met the criteria for this study. The study subjects included 65 males and 35 females (male: female ratio 1.9:1 belonging to 0-16 years age group (mean age: 3.46 ± 2.82 years. The age group of 3-5 years had the highest (n = 40, 40% number of surgeries. Adenotonsillectomy was the commonest (n = 85, 85% surgery performed on patients who had obstructive sleep apnea (OSA. The commonest (n = 6, 6% complication was haemorrhage, and only few (n = 3, 3% patients had blood transfusion. However, mortality was recorded in some (n = 3, 3% patients. Conclusion: This study confirms that the incidence of post adenoidectomy/tonsillectomy bleeding in otherwise healthy children is low and rarely requires blood transfusion

  15. Pre-operative antiseptic shower and bath policy decreases the rate of S. aureus and methicillin-resistant S. aureus surgical site infections in patients undergoing joint arthroplasty.

    Science.gov (United States)

    Colling, Kristin; Statz, Catherine; Glover, James; Banton, Kaysie; Beilman, Greg

    2015-04-01

    Surgical site infection (SSI) following joint arthroplasty increases length of stay, hospital cost, and leads to patient and healthcare provider dissatisfaction. Due to the presence of non-biologic implants (the prosthetic joint) in these procedures, infection is often devastating and treatment of the infection is more difficult. For this reason, prevention of SSI is of crucial importance in this population. Staphylococcus aureus colonizes the nares of approximately 30-40% of the population, is the most common pathogen causing SSI, and is associated with high morbidity and mortality rate. A pre-operative shower or bath with an antiseptic is an inexpensive and effective method of removal of these transient skin pathogens prior to the procedure and may be used to decrease SSI. We hypothesize that a preoperative antiseptic shower or bath will decrease the rate of SSI. A retrospective review was performed at two affiliated hospitals within the same system, one with a hospital-wide policy enforcing pre-operative antiseptic shower or bath and the other with no policy, with cases included from January 2010 to June 2012. International Classification of Disease-Ninth Revision-Clinical Modification (ICD-9-CM) codes and chart review were used to identify patients undergoing joint arthroplasty and to identify those with SSI. Two thousand three-hundred forty-nine arthroplasties were performed at the University of Minnesota Medical Center, a tertiary-care hospital with a pre-operative antiseptic shower or bath policy in place. An additional 1,693 procedures were performed at Fairview Ridges Hospital, a community hospital with no pre-operative policy. There was no difference in the rate of SSI between the two hospitals (1.96% vs. 1.95%; p=1.0). However, the rate of SSI caused by S. aureus was significantly decreased by pre-operative antiseptic shower/bath (17% vs. 61%; p=0.03), as was the rate of methicillin-resistant S. aureus (MRSA) infections (2% vs. 24% p=0.002). A pre-operative

  16. 49 CFR 24.103 - Criteria for appraisals.

    Science.gov (United States)

    2010-10-01

    ... appraisals. (a) Appraisal requirements. This section sets forth the requirements for real property... the remaining real property, where appropriate. (v) The effective date of valuation, date of appraisal...) appraiser to perform the appraisal, such appraiser shall be State licensed or certified in accordance...

  17. Effect of Background Parenchymal Enhancement on Pre-Operative Breast Magnetic Resonance Imaging: How It Affects Interpretation and the Role of Second-Look Ultrasound in Patient Management.

    Science.gov (United States)

    Kim, Soo-Yeon; Lee, Hye Sun; Kim, Eun-Kyung; Kim, Min Jung; Moon, Hee Jung; Yoon, Jung Hyun

    2016-12-01

    Background parenchymal enhancement (BPE) on breast magnetic resonance imaging (MRI) may either obscure or mimic malignancy. We evaluated the impact of BPE on the diagnostic performance of pre-operative MRI in breast cancer patients, and how second-look ultrasound (US) can help in guiding patient management. Two hundred fifty-three breast cancer patients with pre-operative MRI were included. In moderate or marked BPE, abnormal interpretation rate (38.9% vs. 12.2%) and biopsy rate (27.8% vs. 8.3%) were higher, and specificity (64.7% vs. 89.8%) was lower, compared with minimal or mild BPE (all p abnormal interpretation rate, additional biopsy rate and decreased specificity. Second-look US was useful in visualization of MRI-detected additional suspicious lesions, regardless of BPE.

  18. Problem Solving Appraisal of Delinquent Adolescents.

    Science.gov (United States)

    Perez, Ruperto M.; And Others

    The study investigated the following: (1) the relationship of problem solving appraisal to narcissistic vulnerability, locus of control, and depression; (2) the differences in problem solving appraisal, locus of control, and depression in first-time and repeat offenders; and (3) the prediction of problem solving appraisal by narcissistic…

  19. Appraisal and Selection for Digital Curation

    Directory of Open Access Journals (Sweden)

    Jinfang Niu

    2014-10-01

    Full Text Available Based on existing appraisal/selection policies in libraries, archives, museum, social science and science data centers, this paper presents a generic appraisal/selection framework for digital curation. In presenting this framework, the author discusses how archival appraisal theories, methods, and criteria adapt to the general digital curation context.

  20. Teacher Appraisal: Back to the Future.

    Science.gov (United States)

    Mortimore, Peter; Mortimore, Jo

    1991-01-01

    Reviews the government's progress in introducing a formal, systematic, and compulsory system of teacher appraisal across England and Wales, using comparisons with civil service, business, and commerce appraisal techniques. Describes national government-initiated pilot appraisal schemes, concluding with a discussion of implications for developing a…

  1. Approaches to Performance Appraisal in Student Affairs.

    Science.gov (United States)

    Davis, J. Shay

    2001-01-01

    The purpose of this article is to outline models of performance appraisal in business, assess the current status of performance appraisal in higher education, review practices of business which are applicable in the higher education setting, and present a new model of performance appraisal, the DEVELOP model. (Contains 27 references.) (Author)

  2. 5 CFR 301.303 - Performance appraisal.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Performance appraisal. 301.303 Section....303 Performance appraisal. As soon as practicable, but beginning not later than January 1, 1984... in § 315.608(a), of this chapter in accordance with the agency's performance appraisal...

  3. Appraisal of family doctors: an evaluation study.

    NARCIS (Netherlands)

    Lewis, M.I.; Elwyn, G.; Wood, F.

    2003-01-01

    BACKGROUND: Appraisal has evolved to become a key component of workforce management. However, it is not clear from existing proposals for appraisal of doctors whether employers, health authorities or primary care organisations should take responsibility for appraisal processes. AIMS: To evaluate the

  4. Self-Appraisal Based upon Supervisory Feedback.

    Science.gov (United States)

    Steel, Robert P.; Ovalle, Nestor K.

    1984-01-01

    Compared self-appraisals with instructions referencing supervisory feedback with conventional self-appraisals with personnel from a large institution (N=401) and two samples of military personnel (N=117). Results showed that Feedback Based Self Appraisals exhibited more agreement with superior ratings, and degree of feedback available moderated…

  5. 48 CFR 1437.7002 - Appraisal standards.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Appraisal standards. 1437... standards. (a) All real property appraisals for condemnation purposes shall be consistent with requirements of the Interagency Land Acquisition Conference publication “Uniform Appraisal Standards for...

  6. Pre-operative variables affecting final vision outcome with a critical review of ocular trauma classification for posterior open globe (zone III) injury

    Science.gov (United States)

    Agrawal, Rupesh; Ho, Sue Wei; Teoh, Stephen

    2013-01-01

    Purpose: To identify pre-operative variables affecting the outcome of posterior open globe (zone III) injuries. Secondary objective was to re-look at the definition or landmarks for zone III injury and its clinical significance for predicting visual prognosis following open globe injury. Materials and Methods: Retrospective review of medical records of all hospitalized patients with surgical repair of open globe injury over last 10 years at a tertiary referral eye care center in Singapore. Out of 172 eyes with open globe injury, 28 eyes (16.3%) with zone III injury was identified and reviewed further. Pre-operative visual acuity (VA) and other variables, extent of scleral wound in reference to rectus insertion, relative afferent pupillary defect (RAPD) and final vision outcome were recorded. Results: Median age was 37 years with male predilection (92.9%). Mean follow-up was 12.9 months. Pre-operative VA was no light perception (NLP) in 16 (57.1%) eyes. Final VA remained NLP in 14 eyes (50.0%). The factors contributing to poor post-operative vision based on univariate regression analysis were the presence of RAPD, poor pre-operative VA, blunt trauma, extent of trauma, associated traumatic cataract, hyphema, vitreous loss and associated vitreo-retinal trauma. Further on, zone III injuries with scleral wound limited anterior to rectus insertion (6 eyes) had better vision outcome than those with injuries extending beyond rectus insertion (22 eyes). Conclusion: Initial VA, blunt ocular trauma, visual axis involvement, loss of light perception, presence of RAPD, traumatic cataract, hyphema, vitreous loss were the important determinants for final visual outcome in patients with zone III injury. Wound extending posterior to rectus insertion has poorer outcome as those limited anterior to rectus insertion. We suggest that there may be a need to relook at zone III injuries with reference to rectus insertion for prognostic significance, and further studies are warranted. PMID

  7. Patient-specific positioning guides for total knee arthroplasty: no significant difference between final component alignment and pre-operative digital plan except for tibial rotation

    OpenAIRE

    Boonen, Bert; Schotanus, Martijn G.M.; Kerens, Bart; Hulsmans, Frans-Jan; Tuinebreijer, Wim; Kort, Nanne P.

    2015-01-01

    Purpose To assess whether there is a significant difference between the alignment of the individual femoral and tibial components (in the frontal, sagittal and horizontal planes) as calculated pre-operatively (digital plan) and the actually achieved alignment in vivo obtained with the use of patient-specific positioning guides (PSPGs) for TKA. It was hypothesised that there would be no difference between post-op implant position and pre-op digital plan. Methods Twenty-six patients were includ...

  8. Optimising renal cancer patients for nephron-sparing surgery: a review of pre-operative considerations and peri-operative techniques for partial nephrectomy.

    Science.gov (United States)

    Ertemi, Hani; Khetrapal, Pramit; Pavithran, Nevil M; Mumtaz, Faiz

    2017-02-03

    Nonmodifiable factors including pre-operative renal function and amount of healthy renal tissue preserved are the most important predictive factors that determine renal function after partial nephrectomy. Ischaemia time is an important modifiable risk factor and cold ischaemia time should be used if longer ischaemia time is anticipated. New techniques may have a role in maximising postoperative kidney function, but more robust studies are required to understand their potential benefits and risks.

  9. Pre-operative perfusion skewness and kurtosis are potential predictors of progression-free survival after partial resection of newly diagnosed glioblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Paik, Wo Yul [Dept. of Radiology, Dankook University Hospital, Cheonan (Korea, Republic of); Kim, Ho Sung; Choi, Choong Gon; Kim, Sang Joon [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2016-02-15

    To determine whether pre-operative perfusion skewness and kurtosis derived from normalized cerebral blood volume (nCBV) histograms are associated with progression-free survival (PFS) of patients after partial resection of newly diagnosed glioblastoma. A total of 135 glioblastoma patients who had undergone partial resection of tumor (resection of < 50% of pre-operative tumor volume or surgical biopsy) confirmed with immediate postsurgical MRI and examined with both conventional MRI and dynamic susceptibility contrast (DSC) perfusion MRI before the surgery were retrospectively reviewed in this study. They had been followed up post-surgical chemoradiotherapy for tumor progression. Using histogram analyses of nCBV derived from pre-operative DSC perfusion MRI, patients were sub-classified into the following four groups: positive skewness and leptokurtosis (group 1); positive skewness and platykurtosis (group 2); negative skewness and leptokurtosis (group 3); negative skewness and platykurtosis (group 4). Kaplan-Meier analysis and multivariable Cox proportional hazards regression analysis were performed to determine whether clinical and imaging covariates were associated with PFS or overall survival (OS) of these patients. According to the Kaplan-Meier method, median PFS of group 1, 2, 3, and 4 was 62, 51, 39, and 41 weeks, respectively, with median OS of 82, 77, 77, and 72 weeks, respectively. In multivariable analyses with Cox proportional hazards regression, pre-operative skewness/kurtosis pattern (hazard ratio: 2.98 to 4.64; p < 0.001), Karnofsky performance scale score (hazard ratio: 1.04; p = 0.003), and post-operative tumor volume (hazard ratio: 1.04; p = 0.02) were independently associated with PFS but not with OS. Higher skewness and kurtosis of nCBV histogram before surgery were associated with longer PFS in patients with newly diagnosed glioblastoma after partial tumor resection.

  10. Pre-operative endostent placement to allow the complete and safe resection of a recurrent tumor that had tightly adhered to the subclavian artery: A case report

    Directory of Open Access Journals (Sweden)

    Takuya Nakayama

    2015-04-01

    Full Text Available Radiation and tumor infiltration confer a high risk of bleeding on surgical removal of tumor. We report on the case of a 42-year-old woman with a recurrent occult subclavian tumor in her right breast. Computed tomography revealed enhanced tumor adhesion to the subclavian artery at the infraclavicular lymph node. No other metastases were detected. We pre-operatively performed stenting of the right subclavian artery, and the tumor was resected completely and safely.

  11. A randomised controlled trial examining the effect of acupuncture at the EX-HN3 (Yintang) point on pre-operative anxiety levels in neurosurgical patients.

    Science.gov (United States)

    Wiles, M D; Mamdani, J; Pullman, M; Andrzejowski, J C

    2017-03-01

    Pre-operative anxiety is an unpleasant state of psychological distress that occurs in up to 87% of patients awaiting neurosurgical procedures. Sedative medication is undesirable in this population due to the need for early postoperative neurological assessment. Acupuncture has previously been shown to reduce pre-operative anxiety, but studies involving neurosurgical patients are lacking. This single-centre, prospective, randomised controlled trial was designed to determine the effect of acupuncture at the EX-HN3 (Yintang point) on pre-operative anxiety levels in neurosurgical patients. The study was prospectively registered before participant recruitment. After measuring baseline anxiety levels, 128 patients were randomly allocated in a 1:1 ratio by a web-based computer program to receive either acupuncture at the EX-HN3 (Yintang) point (acupuncture group) or no intervention (control group). Participants were not blinded, but all analyses were performed by a member of the research team who was unaware of the group allocation. The primary outcome measure was anxiety level after 30 min, as measured by the six-item short form of the State-Trait Anxiety Inventory (possible score range 20-80). Sixty-two patients in each group were subsequently analysed. Median (IQR [range]) anxiety State-Trait Anxiety Inventory score reduced significantly in the acupuncture group (46.7 (36.7-53.3 [23.3-70.0]) to 40.0 (30.0-46.7) [20.0-53.3]), p < 0.001), with no change seen in the control group (41.7 (33.3-53.3 [20.0-76.7]) to 43.3 (36.7-50.0 [20.0-76.7]), p = 0.829). There were no adverse events in either group. Acupuncture at the EX-HN3 point reduces pre-operative anxiety levels in patients awaiting neurosurgery.

  12. The LIPPSMAck POP (Lung Infection Prevention Post Surgery - Major Abdominal - with Pre-Operative Physiotherapy) trial: study protocol for a multi-centre randomised controlled trial

    OpenAIRE

    Boden, Ianthe; Browning, Laura; Elizabeth H Skinner; Reeve, Julie; El-Ansary, Doa; Robertson, Iain K.; Denehy, Linda

    2015-01-01

    Background Post-operative pulmonary complications are a significant problem following open upper abdominal surgery. Preliminary evidence suggests that a single pre-operative physiotherapy education and preparatory lung expansion training session alone may prevent respiratory complications more effectively than supervised post-operative breathing and coughing exercises. However, the evidence is inconclusive due to methodological limitations. No well-designed, adequately powered, randomised con...

  13. Nuclear safety in perspective

    Directory of Open Access Journals (Sweden)

    J. K. Basson

    1983-03-01

    Full Text Available The impending operation of South Africa’s first nuclear power station, Koeberg, necessitates a thorough analysis of nuclear safety under local conditions. More is known, worldwide, about radiation effects than about any other health hazard, and international norms have already been accepted since 1928. The widespread use of X-rays and radio-isotopes, the extraction and processing of uranium, visits by nuclear-powered ships and, especially, the nuclear-reactor operation in South Africa. Consequently, the pre-operational investigations of Koeberg could be completed thoroughly, with full confidence in its safe commissioning.

  14. The value of oblique pinhole images in pre-operative localisation with {sup 99m}Tc-MIBI for primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Ho Shon, I.A. [Dept. of Nuclear Medicine, Royal North Shore Hospital, Sydney (Australia); Bernard, E.J.; Roach, P.J. [Dept. of Nuclear Medicine, Royal North Shore Hospital, Sydney (Australia); North Shore Radiology and Nuclear Medicine, North Shore Private Hospital, Sydney (Australia); Delbridge, L.W. [Dept. of Surgery, Royal North Shore Hospital, Sydney (Australia)

    2001-06-01

    Technetium-99m labelled 2-methoxyisobutylisonitrile (MIBI) has been extensively utilised for pre-operative localisation of parathyroid adenomas. Imaging techniques have varied widely, with many centres not performing routine oblique images; thus this study aimed to examine the value of routine oblique pinhole imaging. Ninety-two patients underwent pre-operative {sup 99m}Tc-MIBI imaging including early and delayed anterior oblique pinhole images in addition to standard anterior pinhole images and a thyroid study prior to surgery for primary hyperparathyroidism. These studies were reviewed blindly comparing anterior and oblique images and anterior images only in relation to surgical findings. Of the 92 patients, 83 were found to have 86 parathyroid adenomas or parathyroid adenoma/hyperplasia at surgery. When compared to anterior images only, oblique views improved overall sensitivity from 76% to 88% (P<0.05), correctly localised 11 more adenomas than anterior images alone (13%) and improved the confidence of interpretation in 17 patients (20%). In conclusion, routine oblique pinhole views result in greater sensitivity and reporter confidence in pre-operative parathyroid localisation with {sup 99m}Tc-MIBI. (orig.)

  15. Patient satisfaction with total knee replacement cannot be predicted from pre-operative variables alone: A cohort study from the National Joint Registry for England and Wales.

    Science.gov (United States)

    Baker, P N; Rushton, S; Jameson, S S; Reed, M; Gregg, P; Deehan, D J

    2013-10-01

    Pre-operative variables are increasingly being used to determine eligibility for total knee replacement (TKR). This study was undertaken to evaluate the relationships, interactions and predictive capacity of variables available pre- and post-operatively on patient satisfaction following TKR. Using nationally collected patient reported outcome measures and data from the National Joint Registry for England and Wales, we identified 22 798 patients who underwent TKR for osteoarthritis between August 2008 and September 2010. The ability of specific covariates to predict satisfaction was assessed using ordinal logistic regression and structural equational modelling. Only 4959 (22%) of 22 278 patients rated the results of their TKR as 'excellent', despite the majority (71%, n = 15 882) perceiving their knee symptoms to be much improved. The strongest predictors of satisfaction were post-operative variables. Satisfaction was significantly and positively related to the perception of symptom improvement (operative success) and the post-operative EuroQol-5D score. While also significant within the models pre-operative variables were less important and had a minimal influence upon post-operative satisfaction. The most robust predictions of satisfaction occurred only when both pre- and post-operative variables were considered together. These findings question the appropriateness of restricting access to care based on arbitrary pre-operative thresholds as these factors have little bearing on post-operative satisfaction.

  16. Appraisal Psychology, Neurobiology, and Language.

    Science.gov (United States)

    Schumann, John H.

    2001-01-01

    Proposes that the confluence of stimulus appraisal and social cognition that is effected by the neural system in the brain has important implications for language and learning theories. Describes the anatomy and functions of this neural system and discusses how it may operate in motivation for second language acquisition and how in conjunction…

  17. Improving Work Performance Through Appraisal

    Science.gov (United States)

    Kearney, William J.

    1978-01-01

    Effective appraisal depends on three essential elements: employees who are motivated to achieve goals, who have the necessary mental and physical ability, and who clearly understand the demands of the job. What this implies for systems touching on these elements is spelled out in detail. (Author/MLF)

  18. Psychotherapy: A 40-Year Appraisal.

    Science.gov (United States)

    Garfield, Sol L.

    1981-01-01

    Appraises selected issues and developments in the field of psychotherapy since 1940. Discusses increased participation of clinical psychologists in the area of psychotherapy, increased popularity of psychotherapy, declining influence of psychoanalysis and related views, emergence of behavioral and cognitive therapies, and recent emphasis on…

  19. The Rank Hospital Appraisal Experience of Improving the Safety Manage-ment of Nursing Care of Pediatric%通过等级医院评审提高儿科护理安全管理的体会

    Institute of Scientific and Technical Information of China (English)

    李欣

    2016-01-01

    Pediatric nursing belongs to high risk and high pressure in the Department of clinical work, from the perspective of department management, management of nursing safety is particularly important. From the point of view of generalized and modern development of nursing management, nursing safety is not only refers to the patients in the whole process of re-ceiving care, no laws, statutory rules and regulations permitted outside of the psychological and physical structural or func-tional damage, disorder, defect or death. The nurse practitioner should also include security, namely in the process of prac-tice is not allowed outside the scope of the impact of adverse factors and damage. In the process of hospital accreditation through the accreditation standards in-depth study and a thorough understanding of, we recognize the pediatric nursing safety management is a legal basis. In the process of continuous improvement of the management system of nursing service, the safety and quality of care in the past to recognize whether it is from the experience of management or problem manage-ment methods exist in many drawbacks. Grade of hospital accreditation standards to further standardize the pediatric nursing safety management goal and direction. In our department from the aspects of the safety of children (children's identification of safety, drug safety for children, children's pipeline safety, anti-corrosion of children, children use constraints with securi-ty, children safe transfer) and nurse occupational safety aspects (nursing safety, adverse event reporting, emergency safety management) system, the process of perfection; the completion of the training, implementation and quality control and im-prove the quality of nursing safety. And in the hospital grade assessment, the hospital set up a special quality team, contin-ue to carry out safety inspection in the process of existence, timely rectification. The end of the review as a new starting point, effectively

  20. How to critically appraise the clinical literature.

    Science.gov (United States)

    Cronin, Paul; Rawson, James V; Heilbrun, Marta E; Lee, Janie M; Kelly, Aine M; Sanelli, Pina C; Bresnahan, Brian W; Paladin, Angelisa M

    2014-09-01

    Recent efforts have been made to standardize the critical appraisal of clinical health care research. In this article, critical appraisal of diagnostic test accuracy studies, screening studies, therapeutic studies, systematic reviews and meta-analyses, cost-effectiveness studies, recommendations and/or guidelines, and medical education studies is discussed as are the available instruments to appraise the literature. By having standard appraisal instruments, these studies can be appraised more easily for completeness, bias, and applicability for implementation. Appraisal requires a different set of instruments, each designed for the individual type of research. We also hope that this article can be used in academic programs to educate the faculty and trainees of the available resources to improve critical appraisal of health research.

  1. Appraisal-emotion relationships in daily life.

    Science.gov (United States)

    Nezlek, John B; Vansteelandt, Kristof; Van Mechelen, Iven; Kuppens, Peter

    2008-02-01

    Using a daily process design, the present study examined relationships between momentary appraisals and emotional experience based on Smith and Lazarus' (1993) theory of emotions (1993). Nine times a day for 2 weeks, participants (N = 33, 23 women) recorded their momentary experience of 2 positive emotions (joy, love) and 4 negative emotions (anger, guilt, fear, sadness) and the core relational theme appraisal contents Smith and Lazarus hypothesized as corresponding to these emotions. A series of multilevel modeling analyses found that the hypothesized relationships between appraisal contents and these emotions were stronger than relationships between contents and other emotions, although appraisals were related to other emotions in many cases. Moreover, there were some individual differences in the strength of these relationships. These results suggest that there are no one-to-one relationships between appraisal contents and specific emotional experiences, and that specific emotions are associated with different appraisal contents, and that specific appraisals are associated with different emotions.

  2. Analysis of Appraising Agricultural Intangible Asset Value by Cost Method

    OpenAIRE

    Li, Xiao-Juan

    2010-01-01

    On the basis of describing the connotation of agricultural intangible asset and cost method, the technical ideas of appraising by cost method are introduced. The article analyzes the advantages (simple appraisal principle and easy to understand and grasp; overall consideration of various factors related to appraisal result value) and disadvantages (high appraisal cost; difficult to appraise and grasp various appraisal factors) of appraising by cost method. The article also summarizes the prec...

  3. Effect of pre-operative octenidine nasal ointment and showering on surgical site infections in patients undergoing cardiac surgery.

    Science.gov (United States)

    Reiser, M; Scherag, A; Forstner, C; Brunkhorst, F M; Harbarth, S; Doenst, T; Pletz, M W; Hagel, S

    2017-02-01

    To evaluate the effect of pre-operative octenidine (OCT) decolonization on surgical site infection (SSI) rates. Before-and-after cohort study. Patients undergoing an elective isolated coronary artery bypass graft (CABG) procedure: control group (1(st) January to 31(st) December 2013), N=475; intervention group (1(st) January to 31(st) December 2014), N=428. The intervention consisted of nasal application of OCT ointment three times daily, beginning on the day before surgery, and showering the night before and on the day of surgery with OCT soap. A median sternotomy was performed in 805 (89.1%) patients and a minimally invasive direct coronary artery bypass procedure was performed in 98 (10.9%) patients. Overall, there was no difference in SSI rates between the control and intervention groups (15.4% vs 13.3%, P=0.39). The rate of harvest site SSIs was significantly lower in patients in the intervention group (2.5% vs 0.5%, P=0.01). Patients who had undergone a median sternotomy in the intervention group had a significantly lower rate of organ/space sternal SSIs (1.9% vs 0.3%, P=0.04). However, there was a trend towards an increased rate of deep incisional sternal SSIs (1.2% vs 2.9%, P=0.08). Multi-variate analysis did not identify a significant protective effect of the intervention (odds ratio 0.79, 95% confidence interval 0.53-1.15, P=0.27). Pre-operative decolonization with OCT did not reduce overall SSI rates in patients undergoing an elective isolated CABG procedure, but significantly decreased harvest site and organ/space sternal SSIs. Randomized controlled trials, including controlled patient adherence to the intervention, are required to confirm these observations and to determine the clinical utility of OCT in pre-operative decolonization. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  4. Eletrocardiografia pré-operatória em 474 cães Pre-operative electrocardiography evaluation in 474 dogs

    Directory of Open Access Journals (Sweden)

    C.F. Carvalho

    2009-06-01

    Full Text Available Foram realizadas avaliações eletrocardiográficas pré-operatórias em 474 cães, machos e fêmeas, com o objetivo de analisar a frequência de alterações eletrocardiográficas e sua relação com indicação cirúrgica, sexo, idade, raça, peso, escore corporal (obesidade, histórico e sinais físicos de doenças cardíacas. As alterações eletrocardiográficas foram observadas em 220 animais (46%, sendo mais frequentes nos machos (n=116; 52,7%. O aumento na duração do QRS foi a alteração mais observada (n=54; 24,5%. Sugere-se o exame eletrocardiográfico de rotina na avaliação pré-cirúrgica, independentemente de idade, peso, histórico ou sinais físicos de cardiopatia.Pre-operative electrocardiographic evaluations were done in 474 male and female dogs to analyze the frequency of electrocardiographic alterations and its relation with the surgical indication according to age, breed, weight, body score (obesity, and history and physical signs of cardiac diseases. The electrocardiographic alterations occurred in 220 (46% animals, being more frequent in males (n=116; 52.7%. The increase in QRS duration was the most observed alteration (n=54; 24.5%. The electrocardiographic alterations in the pre-operative are common, which suggests that the performing of electrocardiographic exam in the pre-operative is independent of the age, weight, surgical problem, or signs of cardiopathy on clinical exam.

  5. The utility of MRI for pre-operative T and N staging of gastric carcinoma: a systematic review and meta-analysis.

    Science.gov (United States)

    Huang, Z; Xie, D H; Guo, L; Hu, C H; Fang, X; Meng, Q; Ping, X X; Lu, Z W

    2015-06-01

    To perform a meta-analysis and literature review regarding the diagnostic accuracy of MRI for pre-operative tumour depth invasion (T) and regional lymph node invasion (N) staging of gastric carcinoma (GC). Articles were identified through systematic search of Medline, PubMed, Cochrane Library, Web of Science, Springerlink and several Chinese databases. The study quality was assessed by the quality assessment for studies of diagnostic accuracy. 2 reviewers independently extracted and assessed the data from 11 eligible studies. A meta-analysis was then carried out. Subgroup and sensitivity analyses were also performed. 11 studies (439 patients) were finally included in the current review. Among these studies, the significant evidence of heterogeneity was only discovered for specificity in T4 stage (I(2) = 59.8%). Pooled sensitivity and specificity of MRI to diagnose T stage tumour (T3-4 vs T1-2) were 0.93 [95% confidence interval (CI), 0.89-0.96] and 0.91 (95% CI, 0.87-0.95), respectively. Pooled estimates of sensitivity and specificity of MRI to diagnose N stage tumour (N0 vs N+) were 0.86 (95% CI, 0.80-0.92) and 0.67 (95% CI, 0.54-0.79), respectively. Subgroup analyses showed that diffusion-weighted imaging was more helpful for T staging. The present systematic review suggests that MRI has a good diagnostic accuracy for pre-operative T staging of GC and should be widely used in clinical work. However, the ability for N staging is relatively poor on MRI. In the pre-operative staging of GC, MRI was a useful tool and may enhance accuracy for the T staging of advanced GC.

  6. PRE - OPERATIVE PREDICTORS OF DIFFICUL T LAPAROSCOPIC CHOLECYSTECTOMY; COMPARIS ONS OF TWO SCORING SYSTEMS. A SINGLE CENTER PROSPECTIVE STUDY”

    Directory of Open Access Journals (Sweden)

    Hari Gopal

    2013-10-01

    Full Text Available ABSTRACT: INTRODUCTION: Laparoscopic Cholecystectomy has evolved as the standard of care for the treatment of Gall Stone disease over the past decade. Several patient and procedure related factors have been impli cated in setting of failure to complete the procedure by minimal invasive method and various scores have been developed to precisely predict a Difficult Laparoscopic Cholecystectomy. AIMS: The present study was conducted to ascertain various patient relate d pre - operative risk factors for conversion of l apar o scopic Cholecystectomy to open method and to validate the Risk Score for conversion . SETTINGS & DESIGN: A total of 100 patients with diagnosis of Gall Stone Disease admitted to our surgical Unit between October 2011 and April 2013 were assessed for various pre - determined risk factors and were accordingly categorized into three levels of anticipated difficulty according to RSCLO and our new scoring system. The patients were then subjected to Laparoscopic C holecystectomy by the same surgical team and the procedure was then graded as difficult or not according to the pre - defined criteria. The findings were analysed by appropriate statistical analysis. RESULTS: Presence of factors like Male sex, history of att acks of acute cholecystitis, increased GB wall thickness, presence of supra - umbilical abdominal scar, obesity and a contracted GB were associated with a significantly higher rate of conversion to open method. RSCLO was found to correlate better with the ou tcome in this setting than our New Scoring System. CONCLUSION: Several patient related factors may be helpful in predicting a Difficult Laparoscopic Cholecystectomy pre - operatively. RSCLO Scoring system may be useful as a pre - operative tool to predict intr a - operative difficulty during LC.

  7. Effect of pre-operative rectal diclofenac suppository on post-operative analgesic requirement in cleft palate repair: A randomised clinical trial

    Directory of Open Access Journals (Sweden)

    E S Adarsh

    2012-01-01

    Full Text Available Background: Opioid analgesics used for analgesia are associated with sedation, respiratory depression and post-operative nausea and vomiting. Non-steroidal anti-inflammatory drugs such as diclofenac are a safe and effective alternative with opioid-sparing effect. Objective: To evaluate the effectiveness of pre-operative rectal diclofenac suppository (1 mg/kg in cleft palate repair for post-operative analgesia and reduction in post-operative opioid requirements. Study Design: A randomized clinical trial. Methods: After obtaining approval from the institutional ethical committee, 60 children were allocated by a computer-generated randomisation into two groups of 30 each; group D (Diclofenac group and group C (Conventional group. Children in group D and group C were similar in all aspects except for the fact that group D children received 1 mg/kg diclofenac suppository after induction. Pain was evaluated using modification of the objective pain scale by Hannallah and colleagues for 6 h post-operatively by an anaesthesiology resident or nursing staff who was blinded to the group. If the pain score was more than 3, rescue analgesic I.V. fentanyl 0.5 μgm/kg was administered. The pain scores at different intervals, number of doses and quantity of rescue analgesic required were noted. Results: We observed that pre-operative rectal diclofenac provided effective analgesia in the immediate post-operative period, as evidenced by reduced pain scores and reduced opioid requirement (P=0.00002. There was no evidence of any increased perioperative bleeding in the diclofenac group. Conclusion: Pre-operative rectal diclofenac reduces opioid consumption and provides good post-operative analgesia.

  8. Insulin pump risks and benefits: a clinical appraisal of pump safety standards, adverse event reporting and research needs. A joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group.

    Science.gov (United States)

    Heinemann, Lutz; Fleming, G Alexander; Petrie, John R; Holl, Reinhard W; Bergenstal, Richard M; Peters, Anne L

    2015-05-01

    Insulin pump therapy, also known as continuous subcutaneous insulin infusion (CSII), is an important and evolving form of insulin delivery, which is mainly used for people with type 1 diabetes. However, even with modern insulin pumps, errors of insulin infusion can occur due to pump failure, insulin infusion set (IIS) blockage, infusion site problems, insulin stability issues, user error or a combination of these. Users are therefore exposed to significant and potentially fatal hazards: interruption of insulin infusion can result in hyperglycaemia and ketoacidosis; conversely, delivery of excessive insulin can cause severe hypoglycaemia. Nevertheless, the available evidence on the safety and efficacy of CSII remains limited. The European Association for the Study of Diabetes (EASD) and American Diabetes Association (ADA) have therefore joined forces to review the systems in place for evaluating the safety of pumps from a clinical perspective. We found that useful information held by the manufacturing companies is not currently shared in a sufficiently transparent manner. Public availability of adverse event (AE) reports on the US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database is potentially a rich source of safety information but is insufficiently utilised due to the current configuration of the system; the comparable database in Europe (European Databank on Medical Devices, EUDAMED) is not publicly accessible. Many AEs appear to be attributable to human factors and/or user error, but the extent to which manufacturing companies are required by regulators to consider the interactions of users with the technical features of their products is limited. The clinical studies required by regulators prior to marketing are small and over-reliant on bench testing in relation to 'predicate' products. Once a pump is available on the market, insufficient data are made publicly available on its long-term use in a real

  9. Insulin pump risks and benefits: a clinical appraisal of pump safety standards, adverse event reporting, and research needs: a joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group.

    Science.gov (United States)

    Heinemann, Lutz; Fleming, G Alexander; Petrie, John R; Holl, Reinhard W; Bergenstal, Richard M; Peters, Anne L

    2015-04-01

    Insulin pump therapy, also known as continuous subcutaneous insulin infusion (CSII), is an important and evolving form of insulin delivery, which is mainly used for people with type 1 diabetes. However, even with modern insulin pumps, errors of insulin infusion can occur due to pump failure, insulin infusion set (IIS) blockage, infusion site problems, insulin stability issues, user error, or a combination of these. Users are therefore exposed to significant and potentially fatal hazards: interruption of insulin infusion can result in hyperglycemia and ketoacidosis; conversely, delivery of excessive insulin can cause severe hypoglycemia. Nevertheless, the available evidence on the safety and efficacy of CSII remains limited. The European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) have therefore joined forces to review the systems in place for evaluating the safety of pumps from a clinical perspective. We found that useful information held by the manufacturing companies is not currently shared in a sufficiently transparent manner. Public availability of adverse event (AE) reports on the US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database is potentially a rich source of safety information but is insufficiently utilized due to the current configuration of the system; the comparable database in Europe (European Databank on Medical Devices [EUDAMED]) is not publicly accessible. Many AEs appear to be attributable to human factors and/or user error, but the extent to which manufacturing companies are required by regulators to consider the interactions of users with the technical features of their products is limited. The clinical studies required by regulators prior to marketing are small and over-reliant on bench testing in relation to "predicate" products. Once a pump is available on the market, insufficient data are made publicly available on its long-term use in a real

  10. Role of pre-operative imaging using {sup 99m}Tc-MIBI and neck ultrasound in patients with secondary hyperparathyroidism who are candidates for subtotal parathyroidectomy

    Energy Technology Data Exchange (ETDEWEB)

    Fuster, David; Ortin, Jaime; Setoain, Xavier; Paredes, Pilar; Duch, Joan; Pons, Francesca [Hospital Clinic, Nuclear Medicine Department, Barcelona (Spain); Ybarra, Juan; Torregrosa, Jose-Vicente [Hospital Clinic, Renal Transplant Unit, Barcelona (Spain); Gilabert, Rosa [Hospital Clinic, Radiology Department, Barcelona (Spain)

    2006-04-15

    The purpose of this study was to assess whether pre-operative {sup 99m}Tc-methoxyisobutylisonitrile (MIBI) scintigraphy and neck ultrasound (US) are of value in improving the outcome of subtotal parathyroidectomy in patients with secondary hyperparathyroidism. Forty-eight consecutive haemodialysis patients with severe secondary hyperparathyroidism prospectively underwent ''blinded'' subtotal parathyroid surgery, with 1-year follow-up to establish cure or relapse of their secondary hyperparathyroidism. Double-phase {sup 99m}Tc-MIBI scintigraphy and neck US were performed pre-operatively in all patients. When the preserved gland showed {sup 99m}Tc-MIBI uptake or an abnormal size on US, it was considered that ''{sup 99m}Tc-MIBI advice'' and ''US advice'', respectively, had not been followed. Pre-operative and follow-up parathyroid hormone (PTH) levels were obtained in all patients. All data were evaluated on a patient by patient basis. Four parathyroid glands were identified in each patient at primary surgery, resulting in an operative success rate of 100%. Their weight ranged from 15 to 7,300 mg (mean 1,120{+-}900 mg). Nine of the 48 patients (19%) showed a recurrence of their secondary hyperparathyroidism. The recurrence rate was 2% (1/48) and 10% (5/48), respectively, when {sup 99m}Tc-MIBI and US advice was followed. The sensitivity, specificity, NPV and PPV for pre-operative imaging were 72%, 95%, 97% and 80% respectively for {sup 99m}Tc-MIBI, and 55%, 67%, 87% and 28% for US. {sup 99m}Tc-MIBI scintigraphy is a reliable non-invasive exploratory tool and its preoperative use results in a significant reduction in the number of recurrences in haemodialysis patients with secondary hyperparathyroidism who are candidates for subtotal parathyroidectomy. The use of neck US did not significantly improve the results obtained with {sup 99m}Tc-MIBI alone. (orig.)

  11. Relationship between the inability to climb two flights of stairs and outcome after major non-cardiac surgery: implications for the pre-operative assessment of functional capacity.

    Science.gov (United States)

    Biccard, B M

    2005-06-01

    Functional capacity is an integral component of the pre-operative evaluation of the cardiac patient for non-cardiac surgery. Stair climbing capacity has peri-operative prognostic importance. It may predict survival after lung resection and complications after major non-cardiac surgery. However, stair climbing cannot determine the aerobic metabolic capacity necessary to survive the peri-operative stress response. The potential benefits and current limitations of cardiopulmonary exercise testing to determine peri-operative aerobic capacity are discussed. Principles for the selection of an appropriate screening test of aerobic function are put forward.

  12. Pre-operative renal artery embolization and suprarenal IVC filter placement for prevention of fat embolization in renal angiomyolipoma with venous extension.

    Science.gov (United States)

    Cornman-Homonoff, Joshua; Li, David; Schiffman, Marc

    2017-01-26

    Though generally considered benign, angiomyolipomas can invade through the renal vein into the inferior vena cava, putting patients at risk of catastrophic pulmonary fat embolization. Venous invasion is thus an indication for surgical resection but is thought to increase the risk of adverse operative outcomes including intraoperative hemorrhage and embolization of fat and/or tumor thrombus. We report a novel approach to mitigating these complications illustrated in the case of a 43-year-old woman with IVC-invasive renal AML who underwent successful radical nephrectomy after concurrent pre-operative renal artery embolization and placement of a retrievable suprarenal IVC filter.

  13. Accuracy of 3 T versus 1.5 T breast MRI for pre-operative assessment of extent of disease in newly diagnosed DCIS

    Energy Technology Data Exchange (ETDEWEB)

    Rahbar, Habib, E-mail: hrahbar@uw.edu; DeMartini, Wendy B.; Lee, Amie Y.; Partridge, Savannah C.; Peacock, Sue; Lehman, Constance D.

    2015-04-15

    Highlights: •We compared sizes of known ductal carcinoma in situ (DCIS) on pre-operative breast MRI at 3 T and 1.5 T with final pathology sizes. •DCIS sizes on 3 T MRI correlated better with pathologic sizes than 1.5 T MRI. •Imaging features of DCIS, including morphology and kinetics, were similar at 3 T and 1.5 T MRI. -- Abstract: Objectives: While 3 T breast magnetic resonance imaging has increased in use over the past decade, there is little data comparing its use for assessing ductal carcinoma in situ (DCIS) versus 1.5 T. We sought to compare the accuracies of DCIS extent of disease measures on pre-operative 3 T versus 1.5 T MRI. Methods: This institutional review board-approved prospective study included 20 patients with ductal carcinoma in situ diagnosed by core needle biopsy (CNB) who underwent pre-operative breast MRI at both 3 T (resolution = 0.5 mm × 0.5 mm × 1.3 mm) and 1.5 T (0.85 mm × 0.85 mm × 1.6 mm). All patients provided informed consent, and the study was HIPPA compliant. Lesion sizes and imaging characteristics (morphologic and kinetic enhancement) were recorded for the 3 T and 1.5 T examinations. Lesion size measures at both field strengths were correlated to final pathology, and imaging characteristics also were compared. Results: Of the initial cohort of 20 patients with CNB-diagnosed DCIS, 19 underwent definitive surgery. Median DCIS sizes of these 19 patients were 6 mm (range: 0–67 mm) on 3 T, 13 mm (0–60 mm) on 1.5 T, and 6 mm (0–55 mm) on surgical pathology. Size correlation between MRI and pathology was higher for 3 T (Spearman's ρ = 0.66, p = 0.002) than 1.5 T (ρ = 0.36, p = 0.13). In 10 women in which a residual area of suspicious enhancement was identified on both field strengths, there was agreement of morphologic description (NME vs. mass) in nine, and no significant difference in dynamic contrast enhanced kinetics at 3 T compared to 1.5 T. Conclusions: Pre-operative breast MRI at 3 T provided higher

  14. 36 CFR 228.48 - Appraisal and measurement.

    Science.gov (United States)

    2010-07-01

    ... MINERALS Disposal of Mineral Materials General Provisions § 228.48 Appraisal and measurement. (a) Appraisal. All mineral materials for sale must be appraised to determine fair market value. Appraisals must be... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Appraisal and measurement...

  15. Registered nurse participation in performance appraisal interviews.

    Science.gov (United States)

    Spence, Deborah Gail; Wood, Elizabeth E

    2007-01-01

    Performance appraisal interviews have, over the past two decades, become a common phenomenon in nursing. Yet evidence--both anecdotal and those reported in the literature--suggest that these interviews provide minimal satisfaction and are thus not always effective. This article presents the findings of an interpretive study that explored and documented the meaning and impact of participating in performance appraisal interviews. Data gleaned from nine New Zealand registered nurses employed by a single district health board provide evidence that nurses are often disappointed by the process of performance appraisal. Although they believe in the potential value of performance appraisal interviews, they seldom experience the feedback, direction, and encouragement necessary for an effective appraisal process. Changes to the current professional development program and its accompanying performance appraisal will require skilled commitment on the part of nurses, managers, and the employing organization to improve and develop the assessment and promotion of nursing practice.

  16. Appraisal patterns of envy and related emotions

    OpenAIRE

    van de Ven, Niels; Zeelenberg, Marcel; Pieters, Rik

    2011-01-01

    Envy is a frustrating emotion that arises from upward social comparison. Two studies investigated the appraisals that distinguish benign envy (aimed at improving one’s own situation) from malicious envy (aimed at pulling down the superior other). Study 1 found that appraisals of deservingness and control potential differentiated both types of envy. We manipulated these appraisals in Study 2 and found that while both did not influence the intensity of envy, they did determine the type of envy ...

  17. Test Takers' Performance Appraisals, Appraisal Calibration, and Cognitive and Metacognitive Strategy Use

    Science.gov (United States)

    Phakiti, Aek

    2016-01-01

    The current study explores the nature and relationships among test takers' performance appraisals, appraisal calibration, and reported cognitive and metacognitive strategy use in a language test situation. Performance appraisals are executive processes of strategic competence for judging test performance (e.g., evaluating the correctness or…

  18. Comparison of MR and fluoroscopic mucous fistulography in the pre-operative evaluation of infants with anorectal malformation: a pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Alves, Jose C.G.; Lotz, Jan W.; Pitcher, Richard D. [Stellenbosch University, Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Tygerberg Academic Hospital, Cape Town (South Africa); Sidler, Daniel [Stellenbosch University, Division of Pediatric Surgery, Department of Surgical Sciences, Tygerberg Academic Hospital, Cape Town (South Africa)

    2013-08-15

    Anorectal malformations are often associated with rectal pouch fistulas. Surgical correction requires accurate evaluation of the presence and position of such fistulas. Fluoroscopy is currently the chosen modality for the detection of fistulas. The role of MRI is unexplored. To compare the diagnostic accuracy of MR versus fluoroscopic fistulography in the pre-operative evaluation of infants with anorectal malformation. We conducted a pilot study of infants requiring defunctioning colostomy for initial management of anorectal malformation. Dynamic sagittal steady-state free-precession MRI of the pelvis was acquired during introduction of saline into the mucous fistulas. Findings were compared among MR fistulography, fluoroscopic fistulography and intraoperative inspection. Eight children were included. Median age at fistulography was 15 weeks, inter-quartile range 13-20 weeks; all were boys. There was full agreement among MR fistulography, fluoroscopic fistulography and surgical findings. The pilot data suggest that MR fistulography is promising in the pre-operative evaluation of children with anorectal malformation. (orig.)

  19. Nonresponse to pre-operative chemotherapy does not preclude long-term survival after liver resection in patients with colorectal liver metastases.

    Science.gov (United States)

    Neumann, Ulf P; Thelen, Armin; Röcken, Christoph; Seehofer, Daniel; Bahra, Marcus; Riess, Hanno; Jonas, Sven; Schmeding, Maximilian; Pratschke, Johann; Bova, Roberta; Neuhaus, Peter

    2009-07-01

    Liver resection is the only curative treatment offering a chance of long-term survival in patients with colorectal liver metastases (CRM). Recent data indicated that liver resection in patients with tumor progression while receiving chemotherapy was associated with poor outcome. The aim of the study was to identify risk factors for poor outcome in patients with pre-operative chemotherapy of CRM. We analyzed 160 patients after liver resection for CRM with preoperative systemic. chemotherapy. Three groups of patients were identified: 44 patients (27.5%) had a tumor response, 20 (12.5%) showed stable disease, and 96 (60%) patients had tumor progression while on chemotherapy. Median follow-up was 2.4 years (range, 6 days-11.1 years). All available clinicopathologic variables possibly associated with outcome were evaluated. Survival was 88%, 53%, and 37% at 1, 3, and 5 years. Noncurative resection, carcinoembryonic antigen levels >200 ng/ml, tumor grading, size of the largest tumor >5 cm, and number of metastases were associated with poor patient outcome. In the multivariate analysis, tumor free margin and tumor grading correlated with the outcome. Tumor progression while on chemotherapy had no influence on the long-term survival. Liver resection offers a long-term survival benefit for patients with CRM, even when tumor growth proceeds during pre-operative chemotherapy.

  20. Optimism measured pre-operatively is associated with reduced pain intensity and physical symptom reporting after coronary artery bypass graft surgery

    Science.gov (United States)

    Ronaldson, Amy; Poole, Lydia; Kidd, Tara; Leigh, Elizabeth; Jahangiri, Marjan; Steptoe, Andrew

    2014-01-01

    Objective Optimism is thought to be associated with long-term favourable outcomes for patients undergoing coronary artery bypass graft (CABG) surgery. Our objective was to examine the association between optimism and post-operative pain and physical symptoms in CABG patients. Methods We assessed optimism pre-operatively in 197 adults undergoing CABG surgery, and then followed them up 6–8 weeks after the procedure to measure affective pain, pain intensity, and physical symptom reporting directly pertaining to CABG surgery. Results Greater optimism measured pre-operatively was significantly associated with lower pain intensity (β = − 0.150, CI = − 0.196 to − 0.004, p = .042) and fewer physical symptoms following surgery (β = − 0.287, CI = − 0.537 to − 0.036, p = .025), but not with affective pain, after controlling for demographic, clinical and behavioural covariates, including negative affectivity. Conclusions Optimism is a modest, yet significant, predictor of pain intensity and physical symptom reporting after CABG surgery. Having positive expectations may promote better recovery. PMID:25129850

  1. Pre-operative planning and intra-operative guidance in modern neurosurgery: a review of 300 cases.

    Science.gov (United States)

    Wadley, J.; Dorward, N.; Kitchen, N.; Thomas, D.

    1999-01-01

    Operative neurosurgery has recently entered an exciting era of image guided surgery or neuronavigation and application of this novel technology is beginning to have a significant impact in many ways in a variety of intracranial procedures. In order to fully assess the advantages of image guided techniques over conventional planning and surgery in selected cases, detailed prospective evaluation has been carried out during the advanced development of an optically tracked neuronavigation system. Over a 2-year period, 300 operative neurosurgical procedures have been performed with the assistance of interactive image guidance, as well as the development of new software applications and hardware tools. A broad range of intracranial neurosurgical procedures were seen to benefit from image guidance, including 163 craniotomies, 53 interactive stereotactic biopsies, 7 tracked neuroendoscopies and 37 complex skull base procedures. The most common pathological diagnoses were cerebral glioma in 98 cases, meningioma in 64 and metastasis in 23. Detailed analysis of a battery of postoperative questions revealed benefits in operative planning, appreciation of anatomy, lesion location, safety of surgery and greatly enhanced surgical confidence. The authors believe that image guided surgical technology, with new developments such as those described, has a significant role to play in contemporary neurosurgery and its widespread adoption in practice will be realised in the near future. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 PMID:10615186

  2. Pre-operative chemoradiation therapy with 5-fluorouracil and low-dose daily cisplatin for esophageal cancer. A preliminary report

    Energy Technology Data Exchange (ETDEWEB)

    Shimoyama, Shouji; Konishi, Toshiro; Kawahara, Masaki; Ito, Akihiko; Hoji, Keiichi; Takeda, Yuichi; Oba, Hiroshi; Shimizu, Seiichiro [Showa General Hospital, Kodaira, Tokyo (Japan); Kaminishi, Michio

    1999-03-01

    A combination of chemotherapy and radiotherapy (chemoradiation therapy; CRT) has recently been developed to improve the survival of esophageal cancer patients. However, the optimal choice of chemotherapeutic agents and their doses, as well as chemotherapy and radiotherapy regimens, remain unclear. Based on recent advances in knowledge on the radiosensitizing and biochemical modulation effects of chemotherapeutic agents, we have recently developed concurrent CRT which consisted of continuous 5-fluorouracil (5FU) administration (600 mg/m{sup 2}/day, days 1-5) combined with a low dose of daily cisplatin administration (10 mg/m{sup 2}/day, days 1-5, and 5 or 10 mg/m{sup 2}/day, days 8-12 and 15-19) before each fraction of radiation (2 Gy each). To evaluate the efficacy and safety of our concurrent CRT, 10 esophageal cancer patients received one or one and a half courses of the CRT. All patients tolerated and completed a full course of the CRT. The effectiveness of the CRT on the primary tumor included pathologically or endoscopically complete responses in three patients (30%), partial response in five (50%), no response in two (20%) and tumoral downstaging (T-classification) in five (50%). Grade 2 and Grade 3 toxicity, seen in six patients, did not affect surgical operation. No patients showed CRT-related deaths. Eight patients (80%) underwent resection with no operative mortality. Of these, two patients (25%) showed pathologically or endoscopically complete responses, and four (50%) showed partial response. Three patients died of cancer after resection. The two inoperable patients showed a pathologically complete response and partial response, respectively. They were relieved of their cancer-related complaints and were living without hospitalization at the time of this analysis. These results suggest that the concurrent CRT based on the theoretical backgrounds is effective and has acceptable toxicities with maintaining its efficacy for the treatment of esophageal

  3. Schoolteacher Appraisal: Reflections on Recent History.

    Science.gov (United States)

    Morris, Bob

    1991-01-01

    From a National Steering Group perspective, this article reviews the recent history of the national framework for teacher appraisal in England and discusses six lessons to be drawn from a project that tested the new system. Appraisal is still associated with controversy and poor industrial relations, arouses suspicion, is politically complicated,…

  4. 12 CFR 626.6015 - Nondiscriminatory appraisal.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Nondiscriminatory appraisal. 626.6015 Section 626.6015 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM NONDISCRIMINATION IN LENDING § 626.6015 Nondiscriminatory appraisal. No Farm Credit institution shall discriminate against any...

  5. Performance Appraisal in Academic and Research Libraries.

    Science.gov (United States)

    Yarbrough, Larry N.

    There is a need for increased efficiency and effectiveness in the employment of the library's human resources. Performance appraisal can serve as a basis for salary and advancement decisions, career development, and performance improvement. Three criteria for performance appraisal can be distinguished: (1) the trait approach, (2) the job…

  6. Fuzzy Comprehensive Appraisal of Concealed Ore Deposits

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    In this paper, the transformation from the fuzzy to the accurate process is exemplified by the Jiaodong gold ore deposits concentrated region where the mathematical analysis is used to appraise and forecast regional concealed gold ore deposits. In this sense, this paper presents a new way to the appraisal of the non-traditional mineral resources.

  7. Children's Appraisal of Moderately Stressful Situations

    Science.gov (United States)

    Hood, Brianne; Power, Thomas; Hill, Laura

    2009-01-01

    This study investigated 2 questions: (1) do children show consistent styles of appraisal across a range of moderately stressful events?, and (2) what are the adjustment and parenting correlates of individual differences in children's appraisal style? Ninety-nine 3rd though 5th grade children and their mothers participated. For each of 6 vignettes…

  8. Children's Appraisal of Moderately Stressful Situations

    Science.gov (United States)

    Hood, Brianne; Power, Thomas; Hill, Laura

    2009-01-01

    This study investigated 2 questions: (1) do children show consistent styles of appraisal across a range of moderately stressful events?, and (2) what are the adjustment and parenting correlates of individual differences in children's appraisal style? Ninety-nine 3rd though 5th grade children and their mothers participated. For each of 6 vignettes…

  9. Teaching Critical Appraisal of Articles on Psychopharmacology

    Science.gov (United States)

    Mohr, Pavel; Hoschl, Cyril; Volavka, Jan

    2012-01-01

    Objective: Psychiatrists and other physicians sometimes read publications superficially, relying excessively on abstracts. The authors addressed this problem by teaching critical appraisal of individual articles. Method: The authors developed a 23-item appraisal instrument to assess articles in the area of psychopharmacology. The results were…

  10. 45 CFR 1160.12 - Appraisal procedures.

    Science.gov (United States)

    2010-10-01

    ... the Council and the indemnitee shall then select a competent and disinterested arbitrator. (b) After selection of an arbitrator, the appraisers shall assess the partial loss, or damage to, or where appropriate... arbitrator for determination. The appraisers' agreement or the arbitrator's determination shall be final...

  11. Tennessee Extension Agents' Perceptions of Performance Appraisal

    Science.gov (United States)

    Donaldson, Joseph L.; French, Russell L.

    2013-01-01

    Performance appraisal is necessary for summative decisions about employees, such as merit pay and promotion. The research reported here describes Extension agent perceptions of their performance appraisal system. The population studied consisted of all Tennessee Extension agents (N = 312). Surveys were completed by 218 respondents, for a completed…

  12. 5 CFR 430.307 - Appraising performance.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Appraising performance. 430.307 Section 430.307 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE MANAGEMENT Managing Senior Executive Performance § 430.307 Appraising performance. (a) Annual...

  13. Terminal valve of sapheno-femoral junction: a comparative assessment between pre-operative color-duplex ultrasound and intra-operative evaluation

    Directory of Open Access Journals (Sweden)

    Attilio Cavezzi

    2013-01-01

    Full Text Available According to literature data, up to 59% of incompetent great saphenous veins (GSV have no reflux at the terminal valve (TV of the saphenofemoral junction (SFJ. The aim was to compare color duplex ultrasound (CDU investigation and direct intra-operative assessment of competence of the TV at SFJ. A prospective comparative study was performed on 28 patients, who consecutively presented for surgical intervention for their primary varicose veins of the lower limbs with GSV incompetence. CDU assessment was performed pre-operatively to define GSV and SFJ terminal valve morphology and hemodynamics. Under local anesthesia these patients underwent SFJ disconnection (crossectomy and segmental inverted saphenous stripping of the incompetent GSV tract + phlebectomy of the varicose tributaries. SFJ disconnection was performed in four stages in an ascending fashion: I division of GSV below the lower SFJ tributaries, II disconnection of lower SFJ tributaries, III disconnection of upper tributaries, IV flush to CFV ligature of GSV stump. After the completion of stage I, the SFJ stump was opened and kept open when needed throughout the subsequent stages, in order to highlight any possible blood leak through the SFJ stump. To highlight intraoperative blood leak from SFJ stump visual observation was carried out both during respiration and when performing Valsalva maneuver and manual compression of homolateral iliac fossa. As to pre-operative CDU all limbs showed GSV reflux and they were divided in two groups according to TV competence (group A or incompetence (group B. Group A comprised 18 patients (6 M and 12 F, mean age 50.6 years. Group B included 10 patients (4 M and 6 F, mean age 54.8 years. Mean calibre of GSV at proximal/mid thigh was 6.4 mm in group A and 7.8 in group B. Concerning the intra-operative findings: in the group A, 5 patients had blood leak in the SFJ stump after stage I, 4 patients showed blood leak after stage II. After completion of stage III

  14. Appraisal patterns of envy and related emotions.

    Science.gov (United States)

    van de Ven, Niels; Zeelenberg, Marcel; Pieters, Rik

    2012-06-01

    Envy is a frustrating emotion that arises from upward social comparison. Two studies investigated the appraisals that distinguish benign envy (aimed at improving one's own situation) from malicious envy (aimed at pulling down the superior other). Study 1 found that appraisals of deservingness and control potential differentiated both types of envy. We manipulated these appraisals in Study 2 and found that while both did not influence the intensity of envy, they did determine the type of envy that resulted. The more a situation was appraised as undeserved, the more participants experienced malicious envy. Benign envy was experienced more when the situation was not undeserved, and the most when the situation was appraised as both deserved and controllable. The current research also clarifies how the types of envy differ from the related emotions admiration and resentment.

  15. Correct Pre-Operative Diagnosis of Breast Cancer by Tru-cut Biopsy: Key Point in Breast Cancer Management and a Part of Patient Right

    Directory of Open Access Journals (Sweden)

    A. Joulaee

    2009-01-01

    Full Text Available The new revolutionary concept in breast cancer diagnosis and management during the last 3 decades significantly decreases invasion against patients while maximizing the accuracy of diagnosis and the effectiveness of treatment."n"n In this new concept team work multidisciplinary approach is the key. The presence of an interventional breast radiologist in this new approach is absolutely necessary. The role of an interventional and a non interventional breast radiologist in this team work is highlighted and must be respected, especially by surgeons. Now the surgeon performs surgery only to treat the patient either for malignant pathology or symptomatic benign masses. No surgery is acceptable for diagnosis or staging. Diagnosis is best done by preoperative Tru-cut biopsy is done by an interventional breast radiologist for non palpable lesions  in the ideal situation. For palpable lesions depending on the situation either a radiologist or a surgeon would carry out office tru-cut biopsy. For non palpable lesions, the interventional radiologist and not the surgeon performs the diagnosis. Depending on the case, either the radiologist or the surgeon can peform Tru-cut biopsy for palpable lesions. The benefits of pre-operative diagnosis are both for the patients and the whole health care system. The patient would profit the most from this new concept: -No surgery would be done for non-cancerous non-symptomatic lesions. -In the case of cancer, diagnosis would be confirmed pre-operatively. Correct pre-operative diagnosis would eliminate unnecessary surgery for benign pathology for many non-palpable and non-symptomatic palpable lesions. The patient would profit from not having surgery for a benign condition and as a result there will be no endangered health. In the same time avoidance of surgery for non-symptomatic benign breast pathology would significantly decrease the overall health care price for breast disease to have more budgets to instruct standard

  16. Minimally invasive fixation in tibial plateau fractures using an pre-operative and intra-operative real size 3D printing.

    Science.gov (United States)

    Giannetti, Silvio; Bizzotto, Nicola; Stancati, Andrea; Santucci, Attilio

    2017-03-01

    The purpose of our study was to compare the outcome after minimally invasive reconstruction and internal fixation with and without the use of pre- and intra-operative real size 3D printing for patients with displaced tibial plateau fractures (TPFs). We prospectively followed up 40 consecutive adult patients with closed TPF who underwent surgical treatment of reconstruction of the tibial plateau with the use of minimally invasive fixation. Sixteen patients (group 1) were operated using a pre-operative and intra-operative real size 3D-model, while 24 patients (group 2) were operated without 3D-model printing, but using only pre-operative and intra-operative 3D Tc-scan images. The mean operating time was 148.2±15.9min for group 1 and 174.5±22.2min for group 2 (p=0.041). In addition, the mean intraoperative blood loss was less in group 1 (520mL) than in group 2 (546mL) (p=0.534). After discharge, all patients were followed up at 6 weeks, 12 weeks, 6 months, 1year and then every year post surgically and radiographic evaluation was carried out each time using clinical and radiological Rasmussen's score, with no significant differences between the two groups. Two patients (group 2) developed infection which resolved within 3 weeks after usage of antibiotics. Neither superficial nor deep infections were present in group 1. In all patients, no non-union occurred. No intraoperative, perioperative, or postoperative complications, such as loss of valgus correction, bone fractures, or metallic plate failures were detected at follow-up. In patients operated with the use of 3D-model printing, we found a significant reduction in surgical time. Moreover, the technique without a 3D-model increased the patient's and the surgeon's exposure to radiation.

  17. Assessment of a Standardized Pre-Operative Telephone Checklist Designed to Avoid Late Cancellation of Ambulatory Surgery: The AMBUPROG Multicenter Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Sonia Gaucher

    Full Text Available To assess the impact of a standardized pre-operative telephone checklist on the rate of late cancellations of ambulatory surgery (AMBUPROG trial.Multicenter, two-arm, parallel-group, open-label randomized controlled trial.11 university hospital ambulatory surgery units in Paris, France.Patients scheduled for ambulatory surgery and able to be reached by telephone.A 7-item checklist designed to prevent late cancellation, available in five languages and two versions (for children and adults, was administered between 7 and 3 days before the planned date of surgery, by an automated phone system or a research assistant. The control group received standard management alone.Rate of cancellation on the day of surgery or the day before.The study population comprised 3900 patients enrolled between November 2012 and September 2013: 1950 patients were randomized to the checklist arm and 1950 patients to the control arm. The checklist was administered to 68.8% of patients in the intervention arm, 1002 by the automated phone system and 340 by a research assistant. The rate of late cancellation did not differ significantly between the checklist and control arms (109 (5.6% vs. 113 (5.8%, adjusted odds ratio [95% confidence interval] = 0.91 [0.65-1.29], (p = 0.57. Checklist administration revealed that 355 patients (28.0% had not undergone tests ordered by the surgeon or anesthetist, and that 254 patients (20.0% still had questions concerning the fasting state.A standardized pre-operative telephone checklist did not avoid late cancellations of ambulatory surgery but enabled us to identify several frequent causes.ClinicalTrials.gov NCT01732159.

  18. Prevalence of adjacent segment disc degeneration in patients undergoing anterior cervical discectomy and fusion based on pre-operative MRI findings.

    Science.gov (United States)

    Lundine, Kristopher M; Davis, Gavin; Rogers, Myron; Staples, Margaret; Quan, Gerald

    2014-01-01

    Anterior cervical discectomy and fusion (ACDF) is a widely accepted surgical treatment for symptomatic cervical spondylosis. Some patients develop symptomatic adjacent segment degeneration, occasionally requiring further treatment. The cause and prevalence of adjacent segment degeneration and disease is unclear at present. Proponents for motion preserving surgery such as disc arthroplasty argue that this technique may decrease the "strain" on adjacent discs and thus decrease the incidence of symptomatic adjacent segment degeneration. The purpose of this study was to assess the pre-operative prevalence of adjacent segment degeneration in patients undergoing ACDF. A database review of three surgeons' practice was carried out to identify patients who had undergone a one- or two-level ACDF for degenerative disc disease. Patients were excluded if they were operated on for recent trauma, had an inflammatory arthropathy (for example, rheumatoid arthritis), or had previous spine surgery. The pre-operative MRI of each patient was reviewed and graded using a standardised methodology. One hundred and six patient MRI studies were reviewed. All patients showed some evidence of intervertebral disc degeneration adjacent to the planned operative segment(s). Increased severity of disc degeneration was associated with increased age and operative level, but was not associated with sagittal alignment. Disc degeneration was more common at levels adjacent to the surgical level than at non-adjacent segments, and was more severe at the superior adjacent level compared with the inferior adjacent level. These findings support the theory that adjacent segment degeneration following ACDF is due in part to the natural history of cervical spondylosis.

  19. Assessment of a Standardized Pre-Operative Telephone Checklist Designed to Avoid Late Cancellation of Ambulatory Surgery: The AMBUPROG Multicenter Randomized Controlled Trial

    Science.gov (United States)

    Marchand-Maillet, Florence; Baron, Gabriel; Douard, Richard; Béthoux, Jean-Pierre

    2016-01-01

    Objectives To assess the impact of a standardized pre-operative telephone checklist on the rate of late cancellations of ambulatory surgery (AMBUPROG trial). Design Multicenter, two-arm, parallel-group, open-label randomized controlled trial. Setting 11 university hospital ambulatory surgery units in Paris, France. Participants Patients scheduled for ambulatory surgery and able to be reached by telephone. Intervention A 7-item checklist designed to prevent late cancellation, available in five languages and two versions (for children and adults), was administered between 7 and 3 days before the planned date of surgery, by an automated phone system or a research assistant. The control group received standard management alone. Main Outcome Measures Rate of cancellation on the day of surgery or the day before. Results The study population comprised 3900 patients enrolled between November 2012 and September 2013: 1950 patients were randomized to the checklist arm and 1950 patients to the control arm. The checklist was administered to 68.8% of patients in the intervention arm, 1002 by the automated phone system and 340 by a research assistant. The rate of late cancellation did not differ significantly between the checklist and control arms (109 (5.6%) vs. 113 (5.8%), adjusted odds ratio [95% confidence interval] = 0.91 [0.65–1.29], (p = 0.57)). Checklist administration revealed that 355 patients (28.0%) had not undergone tests ordered by the surgeon or anesthetist, and that 254 patients (20.0%) still had questions concerning the fasting state. Conclusions A standardized pre-operative telephone checklist did not avoid late cancellations of ambulatory surgery but enabled us to identify several frequent causes. Trial Registration ClinicalTrials.gov NCT01732159 PMID:26829478

  20. 38 CFR 36.4348 - Servicer Appraisal Processing Program.

    Science.gov (United States)

    2010-07-01

    ... Appraisal Processing Program (SAPP) staff appraisal reviewer. Three years of appraisal related experience is... whose jurisdiction the servicer's staff appraisal reviewer is located before the SAPP authority may be... requirement, routine reviews of SAPP cases will be made by VA staff based upon quality control procedures...

  1. Stigma, Reflected Appraisals, and Recovery Outcomes in Mental Illness

    Science.gov (United States)

    Markowitz, Fred E.; Angell, Beth; Greenberg, Jan S.

    2011-01-01

    Drawing on modified labeling theory and the reflected appraisals process and using longitudinal data from 129 mothers and their adult children with schizophrenia, we estimate models of the effects of mothers' stigmatized identity appraisals of their mentally ill children on reflected and self-appraisals, and how appraisals affect outcomes…

  2. 76 FR 16627 - Statutory Provisions Affecting State Appraiser Regulatory Programs

    Science.gov (United States)

    2011-03-24

    ... the authority of the Appraisal Subcommittee (ASC) and requirements for States' appraiser regulatory... Programs, on March 18, 2011. The Appraisal Subcommittee (ASC) is issuing this Bulletin to State Appraiser... requirements for State licensing in a State with criteria for the licensing of a real estate...

  3. Employee Performance Appraisal and the 95/5 Rule

    Science.gov (United States)

    Rasch, Lee

    2004-01-01

    Many colleges use some form of an employee performance appraisal process. Yet, despite prevalent use, the performance appraisal process is facing growing criticism. The author reviews the literature regarding the process of performance appraisal in higher education, focusing on articles supportive of the use of the performance appraisal, and those…

  4. Stigma, Reflected Appraisals, and Recovery Outcomes in Mental Illness

    Science.gov (United States)

    Markowitz, Fred E.; Angell, Beth; Greenberg, Jan S.

    2011-01-01

    Drawing on modified labeling theory and the reflected appraisals process and using longitudinal data from 129 mothers and their adult children with schizophrenia, we estimate models of the effects of mothers' stigmatized identity appraisals of their mentally ill children on reflected and self-appraisals, and how appraisals affect outcomes…

  5. No effect of ambient odor on the affective appraisal of a desktop virtual environment with signs of disorder.

    Directory of Open Access Journals (Sweden)

    Alexander Toet

    Full Text Available BACKGROUND: Desktop virtual environments (VEs are increasingly deployed to study the effects of environmental qualities and interventions on human behavior and safety related concerns in built environments. For these applications it is essential that users appraise the affective qualities of the VE similar to those of its real world counterpart. Previous studies have shown that factors like simulated lighting, sound and dynamic elements all contribute to the affective appraisal of a desktop VE. Since ambient odor is known to affect the affective appraisal of real environments, and has been shown to increase the sense of presence in immersive VEs, it may also be an effective tool to tune the affective appraisal of desktop VEs. This study investigated if exposure to ambient odor can modulate the affective appraisal of a desktop VE with signs of public disorder. METHOD: Participants explored a desktop VE representing a suburban neighborhood with signs of public disorder (neglect, vandalism and crime, while being exposed to either room air or subliminal levels of unpleasant (tar or pleasant (cut grass ambient odor. Whenever they encountered signs of disorder they reported their safety related concerns and associated affective feelings. RESULTS: Signs of crime in the desktop VE were associated with negative affective feelings and concerns for personal safety and personal property. However, there was no significant difference between reported safety related concerns and affective connotations in the control (no-odor and in each of the two ambient odor conditions. CONCLUSION: Ambient odor did not affect safety related concerns and affective connotations associated with signs of disorder in the desktop VE. Thus, semantic congruency between ambient odor and a desktop VE may not be sufficient to influence its affective appraisal, and a more realistic simulation in which simulated objects appear to emit scents may be required to achieve this goal.

  6. No effect of ambient odor on the affective appraisal of a desktop virtual environment with signs of disorder.

    Science.gov (United States)

    Toet, Alexander; van Schaik, Martin; Theunissen, Nicolet C M

    2013-01-01

    Desktop virtual environments (VEs) are increasingly deployed to study the effects of environmental qualities and interventions on human behavior and safety related concerns in built environments. For these applications it is essential that users appraise the affective qualities of the VE similar to those of its real world counterpart. Previous studies have shown that factors like simulated lighting, sound and dynamic elements all contribute to the affective appraisal of a desktop VE. Since ambient odor is known to affect the affective appraisal of real environments, and has been shown to increase the sense of presence in immersive VEs, it may also be an effective tool to tune the affective appraisal of desktop VEs. This study investigated if exposure to ambient odor can modulate the affective appraisal of a desktop VE with signs of public disorder. Participants explored a desktop VE representing a suburban neighborhood with signs of public disorder (neglect, vandalism and crime), while being exposed to either room air or subliminal levels of unpleasant (tar) or pleasant (cut grass) ambient odor. Whenever they encountered signs of disorder they reported their safety related concerns and associated affective feelings. Signs of crime in the desktop VE were associated with negative affective feelings and concerns for personal safety and personal property. However, there was no significant difference between reported safety related concerns and affective connotations in the control (no-odor) and in each of the two ambient odor conditions. Ambient odor did not affect safety related concerns and affective connotations associated with signs of disorder in the desktop VE. Thus, semantic congruency between ambient odor and a desktop VE may not be sufficient to influence its affective appraisal, and a more realistic simulation in which simulated objects appear to emit scents may be required to achieve this goal.

  7. Using functional analysis in archival appraisal a practical and effective alternative to traditional appraisal methodologies

    CERN Document Server

    Robyns, Marcus C

    2014-01-01

    In an age of scarcity and the challenge of electronic records, can archivists and records managers continue to rely upon traditional methodology essentially unchanged since the early 1950s? Using Functional Analysis in Archival Appraisal: A Practical and Effective Alternative to Traditional Appraisal Methodologies shows how archivists in other countries are already using functional analysis, which offers a better, more effective, and imminently more practical alternative to traditional appraisal methodologies that rely upon an analysis of the records themselves.

  8. SCAMPI Lead Appraiser (Service Mark) Body of Knowledge (SLA BOK)

    Science.gov (United States)

    2007-10-01

    Competencies • CMP 3.2.2, Defining the appraisal team roles and responsibilities Examples • The initial set of appraisal team norms are agreed on...Competencies • CMP 3.1.1, Managing stakeholder involvement • CMP 3.2.2, Defining the appraisal team roles and responsibilities Examples • A site...appraisal team roles and responsibilities Associated Skills • Balancing appraisal team members’ workloads based on team member capabilities and

  9. A Systems Look at Performance Appraisal

    Science.gov (United States)

    Slusher, E. Allen

    1975-01-01

    Results or goal achievement measurements of a manager's performance can be achieved for management with the use of the performance appraisal process which gives a broader perspective in the management of human resources. (Author)

  10. Appraisal and Its Place in Management Development

    Science.gov (United States)

    MacCallum, Keith

    1971-01-01

    Appraisal is a tool for maximising management performance, part of a two way and constructive learning relationship, designed to improve standards throughout the organization in aiding top management to make the best use of its human resources. (Author/EB)

  11. Neural circuits associated with positive and negative self-appraisal.

    Science.gov (United States)

    Brühl, A B; Rufer, M; Kaffenberger, T; Baur, V; Herwig, U

    2014-04-18

    Self-worth is particularly influenced by self-appraisal, which is negatively biased in many psychiatric disorders. Positive and negative self-appraisals also shape current emotional states or even evoke defensive reactions, when they are incongruent with a subject's current state. Prior studies have mainly used externally given evaluative appraisals. In this study, 30 subjects used individual negative and positive self-appraisals during functional magnetic resonance imaging. We additionally investigated the effects of such self-appraisals onto the subsequent perception of photos of the individual subjects. Both self-appraisal conditions activated dorsomedial and dorsolateral prefrontal cortex compared to the neutral condition. Positive self-appraisal evoked stronger activity than negative self-appraisal in the amygdala, ventral striatum and anterior cingulate cortex, whereas negative self-appraisal was associated with increased activity in the occipital regions. Positive self-appraisal had no effect on the perception of a photo of oneself, whereas negative appraisal increased activity in the anterior insula and parietal regions. Overall, positive self-appraisal activated more emotion-related brain regions, whereas negative self-appraisal had a relatively stronger influence on perception-related brain activity. These findings could on the one hand explain the effect of negative self-appraisal on the behavior in the real world and on the other hand support a stronger focus of psychotherapy on enhancing positive self-appraisals.

  12. Evaluation of intraoperative bleeding during an endoscopic surgery of nasal polyposis after a pre-operative single dose versus a 5-day course of corticosteroid.

    Science.gov (United States)

    Atighechi, Saeid; Azimi, Mohammad Reza; Mirvakili, Seyyed Abbas; Baradaranfar, Mohammad Hossein; Dadgarnia, Mohammad Hossein

    2013-09-01

    Nasal polyps are associated with the inflammation of the nasal cavity and the sinus mucosa. When medical treatment cannot solve a patient's problem, a functional endoscopic sinus surgery may be indicated. Bleeding impairs the surgery field during operation and increases the operation risk and time. Pre-operative corticosteroids can reduce bleeding during surgery. In this study, we have evaluated the effect of pre-operative single-dose prednisolone (1 mg/Kg/dose 24 h before surgery) versus 5-day prednisolone (1 mg/Kg/day before operation) on the bleeding volume and the surgery field quality during FESS. In this mono blind randomized clinical trial, 80 patients with bilateral nasal polyps were randomly assigned in two groups. The first group (A) received a single dose of 1 mg/Kg/dose prednisolone on the day before the surgery. The second group (B) received 1 mg/Kg/day prednisolone for 5 days before the operation. The patients were operated on under general anesthesia through the same protocol. The mean arterial blood pressure was 70-80 mm Hg in both groups. The surgeons were not aware of the patients' group. The bleeding volume and the surgeons' opinion about the surgery field quality were recorded at the end of the procedure and analyzed by Chi-square and t test. The two groups were not significantly different in their overall demographic and clinical characteristics. The mean bleeding volume during the operation was 266.5 ± 96.31 ml in group A and 206 ± 52.81 ml in group B; there was a significant difference between the groups (P value = 0.038). There was no significant difference between the groups in the surgeons' opinion about the surgery field quality (P value = 0.09). In conclusion, unlike a single dose (1 mg/kg/dose), treatment with 5-day prednisolone (1 mg/kg/day) can reduce blood loss during FESS more efficiently and may improve the surgery field quality slightly. But this difference is not clinically significant.

  13. The Official Real Estate Appraisal in Germany

    Directory of Open Access Journals (Sweden)

    Christoph JOCHEIM-WIRTZ

    2013-12-01

    Full Text Available The Real Estate Appraisal in Germany is regulated by the articles 192-199 of the German Construction Law. Technical guidelines, including the appraisal methods, are defined in bylaws. For the purpose of official real estate appraisal, Expert Appraisal Committees were founded in counties and large cities. The Committees are comprised of real estate experts doing a honorary service, coming from such professions as land surveying engineers, architects, civil engineers, Tax Office employees, experts from the banking sector, agronomists and real estate agents. The chairman of the Committee is also the director of the Cadastral Office and/or the Surveying Office. Every Committee has its own office within the Cadastral Office or the Surveying Office. The main task of the Committees is to establish and guarantee the transparency of the real estate market, by means of the publication of approximate plot value maps on the Internet as well as the publication of the reports on the real estate market. Apart from that, the Expert Appraisal Committees provide reports on the market value of real estate objects, available upon request. Reports on the market value of real estate objects are also made by publicly appointed and sworn experts. Based on the steady rise in the requests for superregional information about the real estate market in the recent years, the working group comprised of the representatives from the Expert Appraisal Committees from the whole country published its first report on the real estate market in Germany in 2008, and the second one in 2011.

  14. Automatic registration between 3D intra-operative ultrasound and pre-operative CT images of the liver based on robust edge matching

    Science.gov (United States)

    Nam, Woo Hyun; Kang, Dong-Goo; Lee, Duhgoon; Lee, Jae Young; Ra, Jong Beom

    2012-01-01

    The registration of a three-dimensional (3D) ultrasound (US) image with a computed tomography (CT) or magnetic resonance image is beneficial in various clinical applications such as diagnosis and image-guided intervention of the liver. However, conventional methods usually require a time-consuming and inconvenient manual process for pre-alignment, and the success of this process strongly depends on the proper selection of initial transformation parameters. In this paper, we present an automatic feature-based affine registration procedure of 3D intra-operative US and pre-operative CT images of the liver. In the registration procedure, we first segment vessel lumens and the liver surface from a 3D B-mode US image. We then automatically estimate an initial registration transformation by using the proposed edge matching algorithm. The algorithm finds the most likely correspondences between the vessel centerlines of both images in a non-iterative manner based on a modified Viterbi algorithm. Finally, the registration is iteratively refined on the basis of the global affine transformation by jointly using the vessel and liver surface information. The proposed registration algorithm is validated on synthesized datasets and 20 clinical datasets, through both qualitative and quantitative evaluations. Experimental results show that automatic registration can be successfully achieved between 3D B-mode US and CT images even with a large initial misalignment.

  15. MR mammography in the pre-operative staging of breast cancer in patients with dense breast tissue: comparison with mammography and ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    Van Goethem, M.; Schelfout, K.; Verslegers, I.; Biltjes, I.; De Schepper, A. [Department of Radiology, University Hospital Antwerp, Antwerp (Belgium); Dijckmans, L. [Department of Gynecology, University Hospital Antwerp, Antwerp (Belgium); Van Der Auwera, J.C.; Weyler, J. [Department of Epidemiology and Social Medicine, University Hospital Antwerp, Antwerp (Belgium)

    2004-05-01

    The aim of this study was to determine whether pre-operative MR mammography could predict the extent of breast cancer in patients with dense breasts or whether dense parenchyma will lead to false-positive or inconclusive examinations. Sixty-seven patients with dense breasts with a malignant breast tumor planned for conservative surgery were reviewed. Detection rates of mammography, ultrasound, and MR mammography were studied, and the diameters of the lesions were measured and compared with pathological examination. Pathology revealed breast cancer in 65 patients. Sensitivity for detection of index lesions was 83% for mammography, 70.8% for ultrasound, and 98% for MR mammography. Mammography underestimated tumor extent in 37%, ultrasound in 40%, and MR in 12.5%. Of the 20 patients (31%) with multifocal or multicentric carcinoma, mammography detected the lesions in 35%, ultrasound in 30%, and MR in 100%, with a false-positive rate of 12.5, 14, and 23%. The MR mammography is more accurate in assessing tumor extent and multifocality in patients with dense breasts, but benign changes may lead to false-positive examinations. (orig.)

  16. Comparison between FDG Uptake and Pathologic or Immunohistochemical Parametersin Pre-operative PET/CT Scan of Patient with Primary Colorectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Na, Sae Jung; Chung, Yong An; Maeng, Lee So; Kim, Ki Jun; Sohn, Kyung Myung; Kim, Sung Hoon; Sohn, Hyung Sun; Chung, Soo Kyo [College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2009-12-15

    To evaluate the relationship between F-18 FDG uptake of tumor in PET/CT scan and pathological or immunohistochemial parameters of colorectal cancer. 147 colorectal cancer patients who underwent both pre-operative F-18 FDG PET/CT scan and surgery were included. In cases with perceptible FDG uptake in primary tumor, the maximum standardized uptake value (SUVmax) was calculated. The pathologic results such as site, size, depth of invasion (T stage), growth pattern, differentiation of primary tumor, lymph node metastasis and Dukes-Astler and Coller stage and immunohistochemical markers such as expression of EGFR, MLH1, MSH2 and Ki-67 index were reviewed. 146 out of 147 PET/CT scans with colorectal cancer showed perceptible focal FDG uptake. SUVmax showed mild positive linear correlation with size of primary tumor (r=0.277, p=0.001) and Ki-67 index (r=0.226, p=0.019). No significant difference in F-18 FDG uptake was found according to site, depth of invasion (T stage), growth pattern, differentiation of primary tumor, presence of lymph node metastasis, Dukes-Astler and Coller stage and expression of EGFR. The degree of F-18 FDG uptake in colorectal cancer was associated with the size and the degree of Ki-67 index of primary tumor. It could be thought that FDG uptake of primary tumor has a correlation with macroscopic and microscopic tumor growth.

  17. Effects of pre-operative submucosal dexamethasone injection on the postoperative swelling and trismus following surgical extraction of mandibular third molar.

    Science.gov (United States)

    Ehsan, Afeefa; Ali Bukhari, Syed Gulzar; Ashar; Manzoor, Arslan; Junaid, Muhammad

    2014-07-01

    To determine the effects of pre-operative submucosal dexamethasone injection on postoperative swelling and trismus following surgical extraction of mandibular third molar. Randomized controlled trial. Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry (AFID), Rawalpindi, from October 2009 to March 2010. A total of 100 patients aged 18 - 40 years with good periodontal health and mesioangular impaction were divided in two treatment groups (50 in each group). Group-A received prophylactic 4 mg submucosal dexamethasone intraoral injection and Group-B acted as control group. Facial swelling and trismus were assessed at baseline, 2nd and 7th postoperative days. Data was analyzed using SPSS-10. There were 35 (70%) males and 15 (30%) females in group-A and 34 (68%) males and 16 (32%) females in group-B. Surgical time ranged from 30 - 50 minutes (mean = 40.62 ± 4.886 minutes) for group-A and 33 - 50 minutes (mean = 42.12 ± 4.543 minutes) for group-B. Administration of dexamethasone had statistically significant effect in reduction of swelling and trismus on second postoperative day (p trismus.

  18. [Multiple gastro-intestinal stromal tumors (GIST) in a patient with type I neurofibromatosis revealed by chronic bleeding: pre-operative radiological diagnosis].

    Science.gov (United States)

    Guillaud, Olivier; Dumortier, Jérôme; Bringuier, Pierre-Paul; Saurin, Jean-Christophe; Poncet, Gilles; Boulez, Jean; Henry, Luc; Chayvialle, Jean-Alain; Scoazec, Jean-Yves

    2006-02-01

    Recent studies have pointed out a high incidence of GIST, usually multiple and of small intestinal location, in patients with type I neurofibromatosis. We here report an additional case, revealed by chronic gastro-intestinal bleeding and diagnosed at pre-operative imaging studies. A 56-year-old patient, with known type I neurofibromatosis, was referred to our department for the exploration of chronic gastro-intestinal bleeding during anti-aggregant therapy. Endoscopical examination was negative. Enteroscanner showed the presence of four tumor lesions, 3 in the jejunum and 1 in the ileum. Segmental surgical resections were performed. At histological examination, 2 of among the 3 jejunal lesions were diagnosed as typical GIST, of low risk of malignancy, CD117+, CD34+, whereas the last jejunal and ileal lesions were identified as fibroid tumors. Mutations of c-kit gene and of the gene coding for PDGF-Ralpha were not detected. Post-operative recovery was uneventful; no recurrent bleeding was observed. Our case report underlines the potential role of enteroscanner in the management of patients with type I neurofibromatosis with possible digestive complications. It also emphasizes the importance of an accurate diagnosis of the digestive tumors associated with type I neurofibromatosis: GISTs are frequent in this setting and must not be misdiagnosed as neurofibromas.

  19. The value of high-resolution MRI technique in patients with rectal carcinoma: pre-operative assessment of mesorectal fascia involvement, circumferential resection margin and local staging.

    Science.gov (United States)

    Algebally, Ahmed Mohamed; Mohey, Nesreen; Szmigielski, Wojciech; Yousef, Reda Ramadan Hussein; Kohla, Samah

    2015-01-01

    The purpose of the study was to identify the accuracy of high-resolution MRI in the pre-operative assessment of mesorectal fascia involvement, circumfrential resection margin (CRM) and local staging in patients with rectal carcinoma. The study included 56 patients: 32 male and 24 female. All patients underwent high-resolution MRI and had confirmed histopathological diagnosis of rectal cancer located within 15 cm from the anal verge, followed by surgery. MRI findings were compared with pathological and surgical results. The overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI-based T-staging were 92.8, 88.8%, 96.5%, 96%, and 90.3%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV of MRI-based assessment of CRM were 94.6%, 84.6%, 97.6%, 91.4, and 94.6%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV of MRI-based N-staging were 82.1%, 75%, 67.3%, 60%, and 86.1%, respectively. Preoperative high-resolution rectal MRI is accurate in predicting tumor stage and CRM involvement. MRI is a precise diagnostic tool to select patients who may benefit from neo-adjuvant therapy and to avoid overtreatment in those patients who can proceed directly to surgery.

  20. Pre-operative and post-operative effect of a pain management programme prior to total hip replacement: a randomized controlled trial.

    Science.gov (United States)

    Berge, Daniel J; Dolin, Simon J; Williams, Amanda CdeC; Harman, Rachel

    2004-07-01

    Patients may wait some time for total hip replacement with conservative management of pain and disability, but no attempts to rehabilitate them. This study randomised 40 patients accepted for and awaiting total hip replacement to a brief rehabilitative psychologically based pain management programme (PMP) or to a control group with no intervention. Patients were assessed before randomisation, 3 months after the PMP or equivalent waiting time, and again one year later after total hip replacement. Assessments included pain, impact of pain (Arthritis Impact Scale: AIMS), mobility (timed walk), sleep and analgesic consumption. The patients who had learned pain management reported lower pain intensity and pain distress and less sleep disturbance than waiting list controls, but no improvement in function or analgesic consumption. Six patients opted to delay, but this did not differ between groups. Post-hip replacement both groups improved in pain and some aspects of activity (AIMS) with greater improvement in the PMP group for physical activity and total AIMS scores, suggesting that some techniques had continued to be of use post-surgically. Rehabilitative pain management may be useful to patients pre-operatively in managing everyday pain, but not to the extent that they opt to delay surgery; it may also improve their function after hip replacement.

  1. Hand-held echocardiography in the setting of pre-operative cardiac evaluation of patients undergoing non-cardiac surgery: results from a randomized pilot study.

    Science.gov (United States)

    Cavallari, Ilaria; Mega, Simona; Goffredo, Costanza; Patti, Giuseppe; Chello, Massimo; Di Sciascio, Germano

    2015-06-01

    Transthoracic echocardiography is not a routine test in the pre-operative cardiac evaluation of patients undergoing non-cardiac surgery but may be considered in those with known heart failure and valvular heart disease or complaining cardiac symptoms. In this setting, hand-held echocardiography (HHE) could find a potential application as an alternative to standard echocardiography in selected patients; however, its utility in this context has not been investigated. The aim of this pilot study was to evaluate the conclusiveness of HHE compared to standard echocardiography in this subset of patients. 100 patients scheduled for non-cardiac surgery were randomized to receive a standard exam with a Philips Ie33 or a bedside evaluation with a pocket-size imaging device (Opti-Go, Philips Medical System). The primary endpoint was the percentage of satisfactory diagnosis at the end of the examination referred as conclusiveness. Secondary endpoints were the mean duration time and the mean waiting time to perform the exams. No significant difference in terms of conclusiveness between HHE and standard echo was found (86 vs 96%; P = 0.08). Mean duration time of the examinations was 6.1 ± 1.2 min with HHE and 13.1 ± 2.6 min with standard echocardiography (P cardiac surgery, since it provided similar information but it was faster and earlier performed compared to standard echocardiography.

  2. Etiopathogenesis of cataract: An appraisal

    Directory of Open Access Journals (Sweden)

    Varun B Gupta

    2014-01-01

    Full Text Available Natural eye lens is a crystalline substance to produce a clear passage for light. Cataract is opacity within the clear lens of the eye and is the dominant cause of socio-medical problem i.e., blindness worldwide. The only available treatment of cataract is surgery. However, insufficient surgical facilities in poor and developing countries and post-operative complications inspire researchers to find out other modes of treatment for cataract. In this review, an attempt has been made to appraise various etiological factors of cataract to make their perception clear to build up counterpart treatment. Present study is an assortment of various available literatures and electronic information in view of cataract etiopathogenesis. Various risk factors have been identified in development of cataracts. They can be classified in to genetic factors, ageing (systemic diseases, nutritional and trace metals deficiencies, smoking, oxidative stress etc., traumatic, complicated (inflammatory and degenerative diseases of eye, metabolic (diabetes, galactosemia etc., toxic substances including drugs abuses, alcohol etc., radiation (ultraviolet, electromagnetic waves etc. are implicated as significant risk factors in the development of cataract.

  3. 12 CFR 722.3 - Appraisals required; transactions requiring a State certified or licensed appraiser.

    Science.gov (United States)

    2010-01-01

    ..., including mortgage-backed securities, and each loan or interest in a loan, pooled loan, or real property... transaction in which the appraisal conforms to the Federal National Mortgage Association or Federal Home Loan Mortgage Corporation appraisal standards applicable to that category of real estate; or (9) The regional...

  4. 12 CFR 323.3 - Appraisals required; transactions requiring a State certified or licensed appraiser.

    Science.gov (United States)

    2010-01-01

    ... State certified or licensed appraiser is required for all real estate-related financial transactions... lease of real estate is entered into, unless the lease is the economic equivalent of a purchase or sale... that the services of an appraiser are not necessary in order to protect Federal financial and...

  5. Quality Appraisal of Single-Subject Experimental Designs: An Overview and Comparison of Different Appraisal Tools

    Science.gov (United States)

    Wendt, Oliver; Miller, Bridget

    2012-01-01

    Critical appraisal of the research literature is an essential step in informing and implementing evidence-based practice. Quality appraisal tools that assess the methodological quality of experimental studies provide a means to identify the most rigorous research suitable for evidence-based decision-making. In single-subject experimental research,…

  6. No effect of ambient odor on the affective appraisal of a desktop virtual environment with signs of disorder

    NARCIS (Netherlands)

    Toet, A.; Schaik, M.G. van; Theunissen, N.C.M.

    2013-01-01

    Background : Desktop virtual environments (VEs) are increasingly deployed to study the effects of environmental qualities and interventions on human behavior and safety related concerns in built environments. For these applications it is essential that users appraise the affective qualities of the V

  7. No effect of ambient odor on the affective appraisal of a desktop virtual environment with signs of disorder

    NARCIS (Netherlands)

    Toet, A.; Schaik, M.G. van; Theunissen, N.C.M.

    2013-01-01

    Background : Desktop virtual environments (VEs) are increasingly deployed to study the effects of environmental qualities and interventions on human behavior and safety related concerns in built environments. For these applications it is essential that users appraise the affective qualities of the V

  8. Value of tissue markers p27kip1, MIB-1, and CD44s for the pre-operative prediction of tumour features in screen-detected prostate cancer

    NARCIS (Netherlands)

    A.N. Vis (André); B.W. van Rhijn (Bas); M.A. Noordzij (Marinus); F.H. Schröder (Fritz); Th.H. van der Kwast (Theo)

    2002-01-01

    textabstractThe pre-operative prediction of prognostic tumour features in the radical prostatectomy specimen using routine clinicopathological variables remains limited. The present study evaluated the predictive value of the cell-cycle protein p27kip1, the proliferation marker MIB-1, and the cell-a

  9. ERα and ERβ expression in correlation with Ki-67, Bcl-2 and Bak in primary tumors and lymph node metastases of breast cancer: The effect of pre-operative chemotherapy.

    Science.gov (United States)

    Kanczuga-Koda, Luiza; Koda, Mariusz; Tomaszewski, Jakub; Jarzabek, Katarzyna; Lotowska, Joanna; Baltaziak, Marek; Sulkowska, Urszula; Sobaniec-Lotowska, Maria; Sulkowski, Stanisław

    2010-11-01

    This study aimed to assess the pre-operative chemotherapy impact on the relationship between estrogen receptor (ER) expression and markers of proliferation and apoptosis in primary and metastatic breast cancer. Immunohistochemical examinations were conducted on surgically removed ductal invasive breast cancers and their lymph node metastases in 135 patients. A total of 64 patients from this group underwent pre-operative chemotherapy and in 71 cases the surgery was performed without primary chemotherapy. A negative correlation between ERα and Ki-67 was found in primary tumors and lymph node metastases. A positive correlation was observed between ERα and Bcl-2. A positive correlation was also noted between ERβ and Bak, suggesting that the two ERs were involved in the regulation of proteins responsible for the control of the apoptotic process. Assessment of the expression of the proteins conducted separately in primary tumors and lymph node metastases did not reveal a significant effect of pre-operative chemotherapy on the correlations of ERs with Ki-67, Bcl-2 and Bak. However, the analysis of the correlations between the receptor expression in primary tumors and Ki-67, Bcl-2 and Bak in lymph node metastases showed a statistically significant impact of pre-operative chemotherapy on the correlations of ERα and Bcl-2 with ERβ and Bak, confirming involvement of the two ERs in the regulation of apoptosis during breast carcinogenesis.

  10. 5 CFR 430.405 - Procedures for certifying agency appraisal systems.

    Science.gov (United States)

    2010-01-01

    ... SERVICE REGULATIONS PERFORMANCE MANAGEMENT Performance Appraisal Certification for Pay Purposes § 430.405... appraisals of their relative performance against performance expectations in any given appraisal period... pay based on annual summary ratings, ratings of record, or other performance appraisal...

  11. Fechamento de colostomias: com ou sem estudo do cólon? Colostomy closure: with or without pre-operative colon study

    Directory of Open Access Journals (Sweden)

    Hernán Augusto Centurión Sobral

    2008-09-01

    Full Text Available O estudo pré-operatório do cólon para fechamento de colostomias em alça devido a trauma vem perdendo importância nos últimos anos. A necessidade de se avaliar as alterações anatômicas pós-traumáticas do cólon vai de encontro aos custos, desconforto e morbidade dos exames. OBJETIVO: analisar a real necessidade do estudo prévio do cólon no fechamento de colostomia pós-trauma. MÉTODO: foram analisados, retrospectivamente, 98 prontuários de pacientes, no período de janeiro de 2004 a janeiro de 2006, portadores de colostomia em alça confeccionada após traumatismo e que foram alocados em dois grupos: grupo A, composto de 32 casos com estudo do cólon e o grupo B, 66 casos sem estudo colônico prévio. RESULTADOS: 94,9% dos pacientes eram do sexo masculino e a média de idade foi de 27 anos. O tempo de permanência da colostomia foi, em média, 32,8 meses, sendo o flanco esquerdo a localização mais comum em ambos os grupos. A morbidade geral foi de 7,1%, sendo 3,1% de complicações no grupo A e 9,1% no grupo B (p=0,16 e sem mortalidade. A complicação mais freqüente foi hematoma da parede abdominal em cinco casos (5,1%, e apenas um caso de infecção de ferida operatória (1%, e mais um de deiscência de anastomose (1%. CONCLUSÃO: o estudo pré-operatório do cólon para fechamento de colostomia feita após trauma colorretal é dispensável.The pre-operative study of the colon before loop colostomy closure in trauma patients has been loosing its importance since last few years. The need of evaluating the pos-traumatic anatomic alterations of the colon goes against the costs and morbidity of the examinations. OBJECTIVE: to analyze the real necessity of the colon study before colostomy closure in trauma patients. METHODS: a retrospective study of 98 patients submitted to colostomy closure after trauma, from January of 2004 to January of 2006 was carried out. They were divided in two groups: group A, composed of 32 patients with

  12. Appraisal, coping, health status, and psychological symptoms.

    Science.gov (United States)

    Folkman, S; Lazarus, R S; Gruen, R J; DeLongis, A

    1986-03-01

    In this study we examined the relation between personality factors (mastery and interpersonal trust), primary appraisal (the stakes a person has in a stressful encounter), secondary appraisal (options for coping), eight forms of problem- and emotion-focused coping, and somatic health status and psychological symptoms in a sample of 150 community-residing adults. Appraisal and coping processes should be characterized by a moderate degree of stability across stressful encounters for them to have an effect on somatic health status and psychological symptoms. These processes were assessed in five different stressful situations that subjects experienced in their day-to-day lives. Certain processes (e.g., secondary appraisal) were highly variable, whereas others (e.g., emotion-focused forms of coping) were moderately stable. We entered mastery and interpersonal trust, and primary appraisal and coping variables (aggregated over five occasions), into regression analyses of somatic health status and psychological symptoms. The variables did not explain a significant amount of the variance in somatic health status, but they did explain a significant amount of the variance in psychological symptoms. The pattern of relations indicated that certain variables were positively associated and others negatively associated with symptoms.

  13. Cost-Appraising Techniques For Route Planning

    Science.gov (United States)

    Cheng, Pi-Yun

    1987-01-01

    Cost appraisal is one of the most important elements in route planning, especially when dynamic programming is employed in the search technique. Different missions require different routes; for example, a mission may require a minimum-length path, a terrain-constrained path, a tactical path, a threat-avoidance path, a fuel-constrained path, or a combination of such paths. An optimal path is the path whose total cost is appraised to be the minimum. One difficulty in cost appraisal is in identifying common as well as mission-specific parameters. Another difficulty is in ranking the weighting coefficients, or equivalently the importance factors. Many papers can be found on finding an optimal path for some cost function. However, there has been much less published analysis discussing the detailed definitions of cost-measuring functions other than the familiar Euclidean metrics. Known methods of cost appraisal tend to be either exclusively heuristic or numerical. In this paper we present a new formulation of cost appraisal in which intertwined employment of both approaches is evident. An application example is given.

  14. Appraisals, burnout and outcomes in informal caregiving.

    Science.gov (United States)

    Lee, Haejung; Singh, Jagdip

    2010-03-01

    This study draws from the resource depletion and conservation theories to develop a process model of informal caregiving. The model includes the burnout as a key mediator of the relationship between benefit/threat appraisals and critical outcomes including perceived physical health, depression and life satisfaction. A self-report questionnaire was utilized to collect relevant data from 137 informal caregivers of older adults. The proposed model and hypotheses were evaluated with the Structural Equation Modeling method using the software EQS. The relatively high reported levels of emotional exhaustion and reduced personal accomplishment established the relevance of the burnout construct for informal caregivers. In addition, the test of the proposed model provides support for the hypothesis that burnout is an important mediator in the appraisal process model of informal caregiving. However, while burnout effectively mediates the influence of threat appraisals, its role in mediating the effect of benefit appraisals is mixed. The proposed model and results highlight the significance and potential for utilizing a process approach for understanding the link between appraisals and outcomes for informal caregivers. More importantly, the proposed model suggests that attention must be paid toward burnout tendencies to reveal fruitful intervention directions for researchers and practitioners to enhance the positive outcomes of informal caregivers, and maintain their psychological and physical well-being. Copyright © 2010 Korean Society of Nursing Science. Published by . All rights reserved.

  15. Assessing and appraising nursing students' professional communication

    Science.gov (United States)

    Diers, Jane E.

    The purpose of this research was to define professional communication in nursing and to develop a prototype to assess and appraise communication at a selected college. The research focused on verbal and nonverbal communication between the nurse and the client using a simulated environment. The first objective was to identify the major characteristics of professional communication in nursing. In this study, the characteristics of professional communication emerged from the constant comparison method of the results of research studies in the fields of healthcare and communication. These characteristics became the elements, representative properties, and descriptive dimensions to assess and appraise verbal and nonverbal communication at the college of study. The second objective was to develop a template to assess verbal and nonverbal communication at a selected college. Using a two-fold process, the researcher used the results from the first objective to begin template construction. First, specialists in the fields of communication and nursing established the content validity of the elements, representative properties, and descriptive dimensions. Second, the course educators determined the relevancy and importance of the elements, properties, and descriptive dimensions to the objectives of two courses at the college of study. The third objective was to develop a rubric to appraise nursing students' verbal and nonverbal communication in a videotaped communication review. An appraisal rubric was constructed from an extension of the template. This rubric was then tested by faculty at the selected college to appraise the communication of five students each in the junior and senior years of the nursing program.

  16. Analysis of Appraising Agricultural Intangible Asset Value by Cost Method

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    On the basis of describing the connotation of agricultural intangible asset and cost method,the technical ideas of appraising by cost method are introduced.The article analyzes the advantages(simple appraisal principle and easy to understand and grasp;overall consideration of various factors related to appraisal result value) and disadvantages(high appraisal cost;difficult to appraise and grasp various appraisal factors) of appraising by cost method.The article also summarizes the precondition of appraising by cost method:it is applicable to appraise the agricultural intangible asset which can be reproduced and afresh developed.Based on the cognition of agricultural intangible asset and the relevant rules of Ministry of Finance on appraisal of intangible asset by using cost method,the model of appraising agricultural intangible asset by cost method is constructed.That is:agricultural intangible asset value = replacement cost of agricultural intangible asset ×newness rate + opportunity cost of agricultural intangible asset.Determine and analyze parameters of the model,in order to offer references for appraisers to appraise agricultural intangible asset value more reasonably.

  17. How Should an Effective Performance Appraisal Be: EFL Teachers’ Perspective

    Directory of Open Access Journals (Sweden)

    Holi Ibrahim Holi Ali

    2012-11-01

    Full Text Available This study is set to examine EFL teachers’ perceptions, views about what makes an effective performance appraisal system by adopting a quantitative survey design for data collection. A total number of 45 college instructors in the Sultanate of Oman responded to survey on: how is an effective performance appraisal perceived by EFL teachers? How do teachers perceive their participation in developing the appraisal system? And how might the present performance appraisal practices be improved? The result reveals that staff participation in developing performance appraisal system and goals, feedback confidentiality, quality appraiser, quality of place and time of appraisal, appraiser-appraisee relationships, and developmental nature of performance appraisal would help in making effective appraisal and the overall PA effectiveness depends mostly on these factors. The result has a significant implication for improving the process of teacher performance appraisal in Oman and enriches the body knowledge of PA in general. The study puts forwards suggestions and recommendations for improving PA practices and exercises in EFL contexts. Keywords: Effective Performance appraisal, FL teachers' perceptions, critical errors in performance appraisal, Colleges instructors in the Sultanate of Oman

  18. A Comparative Study on the Efficacy of Rectal Diazepam and Midazolam for Reduction of Pre-Operative Anxiety in Pediatric Patients

    Directory of Open Access Journals (Sweden)

    Mohammad-Esmaiel Darabi

    2007-05-01

    Full Text Available Objective: Children, due to their great parental dependency, are amongst the cases that should receive preoperatively medication to reduce their fear and anxiety. The objective of this study was to compare the efficacy of rectal diazepam and midazolam for this purpose in pediatric patients scheduled for elective surgery. Material & Methods: 60 children, aged between 1 and 6 years, scheduled for elective surgery, were included in this double blind, randomized controlled trial. Patients were randomly allocated into three equal groups. Patients in midazolam and diazepam groups received the drugs 0.3 mg/kg and 0.5 mg/kg respectively (in normal saline at a final volume of 2.5 ml and placebo group received only 2.5 ml of normal saline 20 min before arriving operation room through rectal applicator. Sedation and anxiety scores at the time of separation from their parents before arriving operating room were recorded for all groups. Findings: There was a significant reduction in anxiety level in midazolam and diazepam groups as compared to placebo group (P<0.001. Sedation rate was 65% for midazolam, 60% for diazepam, and 15% for placebo group (P=0.007. There were no significant changes in hemodynamic parameters in the three study groups. Conclusion: With respect to effective anxiolytic and sedative activity, rectal midazolam (0.3 mg/Kg and diazepam (0.5 mg/Kg can be used as an anesthetic premedicant for children at pre-operative period and their use is safe regarding hemodynamic variables and related side-effects.

  19. [Evaluation of Wits appraisal with superimposition method].

    Science.gov (United States)

    Xu, T; Ahn, J; Baumrind, S

    1999-07-01

    To compare the conventional Wits appraisal with superimposed Wits appraisal in evaluation of sagittal jaw relationship change between pre and post orthodontic treatment. The sample consists of 48-case pre and post treatment lateral head films. Computerized digitizing is used to get the cephalometric landmarks and measure conventional Wits value, superimposed Wits value and ANB angle. The correlation analysis among these three measures was done by SAS statistical package. The change of ANB angle has higher correlation with the change of superimposed Wits than that of the conventional Wits. The r-value is as high as 0.849 (P < 0.001). The superimposed Wits appraisal reflects the change of sagittal jaw relationship more objectively than the conventional one.

  20. 24 CFR 200.35 - Appraisal standards-nondiscrimination requirements.

    Science.gov (United States)

    2010-04-01

    ... Practice must include a statement that the racial/ethnic composition of the neighborhood surrounding the... the selection of appraiser. In the selection of an appraiser, there shall be no discrimination on...

  1. Perceived Role of the Journal Clubs in Teaching Critical Appraisal ...

    African Journals Online (AJOL)

    Perceived Role of the Journal Clubs in Teaching Critical Appraisal Skills: A Survey of ... The development of skills in critical acquisition and appraisal of the literature is ... The commonest form of feedback was verbal from the consultants and ...

  2. Verification of 'learning credits' by GP appraisers.

    Science.gov (United States)

    Murie, Jill; Wakeling, Judy

    2011-11-01

    The RCGP CPD Learning Credits system aims to enable GPs to demonstrate knowledge and skills relevant to their daily practice. Credits are self-assessed and will form part of the 'evidence' necessary for successful revalidation. At an appraisal, GP appraisers verify the credits in terms of the time spent on the CPD activity and its impact on the GP's practice. The purpose of this study was to examine the extent to which GPs (as appraisees) are able to self-assess their own learning and, as appraisers, verify credits in a standardised way. All 17 GP appraisers in NHS Lanarkshire were invited to participate in a study, which triangulated three sources of evidence on credits: self-rating, peer-assessment and workshop discussion. The resultant data were analysed on an Excel spreadsheet. Outcomes included self-assessed credit value, peer-assessed mean score (range) and free text. Of the 17 appraisers, 15 completed the paperwork and 13 attended the workshop. GPs' self-assessed learning credits were equivalent to peer-assessed score in 5/15 cases, but considered overestimates in 4/15 and underestimates in 6/15 cases. The most extreme variance was for an oncology module, where the variance ranged from 28% to 200% of the self-assessed score. GPs have a variable understanding of how to award themselves learning credits and of how to judge the credits of potential appraisees. Without adequate resources for appraisal training, validated instruments, calibration and reliability, verification of the learning credit system will be flawed by its subjective and arbitrary nature.

  3. Performance appraisal and merit recognition exercise 2007

    CERN Multimedia

    HR Department

    2006-01-01

    The 2007 performance appraisal and merit recognition exercise will start in the usual way with annual interviews between staff and their supervisors. This year, these interviews should be held in the period from 8 January 2007 to 16 April 2007. Interconnection with the 5-yearly review, a number of modifications to the procedures relating to the performance appraisal and merit recognition are currently under study. Administrative Circular No. 26 (Procedures governing the Career Development of Staff Members) and the electronic MAPS form in EDH are being reviewed and will be available from January onwards. HR Department will shortly provide further information on this subject. Human Resources Department Tel. 73566

  4. Performance Appraisal for Librarians: A Guided Self-Study Approach.

    Science.gov (United States)

    Stevenson, Sally

    Intended for use by library managers, this self-study guide provides an introduction to performance appraisal as an effective tool in human resource management, and a review of the extensive management literature on performance appraisal. Topics discussed include: (1) the functions of performance appraisal, which include the provision of…

  5. Performance Appraisal in UK Universities: A Case of Procedural Compliance?

    Science.gov (United States)

    Bryman, Alan; And Others

    1994-01-01

    Research evidence concerning the introduction of performance appraisal in United Kingdom universities is presented. The notion of "procedural compliance" is introduced to draw attention to the largely externally imposed appraisal of universities and to the nature of institutional response. Findings of a study of appraisal in four…

  6. Characteristics of Appraisal Systems That Promote Job Satisfaction of Teachers

    Science.gov (United States)

    Deneire, Alexia; Vanhoof, Jan; Faddar, Jerich; Gijbels, David; Van Petegem, Peter

    2014-01-01

    This article examines if and how characteristics of appraisal systems used for secondary school teachers affect job satisfaction. Using multilevel analyses on data of 3 473 teachers in Flanders (Belgium), we found that appraisals with a developmental purpose and appraisals perceived as being a fair judgement, both have a positive impact on job…

  7. 76 FR 5161 - Determination Regarding National Appraisal Complaint Hotline

    Science.gov (United States)

    2011-01-28

    ... INSTITUTIONS EXAMINATION COUNCIL Determination Regarding National Appraisal Complaint Hotline AGENCY: Appraisal... regarding a national appraisal complaint hotline. SUMMARY: Pursuant to section 1473(p) of the Dodd-Frank... determined that no one national hotline presently exists that fully complies with the Act. The...

  8. Teacher Performance Appraisal in Thailand: Poison or Panacea?

    Science.gov (United States)

    Pimpa, Nattavud

    2005-01-01

    This research focuses on the examination of problems related to the national teacher performance appraisal system by the Thai Ministry of Education. It highlights major problems of the current performance appraisal system by delineating the weaknesses and pitfalls of the current appraisal system. The findings indicate problems to three major…

  9. 28 CFR 345.41 - Performance appraisal for inmate workers.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Performance appraisal for inmate workers... FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Worker Standards and Performance Appraisal § 345.41 Performance appraisal for inmate workers. Work supervisors should complete a...

  10. 42 CFR 24.7 - Performance appraisal system.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Performance appraisal system. 24.7 Section 24.7... RESEARCH SERVICE § 24.7 Performance appraisal system. The members of the Service shall be subject to a performance appraisal system which shall be designed to encourage excellence in performance and shall...

  11. Characteristics of Appraisal Systems That Promote Job Satisfaction of Teachers

    Science.gov (United States)

    Deneire, Alexia; Vanhoof, Jan; Faddar, Jerich; Gijbels, David; Van Petegem, Peter

    2014-01-01

    This article examines if and how characteristics of appraisal systems used for secondary school teachers affect job satisfaction. Using multilevel analyses on data of 3 473 teachers in Flanders (Belgium), we found that appraisals with a developmental purpose and appraisals perceived as being a fair judgement, both have a positive impact on job…

  12. Patients undergoing elective coronary artery bypass grafting exhibit poor pre-operative intakes of fruit, vegetables, dietary fibre, fish and vitamin D.

    Science.gov (United States)

    Ruiz-Núñez, B; van den Hurk, G H A M; de Vries, J H M; Mariani, M A; de Jongste, M J L; Dijck-Brouwer, D A J; Muskiet, F A J

    2015-05-14

    CHD may ensue from chronic systemic low-grade inflammation. Diet is a modifiable risk factor for both, and its optimisation may reduce post-operative mortality, atrial fibrillation and cognitive decline. In the present study, we investigated the usual dietary intakes of patients undergoing elective coronary artery bypass grafting (CABG), emphasising on food groups and nutrients with putative roles in the inflammatory/anti-inflammatory balance. From November 2012 to April 2013, we approached ninety-three consecutive patients (80% men) undergoing elective CABG. Of these, fifty-five were finally included (84% men, median age 69 years; range 46-84 years). The median BMI was 27 (range 18-36) kg/m(2). The dietary intake items were fruits (median 181 g/d; range 0-433 g/d), vegetables (median 115 g/d; range 0-303 g/d), dietary fibre (median 22 g/d; range 9-45 g/d), EPA+DHA (median 0.14 g/d; range 0.01-1.06 g/d), vitamin D (median 4.9 μg/d; range 1.9-11.2 μg/d), saturated fat (median 13.1% of energy (E%); range 9-23 E%) and linoleic acid (LA; median 6.3 E%; range 1.9-11.3 E%). The percentages of patients with dietary intakes below recommendations were 62% (fruits; recommendation 200 g/d), 87 % (vegetables; recommendation 150-200 g/d), 73% (dietary fibre; recommendation 30-45 g/d), 91% (EPA+DHA; recommendation 0.45 g/d), 98% (vitamin D; recommendation 10-20 μg/d) and 13% (LA; recommendation 5-10 E%). The percentages of patients with dietary intakes above recommendations were 95% (saturated fat; recommendation < 10 E%) and 7% (LA). The dietary intakes of patients proved comparable with the average nutritional intake of the age- and sex-matched healthy Dutch population. These unbalanced pre-operative diets may put them at risk of unfavourable surgical outcomes, since they promote a pro-inflammatory state. We conclude that there is an urgent need for intervention trials aiming at rapid improvement of their diets to reduce peri-operative risks.

  13. An evaluation of the validity of the pre-operative oxygen uptake efficiency slope as an indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery.

    Science.gov (United States)

    Bongers, B C; Berkel, A E; Klaase, J M; van Meeteren, N L

    2017-10-01

    This study aimed to investigate the validity of the oxygen uptake efficiency slope as an objective and submaximal indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery. Patients ≥ 60 years of age, with a metabolic equivalent score using the Veterans Activity Questionnaire ≤ 7 and scheduled for major colorectal surgery participated in a pre-operative cardiopulmonary exercise test. The oxygen uptake efficiency slope was calculated up to different exercise intensities, using 100%, 90% and 80% of the exercise data. Data from 71 patients (47 men, mean (SD) age 75.2 (6.7) years) were analysed. The efficiency slope obtained from all the data was statistically significantly different from the values when 90% (p = 0.027) and 80% (p = 0.023) of the data were used. The 90% and 80% values did not differ significantly from each other (p = 0.152). Correlations between the oxygen uptake efficiency slope and the peak oxygen uptake ranged from 0.816 to 0.825 (all p < 0.001), and correlations between oxygen uptake efficiency slope and the ventilatory anaerobic threshold ranged from 0.793 to 0.805 (all p < 0.001). Receiver operating characteristic curves showed that the oxygen uptake efficiency slope is a sensitive and specific predictor of a peak oxygen uptake ≤ 18.2 ml.kg(-1) .min(-1) , with an area under the curve (95%CI) of 0.876 (0.780-0.972, p < 0.001) and a ventilatory anaerobic threshold ≤ 11.1 ml.kg(-1) .min(-1) , with an area under the curve (95%CI) of 0.828 (0.726-0.929, p < 0.001). These correlations suggest that the oxygen uptake efficiency slope provides a valid (sub)maximal measure of cardiorespiratory fitness in these patients, and the predictive ability described indicates that it might help discriminate patients at higher risk of postoperative morbidity. However, future research should investigate the prognostic value of the oxygen uptake efficiency slope for postoperative outcomes. © 2017 The Association of

  14. Can pre-operative axial CT imaging predict syndesmosis instability in patients sustaining ankle fractures? Seven years' experience in a tertiary trauma center

    Energy Technology Data Exchange (ETDEWEB)

    Yeung, Tsz Wai; Chan, Chung Yan Grace; Chan, Wun Cheung Samuel; Yuen, Ming Keung [Tuen Mun Hospital, Department of Radiology, Tuen Mun (China); Yeung, Yuk Nam [Tune Mun Hospital, Department of Orthopaedics and Traumatology, Tuen Mun (China)

    2015-06-01

    The purpose of this study is to explore the diagnostic accuracy of CT measurements in predicting syndesmosis instability of injured ankle, with correlation to operative findings. From July 2006 to June 2013, 123 patients presented to a single tertiary hospital who received pre-operative CT for ankle fractures were retrospectively reviewed. All patients underwent open reduction and internal fixation for fractures and intra-operative syndesmosis integrity tests. The morphology of incisura fibularis was categorized as deep or shallow. The tibiofibular distance (TFD) between the medial border of the fibula and the nearest point of the lateral border of tibia were measured at anterior (aTFD), middle (mTFD), posterior (pTFD), and maximal (maxTFD) portions across the syndesmosis on axial CT images at 10 mm proximal to the tibial plafond. Statistical analysis was performed with independent samples t test and ROC curve analysis. Intraobserver reproducibility and inter-observers agreement were also evaluated. Of the 123 patients, 39 (31.7 %) were operatively diagnosed with syndesmosis instability. No significant difference of incisura fibularis morphology (deep or shallow) and TFDs was demonstrated respective to genders. The axial CT measurements were significantly higher in ankles diagnosed with syndesmosis instability than the group without (maxTFD means 7.2 ± 2.96 mm vs. 4.6 ± 1.4 mm, aTFD mean 4.9 ± 3.7 mm vs. 1.8 ± 1.4 mm, mTFD mean 5.3 ± 2.4 mm vs. 3.2 ± 1.6 mm, pTFD mean 5.3 ± 1.8 mm vs. 4.1 ± 1.3 mm, p < 0.05). Their respective cutoff values with best sensitivity and specificity were calculated; the aTFD (AUC 0.798) and maxTFD (AUC 0.794) achieved the highest diagnostic accuracy. The optimal cutoff levels were aTFD = 4 mm (sensitivity, 56.4 %; specificity, 91.7 %) and maxTFD = 5.65 mm (sensitivity, 74.4 %; specificity, 79.8 %). The inter-observer agreement was good for all aTFD, mTFD, pTFD, and maxTFD measurements (ICC 0.959, 0.799, 0.783, and 0.865). The ICC

  15. Comparison between FDG Uptake and Clinicopathologic and Immunohistochemical Parameters in Pre-operative PET/CT Scan of Primary Gastric Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Han, Eun Ji; Choi, Woo Hee; Chung, Yong An; Kim, Ki Jun; Maeng, Lee So; Sohn, Kyung Myung; Jung, Hyun Suk; Sohn, Hyung Sun; Chung, Soo Kyo [College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2009-02-15

    The purpose of this study was to find out what clinicopathologic or immunohistochemical parameter that may affect FDG uptake of primary tumor in PET/CT scan of the gastric carcinoma patient. Eighty-nine patients with stomach cancer who underwent pre-operative FDG PET/CT scans were included. In cases with perceptible FDG uptake in primary tumor, the maximum standardized uptake value (SUVmax) was calculated. The clinicopathologic results such as depth of invasion (T stage), tumor size, lymph node metastasis, tumor differentiation and Lauren's classification and immunohistochemical markers such as Ki-67 index, expression of p53, EGFR, Cathepsin D, c-erb-B2 and COX-2 were reviewed. Nineteen out of 89 gastric carcinomas showed imperceptible FDG uptake on PET/CT images. In cases with perceptible FDG uptake in primary tumor, SUVmax was significantly higher in T2, T3 and T4 tumors than T1 tumors (5.8{+-}3.1 vs. 3.7{+-}2.1, p=0.002). SUVmax of large tumors (above or equal to 3 cm) was also significantly higher than SUVmax of small ones (less than 3 cm) (5.7{+-}3.2 vs. 3.7{+-}2.0, p=0.002). The intestinal types of gastric carcinomas according to Lauren showed higher FDG uptake compared to the non-intestinal types (5.4{+-}2.8 vs. 3.7{+-}1.3, p=0.003). SUVmax between p53 positive group and negative group was significantly different (6.0{+-}2.8 vs. 4.4{+-}3.0, p=0.035). No significant difference was found in presence of LN metastasis, tumor differentiation, Ki-67 index, and expression of EGFR, Cathepsin D, c-erb-B2 and COX-2. T stage of gastric carcinoma influenced the detectability of gastric cancer on FDG PET/CT scan. When gastric carcinoma was perceptible on PET/CT scan, T stage, size of primary tumor, Lauren's classification and p53 expression were related to degree of FDG uptake in primary tumor.

  16. AN UNDERSTANDING TOWARDS BENEFITS AND CONCERNS ASSOCIATED WITH PERFORMANCE APPRAISALS- A STUDY HIGHLIGHTING THE ESSENTIALS OF GOOD APPRAISAL SYSTEM

    Directory of Open Access Journals (Sweden)

    Dr. Mohammed Nazeer Ahmed,

    2015-10-01

    Full Text Available Performance appraisal is a formal and structured system followed by the organizations for reviewing and assessing the performance of employees. Organizations‘ initiate the performance appraisals process for administrative purposes and for employee development purposes. For administrative purposes, it assists management in selection; retention; and training of personnel‘s, in estimating the number of personnel required, for rewarding and honoring employees, for legal requirements, and for granting hike in employees‘ salary. For employee development purposes, the appraisal process is used to communicate employees‘ strengths & weaknesses, to identify individuals‘ training needs & identify gaps in workers‘ performance, to judge the efficiency of human resource personnel‘s involved with recruitment, selection etc. and also to reduce the grievances of employees. An effective appraisal would always assist organizations in achieving the organizational goals. Nevertheless, an appraisal would also be the cause of negative experience when the managers judge the employees‘ performance in a biased manner. The purpose of this paper is to focus on the purposes of using appraisals in an organization also to emphasize both the benefits and concerns associated with the appraisals. The main purpose of the study is to emphasis comprehensively the various essential requirements of good appraisal system. The good appraisal system is required to overcome the concerns associated with appraisals and to garner the true benefits of appraisals. The present study recommends that, for the successful achievement of organizational objectives, the appraisal system should be appropriate and effective.

  17. Role of Appraisals in Energy Efficiency Financing

    Energy Technology Data Exchange (ETDEWEB)

    Doyle, V.; Bhargava, A.

    2012-05-01

    This research identifies barriers and challenges and current industry status including several key appraisal industry developments for identifying and valuing energy efficiency, critical obstacles to documenting and assessing the potential added value from energy efficiency improvements, current opportunities to support and standardize reporting on energy efficiency and to ensure proper valuation, and next steps towards enabling energy efficiency financing market transformation.

  18. 5 CFR 9901.411 - Appraisal period.

    Science.gov (United States)

    2010-01-01

    ....411 Administrative Personnel DEPARTMENT OF DEFENSE HUMAN RESOURCES MANAGEMENT AND LABOR RELATIONS... PERSONNEL SYSTEM (NSPS) Performance Management § 9901.411 Appraisal period. (a) Except as provided in... period, an employee has not met the minimum period of performance, management may extend the...

  19. Energy considerations in real estate appraising

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-04-01

    Purposes of the seminar on the subject, the basis of this report, include the following: (1) to provide the appraiser an opportunity to learn how to identify and analyze the actual physical consumption of energy as well as the energy-saving improvements in properties under appraisal and in comparable sale and lease properties; (2) to help the appraiser in developing methods to keep meaningful records on the energy consumption of subject and comparable properties so as to observe in an orderly way the behavior of buyers, sellers, tenants, landlords, borrowers, and lenders with respect to energy efficiency; and (3) to assist the appraiser in learning to measure the relative sensitivities of the various segments of the market to energy considerations as indicated by differences in sale prices and rentals. To achieve these goals, the seminar employed two case studies, one for a angle-family residence and one for a multi-family building, both in Topeka, Kansas. The case studies are for illustrative purposes only; in applying the lessons of the seminar to their own daily work, students should be careful to develop information that is pertinent to their subject properties and subject areas and not rely on any of the particulars laid out in the cases.

  20. 32 CFR 644.42 - Appraisal report.

    Science.gov (United States)

    2010-07-01

    ... appraiser's final conclusion of market value. (2) The use of preprinted narrative sales data sheets is... concern. All graphic material shall include captions. 5. STATEMENT OF LIMITING CONDITIONS AND ASSUMPTIONS... designed, dates of original construction and/or additions; include, for privately owned property, a ten...

  1. Evaluating Medical Residents' Literature-Appraisal Skills.

    Science.gov (United States)

    Stern, David T.; And Others

    1995-01-01

    A study of 28 medical residents' skills in evaluating research compared student evaluations of a journal article with 1 developed by means of a Delphi technique utilizing 5 experts. Residents' scores were not significantly associated with residency year or self-assessed critical appraisal skill. The method is proposed as an objective means of…

  2. 7 CFR 1955.128 - Appraisers.

    Science.gov (United States)

    2010-01-01

    ... Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE... REGULATIONS (CONTINUED) PROPERTY MANAGEMENT Disposal of Inventory Property Use of Contractors to Dispose of Inventory Property § 1955.128 Appraisers. (a) Real property. The State Director may authorize the County...

  3. 12 CFR 34.85 - Appraisal requirements.

    Science.gov (United States)

    2010-01-01

    ... accordance with subpart C of this part; or (ii) An appropriate evaluation when the recorded investment amount is equal to or less than the threshold amount in subpart C of this part. (2) A national bank shall... bank has a valid appraisal or an appropriate evaluation obtained in connection with a real estate loan...

  4. Evaluating Housing Problems through Participatory Rural Appraisal ...

    African Journals Online (AJOL)

    Nekky Umera

    planned for the people in order to solve the housing problems within the ... way of learning relatively quickly, by both insiders and outsiders about the ... Action, Participatory Rural Appraisal involves interaction between the ... (3). Force Field Analysis - This is a technique, to visually identify and analyse forces affecting a ...

  5. Employee Perceptions and Value of Performance Appraisals

    Science.gov (United States)

    Bagnell, Rhea

    2012-01-01

    Performance appraisals traditionally have been studied quantitatively, from the manager's point of view, without considering their value or lack of value to workers. The absence of this information indicates that workers' perceptions and feelings have not always been considered. Therefore, the purpose of this phenomenological study was…

  6. Performance Appraisal of Physical Education Teachers

    Science.gov (United States)

    Bahadir, Ziya

    2013-01-01

    In this study, the aim was to determine views of school principals on how performance appraisal of physical education teachers who worked at primary schools should be done. The research was designed in a screening model. The research group composed of 152 school principals and deputy principals who worked at state primary schools located in…

  7. 某教学楼的抗震检测鉴定研究%Research on earthquake resistance examines and appraises of a teaching building

    Institute of Scientific and Technical Information of China (English)

    薛云岗

    2011-01-01

    Based on a teaching building's earthquake resistance examination appraisal example,through uses the work mentality which the reliability appraisal and the anti-knocking appraisal unify to carry on the examination and the appraisal,namely reflecting current teaching house structure present situation,also had determined the structure earthquake resistance performance,provides the scientific basis for the school house's safety handling.%针对某教学楼的抗震检测鉴定实例,通过采用可靠性鉴定与抗震性鉴定相结合的方式进行检测鉴定,既能得知房屋的现状质量,又能确定房屋结构的抗震性能,为学校建筑的正常安全使用提供科学的依据。

  8. Performance appraisal process and system facets: relationship with contextual performance.

    Science.gov (United States)

    Findley, H M; Giles, W F; Mossholder, K W

    2000-08-01

    Because appraisal-related interactions between supervisors and employees may influence more than task performance, the authors considered the potential effects of social and interpersonal processes in performance appraisal on contextual performance. They hypothesized that performance appraisal process and system facets were associated with employees' contextual performance as well as with their perceptions of appraisal accuracy. After controlling relevant variables, they found that appraisal process facets explained variance in contextual performance and perceived accuracy beyond that accounted for by the system facets. However, when the order of entry for the process and system variable sets was reversed, only for perceived appraisal accuracy, as hypothesized, did the system facets account for variance beyond that explained by the appraisal process facets.

  9. 手术室护理人员术前访视实施情况的调查研究%Investigation on the Implementing Situation of Pre-operative Interview of Nursing Staff in Operation room

    Institute of Scientific and Technical Information of China (English)

    易镁

    2013-01-01

      目的调查研究手术室护理人员实施术前访视的具体情况。方法选取2010年6月至2011年12月的42名手术室护理人员为研究对象,对其术前访视的具体实施情况进行调查研究。结果经调查研究发现,不同工作年限的护理人员在访视内容、实施方法、患者满意度存在明显的差异,P均<0.05,而不同学历者之间除访视内容及满意度外其他方面均无显著性差异。结论手术室护理人员术前访视实施情况较佳,且工作年限对其实施效果有明显的影响。%Objective To investigate the implementing situation of pre-operative interview of nursing staff in operation room. Methods 42 nursing staff in operation room from June 2010 to December 2011 were selected as research object,and the implementing situation of pre-operative interview of all the nurses were investigate . Results According to the investigation ,the interview content,implementation method and patients′satisfaction rate between different working years had significant differences,all P<0.05,but other items all had no significant differences between different academic careers except interview content . Conclusion The implementing situation of pre-operative interview of nursing staff in operation room is better,and the influence of working years for the pre-operative interview is obvious.

  10. Segmental analysis of cochlea on three-dimensional MR imaging and high-resolution CT. Application to pre-operative assessment of cochlear implant candidates

    Energy Technology Data Exchange (ETDEWEB)

    Akiba, Hidenari; Himi, Tetsuo; Hareyama, Masato [Sapporo Medical Coll. (Japan). School of Medicine

    2002-12-01

    High-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) have recently become standard pre-operative examinations for cochlear implant candidates. HRCT can demonstrate ossification and narrowing of the cochlea, but subtle calcification or soft tissue obstruction may not be detected by this method alone, and so conventional T2 weighted image (T2WI) on MRI has been recommended to disclose them. In this study, segmental analyses of the cochlea were made on three-dimensional MRI (3DMRI) and HRCT in order to predict cochlear implant difficulties. The study involved 59 consecutive patients with bilateral profound sensorineural hearing loss who underwent MRI and HRCT from November 1992 to February 1998. Etiologies of deafness were meningogenic labyrinthitis (n=9), tympanogenic labyrinthitis (n=12), and others (n=38). Pulse sequence of heavy T2WI was steady state free precession and 3DMRI was reconstructed by maximum intensity projection method. HRCT was reconstructed by bone algorithm focusing on the temporal bone. For alternative segmental analysis, cochleas were anatomically divided into five parts and each of them was classified by three ranks of score depending on 3DMRI or HRCT findings. There was a close correlation by ranks between the total score of the five parts on 3DMRI and HRCT (rs=0.86, P<0.001), and a statistically significant difference was identified between causes of deafness in the total score on 3DMRI or HRCT (P<0.001, respectively). There was a significant difference in the score among the five parts on each examination (P<0.001, respectively), and abnormal findings were more frequent in the inferior horizontal part (IHP) of the basal turn. Of the 35 patients who underwent cochlear implantation, no one had ossification in the IHP on HRCT and only one patient had an obstacle to implantation. When no signal void in the IHP on 3DMRI and no ossification in the IHP on HRCT were assumed to be the criteria for candidacy for cochlear

  11. The effect of pre-operative topical anaesthetic cream on the ablative width and coagulative depth of ablative fractional resurfacing laser.

    Science.gov (United States)

    Punyaratabandhu, Preawphan; Wanitphakdeedecha, Rungsima; Pattanaprichakul, Penvadee; Sitthinamsuwan, Panitta; Phothong, Weeranut; Eimpunth, Sasima; Lohsiriwat, Visnu; Manuskiatti, Woraphong

    2017-02-01

    Topical anaesthetic cream (TAC) is commonly used as a pre-treatment of ablative fractional resurfacing (AFR) laser. Most of anaesthetic cream contains distilled water as major component. Therefore, pre-operative TAC may interfere the photothermal reaction in the skin treated with fractional carbon-dioxide (FCO2) laser and fractional erbium-doped yttrium aluminium garnet (FEr:YAG) laser. The objective of the study was to compare the ablative width (AW) and coagulative depth (CD) of AFR laser with and without pre-treatment with TAC. Four Thai females who underwent abdominoplasty were included in the study. The excised skin of each subject was divided into four areas. TAC (eutectic mixture of local anaesthesia; EMLA) with 1-h occlusion was applied only on the first and second areas. The first and third areas were treated with FCO2 at 15 mj and 5% density. The second and fourth areas were treated with FEr:YAG at 28 J/cm(2) and 5% density. Six biopsied specimens were obtained from each area. A total of 96 specimens (24 specimens from each area) were collected from four patients and examined randomly by two dermatopathologists. The ablative width and coagulative depth from each specimen were determined. In FCO2-treated specimens, the mean AW of the specimens that were pre-treated with TAC and control was 174.86 ± 24.57 and 188.52 ± 41.32 μm. The mean CD of the specimens that were pre-treated with TAC and control was 594.96 ± 111.72 and 520.03 ± 147.40 μm. There were no significant differences in AW and CD between both groups (p = 0.53 and p = 0.15). In FEr:YAG-treated specimens, the mean AW of the specimens that were pre-treated with TAC and control was 381.11 ± 48.02 and 423.65 ± 60.16 μm. The mean CD of the specimens that were pre-treated with TAC and control was 86.03 ± 29.44 and 71.59 ± 18.99 μm. There were no significant differences in AW and CD between both groups (p = 0.16 and p = 0.24). The pre

  12. Report of the aviation safety review of Department of Energy helicopter operations

    Energy Technology Data Exchange (ETDEWEB)

    1992-02-01

    In a memorandum dated November 27, 1991, the Secretary of Energy directed the Office of Environment, Safety and Health (EH) to lead, with Program Secretarial Office participation, an aviation safety review of the safe operation of the Department`s helicopter program. The Aviation Safety Review Team comprised of aviation experts from the US Army, the Federal Aviation Administration, private consulting organizations, and Department of Energy (DOE) staff was assembled. The scope of the Aviation Safety Review Team`s appraisals included the following as applicable: policy; operations; maintenance; crew training; previous appraisals; contract requirements; aviation safety analysis reports; refueling facilities and management; night vision goggle (NVG) operations; helicopter limited standdown initiative; Secretary of Energy Notice (SEN) -6D-91 Compliance; and, DOE/contractor organizational structures and responsibilities. The appraisals at each site included a review of aviation policy, manuals, procedures, facilities, and documentation pertaining to management, safety, operations, maintenance, and quality control.

  13. Report of the aviation safety review of Department of Energy helicopter operations

    Energy Technology Data Exchange (ETDEWEB)

    1992-02-01

    In a memorandum dated November 27, 1991, the Secretary of Energy directed the Office of Environment, Safety and Health (EH) to lead, with Program Secretarial Office participation, an aviation safety review of the safe operation of the Department's helicopter program. The Aviation Safety Review Team comprised of aviation experts from the US Army, the Federal Aviation Administration, private consulting organizations, and Department of Energy (DOE) staff was assembled. The scope of the Aviation Safety Review Team's appraisals included the following as applicable: policy; operations; maintenance; crew training; previous appraisals; contract requirements; aviation safety analysis reports; refueling facilities and management; night vision goggle (NVG) operations; helicopter limited standdown initiative; Secretary of Energy Notice (SEN) -6D-91 Compliance; and, DOE/contractor organizational structures and responsibilities. The appraisals at each site included a review of aviation policy, manuals, procedures, facilities, and documentation pertaining to management, safety, operations, maintenance, and quality control.

  14. Identification of Employee Performance Appraisal Methods in Agricultural Organizations

    Directory of Open Access Journals (Sweden)

    Venclova Katerina

    2013-06-01

    Full Text Available A formal employee performance appraisal is regarded as one of the tools of human resources performance management. People, their knowledge and skills are currently considered to be the most valuable resource a company has. The article focuses on methods of employee performance appraisal in agricultural organizations in the Czech Republic. The first part of the article deals with the theoretical background of the term “formal appraisal” and employee performance appraisal methods as defined by Czech and foreign specialists. Further, the article describes, based on a questionnaire survey, employee performance appraisal methods that are considered importantfor the agricultural organizations in the Czech Republic. The aim of the article is to identify the current state of formal employee appraisal in a sample group of agricultural organizationsand to test dependencies between selected qualitative characteristics. The outcomes show that the most commonly used methods of employee performance appraisal in agricultural organizations include predefined goal-based performance appraisal, predefined standard outcome-based performance appraisal and appraisal interviews. Agricultural organizations apply these methodsin particular due to the fact that their findings are further utilized in other areas of human resource management, such as reward system and personnel planning. In statistical terms, dependencybetween the method of employee performance appraisal according to predefined goals applied by agricultural organizations and personnel planning (an area of human resources managementhas been proven (p-value: 0.032, Phi coefficient: 4.578.

  15. Not so critical appraisal of dapagliflozin

    Directory of Open Access Journals (Sweden)

    Doggrell SA

    2014-08-01

    Full Text Available Sheila A Doggrell School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, QLD, AustraliaA recent review by Salvo et al published in Patient Preference and Adherence concerned dapagliflozin, and was titled “Patient considerations in the management of type 2 diabetes – critical appraisal of dapagliflozin”.1 Having read the article, I do not consider it to be a critical appraisal of dapagliflozin. Thus, after comparing dapagliflozin with other oral antidiabetic medications, the authors concluded that “Dapagliflozin’s noted blood pressure reduction, weight loss, and low potential to cause hypoglycemia are advantageous, when compared with currently available oral medications”.1 This statement is not supported by the content of the review and/or the literature. Read the original article 

  16. An Appraisal of Coupled Climate Model Simulations

    Energy Technology Data Exchange (ETDEWEB)

    Sperber, K; Gleckler, P; Covey, C; Taylor, K; Bader, D; Phillips, T; Fiorino, M; Achutarao, K

    2004-02-24

    In 2002, the Program for Climate Model Diagnosis and Intercomparison (PCMDI) proposed the concept for a state-of-the-science appraisal of climate models to be performed approximately every two years. Motivation for this idea arose from the perceived needs of the international modeling groups and the broader climate research community to document progress more frequently than provided by the Intergovernmental Panel on Climate Change (IPCC) Assessment Reports. A committee of external reviewers, which included senior researchers from four leading international modeling centers, supported the concept by stating in its review: ''The panel enthusiastically endorses the suggestion that PCMDI develop an independent appraisal of coupled model performance every 2-3 years. This would provide a useful 'mid-course' evaluation of modeling progress in the context of larger IPCC and national assessment activities, and should include both coupled and single-component model evaluations.''

  17. Performance appraisal and advancement exercise 2006

    CERN Multimedia

    Human Resources Department

    2005-01-01

    The 2006 performance appraisal and advancement exercise will start in the usual way with annual interviews between staff and their supervisors. This year, these interviews should be held in the period from 1 December 2005 to 31 March 2006. In this connection, a number of improvements to the procedures relating to the interviews and performance appraisal are currently under study. Administrative Circular No 26 (Procedures governing the Career Development of Staff Members) and the electronic MAPS form in EDH are being reviewed and will be available from December onwards. In the meantime supervisors can start the interview procedure. HR Department will shortly provide further information on this subject. The 2005 MAPS report can be retrieved for consultation at any time via EDH. Human Resources Department Tel. 73566

  18. Performance appraisal and advancement exercise 2006 (Rev)

    CERN Multimedia

    Human Resources Department

    2005-01-01

    The 2006 performance appraisal and advancement exercise will start in the usual way with annual interviews between staff and their supervisors. This year, these interviews should be held in the period from 1 December 2005 to 15 March 2006*. In this connection, a number of improvements to the procedures relating to the interviews and performance appraisals are currently under study. Administrative Circular No. 26 (Procedures Governing the Career Development of Staff Members) and the electronic MAPS form in EDH are being reviewed and will be available from December onwards. In the meantime supervisors can start the interview procedure. HR Department will shortly provide further information on this subject. The 2005 MAPS report can be retrieved for consultation at any time via EDH. * Instead of 31 March, as indicated in the electronic Bulletin No. 47 of 21 November 2005 Human Resources Department Tel. 73566

  19. Critical appraisal of mixed methods studies

    OpenAIRE

    Heyvaert, Mieke; Hannes, Karin; Maes, Bea; Onghena, Patrick

    2013-01-01

    In several subdomains of the social, behavioral, health, and human sciences, research questions are increasingly answered through mixed methods studies, combining qualitative and quantitative evidence and research elements. Accordingly, the importance of including those primary mixed methods research articles in systematic reviews grows. It is generally known that the critical appraisal of articles is an essential step in the development of a methodologically sound review. This article provid...

  20. Appraisal of emotions in media use

    OpenAIRE

    Bartsch, Anne; Vorderer, Peter; Mangold, Roland; Reinhold, Viehoff

    2008-01-01

    Over the past 20 years, research on meta-emotion and related concepts such as meta-mood and need for affect has become fruitful and prominent across a variety of disciplines, including media psychology. This paper reviews the literature on meta-emotion and considers problems regarding the definition and operationalization of this construct. We propose a process model of meta-emotion and emotion regulation to integrate and extend existing work. Drawing on appraisal theories of emotion, we unde...

  1. Image Based Appraisal of Real Estate Properties

    OpenAIRE

    You, Quanzeng; Pang, Ran; Luo, Jiebo

    2016-01-01

    Real estate appraisal, which is the process of estimating the price for real estate properties, is crucial for both buys and sellers as the basis for negotiation and transaction. Traditionally, the repeat sales model has been widely adopted to estimate real estate price. However, it depends the design and calculation of a complex economic related index, which is challenging to estimate accurately. Today, real estate brokers provide easy access to detailed online information on real estate pro...

  2. Appraisals, Burnout and Outcomes in Informal Caregiving

    Directory of Open Access Journals (Sweden)

    Haejung Lee, PhD, RN

    2010-03-01

    Conclusion: The proposed model and results highlight the significance and potential for utilizing a process approach for understanding the link between appraisals and outcomes for informal caregivers. More importantly, the proposed model suggests that attention must be paid toward burnout tendencies to reveal fruitful intervention directions for researchers and practitioners to enhance the positive outcomes of informal caregivers, and maintain their psychological and physical well-being.

  3. The performance appraisal as a developmental tool.

    Science.gov (United States)

    Schoessler, Mary Theresa; Aneshansley, Pamela; Baffaro, Carrie; Castellano, Terri; Goins, Lindi; Largaespada, Elena; Payne, Raushanah; Stinson, Darlene

    2008-01-01

    This article describes the key components and outcomes of a performance appraisal tool designed to measure and support the development of registered nurses. The tool is organized by the domains of nursing and based on the novice-to-expert framework. Core competency statements reflect required nursing behaviors. Skill acquisition level descriptors support identification of individual's level of practice. Self-evaluation, developmental goals, and specific evaluator feedback help registered nurses focus their development.

  4. Vaccine Safety

    Science.gov (United States)

    ... Vaccine Safety Shingles (Herpes Zoster) Vaccine Safety Smallpox Vaccine Safety Common Concerns Adjuvants Autism CDC Statement: 2004 Pediatrics Paper on MMR and Autism Fainting (Syncope) Febrile ...

  5. MASS APPRAISAL AND REAL ESTATE TAXATION

    Directory of Open Access Journals (Sweden)

    VORONIN V. О.

    2015-12-01

    Full Text Available Raising of problem. The government at the legislative level fixed the definition of market value for tax purposes as mandatory in the implementation of real estate transactions. In order to meet the requirements of objectivity, uniformity and consistency of the results obtained during the evaluation procedures, as well as minimize the influence of subjective factors, there is a need to develop a methodology for evaluating an automated procedure for determining the estimated value of the property based on its market value. To solve this problem, we use special techniques and methods of mass appraisal that incorporates computer-supported statistical analyses, such as multiple regression analysis and adaptive estimation procedure for use in the field of property valuation and property rights. Purpose. Realization of this goal involves the development of the concept of a computer-assisted mass appraisal. The basis of this concept is an adaptive hybrid models of market pricing in different market segments that incorporates software adaptive algorithms for determining the market value by the three evaluation approaches using the results of a multi-level real estate market analysis. It was proposed the utility automated valuation models which is intended for the implementation of a computerized real estate valuation based on the developed software adaptive algorithms. Con-clusion. To achieve this goal have been developed and used concepts underlying of computerized mass appraisal. The basis of this concept is adaptive hybrid pricing models in various segments of the real estate market of Ukraine. The problem is solved by the application of the developed software-based adaptive algorithms for determining the market value of three evaluation approaches using the results of a multi-level analysis of the real estate market. It was pro-posed the model of automated appraisal, according to it was implemented computerization of appraisal procedures on the

  6. Hurricane Safety

    Science.gov (United States)

    ... English Hurricane Safety Checklist - Arabic Hurricane Safety Checklist - Chinese Hurricane Safety Checklist - French Hurricane Safety Checklist - Haitian ... Cross serves in the US, its territories and military installations around the world. Please try again. Your ...

  7. Targeted imaging of α(v)β(3) expressing sarcoma tumor cells in vivo in pre-operative setting using near infrared: a potential tool to reduce incomplete surgical resection.

    Science.gov (United States)

    Dutour, Aurelie; Josserand, Veronique; Jury, Delphine; Guillermet, Stephanie; Decouvelaere, Anne Valerie; Chotel, Franck; Pointecouteau, Thomas; Rizo, Philippe; Coll, Jean Luc; Blay, Jean Yves

    2014-05-01

    Tumor size and location along with efficacy of pre-operative imaging are limiting factors for optimal surgical excision for osteosarcoma. Our general hypothesis is that targeting αvβ3 integrin-rich osteosarcoma neoangiogenesis should provide improved delivery of diagnostic compounds and assist surgeons intra operatively using near-infrared imaging techniques. We evaluated in an orthotopic metastatic osteosarcoma in rats the potential of AngioStamp™ targeting αvβ3 integrins and detected intra operatively by near infrared (NIR) illumination (Fluobeam™) as a novel, intra operative imaging technique. To determine the potential of this association in improving tumor and metastasis detection, we compared the quality and sensitivity of tumor/metastasis margin delineation and tumor resection using intra-operative NIR imaging to the ones guided by pre-operative imaging (i.e., MRI subsequently confirmed by histopathological analysis). Chemotherapy being essential in osteosarcoma treatment, we evaluated the capacity of AngioStamp™ to specifically localize to the tumor after chemotherapy treatment. We showed a significantly lesser extent of healthy tissue resection after surgical excision when assessing tumor margin intra operatively using AngioStamp™/Fluobeam™ association compared to pre-operative MRI post-operatively confirmed by histopathological analysis (plungs revealed more metastases than were detected by CT Scan or under intra-operative white light examination (plung metastasis excision. Based on these promising results, we now propose to evaluate this approach as a mean to improve surgical excision while maintaining tumor control in other sarcoma or tumors overexpressing αvβ3 integrins. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. A comparison of the effect of two doses of oral melatonin with oral midazolam and placebo on pre-operative anxiety, cognition and psychomotor function in children: A randomised double-blind study

    Science.gov (United States)

    Kurdi, Madhuri S; Muthukalai, Sindhu Priya

    2016-01-01

    Background and Aims: Melatonin (MT), a naturally occurring pituitary hormone has a sleep promoting effect. There are very few studies on pre-operative oral MT (0.2–0.5 mg/kg) in children. We planned a study to assess the efficacy of oral MT in two doses and compare it with oral midazolam and placebo for pre-operative anxiolysis, sedation, maintenance of cognition and psychomotor skills, parental separation behaviour and venepuncture compliance. Methods: This prospective double-blind randomised study was conducted after ethical committee approval on 100 children aged 5–15 years, American Society of Anaesthesiologists physical status I and II undergoing elective surgery at our hospital from January 1, 2014, to December 31, 2014. Mentally disordered children were excluded from the study. They were randomised into four groups of 25 each (A, B, C, D) to receive either oral MT 0.5 mg/kg or 0.75 mg/kg or oral midazolam 0.5 mg/kg or placebo 45–60 min, respectively, before induction. The child's anxiety, cognition and psychomotor function before and after pre-medication, behaviour during the parental separation and venepuncture were appropriately scored. Kruskal–Wallis analysis of variance for intergroup and Wilcoxon matched pairs tests for intragroup comparisons of data were applied. Results: The four groups were comparable regarding mean age, weight and sex. The anxiety score reductions in the three groups when compared to placebo were statistically significant. Children receiving MT 0.75 mg/kg had maximum anxiolysis and venepuncture compliance (P < 0.05). Cognition was decreased with maximum sedation, successful parental separation and psychomotor impairment in the midazolam group (P < 0.05). Conclusion: Oral MT (0.5 mg/kg and 0.75 mg/kg) in children decreases pre-operative anxiety without impairing cognitive and psychomotor functions, the 0.75 mg/kg dose being most effective.

  9. Non-rigid alignment of pre-operative MRI, fMRI, and DT-MRI with intra-operative MRI for enhanced visualization and navigation in image-guided neurosurgery.

    Science.gov (United States)

    Archip, Neculai; Clatz, Olivier; Whalen, Stephen; Kacher, Dan; Fedorov, Andriy; Kot, Andriy; Chrisochoides, Nikos; Jolesz, Ferenc; Golby, Alexandra; Black, Peter M; Warfield, Simon K

    2007-04-01

    The usefulness of neurosurgical navigation with current visualizations is seriously compromised by brain shift, which inevitably occurs during the course of the operation, significantly degrading the precise alignment between the pre-operative MR data and the intra-operative shape of the brain. Our objectives were (i) to evaluate the feasibility of non-rigid registration that compensates for the brain deformations within the time constraints imposed by neurosurgery, and (ii) to create augmented reality visualizations of critical structural and functional brain regions during neurosurgery using pre-operatively acquired fMRI and DT-MRI. Eleven consecutive patients with supratentorial gliomas were included in our study. All underwent surgery at our intra-operative MR imaging-guided therapy facility and have tumors in eloquent brain areas (e.g. precentral gyrus and cortico-spinal tract). Functional MRI and DT-MRI, together with MPRAGE and T2w structural MRI were acquired at 3 T prior to surgery. SPGR and T2w images were acquired with a 0.5 T magnet during each procedure. Quantitative assessment of the alignment accuracy was carried out and compared with current state-of-the-art systems based only on rigid registration. Alignment between pre-operative and intra-operative datasets was successfully carried out during surgery for all patients. Overall, the mean residual displacement remaining after non-rigid registration was 1.82 mm. There is a statistically significant improvement in alignment accuracy utilizing our non-rigid registration in comparison to the currently used technology (paugmented reality visualization to aid the surgeon.

  10. Ulipristal acetate for pre-operative treatment of moderate-to-severe uterine fibroids in women of reproductive age in The Netherlands: cost minimization analysis and budget impact analysis.

    Science.gov (United States)

    Zakiyah, N; van Asselt, A D I; Postma, M J

    2017-03-01

    Ulipristal acetate has been found to be non-inferior to other pre-operative treatments of uterine fibroids, particularly leuprolide. The objective of this study was to assess the pharmacoeconomic profile of ulipristal acetate compared to leuprolide for the pre-operative treatment of moderate-to-severe uterine fibroids in women of reproductive age in The Netherlands. The analysis was performed and applied within the framework of the ulipristal acetate submission for reimbursement in 2012. A decision model was developed to compare the total costs of ulipristal acetate compared to leuprolide, the standard care in The Netherlands. The target population of this study corresponded to the type of patients included in the PEARL II clinical trial; i.e. women of reproductive age requiring pre-operative treatment for uterine fibroids. Sensitivity analysis was implemented to assess uncertainties. Data regarding costs, effects, and other input parameters were obtained from relevant published literatures, the Dutch Healthcare Insurance Board, and expert opinion obtained by means of a panel of experts from several medical centers in The Netherlands. In The Netherlands, the total costs of ulipristal acetate and leuprolide were estimated at €4,216,027 and €4,218,095, respectively. The annual savings of ulipristal acetate were, therefore, estimated at €2,068. The major driver of this cost difference was the cost of administration for leuprolide. Sensitivity analyses showed that ulipristal acetate mostly remained cost-saving over a range of assumptions. The budget impact analysis indicated that the introduction of ulipristal acetate was estimated to result in cost savings in the first 3 years following the introduction. The results of this study were used in the decision on reimbursement of ulipristal acetate according to the Dutch Reference Pricing system in 2012. Ulipristal acetate was cost saving compared to leuprolide and has the potential to provide substantial savings on

  11. Geotechnical Appraisal of the Thar Open Cut\\ud Mining Project

    OpenAIRE

    R. N. SINGH; Pathan, A G; Reddish, D D J; ATKINS, Anthony

    2011-01-01

    This paper is concerned with a slope stability appraisal of the proposed open cut mining\\ud operations in the Thar lignite field in Sindh, Pakistan. The Thar coalfield covers an area of approximately\\ud 9 000 km2 and is estimated to contain 193 billion tonnes of lignite resources. The design of safe high wall\\ud slopes is necessary to ensure mine safety and overall economical viability of the mining operations. In the\\ud Thar lignite field, the presence of three main aquifers induces pore pre...

  12. 5 CFR 1330.405 - Procedures for certifying agency appraisal systems.

    Science.gov (United States)

    2010-01-01

    ... REGULATIONS WITH THE OFFICE OF PERSONNEL MANAGEMENT HUMAN RESOURCES MANAGEMENT Performance Appraisal... senior employees based on appraisals of their relative performance against performance expectations in any given appraisal period reflecting performance evaluation results that make meaningful...

  13. Safety Needs Mediate Stressful Events Induced Mental Disorders

    Science.gov (United States)

    Gu, Simeng; Lei, Yu; Lu, Shanshan

    2016-01-01

    Safety first,” we say these words almost every day, but we all take this for granted for what Maslow proposed in his famous theory of Hierarchy of Needs: safety needs come second to physiological needs. Here we propose that safety needs come before physiological needs. Safety needs are personal security, financial security, and health and well-being, which are more fundamental than physiological needs. Safety worrying is the major reason for mental disorders, such as anxiety, phobia, depression, and PTSD. The neural basis for safety is amygdala, LC/NE system, and corticotrophin-releasing hormone system, which can be regarded as a “safety circuitry,” whose major behavior function is “fight or flight” and “fear and anger” emotions. This is similar to the Appraisal theory for emotions: fear is due to the primary appraisal, which is related to safety of individual, while anger is due to secondary appraisal, which is related to coping with the unsafe situations. If coping is good, the individual will be happy; if coping failed, the individual will be sad or depressed. PMID:27738527

  14. Safety Needs Mediate Stressful Events Induced Mental Disorders

    Directory of Open Access Journals (Sweden)

    Zheng Zheng

    2016-01-01

    Full Text Available “Safety first,” we say these words almost every day, but we all take this for granted for what Maslow proposed in his famous theory of Hierarchy of Needs: safety needs come second to physiological needs. Here we propose that safety needs come before physiological needs. Safety needs are personal security, financial security, and health and well-being, which are more fundamental than physiological needs. Safety worrying is the major reason for mental disorders, such as anxiety, phobia, depression, and PTSD. The neural basis for safety is amygdala, LC/NE system, and corticotrophin-releasing hormone system, which can be regarded as a “safety circuitry,” whose major behavior function is “fight or flight” and “fear and anger” emotions. This is similar to the Appraisal theory for emotions: fear is due to the primary appraisal, which is related to safety of individual, while anger is due to secondary appraisal, which is related to coping with the unsafe situations. If coping is good, the individual will be happy; if coping failed, the individual will be sad or depressed.

  15. Safety Needs Mediate Stressful Events Induced Mental Disorders.

    Science.gov (United States)

    Zheng, Zheng; Gu, Simeng; Lei, Yu; Lu, Shanshan; Wang, Wei; Li, Yang; Wang, Fushun

    2016-01-01

    "Safety first," we say these words almost every day, but we all take this for granted for what Maslow proposed in his famous theory of Hierarchy of Needs: safety needs come second to physiological needs. Here we propose that safety needs come before physiological needs. Safety needs are personal security, financial security, and health and well-being, which are more fundamental than physiological needs. Safety worrying is the major reason for mental disorders, such as anxiety, phobia, depression, and PTSD. The neural basis for safety is amygdala, LC/NE system, and corticotrophin-releasing hormone system, which can be regarded as a "safety circuitry," whose major behavior function is "fight or flight" and "fear and anger" emotions. This is similar to the Appraisal theory for emotions: fear is due to the primary appraisal, which is related to safety of individual, while anger is due to secondary appraisal, which is related to coping with the unsafe situations. If coping is good, the individual will be happy; if coping failed, the individual will be sad or depressed.

  16. Effects of personal relevance and simulated darkness on the affective appraisal of a virtual environment.

    Science.gov (United States)

    Toet, Alexander; Houtkamp, Joske M; Vreugdenhil, Paul E

    2016-01-01

    This study investigated whether personal relevance influences the affective appraisal of a desktop virtual environment (VE) in simulated darkness. In the real world, darkness often evokes thoughts of vulnerability, threat, and danger, and may automatically precipitate emotional responses consonant with those thoughts (fear of darkness). This influences the affective appraisal of a given environment after dark and the way humans behave in that environment in conditions of low lighting. Desktop VEs are increasingly deployed to study the effects of environmental qualities and (architectural or lighting) interventions on human behaviour and feelings of safety. Their (ecological) validity for these purposes depends critically on their ability to correctly address the user's cognitive and affective experience. Previous studies with desktop (i.e., non-immersive) VEs found that simulated darkness only slightly affects the user's behavioral and emotional responses to the represented environment, in contrast to the responses observed for immersive VEs. We hypothesize that the desktop VE scenarios used in previous studies less effectively induced emotional and behavioral responses because they lacked personal relevance. In addition, factors like signs of social presence and relatively high levels of ambient lighting may also have limited these responses. In this study, young female volunteers explored either a daytime or a night-time (low ambient light level) version of a desktop VE representing a deserted (no social presence) prototypical Dutch polder landscape. To enhance the personal relevance of the simulation, a fraction of the participants were led to believe that the virtual exploration tour would prepare them for a follow-up tour through the real world counterpart of the VE. The affective appraisal of the VE and the emotional response of the participants were measured through self-report. The results show that the VE was appraised as slightly less pleasant and more

  17. Effects of personal relevance and simulated darkness on the affective appraisal of a virtual environment

    Directory of Open Access Journals (Sweden)

    Alexander Toet

    2016-02-01

    Full Text Available This study investigated whether personal relevance influences the affective appraisal of a desktop virtual environment (VE in simulated darkness. In the real world, darkness often evokes thoughts of vulnerability, threat, and danger, and may automatically precipitate emotional responses consonant with those thoughts (fear of darkness. This influences the affective appraisal of a given environment after dark and the way humans behave in that environment in conditions of low lighting. Desktop VEs are increasingly deployed to study the effects of environmental qualities and (architectural or lighting interventions on human behaviour and feelings of safety. Their (ecological validity for these purposes depends critically on their ability to correctly address the user’s cognitive and affective experience. Previous studies with desktop (i.e., non-immersive VEs found that simulated darkness only slightly affects the user’s behavioral and emotional responses to the represented environment, in contrast to the responses observed for immersive VEs. We hypothesize that the desktop VE scenarios used in previous studies less effectively induced emotional and behavioral responses because they lacked personal relevance. In addition, factors like signs of social presence and relatively high levels of ambient lighting may also have limited these responses. In this study, young female volunteers explored either a daytime or a night-time (low ambient light level version of a desktop VE representing a deserted (no social presence prototypical Dutch polder landscape. To enhance the personal relevance of the simulation, a fraction of the participants were led to believe that the virtual exploration tour would prepare them for a follow-up tour through the real world counterpart of the VE. The affective appraisal of the VE and the emotional response of the participants were measured through self-report. The results show that the VE was appraised as slightly less

  18. 12 CFR 225.63 - Appraisals required; transactions requiring a State certified or licensed appraiser.

    Science.gov (United States)

    2010-01-01

    ...) The transaction involves underwriting or dealing in mortgage-backed securities; or (13) The Board... mortgaged-backed securities, and each loan or interest in a loan, pooled loan, or real property interest met... in which the appraisal conforms to the Federal National Mortgage Association or Federal Home Loan...

  19. Performance appraisal & promotion process: A measured approach

    Science.gov (United States)

    Kumar, Jitendra

    2012-06-01

    Most of the companies have yearly performance appraisal process for their employees. This process involves rating of employees by their manager. And Companies rely purely on managerís state of thinking and perception. Humans have tendency to become biased, corrupt, give favor to some employees whom they like. This favor is due to some other reasons e.g. personal reason, social reason, political reason, flattering. All these reasons are not related to the work that the employee is doing for the organization.

  20. Discounting in intergenerational investment appraisal - Survey results

    Directory of Open Access Journals (Sweden)

    Monika Foltyn-Zarychta

    2014-04-01

    Full Text Available Appraising projects with intergenerational effects is a complex task, incorporating the issue of bringing future impacts to present value. This is usually achieved by applying the discount factor. However, the choice of discount rate to intergenerational context faces multiple technical and moral problems. The paper analyses a theoretical rationale behind the concept of intergenerational discount rate and preliminary assessment of intergenerational discount rate level in Poland based on survey done in 2012 among Finance & Insurance Faculty students at University of Economics in Katowice showing the decline in the value of discount rates with time.

  1. Performance appraisal and advancement exercise 2005

    CERN Multimedia

    Human Resources Department

    2004-01-01

    The 2005 performance appraisal and advancement exercise will start in the usual way with annual interviews between staff and their supervisors. These interviews should be held in the period from 15 November 2004 to 15 February 2005 [see Administrative Circular No 26 (Rev. 5) Annex II, § 3. For this exercise, the paper MAPS form has been replaced by an electronic form in the EDH system, which is available via EDH (on the EDH desktop under Other Tasks / HR & Training) No changes have been made to the contents of the form. HR Department will shortly provide further information on this subject. Human Resources Department Tel. 73566

  2. Tonalization and appraisal theories: two complementary visions

    OpenAIRE

    Pardo, María Laura

    2010-01-01

    The purpose of this study is to analyse two theories: 1.the “tonalization” theory (Lavandera, 1986, Pardo, 1996) and 2. the appraisal theory (Iedema et al, 1994, Martin 2000 and White 2003). Both explore phenomena of the so-called “evaluation”, “appreciation” or “tonalization.” In order to compare both theories an example is analyzed and differences and similarities are pointed out which also imply different cultural perspectives, as one comes from the West and the other from the East....

  3. BOOK APPRAISAL: HISTORY OF DENTISTRY IN NIGERIA.

    Science.gov (United States)

    Michael, O S

    2016-06-01

    The book appraised in this edition of Chronicles of Medical History, History of Dentistry in Nigeria, is a product of many years of painstaking research. The Author, Professor Eyitope Ogunbodede, has put together an excellent book that is a great work of art. Dentistry is one of the first specialties in medicine with a very long history; evidence of periodontal disease has been traced back to at least 100, 000 years in human remains. However, the book by Professor Ogunbodede is the first comprehensive record of the History of dentistry in Nigeria. It is a must-read for every medical professional practicing in Nigeria and a worthy addition to every library.

  4. Portfolio Assessment as an Alternate Appraisal Method: A Faculty Perspective

    Science.gov (United States)

    Clements, Kimberly D.; McArdle, Geri; Cole, Ann F.

    2005-01-01

    Performance appraisal continues to be an area of research within Human Resource Development. This case study explores the impact of promotion portfolios upon the performance and professional development of university professors. Specific themes from data analysis indicated that portfolios are viewed as a performance appraisal measure/learning tool…

  5. ORIGINAL Is the Role of Teacher Performance Appraisal in Ethiopia ...

    African Journals Online (AJOL)

    Teachers, school administrative committee, students, and parents were participants of the study. ... *Associate Professor, Department of Psychology, Bahir Dar University, ... secondary purpose of motivating employees. When a performance appraisal links the ...... Appraisers focus on the behavior of teaching just before the ...

  6. Teacher Emotion Management in the Classroom: Appraisal, Regulation, and Coping

    Science.gov (United States)

    Chang, Mei-Lin

    2009-01-01

    Compared with other professions, teachers in P-12 schools seem to experience the highest level of emotional exhaustion. The purpose of this study was to examine teacher emotions within the context of teachers' appraisals and the ways they regulate and cope with their emotions. This was done by exploring novice teachers' appraisals of classroom…

  7. 9 CFR 52.3 - Appraisal of swine.

    Science.gov (United States)

    2010-01-01

    ... COOPERATIVE CONTROL AND ERADICATION OF LIVESTOCK OR POULTRY DISEASES SWINE DESTROYED BECAUSE OF PSEUDORABIES § 52.3 Appraisal of swine. (a) Herds of swine and individual breeding sows to be destroyed because they... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Appraisal of swine. 52.3 Section 52.3...

  8. Appraisal patterns of emotions in human-product interaction

    NARCIS (Netherlands)

    Demir, E.; Desmet, P.M.A.; Hekkert, P.

    2009-01-01

    Emotional design, i.e., designing with an intention to evoke or to prevent a particular emotion, can be facilitated by understanding the processes underlying emotions. A promising approach to understanding these processes in the current psychological literature is appraisal theory. Appraisal theory

  9. Real Estate Appraising. A Suggested Adult Education Course.

    Science.gov (United States)

    New York State Education Dept., Albany. Bureau of Continuing Education Curriculum Development.

    Developed to assist teachers of classes in real estate appraisal and to help students prepare for professional qualification, this guide presents 12 lessons which may be taught in 15 two-hour sessions. The twelve lessons are (1) The Appraisal of Real Estate, (2) Real Property Value, (3) Basic Principles of Real Property Value, (4) The Appraisal…

  10. New Perspectives Concerning Performance Appraisals of Intercollegiate Coaches

    Science.gov (United States)

    Cunningham, George B.; Dixon, Marlene A.

    2003-01-01

    Despite advances in the study of performance appraisals within the intercollegiate athletic context, there are several limitations to the extant research. Specifically, this literature does not take into account the multi-level nature of organizations and performance appraisals or the reciprocal interdependence of coaching staffs. In considering…

  11. Performance Appraisal: An Obstacle to Training and Development?

    Science.gov (United States)

    Wilson, John P.; Western, Steven

    2001-01-01

    Surveys and interviews of 39 hospital staff uncovered mixed attitudes about preparation for performance appraisal and the process for formulating and implementing training and development plans, reflecting varying degrees of motivation, involvement, and commitment. Recommendations for improving appraisal and the training associated with it were…

  12. Teacher Performance Appraisal: More about Performance or Development?

    Science.gov (United States)

    Elliott, Kerry

    2015-01-01

    Given that "teacher appraisal can be a key lever for increasing the focus on teaching quality" (OECD, 2013b, p.9) and that many reforms in the past have failed (Kleinhenz & Ingvarson, 2004), an understanding of the various aspects of successful performance appraisal is essential. The literature has begun to refer to a number of…

  13. 32 CFR 644.47 - Appraisal of other interests.

    Science.gov (United States)

    2010-07-01

    ... classified in the appraisal according to species, type, range of size, quantity, unit value, and total value... value of fee title. (vi) Estimate of annual rental value assuming unrestricted use over a reasonable... cases, the value of the subsurface will be included or accounted for in the appraisal report in such...

  14. Alienation Appraisals Distinguish Adults Diagnosed With DID From PTSD

    NARCIS (Netherlands)

    DePrince, Anne P.; Huntjens, Rafaële J.C.; Dorahy, Martin J.

    2015-01-01

    Studies are beginning to show the importance of appraisals to different types and severities of psychiatric disorders. Yet, little work in this area has assessed whether trauma-related appraisals can differentiate complex trauma-related disorders, such as posttraumatic stress disorder (PTSD) and

  15. Appraisal patterns of emotions in human-product interaction

    NARCIS (Netherlands)

    Demir, E.; Desmet, P.M.A.; Hekkert, P.

    2009-01-01

    Emotional design, i.e., designing with an intention to evoke or to prevent a particular emotion, can be facilitated by understanding the processes underlying emotions. A promising approach to understanding these processes in the current psychological literature is appraisal theory. Appraisal theory

  16. A Composite Model for Employees' Performance Appraisal and Improvement

    Science.gov (United States)

    Manoharan, T. R.; Muralidharan, C.; Deshmukh, S. G.

    2012-01-01

    Purpose: The purpose of this paper is to develop an innovative method of performance appraisal that will be useful for designing a structured training programme. Design/methodology/approach: Employees' performance appraisals are conducted using new approaches, namely data envelopment analysis and an integrated fuzzy model. Interpretive structural…

  17. A systematic review of the content of critical appraisal tools

    Directory of Open Access Journals (Sweden)

    Kumar VS Saravana

    2004-09-01

    Full Text Available Abstract Background Consumers of research (researchers, administrators, educators and clinicians frequently use standard critical appraisal tools to evaluate the quality of published research reports. However, there is no consensus regarding the most appropriate critical appraisal tool for allied health research. We summarized the content, intent, construction and psychometric properties of published, currently available critical appraisal tools to identify common elements and their relevance to allied health research. Methods A systematic review was undertaken of 121 published critical appraisal tools sourced from 108 papers located on electronic databases and the Internet. The tools were classified according to the study design for which they were intended. Their items were then classified into one of 12 criteria based on their intent. Commonly occurring items were identified. The empirical basis for construction of the tool, the method by which overall quality of the study was established, the psychometric properties of the critical appraisal tools and whether guidelines were provided for their use were also recorded. Results Eighty-seven percent of critical appraisal tools were specific to a research design, with most tools having been developed for experimental studies. There was considerable variability in items contained in the critical appraisal tools. Twelve percent of available tools were developed using specified empirical research. Forty-nine percent of the critical appraisal tools summarized the quality appraisal into a numeric summary score. Few critical appraisal tools had documented evidence of validity of their items, or reliability of use. Guidelines regarding administration of the tools were provided in 43% of cases. Conclusions There was considerable variability in intent, components, construction and psychometric properties of published critical appraisal tools for research reports. There is no "gold standard' critical

  18. Appraising digital records for long-term preservation

    Directory of Open Access Journals (Sweden)

    Terry Eastwood

    2006-01-01

    Full Text Available This paper aims to extract lessons from archivists' experience of appraising electronic records that are likely to have wider application in the preservation of other digital materials, including scientific data. It relies mainly on the work of the Appraisal Task Force of the InterPARES project on long-term preservation of authentic electronic records to develop a picture of the process of appraisal. It concludes that the aspects of assessment of authenticity, determination of the feasibility of preservation, and monitoring electronic records as they are maintained in the live environment are likely to find counterparts in attempts to appraise digital objects for long-term preservation in the scientific community. It also argues that the activities performed during appraisal constitute the first vital step in the process of preservation of digital materials.

  19. Precompetitive achievement goals, stress appraisals, emotions, and coping among athletes.

    Science.gov (United States)

    Nicholls, Adam R; Perry, John L; Calmeiro, Luis

    2014-10-01

    Grounded in Lazarus's (1991, 1999, 2000) cognitive-motivational-relational theory of emotions, we tested a model of achievement goals, stress appraisals, emotions, and coping. We predicted that precompetitive achievement goals would be associated with appraisals, appraisals with emotions, and emotions with coping in our model. The mediating effects of emotions among the overall sample of 827 athletes and two stratified random subsamples were also explored. The results of this study support our proposed model in the overall sample and the stratified subsamples. Further, emotion mediated the relationship between appraisal and coping. Mediation analyses revealed that there were indirect effects of pleasant and unpleasant emotions, which indicates the importance of examining multiple emotions to reveal a more accurate representation of the overall stress process. Our findings indicate that both appraisals and emotions are just as important in shaping coping.

  20. How to appraise a diagnostic test.

    Science.gov (United States)

    Manikandan, Ramanitharan; Dorairajan, Lalgudi N

    2011-10-01

    Urologists frequently encounter problems in making a clinical diagnosis whose resolution requires the use of diagnostic tests. With an ever increasing choice of investigations being available, the urologist often has to decide which diagnostic test(s) will best resolve the patient's diagnostic problem. In this article, we aim to help the urologist understand how to critically appraise studies on diagnostic tests and make a rational choice. This article presents the guiding principles in scientifically assessing studies on diagnostic tests by proposing a clinical scenario. The authors describe a standardized protocol to assess the validity of the test and its relevance to the clinical problem that can help the urologist in decision making. The three important issues to be considered when evaluating the validity of the study are to identify how the study population was chosen, how the test was performed and whether there is a comparison to the gold standard test so as to confirm or refute the diagnosis. Then, the urologist would need to know the probability of the test in providing the correct diagnosis in an individual patient in order to decide about its utility in solving the diagnostic dilemma. By performing the steps described in this article, the urologist would be able to critically appraise diagnostic studies and draw meaningful conclusions about the investigations in terms of validity, results and its applicability to the patient's problem. This would provide a scientific basis for using diagnostic tests for improving patient care.

  1. Is Intravenous Thrombolysis Safe and Effective in Central Retinal Artery Occlusion? A Critically Appraised Topic.

    Science.gov (United States)

    Dumitrascu, Oana M; Shen, Joanne F; Kurli, Madhavi; Aguilar, Maria I; Marks, Lisa A; Demaerschalk, Bart M; Wingerchuk, Dean M; O'Carroll, Cumara B

    2017-07-01

    Central retinal artery occlusion (CRAO) is a neurological and ophthalmologic emergency associated with poor visual recovery. There is a dilemma regarding the appropriate treatment, as formal guidelines are lacking. Despite being considered an ocular equivalent of cerebral infarction, the time window of intravenous (IV) thrombolysis administration for maximum efficacy and safety in CRAO remains uncertain. To critically assess the current evidence regarding the safety and effectiveness of IV thrombolysis in the treatment of patients with CRAO. The objective was addressed through the development of a critically appraised topic that included a clinical scenario, structured question, literature search strategy, critical appraisal, assessment of results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, and content experts in the fields of vascular neurology and ophthalmology. A recent patient-level meta-analysis was selected for critical appraisal. The study compared the visual recovery rates after IV thrombolysis in CRAO against the natural history of this illness and conservative therapies (ocular massage, anterior chamber paracentesis, and/or hemodilution). Time to thrombolytic therapy administration had a significant impact on visual recovery in CRAO (PIV thrombolysis within the first 4.5 hours after symptom onset resulted in recovery of vision in 50.0% of the patients [95% confidence interval (CI), 32.4%-67.6%]. The rate of visual recovery was nearly 3 times higher than in the natural history cohort [odds ratio, 4.7 (95% CI, 2.3-9.6); PIV thrombolysis in CRAO seems to be safe and effective within the first 4.5 hours of symptom onset. A clinical decision based on this meta-analysis alone cannot be made due to several limitations. A randomized controlled clinical trial of early IV alteplase administration in CRAO is necessary to provide evidence-based therapeutic guidance.

  2. Physics of reactor safety. Volume II. Quarterly report, April-June 1980

    Energy Technology Data Exchange (ETDEWEB)

    1980-08-01

    The work in the Applied Physics Division includes reports on reactor safety modeling and assessment by members of the Reactor Safety Appraisals Section. Work on reactor core thermal-hydraulics is performed in ANL's Components Technology Division, emphasizing 3-dimensional code development for LMFBR accidents under natural convection conditions.

  3. Potential methods and approaches to assess social impacts associated with food safety issues

    NARCIS (Netherlands)

    Cope, S.F.; Frewer, L.J.; Renn, R.; Dreyer, M.

    2010-01-01

    There is evidence to suggest that consumer confidence in the European food safety has declined in recent years. Consequently, the need to integrate multifaceted dimensions into food safety governance has been recognised, although a lack of established methodologies to appraise wider social impacts r

  4. The effectiveness of health appraisal processes currently in addressing health and wellbeing during spatial plan appraisal: a systematic review

    Directory of Open Access Journals (Sweden)

    Gray Selena

    2011-11-01

    Full Text Available Abstract Background Spatial planning affects the built environment, which in turn has the potential to have a significant impact on health, for good or ill. One way of ensuring that spatial plans take due account of health is through the inclusion of health considerations in the statutory and non statutory appraisal processes linked to plan-making processes. Methods A systematic review to identify evaluation studies of appraisals or assessments of plans where health issues were considered from 1987 to 2010. Results A total of 6161 citations were identified: 6069 from electronic databases, 57 fromwebsite searches, with a further 35 citations from grey literature, of which 20 met the inclusion criteria. These 20 citations reported on a total of 135 different case studies: 11 UK HIA; 11 non UK high income countries HIA, 5 UK SEA or other integrated appraisal; 108 non UK high income SEA or other integrated appraisal. All studies were in English. No relevant studies were identified reporting on low or middle income countries. The studies were limited by potential bias (no independent evaluation, with those undertaking the appraisal also responsible for reporting outcomes, lack of detail and a lack of triangulation of results. Health impact assessments generally covered the four specified health domains (physical activity, mental health and wellbeing, environmental health issues such as pollution and noise, injury more comprehensively than SEA or other integrated appraisals, although mental health and wellbeing was an underdeveloped area. There was no evidence available on the incorporation of health in Sustainability Appraisal, limited evidence that the recommendations from any type of appraisal were implemented, and almost no evidence that the recommendations had led to the anticipated outcomes or improvements in health postulated. Conclusion Research is needed to assess (i the degree to which statutory plan appraisal processes (SA in the UK

  5. Safety culture

    Energy Technology Data Exchange (ETDEWEB)

    Keen, L.J. [Canadian Nuclear Safety Commission, Ottawa, Ontario (Canada)

    2003-07-01

    Safety culture has become a topic of increasing interest for industry and regulators as issues are raised on safety problems around the world. The keys to safety culture are organizational effectiveness, effective communications, organizational learning, and a culture that encourages the identification and resolution of safety issues. The necessity of a strong safety culture places an onus on all of us to continually question whether the safety measures already in place are sufficient, and are being applied. (author)

  6. A rapid appraisal method for reviewing the effectiveness of workplace smoking policies in large and medium sized organisations.

    Science.gov (United States)

    Harvey, H D; Fleming, P; Patterson, M

    2001-03-01

    Workplace smoking policies have been developed in response to growing scientific evidence about the harmful effects of environmental tobacco smoke (ETS), increasing opposition from non-smokers, concern over escalating costs of health damage and productivity losses, and the emergence of relevant laws and codes of good practice. Much has been written on the development and implementation of workplace smoking policies, but little about their evaluation. This paper describes a rapid appraisal method for the evaluation of workplace smoking policies. The four-stage process involves rapid, focused consultation with policy makers in the workplace, appropriate risk assessment, rapid consultation with those affected by the policy and focused feedback of results for planning and ongoing monitoring. In the pilot site the existing health and safety committee members were effective informants for the identification of key issues in smoking policy. The risk assessment phase was incorporated into the main appraisal which involved a canvass of staff and others on ETS issues identified by the informants. In the final stage of the process the health and safety committee proved to be both responsive to identified need, and proactive in facilitating ongoing review of the smoking policy. It therefore proved possible to develop the rapid appraisal process for administration in a limited time frame, three months for the whole process, with the rapid canvass element being achieved within one week.

  7. Performance Appraisal-Management by Objective and Assessment Centre

    Directory of Open Access Journals (Sweden)

    Kai-Ping Huang

    2011-01-01

    Full Text Available Problem statement: Two methods for performance appraisal that are discussed in this study and they are Management By Objective (MBO and Assessment Centre techniques. Employees are appraised for several reasons, the most important of which is to realize the best use of human resources and to plan for future needs; reward and punishment are secondary. Assessment Centre evaluation or appraisal is valuable because it allows a candidate to concentrate on the task at hand. Approach: The literature review and arguments were conducted to provide a systematic discussion of the study. Results: In Management by Objective performance appraisal, employees are obliged to deal with overcoming empirical challenges. In Assessment Centre Appraisal, the different outcomes for particular tasks can be evaluated and management can assess employees relative proficiencies in terms of these tasks. In both forms, consistency in criteria is crucial, for purposes of comparison and standardization. Where comparisons are made with other employees, the criteria need to be parallel for employees at similar levels of responsibility. Conclusion: Differences between organizational cultures will impact on the way that assessment results are received under MBO performance appraisal as well. The outcomes that employees achieve in the tasks provided for appraisal purposes may involve different levels of risk, even within firm guidelines. In the assessment centre, the candidate is separated from colleagues. To make comparative rating assessments, effective MBO will incorporate objective criteria. At times, MBO will be useful in judging change over time for employees performing fairly routine work.

  8. Employees' perceptions of justice in performance appraisals.

    Science.gov (United States)

    Vasset, Frøydis; Marnburg, Einar; Furunes, Trude

    2010-05-01

    Of all the tasks undertaken by human resource managers, performance appraisals (PAs) are one of the most unpopular among employees (Meyer 1991, Murphy and Cleveland 1995, Holbrook 2002, Jackman and Strober 2003). As PA guides and plans show (Fletcher 2004, CatalystOne 2010), PAs can be implemented in similar ways in organisations throughout Europe and developed countries elsewhere. But, if employees perceive PA processes as unfair, they may reject the usefulness and validity of the information they receive and so may not be motivated to change behaviour. This article concerns perceptions of organisational justice and explains the results of a study of perceived fairness in PAs among nurses and auxiliary nurses in Norway's municipal health service.

  9. Photographic appraisal of crystal lattice growth technique

    Directory of Open Access Journals (Sweden)

    Kapoor D

    2005-01-01

    Full Text Available Concept of creating mechanical retention for bonding through crystal growth has been successfully achieved in the present study. By using polyacrylic acid, sulphated with sulphuric acid as etchant, abundant crystal growth was demonstrated. Keeping in view the obvious benefits of crystal growth technique, the present SEM study was aimed to observe and compare the changes brought about by different etching agents (phosphoric acid, polyacrylic acid and polyacrylic acid sulphated and to evaluate their advantages and disadvantages in an attempt to reduce iatrogenic trauma caused due to surface enamel alteration. Control and experimental groups were made of 24 and 30 premolars, respectively, for scanning electron microscopic appraisal of normal unetched and etched enamel surface and fracture site and finished surface evaluation. When compared with conventional phosphoric acid and weaker polyacrylic acid, investigations indicated that crystal growth treatment on enamel surface caused minimal iatrogenic trauma and surface alteration were restored to the original untreated condition to a large extent.

  10. Nailfold capillaroscopy microscopy - an interdisciplinary appraisal.

    Science.gov (United States)

    Klein-Weigel, Peter Franz; Sunderkötter, Cord; Sander, Oliver

    2016-09-01

    Nailfold capillaroscopy is a method of great diagnostic value in the differential diagnosis of primary versus secondary Raynaud´s phenomenon, of systemic sclerosis versus other so called connective tissue diseases and of additional diagnostic value in other entities. Rheumatologists, dermatologists, and angiologists in Germany have convened in an interdisciplinary working group in which they synergistically combined their expertise to develop a common nomenclature and standards for the technical performance of nailfold capillary microscopy. The article gives an overview of historical and technical aspects of capillaroscopy, morphologic findings, and disease-specific patterns. It also provides a critical appraisal of its significance in the diagnosis and sequelae of these interdisciplinarily-managed diseases including its performance in children and gives an excursion in the potential perspectives of capillaroscopy in less common indications.

  11. 78 FR 54465 - Appraisal Subcommittee of the Federal Financial Institutions Examination Council; Notice of Meeting

    Science.gov (United States)

    2013-09-04

    ... State Grant Policy FY14 Appraisal Foundation and State Grant Recommendation FY14 ASC Budget April 2013 Appraisal Foundation Grant Reimbursement Report on the Maine Real Estate Appraisal Program How To Attend and... INSTITUTIONS EXAMINATION COUNCIL Appraisal Subcommittee of the Federal Financial Institutions...

  12. A psychometric appraisal of the DREEM

    LENUS (Irish Health Repository)

    Hammond, Sean M

    2012-01-12

    Abstract Background The quality of the Educational environment is a key determinant of a student centred curriculum. Evaluation of the educational environment is an important component of programme appraisal. In order to conduct such evaluation use of a comprehensive, valid and reliable instrument is essential. One of most widely used contemporary tools for evaluation of the learning environment is the Dundee Ready Education Environment Measure (DREEM). Apart from the initial psychometric evaluation of the DREEM, few published studies report its psychometric properties in detail. The aim of this study was to examine the psychometric quality of the DREEM measure in the context of medical education in Ireland and to explore the construct validity of the device. Methods 239 final year medical students were asked to complete the DREEM inventory. Anonymised responses were entered into a database. Data analysis was performed using PASW 18 and confirmatory factor analysis performed. Results Whilst the total DREEM score had an acceptable level of internal consistency (alpha 0.89), subscale analysis shows that two subscales had sub-optimal internal consistency. Multiple group confirmatory factor analysis (using Fleming\\'s indices) shows an overall fit of 0.76, representing a weak but acceptable level of fit. 17 of the 50 items manifest fit indices less than 0.70. We sought the best fitting oblique solution to the 5-subscale structure, which showed large correlations, suggesting that the independence of the separate scales is open to question. Conclusions There has perhaps been an inadequate focus on establishing and maintaining the psychometric credentials of the DREEM. The present study highlights two concerns. Firstly, the internal consistency of the 5 scales is quite variable and, in our sample, appears rather low. Secondly, the construct validity is not well supported. We suggest that users of the DREEM will provide basic psychometric appraisal of the device in future

  13. A psychometric appraisal of the DREEM

    Directory of Open Access Journals (Sweden)

    Hammond Sean M

    2012-01-01

    Full Text Available Abstract Background The quality of the Educational environment is a key determinant of a student centred curriculum. Evaluation of the educational environment is an important component of programme appraisal. In order to conduct such evaluation use of a comprehensive, valid and reliable instrument is essential. One of most widely used contemporary tools for evaluation of the learning environment is the Dundee Ready Education Environment Measure (DREEM. Apart from the initial psychometric evaluation of the DREEM, few published studies report its psychometric properties in detail. The aim of this study was to examine the psychometric quality of the DREEM measure in the context of medical education in Ireland and to explore the construct validity of the device. Methods 239 final year medical students were asked to complete the DREEM inventory. Anonymised responses were entered into a database. Data analysis was performed using PASW 18 and confirmatory factor analysis performed. Results Whilst the total DREEM score had an acceptable level of internal consistency (alpha 0.89, subscale analysis shows that two subscales had sub-optimal internal consistency. Multiple group confirmatory factor analysis (using Fleming's indices shows an overall fit of 0.76, representing a weak but acceptable level of fit. 17 of the 50 items manifest fit indices less than 0.70. We sought the best fitting oblique solution to the 5-subscale structure, which showed large correlations, suggesting that the independence of the separate scales is open to question. Conclusions There has perhaps been an inadequate focus on establishing and maintaining the psychometric credentials of the DREEM. The present study highlights two concerns. Firstly, the internal consistency of the 5 scales is quite variable and, in our sample, appears rather low. Secondly, the construct validity is not well supported. We suggest that users of the DREEM will provide basic psychometric appraisal of the

  14. Preparing for your annual staff appraisal: part 2.

    Science.gov (United States)

    Price, B

    Annual appraisals are part of performance management and are designed to motivate, develop and support employees in performing their roles to the highest possible standard. They provide an opportunity for constructive discussion of performance, identification of areas for development and agreement of approaches by which employees needs could be met. Part 1 of this article was concerned with preparation of the employee and manager for annual staff appraisal. This article provides advice for managers who perform annual appraisal interviews. Guidance is offered on how to ensure the strategic objectives of the team and healthcare organisation are met, a balanced understanding of nurse performance is achieved, and future objectives are identified and agreed

  15. Performance appraisal: helpful hints for the busy medical practice manager.

    Science.gov (United States)

    Bolon, Douglas S

    2006-01-01

    This article describes the performance appraisal process in terms of its three fundamental steps. defining job performance, measuring actual job performance, and providing job performance feedback. Given that most practice managers wear many hats and do not have extensive experience or staff support in human resources, the purpose of this article is to provide these busy individuals with useful, practical suggestions that should enhance the effectiveness of the performance appraisal process for nonphysician employees within the medical practice setting. Performance appraisal should be a priority for all practice managers, as the performance of individual employees represents the key to long-term success for any medical practice.

  16. Making the link between critical appraisal, thinking and analysis.

    Science.gov (United States)

    Whiffin, Charlotte Jane; Hasselder, Alison

    Nursing has become an all-graduate profession; as such, student nurses must develop their skills of critical analysis. The need to develop critical analytical thinking has been identified as the single most important skill in undergraduate education and reaching the academic requirements of level six study. In degree-level healthcare programmes, students are frequently asked to complete a structured critical appraisal of research. This paper examines how critical appraisal activities can be an opportunity for students to develop transferable critical thinking skills. Critical appraisal teaches objectivity, reflection, logic and discipline, which encourage students to think critically in both theory and practice.

  17. CTP在颅内动脉狭窄支架成形术中的术前评估价值%Pre-operative evaluation value of CT perfusion imaging in intravascular stenting of intracranial arterial stenosis

    Institute of Scientific and Technical Information of China (English)

    袁晖; 赵振伟; 曲友直; 袁阳; 杨震

    2013-01-01

    Objective To analyze the changes of CT brain perfusion imaging parameters before and after stent-assisted angioplasty in severe symptomatic intracranial atherosclerotic, and to investigate the pre-operative evaluation value of computed tomography perfusion (CTP) imaging. Methods A total of 58 cases of intracranial stenosis (the degree of stenosis >70% ) were divided into low perfusion group and normal perfusion group through pre-operative CTP imaging. The patients were performed with CTP again to evaluate the cerebral hemodynamic changes 3 months after intracranial stent-assisted angioplasty. The relative perfusion parameters including regional cerebral blood flow (rCBF).regional cerebral blood volume (rCBV), regional mean transit time (rMTT), and regional time to peak (rTTP) in both groups were compared. The curative effects of both groups were compared. Results rCBF, rMTT, and rTTP were improved significantly (P < 0.05) in the low perfusion group after treatment. The post-treatment follow-up indicated that the incidence of ischemic events in the low perfusion group were significantly lower than the normal perfusion group (P < 0. 05). The number of patients with mRS ≤ 2 was increased and better function improvement was obtained in the low perfusion group than the normal perfusion group (P < 0. 05). Conclusion According to pre-operative CTP parameters, it plays an important guiding role for the pre-operative assessment in treatment of severe symptomatic intracranial atherosclerotic stenosis.%目的 分析CT脑灌注成像(CTP)在重度症状性颅内动脉狭窄支架成形术前后的变化,探讨其对术前评估的价值.方法 根据术前CTP将58例颅内动脉狭窄程度>70%患者分为低灌注组和正常灌注组,术后3个月查CTP,比较相对局部脑血流量(rCBF)、脑血容量(rCBV)、平均通过时间(rMTT)、达峰时间(rTTP)变化及疗效.结果 低灌注组术后rCBF、rMTT、rTTP改善明显(P<0.05).低灌注组术后缺血事件

  18. Distribution of MRI signal alterations of the cartilage endplate in pre-operated patients with special focus on recurrent lumbar disc herniation; Verteilungsmuster von (Modic-)Signalveraenderungen an den vertebralen Endplatten voroperierter Patienten und ihr Bezug zu Rezidivvorfaellen

    Energy Technology Data Exchange (ETDEWEB)

    Becker, G.T.; Liphofer, J.; Koester, O. [Inst. fuer Diagnostische und Interventionelle Radiologie und Nuklearmedizin, St. Josef-Hospital, Bochum (Germany); Willburger, R.E. [Abt. fuer Rheumaorthopaedie, St. Elisabeth-Hospital, Bochum (Germany); Schmid, G. [Klinik fuer Diagnostische und Interventionelle Radiologie, Johanna-Etienne-Krankenhaus, Neuss (Germany)

    2006-01-01

    Purpose: To study the location of (Modic) MR signal alterations (SA) of the cartilage endplate (CEP) in pre- and non-operated segments L3-S1 with special focus on the presence of recurrent lumbar disc herniation (RLDH). Materials and Methods: In a retrospective study the MR images of vertebrae L3-S1 of 65 consecutive patients with a history of microdiscectomy were evaluated. Of the 190 segments studied, 67 were pre-operated. These were divided into a group with recurrent lumbar disc herniation (RLDH) (n=19) and a group without evidence of RLDH (n=48). Non-operated segments (n=123) were also considered as a separate group. In these three groups the prevalence of different Modic types was determined using the sag. T1- and T2-weighted images, and, in particular, the distribution of SA at the upper and lower CEP was examined by evaluating the sag. T2-weighted images. In order to achieve this, each CEP was divided into nine regions. Results: Pre-operated segments showed significantly more frequent (p<0.001) and more expansive (p<0.001) SA than non-operated segments. Non-operated segments showed SA less frequently in the central region of both upper and lower CEP (p=0.056 and p=0.015, respectively). In operated segments without RLDH, the upper CEP had significantly more SA on the operation side than in the mid-sagittal and contra-lateral regions (p=0.016, p=0.037) and significantly more on the operation side of the lower CEP than in the contra-lateral region (p=0.027). Operated segments with RLDH did not show an emphasis of SA on the operation side. In this group SA occurred significantly more often in the central and ventral mid-sagittal regions of the upper CEP than in the preoperated segments without RLDH. (orig.)

  19. Comparison of the effects of using the Crowe Critical Appraisal Tool versus informal appraisal in assessing health research: a randomised trial.

    Science.gov (United States)

    Crowe, Michael; Sheppard, Lorraine; Campbell, Alistair

    2011-12-01

    In systematic reviews, evidence-based practice and journal clubs critical appraisal tools are used to rate research papers. However, little evidence exists on whether the critical appraisal tool, subject matter knowledge or research design knowledge affect the appraisal of research papers. A match paired randomised trial was conducted in August/September 2010 in the Faculty of Medicine, Health and Molecular Science, James Cook University, Australia. Ten participants in total were randomly assigned to two groups using either an informal appraisal of research (IA group) or the Crowe Critical Appraisal Tool (CCAT group), a general critical appraisal tool. Participant independently appraised five research papers, where each paper had a different research design. The scores allocated to the papers by each group were analysed. The intraclass correlation coefficient for absolute agreement was 0.76 for the informal appraisal group and 0.88 for the Crowe Critical Appraisal Tool group. The G study showed that in the informal appraisal group 24% of variance in scores was attributable to either the rater or paper × rater interactions, whereas this was 12% in the Crowe Critical Appraisal Tool group. Analysis of covariance showed that there were statistically significant results in the informal appraisal group for subject matter knowledge (F(1,18) = 7.03, P Crowe Critical Appraisal Tool was more reliable than an informal appraisal of the research papers. In the informal appraisal group, there were significant effects for rater and subject matter knowledge, whereas the Crowe Critical Appraisal Tool almost eliminated the rater effect, and no subject matter knowledge effect was apparent. There was no research design knowledge effect in either group. The Crowe Critical Appraisal Tool provided much better score reliability and should help readers with different levels and types of knowledge to reach similar conclusions about a research paper.

  20. The misdiagnosis of epilepsy: Appraising risks and managing uncertainty.

    Science.gov (United States)

    Oto, Maria Meritxell

    2017-01-01

    To present evidence from the literature on the rates, underlying causes and consequences of the misdiagnosis of epilepsy and place these meaningfully within a practical framework of risk appraisal and managed diagnostic uncertainty towards informing a clinical practice that might make misdiagnosis less likely. Narrative review. Misdiagnosis of epilepsy remains common and the consequences for the individual significant. Evidence and critical appraisal are presented as regards the absolute level of risk associated with the false positive diagnosis epilepsy, and reasons as to why those risks need to be appraised against the risks associated to false negative diagnosis. Diagnostic error is not entirely avoidable and a degree of uncertainty, and perforce risk, is intrinsic to the diagnostic process of epilepsy. The risks of a false negative diagnosis of epilepsy must be appraised against the also significant risks of a false positive diagnosis. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  1. 77 FR 52721 - Appraisal Subcommittee; Proposed Policy Statements

    Science.gov (United States)

    2012-08-30

    ... unethical, incompetent and/or fraudulent practices performed while in the State; e. Notify the appraiser's... agency for unethical, incompetent or fraudulent practices under a temporary practice permit. C....

  2. SELCAT. Safer European Level Crossing Appraisal and Technology

    OpenAIRE

    R. Slovak; EL-KOURSI, EM; TORDAI, L; Woods, M.; SCHNIEDER, E

    2008-01-01

    The paper presents preliminary results of the SELCAT project, funded by the European Commission. Its main objective is the collection and dissemination of knowledge related to level crossing risk appraisal, technology and methodology.

  3. Aquatic Resources Awareness Course for Real Estate Appraisers

    Science.gov (United States)

    This training module is intended for licensed real estate appraisers. It is designed to increase the awareness of aquatic resources including why they are protected, signs to look for and documentation.

  4. Performance appraisal: carrot or stick? | Quinn | South African ...

    African Journals Online (AJOL)

    In line with the growing movement to extend the professionalism of teachers and to meet the ... To be critically reflective, practitioners need to gather feedback about their ... of Performance Appraisal as a tool for becoming critically reflective.

  5. An appraisal of construction management practice in Nigeria | Ugwu ...

    African Journals Online (AJOL)

    An appraisal of construction management practice in Nigeria. ... A questionnaire survey was conducted and fifty-seven (57) factors were identified, ... the project team, lack of construction management knowledge and known work progress.

  6. The Exhibition Performance Appraisal Index System Based on Stakeholder Theory

    Institute of Scientific and Technical Information of China (English)

    YAN Shu-min; HAO Qi-hui

    2009-01-01

    Exhibition performance should be evaluated from different perspectives of stakeholders. The benefits of each stakeholder can not be satisfied when evaluating the exhibition performance from a single perspective or. only evaluating the economic performance of the exhibition. In this paper, the stakeholders are defined on the basis of questionnaire investigation and classified by mathematical statistical method. According to the requirements of the stakeholders, the exhibition performance appraisal indicators are extracted and, simplified by factor analysis, which leads to the formation of a set of performance appraisal index system. It is an instructive attempt to work out the exhibition performance appraisal model from the perspective of stakeholders, which may provide theoretical foundation and practice instruction for exhibition performance appraisal in our country.

  7. Critical appraisal: dental amalgam update--part II: biological effects.

    Science.gov (United States)

    Wahl, Michael J; Swift, Edward J

    2013-12-01

    Dental amalgam restorations have been controversial for over 150 years. In Part I of this Critical Appraisal, the clinical efficacy of dental amalgam was updated. Here in Part II, the biological effects of dental amalgam are addressed.

  8. 116 Appraisal as a Determinant for Adequate Compensation in ...

    African Journals Online (AJOL)

    User

    2012-01-24

    mail: ... management. The information obtained through appraisal provides .... definition provided by the United States office of personnel management. That office defines ..... Exclusive Report, Library Journal 119, (18), 44 – 49.

  9. Career Development and Performance Appraisal: It Takes Two to Tango.

    Science.gov (United States)

    Jacobson, Betsy; Kaye, Beverly L.

    1986-01-01

    The authors state that when career development and performance appraisal are viewed as supporting each other, each becomes stronger. Consequently, each is in a better position to achieve the broad organizational objective of increasing the contributions of human resources. (CT)

  10. Managerial Competencies and the Managerial Performance Appraisal Process.

    Science.gov (United States)

    Abraham, Steven E.; Karns, Lanny A.; Shaw, Kenneth; Mena, Manuel A.

    2001-01-01

    Human resource managers (n=277) identified six management competencies as critical: leadership, customer focus, results orientation, problem solving, communication skills, and teamwork. However, many companies do not assess these competencies in the management performance appraisal process. (Contains 22 references.) (SK)

  11. An appraisal of rabies occurrence and control in Kisumu ...

    African Journals Online (AJOL)

    An appraisal of rabies occurrence and control in Kisumu Municipality, Kenya. ... Log in or Register to get access to full text downloads. ... The occurrence of animal bites and costs involved in treatment was also investigated using retrospective ...

  12. Project Work by Students for First Degree: An Appraisal | Ekwenze ...

    African Journals Online (AJOL)

    Project Work by Students for First Degree: An Appraisal. ... The proper order, format and form for legal research and writing must be observed. ... law faculties should have websites that will enable supervisors cross-check projects for originality.

  13. Students' Appraisal of the Quality of Instruction in Clothing and ...

    African Journals Online (AJOL)

    FIRST LADY

    function effectively for the development of self and the society, thus contributing to the ... there has been a lot of resistance to the use of Students' in appraising teacher's ... decisions concerning pay increase, promotion and tenure. 2. Providing ...

  14. How to critically appraise a clinical practice guideline

    OpenAIRE

    Clubb, Adrian B.; Dahm, Philipp

    2011-01-01

    Purpose: Clinical practice guidelines play a critical role in guiding the evidence-based clinical practice of urology. We describe a systematic approach to critical appraisal of urology guidelines. Materials and Methods: Based on a focused clinical question derived from a clinical scenario, we identified a relevant clinical practice guideline that we critically appraised using the Users’ Guide to the Medical Literature framework as to whether the results are valid, what are the results, and c...

  15. Health system guidance appraisal-concept evaluation and usability testing

    OpenAIRE

    2016-01-01

    Background Health system guidance (HSG) provides recommendations aimed to address health system challenges. However, there is a paucity of methods to direct, appraise, and report HSG. Earlier research identified 30 candidate criteria (concepts) that can be used to evaluate the quality of HSG and guide development and reporting requirements. The objective of this paper was to describe two studies aimed at evaluating the importance of these 30 criteria, design a draft HSG appraisal tool, and te...

  16. Appraisal tools for clinical practice guidelines: a systematic review.

    Directory of Open Access Journals (Sweden)

    Ulrich Siering

    Full Text Available INTRODUCTION: Clinical practice guidelines can improve healthcare processes and patient outcomes, but are often of low quality. Guideline appraisal tools aim to help potential guideline users in assessing guideline quality. We conducted a systematic review of publications describing guideline appraisal tools in order to identify and compare existing tools. METHODS: Among others we searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews from 1995 to May 2011 for relevant primary and secondary publications. We also handsearched the reference lists of relevant publications. On the basis of the available literature we firstly generated 34 items to be used in the comparison of appraisal tools and grouped them into thirteen quality dimensions. We then extracted formal characteristics as well as questions and statements of the appraisal tools and assigned them to the items. RESULTS: We identified 40 different appraisal tools. They covered between three and thirteen of the thirteen possible quality dimensions and between three and 29 of the possible 34 items. The main focus of the appraisal tools were the quality dimensions "evaluation of evidence" (mentioned in 35 tools; 88%, "presentation of guideline content" (34 tools; 85%, "transferability" (33 tools; 83%, "independence" (32 tools; 80%, "scope" (30 tools; 75%, and "information retrieval" (29 tools; 73%. The quality dimensions "consideration of different perspectives" and "dissemination, implementation and evaluation of the guideline" were covered by only twenty (50% and eighteen tools (45% respectively. CONCLUSIONS: Most guideline appraisal tools assess whether the literature search and the evaluation, synthesis and presentation of the evidence in guidelines follow the principles of evidence-based medicine. Although conflicts of interest and norms and values of guideline developers, as well as patient involvement, affect the trustworthiness of guidelines, they are currently

  17. Fostering a culture of accountability through a performance appraisal system.

    Science.gov (United States)

    Gillani, Asmita; Jarvi, Kristine; De Angelis, Andrew

    2005-01-01

    The current climate in Canadian healthcare requires that healthcare providers be more accountable to the government and other stakeholders. Using a well-structured performance appraisal system that is based on quantifiable objectives and standards, a high level of accountability can be achieved. The objective of this article is to demonstrate how a sound performance appraisal system can increase accountability and performance of healthcare organizations and their senior management.

  18. Performance appraisals: never mind the boss, please the customer.

    Science.gov (United States)

    Nevling, H R

    1992-01-01

    Compares the general conception of the performance appraisal system as evidenced in yesterday's and today's attitudes and goes on to prognosticate the approach of tomorrow. Radically proposes the removal of such a system altogether, switching from performance appraisal to systems analysis, involving feedback from external (customer/supplier) as opposed to internal (management) sources. Also extends the paradigm shift to salaries, communications and promotion, and highlights training as a vital component, if Deming's seminal eleventh and twelfth points are to be realized.

  19. Dynamic Models of Appraisal Networks Explaining Collective Learning

    OpenAIRE

    Mei, Wenjun; Friedkin, Noah E.; Lewis, Kyle; Bullo, Francesco

    2016-01-01

    This paper proposes models of learning process in teams of individuals who collectively execute a sequence of tasks and whose actions are determined by individual skill levels and networks of interpersonal appraisals and influence. The closely-related proposed models have increasing complexity, starting with a centralized manager-based assignment and learning model, and finishing with a social model of interpersonal appraisal, assignments, learning, and influences. We show how rational optima...

  20. Alienation appraisals distinguish adults diagnosed with DID from PTSD.

    Science.gov (United States)

    DePrince, Anne P; Huntjens, Rafaële J C; Dorahy, Martin J

    2015-11-01

    Studies are beginning to show the importance of appraisals to different types and severities of psychiatric disorders. Yet, little work in this area has assessed whether trauma-related appraisals can differentiate complex trauma-related disorders, such as posttraumatic stress disorder (PTSD) and dissociative identity disorder (DID). The current study evaluated whether any of 6 trauma-related appraisals distinguished adults diagnosed with DID from those diagnosed with PTSD. To accomplish this, we first examined the basic psychometric properties of a Dutch-translated short-form of the Trauma Appraisals Questionnaire (TAQ) in healthy control (n = 57), PTSD (n = 27) and DID (n = 12) samples. The short-form Dutch translation of the TAQ showed good internal reliability and criterion-related validity for all 6 subscales (betrayal, self-blame, fear, alienation, shame, anger). Of the 6 subscales, the alienation appraisal subscale specifically differentiated DID from PTSD, with the former group reporting more alienation. Abuse-related appraisals that emphasize disconnection from self and others may contribute to reported problems of memory and identity common in DID. The current findings suggest that addressing experiences of alienation may be particularly important in treatment for clients diagnosed with DID. (c) 2015 APA, all rights reserved).

  1. The Effects of Safety Behavior Directed Towards a Safety Cue on Perceptions of Threat.

    Science.gov (United States)

    Engelhard, Iris M; van Uijen, Sophie L; van Seters, Niels; Velu, Nicolette

    2015-09-01

    Safety behavior involves precautions to prevent or minimize a feared outcome, and is involved in the maintenance of anxiety disorders. Earlier research has shown that safety behavior prevents the extinction of conditioned fear and maintains threat expectations. This study tested whether safety behavior directed towards an objectively safe stimulus increases the perceived threat of that stimulus when it is subsequently experienced in the absence of the safety measure. In a conditioning task, participants first learned that one "danger" cue (A) was followed by shock and two "safety" cues (B, C) were not. Then they learned to apply safety behavior during A trials, which prevented the shock. Next, the experimental group, and not the control group, was given the opportunity to display safety behavior to C trials, which had never been coupled with the shock. In a subsequent test phase, A, B, and C were presented without the opportunity for participants to engage in safety behavior. Results showed that safety behavior increased shock expectancy to C in the test phase and maintained a preexisting shock expectancy in the experimental group, but not in the control group. This is the first study to show that safety behavior can maintain threat appraisal to stimuli that only ever acquired threat indirectly. This may be a possible mechanism for the origin of biased threat beliefs, superstitious behaviors, and irrational fears. It is also practically relevant: safety behavior reduces actual danger, but in relatively safe situations, its potential costs may outweigh the benefits. Copyright © 2015. Published by Elsevier Ltd.

  2. Comparação entre exames de imagem e achados operatórios em doadores para transplante hepático intervivos Comparison of pre-operative exams and per-operative findings in living donor liver transplantation

    Directory of Open Access Journals (Sweden)

    Alexandre Coutinho Teixeira de Freitas

    2007-12-01

    ático intervivos em relação aos achados peroperatórios.BACKGROUND: Success in living donor liver transplantation is associated to donor vascular and biliar anatomy. AIM: Compare pre-operative and per-operative findings in living liver donors related to portal vein, hepatic artery, bile duct and hepatic venous drainage anatomy. METHODS: Donors charts of living donor liver transplants done at Clinics Hospital of the Federal University of Paraná, Curitiba, PR, Brazil, were reviewed between March 1998 and August 2005. On the pre-operative period the anatomy was analysed through: celiac and mesenteric arteriography of the hepatic artery and portal vein (venous phase; magnetic resonance imaging of the venous drainage, portal vein and bile duct. Normality was determined based on data of the literature. Pre-operative findings were compared to per-operative findings. RESULTS: Portal vein and hepatic artery were studied in 44 patients, 16 females and 28 males, mean age of 33 years old. In 8 cases the left liver lobe was used to pediatric receptor, in 36 cases the right liver lobe was used to adult receptor. Bile duct anatomy was studied in 37 cases and venous drainage in 32. Over all, the findings related to pre-operative and per-operative anatomy were not coincident in 36.36% of the cases. In the case of hepatic artery, they were not coincident in 11.36%, in the case of the portal vein in 9.1%, in the case of the venous drainage in 9.37% and in the case of the bile duct in 21.6%. CONCLUSION: The pre-operative and per-operative findings related to vascular and bile duct donor anatomy are frequently different in living donor liver transplantation.

  3. An annual performance appraisal for CERN

    CERN Multimedia

    2012-01-01

    The March Council session is the occasion for CERN’s annual performance appraisal, but instead of the MARS form familiar to CERN staff, the lab’s working document is an Annual Progress Report, linked to the Medium-Term Plan, matching achievements to objectives. This year, I think it’s fair to say, we were firmly able to tick the ‘achieved’ box.   Top of the list of objectives was the LHC, which exceeded expectations in 2011 by delivering over five times the anticipated luminosity for protons while improving the lead-ion integrated luminosity by an order of magnitude compared to 2010.  As a result, the experiments published over 190 papers and made a staggering 1900 conference presentations. Underpinning this was the Worldwide LHC Computing Grid, which routinely performs so well that we hardly notice it's there. Non-LHC physics also had its day in the sun in 2011, with experiments at the PS, SPS, AD, n_TOF and ISOLDE, as well ...

  4. Appraising and monitoring a life on dialysis.

    Science.gov (United States)

    Brunier, G

    1990-01-01

    I feel that the adaptation theories proposed by Nerenz and Leventhal (1983) and by Taylor (1983), although offering insights into how chronically sick individuals may interpret and manage their illness, do not capture completely the complexities of how D.R. has successfully learned over the years to live with renal disease and dialysis. I find it interesting that Lazarus and Folkman's theory of stress, adaptation and coping, which is based more on the belief that everyone experiences stress every day and, thereby, does not single out chronically ill people as being different, has more to offer in interpreting D.R.'s own perceptions on how he monitors his health than the illness-based models of Nerenz/Leventhal and Taylor. After eight years of continuous appraisal and reappraisal, D.R. has taught himself, through his own perceptions and interactions with those close to him, how he can live successfully with renal failure. The recording of his insights has helped me appreciate more deeply what an endless challenge a life lived on dialysis is.

  5. Hand Safety

    Science.gov (United States)

    ... Gardening Safety Turkey Carving Removing a Ring Español Artritis de la base del pulgar Dedo en gatillo ... Gardening Safety Turkey Carving Removing a Ring Español Artritis de la base del pulgar Dedo en gatillo ...

  6. Water Safety

    Science.gov (United States)

    ... Old Feeding Your 1- to 2-Year-Old Water Safety KidsHealth > For Parents > Water Safety Print A ... best measure of protection. previous continue Making Kids Water Wise It's important to teach your kids proper ...

  7. SAFETY FIRST

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Ensuring safety while peacefully utilizing nuclear energy is a top priority for China A fter a recent earthquake in Japan caused radioactive leaks at a nuclear power plant in Tokyo, the safety of nuclear energy has again aroused public attention.

  8. Safety Plan

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The Swan Lake National Wildlife Refuge Safety Plan discusses policies for the safety of the station employees, volunteers, and public. This plan seeks to identify...

  9. A critical appraisal of medication package inserts

    Directory of Open Access Journals (Sweden)

    Pranjit Narzaree

    2015-10-01

    Full Text Available Introduction: Package Inserts (PIs refers to officially specified document that accompanies a drug for relevant, updated and unbiased information for rational drug use based on regulatory guidelines as per section 6.2 and 6.3 of schedule D of Indian Drug and cosmetic Act 1945. But some studies had shown non-uniformity with suboptimal level of informations which frequently can lead to medication errors. Hence this study was conducted to evaluate the completeness of PIs.Aim: To critically evaluate package inserts of allopathic medicines.Material and Methods: 100 allopathic drug PIs were collected from pharmacies in Rohtak and were checked for the presence of each heading as per schedule D criteria, followed by scrutiny of the information included under the heading. Indian guidelines were also compared with US FDA guidelines for PIs.Scoring of package inserts: The informations were evaluated for completeness and scored as 1 if present otherwise scored as zero for no information or partial information. Scores for each heading were calculated by totaling the scores of all the package inserts. The total scores were expressed as absolute numbers and percentages.Results:  On an average PIs analyzed for the completeness of the criteria scored 10 (Mean± SD = 9.73±2.48 out of 16. Absence of common layout and headings caused inconvenience. In comparison to US FDA guidelines it lacked, disclaimer statement, boxed warning, revision date, approval date, toll-free number etc.Conclusion: PIs don’t seem to be serving effectively because of multiple deficiencies like completeness, uniformity, absence of headings.Keywords: Critical appraisal, package inserts.

  10. Snapshot of the AAOHN Membership-Health Risk Appraisal Priority Areas.

    Science.gov (United States)

    Deangelis, Matthew P; Burgel, Barbara J

    2013-06-01

    A 2012 American Association of Occupational Health Nurses, Inc. (AAOHN) web-based membership survey of 5,138 members was designed to identify occupational health and safety issues facing members. A total of 2,123 members responded to the survey (41% response rate). Of the AAOHN members who responded to this survey, 61% reported health risk appraisal (HRA) priorities for 2012. HRA priority areas are identified among various subgroups of the AAOHN responders in this article. The top three HRA priority areas identified were weight management/nutrition/healthy eating, physical activity, and mental health/stress management. These priority areas were consistent across three industry sectors, three occupational health nurse job titles, and the smallest and largest employers. These results suggest that occupational health nurses should consider prioritizing their employee wellness efforts in these areas.

  11. Dancing in pain: pain appraisal and coping in dancers.

    Science.gov (United States)

    Anderson, Ruth; Hanrahan, Stephanie J

    2008-01-01

    This study investigated the relationships between the type of pain experienced (performance pain and injury pain), the cognitive appraisal of pain and pain coping styles in dancers. Fifty-one professional ballet and contemporary dancers (17 males and 34 females), with the mean age of 25.9 years, completed a general pain questionnaire, the Pain Appraisal Inventory, the Survey of Pain Attitudes Control Subscale, and the Sports Inventory for Pain. Multivariate analyses of variance indicated that both the cognitive appraisal of the pain and pain coping styles did not differ according to the type of pain experienced or the pain severity. However, it was found that dancers with performance pain of either low or high severity were more likely to dance in pain than dancers experiencing injury pain. Multiple regression analyses indicated that the appraisal of pain as threatening was predictive of the use of avoidance and catastrophizing pain coping styles. Overall, results indicated that dancers may not differentiate between performance pain and injury pain, or modify their appraisal and coping strategies according to the characteristics of the pain experienced. The study highlighted an opportunity for increased education for dancers in recognizing the difference between pain considered to be a routine aspect of training and pain which is a signal of serious injury.

  12. Attributions, appraisals and attention for symptoms in depersonalisation disorder.

    Science.gov (United States)

    Hunter, Elaine C M; Salkovskis, Paul M; David, Anthony S

    2014-02-01

    A cognitive-behavioural model of depersonalisation disorder (DPD) suggests that catastrophic attributions and appraisals, and increased attention to symptoms, play important roles in the development and maintenance of the disorder. Empirical testing of this model was investigated in three groups: 25 patients with DPD, 21 patients with anxiety (obsessive-compulsive or panic disorder), and 22 psychiatrically healthy participants. Task 1 examined attributions for ambiguous symptoms. Task 2 used a questionnaire to compare the groups on the content, frequency, and conviction in appraisals when participants worried about their health. Task 3 employed four experimental manipulations designed to either increase, or decrease, attention to catastrophic appraisals and/or symptoms of DPD. Results indicate that the DPD group make less normalising attributions for symptoms (Task 1) and have more catastrophic appraisals (Task 2) than those in the Healthy Control group. The DPD and Anxiety groups were similar in their patterns of appraisals and attributions. In Task 3, the DPD group showed a perceived reduction in DPD severity when their attention was focussed on cognitively demanding tasks, whereas the other two groups showed an increase. The findings are consistent with the hypothesis that these cognitive processes play an important role in the development and maintenance of DPD.

  13. EMPLOYEE PERFORMANCE APPRAISAL AND ITS IMPLICATION FOR INDIVIDUAL AND ORGANIZATIONAL GROWTH

    Directory of Open Access Journals (Sweden)

    Chris Obisi , Ph.D

    2011-10-01

    Full Text Available Organizational performance and its resultant efficiency and effectiveness can only be achieved when individuals are continuously appraised and evaluated. The inability of organization to install an effective performance appraisal strategy has hindered them from achieving competitive advantage which they require more now than ever before. Appraisal processes are not systematic and regular and often characterized by personal influences occasioned by organizations preoccupation to use confidential appraisal system which hinders objectivity and fairness. Often organizations ignore management by objectives, critical incidents to personal prejudices. This is retrogressive as it affects the overall performance of the individual. 360 degrees appraisal method whereby superiors and the appraise their subordinates, subordinates appraise their superior and the appraisee appraise himself or herself and the average of all the appraisal taken to arrive at the final appraisal outcome should be now be considered by organizations. Also post appraisal counseling whereby the appraisal outcomes are analyzed to explain strengths and weaknesses and set agenda for better future performance. Organizationsshould stop giving less attention to the evaluation of their employees and recognize that organizational training needs can only be identified from performance appraisal outcomes. It is an invaluable tool but in the hands of human resource management officers to continuously evaluates and audits the performance of its employees in other to help organizations win competitive advantage.

  14. National Safety Council

    Science.gov (United States)

    ... Defensive Driving Workplace Training NSC University International Knowledge Knowledge Introduction Safety at Home Safety at Work Safety on ... or contact us . Measure Measure Safety Measure Safety Introduction Safety Management Systems Workplace Safety Consulting Employee Perception Surveys Research ...

  15. Evidence-based decision-making 1: Critical appraisal.

    Science.gov (United States)

    Twells, Laurie K

    2015-01-01

    This chapter provides an introduction to the concept of Evidence-based Medicine (EBM) including its history, rooted in Canada and its important role in modern medicine. The chapter both defines EBM and explains the process of conducting EBM. It includes a discussion of the hierarchy of evidence that exists with reference to common methods used to assess the levels of quality inherent in study designs. The focus of the chapter is on how to critically appraise the medical literature, as one step in the EBM process. Critical appraisal requires an understanding of the strengths and weaknesses of study design and how these in turn impact the validity and applicability of research findings. Strong critical appraisal skills are critical to evidence-based decision-making.

  16. Psychology and theology meet: illness appraisal and spiritual coping.

    Science.gov (United States)

    Baldacchino, Donia R; Borg, Josette; Muscat, Charlene; Sturgeon, Cassandra

    2012-10-01

    This descriptive exploratory study explored illness appraisal and spiritual coping of three groups of individuals with life-threatening illness. These were hospice clients with cancer (Ca; n = 10), clients with first myocardial infarction (MI; n = 6), and parents of children with cystic fibrosis (CF; n = 16). Qualitative data were collected by audiotaped face-to-face interviews (parents) and focus groups (MI and Ca). Similarities in illness appraisal and spiritual coping were found across the three groups except appreciation of crafts, which was found only in clients with Ca and causal meaning of parents (CF). Overall, illness was appraised negatively and positively, whereas spiritual coping incorporated existential and religious coping. These findings confirm the psychological theory (Lazarus & Folkman, 1984) and theological theory (Otto, 1950), which guided this study. Recommendations were proposed to integrate spirituality and religiosity in the curricula, clinical practice and to conduct cross-cultural comparative longitudinal research.

  17. Authentic performance appraisal: when home is the workplace.

    Science.gov (United States)

    O'Connor, Margaret; Lee, Susan

    2007-12-01

    Home care services have characteristics that are distinctive from other health care settings. Thus, they require different management systems to those traditionally used in institutional settings. Typical management models often require adaptation for home care services in areas such as staffing, education and support. This includes performance appraisal, where traditional models may be inappropriate when clinicians work alone, with little supervision. This article describes an experience of adapting a performance appraisal tool, in order to be more relevant for staff working in home-based care. The project arose from staff frustration with the expectation of management that a tool developed for institutional settings would be appropriate for the home setting. This frustration gave the impetus for developing a successful appraisal system, and because of staff involvement, the model was wholeheartedly embraced. The process of development is discussed, and the model explained, with commentary about its implementation in a home care service.

  18. 76 FR 49787 - Rural Water Supply Program Approved Appraisal Reports; Availability

    Science.gov (United States)

    2011-08-11

    ... for appraisal investigations and feasibility studies for rural water supply projects intended to serve... alternative that warrants a more detailed investigation through a feasibility study. SUPPLEMENTARY INFORMATION... address those needs through appraisal investigations and feasibility studies. ] Background The...

  19. Characteristics of Performance Appraisals and Their Impact on Sales Force Satisfaction.

    Science.gov (United States)

    Pettijohn, Charles E.; Pettijohn, Linda S.; d'Amico, Michael

    2001-01-01

    A survey of 15 automobile salespeople indicated that job satisfaction increased when performance appraisals provided clear criteria that met workers' approval and when appraisals were fair and used to determine rewards. (Contains 61 references.) (SK)

  20. Using Appraisal Theory to Predict Emotional and Coping Responses to Hurtful Messages

    Directory of Open Access Journals (Sweden)

    Amy M. Bippus

    2012-12-01

    Full Text Available Based on appraisal theory (Lazarus 1991; 1999, this study examined the degree to which primary and secondary cognitive appraisals of hurtful messages predict the amountof hurt individuals feel, and the coping behaviors they enact. This study presents a significant step forward in its operationalization of both primary and secondary appraisal variables by treating hurt as an outcome, rather than an antecedent, of the appraisal process, and considers an extensive range of coping responses. We surveyed participants (N = 217 about hurtful messages they received within an array of relationship types. The results revealed that fours types of appraisals predicted the amount of hurt recipients experienced. All coping behaviors except positive reappraisal were significantly predicted by the primary appraisals (categories of risk and secondary appraisals (perceived intentionality and frequency of hurtful messages. The findings explicate appraisal theory’s potential in explaining individuals’ responses to hurtful communication.

  1. Colleague and patient appraisal of consultant psychiatrists and the effects of patient detention on appraisal scores.

    Science.gov (United States)

    Heneghan, Miranda; Chaplin, Robert

    2016-08-01

    Aims and method This paper aims to review colleague and patient feedback from the 10-year period of the operation of the Royal College of Psychiatrists' 360-degree appraisal system, specifically: (1) examine the overall distribution of ratings; (2) examine the effect of working primarily with detained patients on patient feedback, represented by forensic psychiatrists; and (3) look for a relationship between colleague and patient ratings. Results Data were analysed for 977 participating psychiatrists. Both colleagues and patients rated psychiatrists overall with high scores. Less than 1% were identified as low scorers, although there was no relationship between those identified by colleagues or patients. Colleague and patient feedback scores varied little between subspecialties including forensic consultants. Clinical implications Psychiatrists in all subspecialties obtained high scores from colleagues and staff. Working with detained patients appeared to have little effect on patient ratings.

  2. Diagnostics and air pollution damage appraisals: Are we being sufficiently careful in appraising our forest health?

    Energy Technology Data Exchange (ETDEWEB)

    Skelly, J.M. [Dept. of Plant Pathology, Pennsylvania State Univ., University Park, PA (United States)

    1993-04-01

    Numerous forest surveys are conducted annually on a worldwide basis. These surveys have multiple purposes which may include estimates of forest growth and productivity, community structure, biodiversity appraisals and/or forest condition (health) appraisals as examples. Many of these surveys are then utilized by others in developing reports of a more generalized nature. Hence, data collected without attention to detail may become lost in averages and the data itself can more easily become susceptible to accidental or directed misinterpretations and manipulations. Such may very well be the case in surveys previously conducted to determine forest condition (health) and subsequent misinterpretations about generalized symptoms being ascribed to air pollutants as their sole etiological agents. Terms such as forest decline and `Waldsterben` and `neuartige Waldschaeden` have become erroneously associated with air pollutants (acid rain) as the primary etiological agent. (orig.) [Deutsch] Zahlreiche Waldbestandsaufnahmen werden jaehrlich weltweit durchgefuehrt. Sie dienen vielseitigen Zwecken, so z.B. Waldzuwachs- und -ertragsschaetzungen, Feststellung von Struktur und Artenreichtum der Lebensgemeinschaft Wald, und/oder Wald- (Gesundheits-)zustandserhebung. Viele dieser Bestandsaufnahmen werden dann von Dritten bei der Erstellung mehr allgemeiner Berichte praktisch ausgewertet. Damit koennen Daten, die ohne Beachtung von Einzelheiten erhoben wurden, in Durchschnittswerten verloren gehen und die einzelnen Daten selbst leicht Gegenstand zufaelliger oder gezielter Fehlauslegung und Zweckentfremdung werden. Das kann durchaus der Fall sein bei frueheren Wald- (gesundheits-)zustandserhebungen und nachfolgenden Fehleinschaetzungen verallgemeinerter Symptome, die ausschliesslich der Luftverschmutzung zugeschrieben wurden. Ausdruecke wie Rueckgang der Gesundheit des Waldes ``Waldsterben`` und ``neuartige Waldschaeden`` wurden faelschlich mit Luftverschmutzung (saurer Regen) als

  3. Safety; Avertissement

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-07-01

    This annual report of the Senior Inspector for the Nuclear Safety, analyses the nuclear safety at EDF for the year 1999 and proposes twelve subjects of consideration to progress. Five technical documents are also provided and discussed concerning the nuclear power plants maintenance and safety (thermal fatigue, vibration fatigue, assisted control and instrumentation of the N4 bearing, 1300 MW reactors containment and time of life of power plants). (A.L.B.)

  4. The Perception of the Employees toward the Outcomes and Detriments of Performance Appraisal System

    OpenAIRE

    Ibrahim Sani Mert

    2011-01-01

    Although performance appraisal is one of the most important functions of human resources management, it can not be said that the organizations have obtained the full benefit from performance appraisal system as they expected. Lack of enough investigation about employees’ perception toward the effectiveness of the performance appraisal system can be mentioned as one of the reasons. The perception of employees toward the effectiveness of performance appraisal system helps human resources employ...

  5. Integrating a quantitative risk appraisal in a health impact assessment

    DEFF Research Database (Denmark)

    Adám, Balázs; Molnár, Agnes; Gulis, Gabriel;

    2013-01-01

    BACKGROUND: Although the quantification of health outcomes in a health impact assessment (HIA) is scarce in practice, it is preferred by policymakers, as it assists various aspects of the decision-making process. This article provides an example of integrating a quantitative risk appraisal in an ...... a practical example of applying quantification in an HIA, thereby promoting its incorporation into political decision making.......BACKGROUND: Although the quantification of health outcomes in a health impact assessment (HIA) is scarce in practice, it is preferred by policymakers, as it assists various aspects of the decision-making process. This article provides an example of integrating a quantitative risk appraisal...

  6. Visit safety

    CERN Multimedia

    2012-01-01

    Experiment areas, offices, workshops: it is possible to have co-workers or friends visit these places.     You already know about the official visits service, the VIP office, and professional visits. But do you know about the safety instruction GSI-OHS1, “Visits on the CERN site”? This is a mandatory General Safety Instruction that was created to assist you in ensuring safety for all your visits, whatever their nature—especially those that are non-official. Questions? The HSE Unit will be happy to answer them. Write to safety-general@cern.ch.   The HSE Unit

  7. Medication safety.

    Science.gov (United States)

    Keohane, Carol A; Bates, David W

    2008-03-01

    Patient safety is a state of mind, not a technology. The technologies used in the medical setting represent tools that must be properly designed, used well, and assessed on an on-going basis. Moreover, in all settings, building a culture of safety is pivotal for improving safety, and many nontechnologic approaches, such as medication reconciliation and teaching patients about their medications, are also essential. This article addresses the topic of medication safety and examines specific strategies being used to decrease the incidence of medication errors across various clinical settings.

  8. Appraisal and Coping: Moderators or Mediators of Stress in Alzheimer's Disease Caregivers?

    Science.gov (United States)

    Morano, Carmen Louis

    2003-01-01

    This study focused on one question: Do caregiver responses--emotion-focused coping, problem-focused coping, appraisal of burden, and appraisal of satisfaction--mediate or moderate the effects of caregiving stress on psychological well-being? Findings indicate that development of interventions that focus on how caregivers appraise their situation,…

  9. Multi source feedback based performance appraisal system using Fuzzy logic decision support system

    Directory of Open Access Journals (Sweden)

    G.Meenakshi

    2012-03-01

    Full Text Available In Multi-Source Feedback or 360 Degree Feedback, data on the performance of an individual are collected systematically from a number of stakeholders and are used for improving performance. The 360-Degree Feedback approach provides a consistent management philosophy meeting the criterion outlined previously. The 360-degree feedback appraisal process describes a human resource methodology that is frequently used for both employee appraisal and employee development. Used in employee performance appraisals, the 360-degree feedback methodology is differentiated from traditional, top-down appraisalmethods in which the supervisor responsible for the appraisal provides the majority of the data. Instead it seeks to use information gained from other sources to provide a fuller picture of employees’ performances. Similarly, when this technique used in employee development it augments employees’ perceptions of training needs with those of the people with whom they interact. The 360-degree feedback based appraisal is a comprehensive method where in the feedback about the employee comes from all the sources that come into contact with the employee on his/her job. The respondents for an employee can be her/his peers, managers, subordinates team members, customers, suppliers and vendors. Hence anyone who comes into contact with the employee, the 360 degree appraisal has four components that include self-appraisal, superior’s appraisal, subordinate’s appraisal student’s appraisal and peer’s appraisal .The proposed system is an attempt to implement the 360 degree feedback based appraisal system in academics especially engineering colleges.

  10. Learning to Appraise the Quality of Qualitative Research Articles: A Contextualized Learning Object for Constructing Knowledge

    Science.gov (United States)

    Chenail, Ronald J.

    2011-01-01

    Helping beginning qualitative researchers critically appraise qualitative research articles is a common learning objective for introductory methodology courses. To aid students in achieving competency in appraising the quality of qualitative research articles, a multi-part activity incorporating the Critical Appraisal Skills Programme's (CASP)…

  11. The Electronic Mirror: Human-Computer Interaction and Change in Self-Appraisals.

    Science.gov (United States)

    De Laere, Kevin H.; Lundgren, David C.; Howe, Steven R.

    1998-01-01

    Compares humanlike versus machinelike interactional styles of computer interfaces, testing hypotheses that evaluative feedback conveyed through a humanlike interface will have greater impact on individuals' self-appraisals. Reflected appraisals were more influenced by computer feedback than were self-appraisals. Humanlike and machinelike interface…

  12. A Field Study of Discrete Emotions: Athletes' Cognitive Appraisals during Competition

    Science.gov (United States)

    Martinent, Guillaume; Ferrand, Claude

    2015-01-01

    Purpose: Cognitive-motivational-relational theory (CMRT) emphasizes that cognitive appraisal components and core relational themes (in which the 6 separate appraisal judgments are brought together as 1) are the proximal determinants of athletes' emotions. This study aimed to explore appraisals associated with discrete emotions experienced by…

  13. Appraisal and Coping: Moderators or Mediators of Stress in Alzheimer's Disease Caregivers?

    Science.gov (United States)

    Morano, Carmen Louis

    2003-01-01

    This study focused on one question: Do caregiver responses--emotion-focused coping, problem-focused coping, appraisal of burden, and appraisal of satisfaction--mediate or moderate the effects of caregiving stress on psychological well-being? Findings indicate that development of interventions that focus on how caregivers appraise their situation,…

  14. On the scientific status of cognitive appraisal models of anxiety disorder.

    Science.gov (United States)

    McNally, R J

    2001-05-01

    The cognitive paradigm for understanding and treating anxiety disorders comprises two distinct and potentially incompatible approaches: appraisal and information-processing. Advocates of the latter approach have sharply criticized the scientific adequacy of the appraisal models popularized by cognitive therapists. The purpose of this essay is to provide a reappraisal of these critiques of appraisal, and to defend an argument for methodological pluralism.

  15. 7 CFR 1980.444 - Appraisal of property serving as collateral.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 14 2010-01-01 2009-01-01 true Appraisal of property serving as collateral. 1980.444 Section 1980.444 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING... Program § 1980.444 Appraisal of property serving as collateral. (a) Appraisal reports prepared...

  16. Problem-Solving Appraisal, Stress, Hopelessness, and Suicide Ideation in a College Population.

    Science.gov (United States)

    Dixon, Wayne A.; And Others

    1991-01-01

    College students completed measures of problem-solving appraisal, negative life stress, and suicide ideation (Study 1, n=1,277) or problem-solving appraisal, negative life stress, and hopelessness (Study 2, n=382). Results from both studies suggest that problem-solving appraisal and negative life stress are significant independent predictors of…

  17. DMPD: Toll like receptors and autoimmunity: a critical appraisal. [Dynamic Macrophage Pathway CSML Database

    Lifescience Database Archive (English)

    Full Text Available 17959357 Toll like receptors and autoimmunity: a critical appraisal. Papadimitraki ...ml) Show Toll like receptors and autoimmunity: a critical appraisal. PubmedID 17959357 Title Toll like recep...tors and autoimmunity: a critical appraisal. Authors Papadimitraki ED, Bertsias G

  18. 5 CFR 430.204 - Agency performance appraisal system(s).

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Agency performance appraisal system(s... REGULATIONS PERFORMANCE MANAGEMENT Performance Appraisal for General Schedule, Prevailing Rate, and Certain Other Employees § 430.204 Agency performance appraisal system(s). (a) Each agency as defined at...

  19. (Un)ethical behavior and performance appraisal: the role of affect, support, and organizational justice

    NARCIS (Netherlands)

    Jacobs, G.; Belschak, F.D.; den Hartog, D.N.

    2014-01-01

    Performance appraisals are widely used as an HR instrument. This study among 332 police officers examines the effects of performance appraisals from a behavioral ethics perspective. A mediation model relating justice perceptions of police officers’ last performance appraisal to their work affect, pe

  20. 5 CFR 430.205 - Agency performance appraisal program(s).

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Agency performance appraisal program(s... REGULATIONS PERFORMANCE MANAGEMENT Performance Appraisal for General Schedule, Prevailing Rate, and Certain Other Employees § 430.205 Agency performance appraisal program(s). (a) Each agency shall establish...

  1. Performance Appraisal Systems in Higher Education: An Exploration of Christian Institutions

    Science.gov (United States)

    Flaniken, Forrest W.

    2009-01-01

    Although there is substantial literature on the use of performance appraisal in the for-profit world, there is little literature available concerning the appraisal of staff positions in higher education. More knowledge is needed in this area since there is considerable research indicating that performance appraisal creates benefits to an…

  2. (Un)ethical behavior and performance appraisal: the role of affect, support, and organizational justice

    NARCIS (Netherlands)

    Jacobs, G.; Belschak, F.D.; den Hartog, D.N.

    2014-01-01

    Performance appraisals are widely used as an HR instrument. This study among 332 police officers examines the effects of performance appraisals from a behavioral ethics perspective. A mediation model relating justice perceptions of police officers’ last performance appraisal to their work affect,

  3. A Field Study of Discrete Emotions: Athletes' Cognitive Appraisals during Competition

    Science.gov (United States)

    Martinent, Guillaume; Ferrand, Claude

    2015-01-01

    Purpose: Cognitive-motivational-relational theory (CMRT) emphasizes that cognitive appraisal components and core relational themes (in which the 6 separate appraisal judgments are brought together as 1) are the proximal determinants of athletes' emotions. This study aimed to explore appraisals associated with discrete emotions experienced by…

  4. Individual Differences in Children's Risk Perception and Appraisals in Outdoor Play Environments

    Science.gov (United States)

    Little, Helen; Wyver, Shirley

    2010-01-01

    Child characteristics including age, gender, risk-taking behaviour and sensation seeking are thought to influence children's ability to appraise risks. The present study investigated children's risk perceptions and appraisals in the context of common outdoor physical play activities. Risk perceptions and appraisal of four- and five-year olds were…

  5. Application of 3D Printing Technology in the Pre-operative Evaluation of Acetabular Fractures%3D打印技术在髋臼骨折术前评估中的应用

    Institute of Scientific and Technical Information of China (English)

    王庆; 安林; 薛波; 叶鹏翰; 徐荣明

    2016-01-01

    目的:探讨3D打印技术在髋臼骨折术前评估的临床应用价值。方法整群选取2014年1月—2015年6月对该院收治的7例髋臼骨折患者进行螺旋CT扫描,将其DICOM数据输入计算机中。应用3D打印技术打印骨折模型,将骨折模型与CT 3维重建影像进行比较,制定手术方案,随后实施手术,术后进行影像学检查,观察复位效果。与既往仅根据x线及CT 3维重建影像进行术前计划者对比术后复位效果。结果7例随访X线及CT显示关节面解剖复位5例,满意复位2例。与3维重建影像相比,可以更直观观察骨折块移位情况,在模型上可以模拟骨折复位情况,使术前计划更完善。结论3D打印技术应用有助于术者对髋臼骨折的理解和术前计划的制定,提高骨折复位质量。%Objective To explore the value of three dimension 3D printing technology in the pre-operation evaluation of ac-etabular fractures. Methods Convenient selection from January 2014 to June 2015, spiral CT scan was performed in 7 pa-tients with acetabular fracture. DICOM data were imported into Mimics software. The fracture models were printed out by 3D printing technology. Models and 3D reconstructed images were compared respectively. Operative planning was worked out, and then the operation was implemented. Postoperative reduction quality was assessed on radiographs and CT scan by observers. The results were compared with the planning that made on the basis of imaging. Results The follow up CT scan showed that 5 patients achieved anatomic reduction of articular surface, and 2 patients achieved satisfactory results. Com-parative result shows that surgeons with 3D technology can observe fractures visually and operations may be stimulated on modes. So pre-operative planning can be improved. Conclusion The 3D printing technology can help surgeons to under-stand about acetabular facture, and may be a powerful tool to work out preoperative

  6. 术前肺康复运动训练在肺癌患者中的应用现状%Application Value of Pre-operative Pulmonary Rehabilitation Exercise Training in Patients with Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    王一帆; 高科; 沈晨; 车国卫

    2016-01-01

    肺康复在肺癌患者中的应用越来越受到重视,系统性回顾国内外相关文献发现,目前研究结果表明术前肺康复运动训练在围手术期的价值尤为重要,它能有效地改善肺癌患者的运动耐量和生活质量、减少术后并发症,缩短术后住院时间并增加手术机会.但证据来源于小样本的临床研究,且训练方案缺乏标准化的治疗规范.期待更多的临床研究论证,使术前肺康复运动训练成为肺癌综合治疗的重要组成部分,让肺癌患者得到更多的获益.%Pulmonary rehabilitation therapy is gaining more attention.The recent systematic review of domestic and foreign relevant literature indicates pre-operative pulmonary rehabilitation exercise training performs an important role in per-operative period.The rehabilitation therapy can efficiendy improve exercise tolerance and quality of life of patients with lung cancer,reduce post-operative complications,shorten hospitalization time,and increase opportunity of operation.However,the evidence comes from small samples reported by present clinical study,and a standard treatment guideline of pulmonary rehabilitation has not been established until now.Further researches are expected to provide demonstration and promote pulmonary rehabilitation.It is an important part of comprehensive treatment of lung cancer.The therapy will benefit more patients suffering from lung cancer.

  7. 意象对话技术对妇科患者术前睡眠的影响%The effects of imagery-dialogue skill on sleep of gynecological pre-operation patients

    Institute of Scientific and Technical Information of China (English)

    郭先菊; 高文斌; 李忻蓉; 赵玉峰; 郭李龙; 刘雪玲; 王蕊

    2009-01-01

    目的 观察意象对话技术对改善妇科患者术前睡眠的作用.方法 将190例焦虑自评量表(SAS)测评得分>50分的妇科手术患者,用随机数字表法分为意象对话干预组、音乐意象放松干预组及对照组.意象对话干预组给予意象对话心理干预,音乐意象放松干预组给予播放自制的音乐意象放松录音干预,并比较3组干预前后的睡眠变化情况.结果 入睡时间意象对话组[(58.55±83.80)min]最短,与音乐意象放松组[(102.83±132.92)min]及对照组[(127.76±136.64)min]均有差异(P<0.05);总睡眠时间意象对话组[(6.42±2.12)h]最长,与音乐意象放松组[(5.52±2.36)h]及对照组[(4.93±2.10)h]均有差异(P<0.05或<0.01);睡眠效率意向组最高,与对照组(54.89±23.73)差别显著(P<0.01);意象对话组干预后与干预前相比总睡眠时间延长(P<0.05)、睡眠效率提高(P<0.05).对照组术前1d与术前2d相比总睡眠时间缩短(P<0.01)、睡眠效率下降(t=4.118,P<0.01)、入睡时间延长(t=3.692,P<0.01)、觉醒次数增加(t=2.664,P<0.01).结论 意象对话技术和音乐意象放松干预对减轻手术前的心理和生理应激有不同的作用,意象对话技术在改善睡眠方面更优于音乐意象放松.%Objective To observe the effects of imagery-dialogue skill on sleep of gynecological pre-operation patients and explore the best way to relieve pre-operation anxiety. Methods 190 patients with the SAS scores above 50 were randomly divided into imagery-dialogue skill group, music-imagery-relaxation group and control group. The imagery-dialogue skill group was given imagery-dialogue skill mental intervention. The music-imagery-relaxation group was given to listen to the self-made relaxation music. To collect the sleep information 2 days and 1 day before the operation among the 3 groups. Results The imagery-dialogue skill group' s time of fall asleep (58.55 ±83. 80)min was the shortest and there were significant differences between

  8. A espirometria na avaliação pré e pós-transplante de medula óssea Pre-operative and post-operative spirometry in bone marrow transplant patients

    Directory of Open Access Journals (Sweden)

    Eliane Viana Mancuzo

    2007-02-01

    complications and looking for correlations with postoperative outcomes. METHODS:The spirometry findings in 120 male and female patients, all above the age of 12, were evaluated retrospectively and compared in terms of the following parameters: the type of bone marrow transplant; the underlying disease; cytomegalovirus serology; source of the transplanted cells; smoking; pulmonary infection; history of lung disease; duration of the hematological disease; chemotherapy employed; conditioning regimen; acute or chronic rejection of the transplant; and post-operative mortality. RESULTS: In the pre-operative spirometry, 16 patients (13.3% presented alterations: 6 (5% presented pure obstruction; 7 (5.8% presented pure restriction; and 3 (2.5% presented obstruction accompanied by a reduction in vital capacity. In the post-operative spirometry, 29 patients (24.2% presented alterations. The chance of presenting post-operative spirometry alterations was greater in patients presenting acute transplant rejection (p = 0.02, patients older than 30 (p = 0.02, female patients (p = 0.02 and patients receiving stem cells (p = 0.01. Having a history of lung disease was found to be associated with greater mortality, as was suffering from chronic transplant rejection. No relationship was found between pre-operative spirometry alterations and post-operative mortality. CONCLUSION: In bone marrow transplant patients, the alterations found through pre-operative spirometry were not predictive of post-operative pulmonary complications or mortality. Nor were such alterations determinant of whether or not a given patient was a good candidate for bone marrow transplant. Simple spirometry seems to be of little practical importance in the evaluation of such patients.

  9. Safety Systems

    Science.gov (United States)

    Halligan, Tom

    2009-01-01

    Colleges across the country are rising to the task by implementing safety programs, response strategies, and technologies intended to create a secure environment for teachers and students. Whether it is preparing and responding to a natural disaster, health emergency, or act of violence, more schools are making campus safety a top priority. At…

  10. Safety Instructions

    CERN Multimedia

    2003-01-01

    Please note that the Safety Instructions N0 37 rev. 3 (IS 37 rev. 3) entitled ""LEVEL-3" SAFETY ALARMS AND ALARM SYSTEMS" Is available on the web at the following URL: http://edms.cern.ch/document/335802 Paper copies can also be obtained from the TIS divisional secretariat, e-mail: tis.secretariat@cern.ch TIS Secretariat

  11. The Influence of Product Exposure on Trendiness and Aesthetic Appraisal

    NARCIS (Netherlands)

    Blijlevens, J.; Mugge, R.; Ye, P.; Schoormans, J.P.L.

    2013-01-01

    Designers use product attributes (e.g., trendiness) to design aesthetically appealing products. The relationships of physical properties (e.g., shape) of product designs with product attributes and aesthetic appraisal are often considered to be generalizable over product categories and markets. Howe

  12. An appraisal of European exchange programmes for nursing students.

    Science.gov (United States)

    Cowan, Robert Barton

    This article appraises contemporary approaches to European student exchange programmes. It explores the impact of exchange programmes on the learning experience of nursing students, with discussion of the findings. Practical suggestions are made to prepare students who are considering this challenging opportunity. Recommendations to optimise the potential for professional, cultural and personal development are also highlighted.

  13. Performance Appraisal: A New Model for Academic Advisement.

    Science.gov (United States)

    Hazleton, Vincent; Tuttle, George E.

    1981-01-01

    Presents the performance appraisal model for student advisement, a centralized developmental model that focuses on the content and process of advisement. The model has three content objectives: job definition, performance assessment, and goal setting. Operation of the model is described. Benefits and potential limitations are identified. (Author)

  14. Appraisal Distortions and Intimate Partner Violence: Gender, Power, and Interaction

    Science.gov (United States)

    Whiting, Jason B.; Oka, Megan; Fife, Stephen T.

    2012-01-01

    In relationships characterized by control, abuse, or violence, many appraisal distortions occur including denial and minimization. However, the nature of the distortion varies depending on the individual's role in the relationship (i.e., abuser or victim). Reducing these distortions is an important component in treatment success and involves…

  15. Teaching Critical Appraisal to Sport & Exercise Sciences and Biosciences Students

    Science.gov (United States)

    Phillips, Anna C.

    2009-01-01

    Seminars were implemented to develop undergraduates' critical appraisal skills and their effectiveness was evaluated. Participants were 140 undergraduate students consisting of 103 students from Sport and Exercise Sciences and 37 from Biosciences. Four seminars were employed to develop and reinforce critical thinking and provide an opportunity for…

  16. Level and appraisal of fatigue are not specific in burnout

    NARCIS (Netherlands)

    Dam, A. van; Keijsers, G.P.J.; Verbraak, M.J.P.M.; Eling, P.A.T.M.; Becker, E.S.

    2015-01-01

    Fatigue is a main feature of the burnout syndrome but also very common in other psychiatric disorders such as major depression and anxiety disorders. This raises the question of whether the level and appraisal of fatigue is experienced differently by individuals suffering from burnout than by those

  17. Participatory rural appraisal of spate irrigation systems in eastern Eritrea

    NARCIS (Netherlands)

    Tesfai, M.; Graaff, de J.

    2000-01-01

    In the Sheeb area in eastern Eritrea a Participatory Rural Appraisal (PRA) was carried out in two villages, one upstream and one downstream of the ephemeral rivers Laba and Mai-ule. The objectives of the study were to obtain a better understanding of farmer-managed spate irrigation systems and to

  18. The First APU Primary Maths Survey: An Appraisal.

    Science.gov (United States)

    Preston, Mike

    1980-01-01

    The author appraises the first report--on primary maths--of the APU primary survey unit which was designed as an assessment of sample selected age groups in primary and secondary schools to provide a general picture of performance. (Author/KC)

  19. Viewing Performance Appraisal with a Wide Angle Lens.

    Science.gov (United States)

    DeVries, David L.

    The majority of empirical studies on performance appraisal (PA) systems focus on the search for the perfect form in which subjective traits are replaced by objective and job-relevant, measurable behaviors. Organizations using a PA system to evaluate their employees struggle with issues of implementation, adaptation, and linkage with other human…

  20. The early evolution of the Archegoniatae: a re-appraisal

    NARCIS (Netherlands)

    Meeuse, A.D.J.

    1966-01-01

    After a re-appraisal of the alternative hypotheses concerning the origin and the early evolution of the archegoniate land plants, the postulation of a thalassiophytic group of precursors with free isomorphic alternating generations by Church, Zimmermann, and several others is rejected. Several versi

  1. Investment appraisal of technology innovations on dairy farm electricity consumption

    NARCIS (Netherlands)

    Upton, J.; Murphy, M.; Boer, de I.J.M.; Groot Koerkamp, P.W.G.; Berentsen, P.B.M.; Shalloo, L.

    2015-01-01

    The aim of this study was to conduct an investment appraisal for milk-cooling, water-heating, and milk-harvesting technologies on a range of farm sizes in 2 different electricity-pricing environments. This was achieved by using a model for electricity consumption on dairy farms. The model simulated

  2. An Appraisal of the DEXA Wave Energy Converter

    DEFF Research Database (Denmark)

    Pecher, Arthur; Kofoed, Jens Peter

    This report has been requested by VækstFonden and aims at giving an overview of the experimental tests and a general appraisal of the DEXA wave energy converter (WEC). The reported results and findings were obtained during previously performed experimental tests by the Wave Energy Research Group...

  3. 78 FR 10367 - Appraisals for Higher-Priced Mortgage Loans

    Science.gov (United States)

    2013-02-13

    ...- 3667, or Carmen Holly, Supervisory Financial Analyst, Division of Banking Supervision and Regulation... initial mortgage application, with a statement that any appraisal prepared for the mortgage is for the... secured by a mobile home, boat, or trailer; (3) transactions to finance the initial construction of...

  4. 7 CFR 1781.14 - Planning, options, and appraisals.

    Science.gov (United States)

    2010-01-01

    ..., DEPARTMENT OF AGRICULTURE (CONTINUED) RESOURCE CONSERVATION AND DEVELOPMENT (RCD) LOANS AND WATERSHED (WS) LOANS AND ADVANCES § 1781.14 Planning, options, and appraisals. (a) WS and RCD area plans are developed... and State agencies. These plans include WS works of improvement and RCD measures to be developed or...

  5. Filmed narratives. Telling stories with Visual Problem Appraisals

    NARCIS (Netherlands)

    Witteveen, L.; Lie, R.

    2015-01-01

    The film-based learning strategy Visual Problem Appraisal is used to enhance the analysis of complex issues and facilitate a plan of action. It is used in workshops dealing with problem analysis and policy design. Participants consult stakeholders whose stories are captured on film. A VPA set consis

  6. Cybersickness Influences the Affective Appraisal of a Virtual Environment

    NARCIS (Netherlands)

    Toet, A.; Spek, E.D. van der; Houtkamp, J.M.

    2010-01-01

    We investigated if cybersickness has an effect on the affective appraisal of a virtual environment (VE). For many applications it is essential that users experience the simulated environment in a similar way as the corresponding real one. Navigation through VEs is known to negatively influence the p

  7. Investment Appraisal Process in the Banking & Finance Industry

    NARCIS (Netherlands)

    M.M. Akalu; J.R. Turner (Rodney)

    2002-01-01

    textabstractWe have studied how the banking and finance industry performs investment appraisal, measures subsequent follow-up and designates project success or failure. Furthermore, the authors looked into the extent of use of the new generation value management models. The result shows that firms a

  8. Evaluating the Capacity of Standard Investment Appraisal Methods

    NARCIS (Netherlands)

    M.M. Akalu

    2002-01-01

    textabstractThe survey findings indicate the existence of gap between theory and practice of capital budgeting. Standard appraisal methods have shown a wider project value discrepancy, which is beyond and above the contingency limit. In addition, the research has found the growing trend in the use o

  9. Establishing Content Validity for a Literacy Coach Performance Appraisal Instrument

    Science.gov (United States)

    Lane, Mae; Robbins, Mary; Price, Debra

    2013-01-01

    This study's purpose was to determine whether or not the Literacy Coach Appraisal Instrument developed for use in evaluating literacy coaches had content validity. The study, a fully mixed concurrent equal status design conducted from a pragmatist philosophy, collected qualitative and quantitative data from literacy experts about the elements of…

  10. Participatory rural appraisal of spate irrigation systems in eastern Eritrea

    NARCIS (Netherlands)

    Tesfai, M.; Graaff, de J.

    2000-01-01

    In the Sheeb area in eastern Eritrea a Participatory Rural Appraisal (PRA) was carried out in two villages, one upstream and one downstream of the ephemeral rivers Laba and Mai-ule. The objectives of the study were to obtain a better understanding of farmer-managed spate irrigation systems and to en

  11. 9 CFR 53.3 - Appraisal of animals or materials.

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Appraisal of animals or materials. 53.3 Section 53.3 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF... animals or materials. (a) Animals affected by or exposed to disease, and materials required to...

  12. Investment Appraisal Process in the Banking & Finance Industry

    NARCIS (Netherlands)

    M.M. Akalu; J.R. Turner (Rodney)

    2002-01-01

    textabstractWe have studied how the banking and finance industry performs investment appraisal, measures subsequent follow-up and designates project success or failure. Furthermore, the authors looked into the extent of use of the new generation value management models. The result shows that firms

  13. Investment appraisal of technology innovations on dairy farm electricity consumption

    NARCIS (Netherlands)

    Upton, J.; Murphy, M.; Boer, de I.J.M.; Groot Koerkamp, P.W.G.; Berentsen, P.B.M.; Shalloo, L.

    2015-01-01

    The aim of this study was to conduct an investment appraisal for milk-cooling, water-heating, and milk-harvesting technologies on a range of farm sizes in 2 different electricity-pricing environments. This was achieved by using a model for electricity consumption on dairy farms. The model simulated

  14. Cybersickness Influences the Affectieve Appraisal of a Virtual Environment

    NARCIS (Netherlands)

    Toet, A.; Houtkamp, J.M.; Spek, van der E.D.

    2010-01-01

    We investigated if cybersickness has an effect on the affective appraisal of a virtual environment (VE). For many applications it is essential that users experience the simulated environment in a similar way as the corresponding real one. Navigation through VEs is known to negatively influence the

  15. Cybersickness Influences the Affective Appraisal of a Virtual Environment

    NARCIS (Netherlands)

    Toet, A.; Spek, E.D. van der; Houtkamp, J.M.

    2010-01-01

    We investigated if cybersickness has an effect on the affective appraisal of a virtual environment (VE). For many applications it is essential that users experience the simulated environment in a similar way as the corresponding real one. Navigation through VEs is known to negatively influence the

  16. Appraisal and acquisition innovative practices for archives and special collections

    CERN Document Server

    Theimer, Kate

    2015-01-01

    Appraisal and Acquisition: Innovative Practices for Archives and Special Collections explores how archivists and special collections librarians in organizations of different sizes and types have approached the challenges of collection, as well as exploring opportunities to acquire new kinds of materials and conduct thoughtful reappraisal.

  17. Performance Appraisal at Four and Five Star Hotels: Ankara Case

    Directory of Open Access Journals (Sweden)

    Yalçın Arslantürk

    2009-12-01

    Full Text Available Nowadays, tourism establishments developing human resources and motivating will make it easier to reach their goals and those who cannot mange to do this will be obsolete in the ever-changing nature of the tourism business. The most important feature of the tourism sector is that it is based on human element and it s labor-intensive. Hence, human element is of great importance. This being the case, the customer satisfaction in accommodation establishments will be greatly dependent on the success of the personnel. Performance appraisal in this regard is a tool used to measure the performance of the employees in establishing job satisfaction and enhancing success. Performance appraisal indicates the performance of the individuals and gives insights as to what should be done to improve the performance. As well as promoting the communication between the employees and the establishment. From the perspectives of the managers, it paves the way for an efficient information flow about the performance of the personnel and makes job planning more rationally. This study first examines performance and performance appraisal. Then, through a field study, deficiencies in the application of performance appraisal were determined in the four and five star hotel establishments. According to the results obtained, some suggestions were put forward.

  18. Filmed narratives. Telling stories with Visual Problem Appraisals

    NARCIS (Netherlands)

    Witteveen, L.; Lie, R.

    2015-01-01

    The film-based learning strategy Visual Problem Appraisal is used to enhance the analysis of complex issues and facilitate a plan of action. It is used in workshops dealing with problem analysis and policy design. Participants consult stakeholders whose stories are captured on film. A VPA set

  19. Cybersickness Influences the Affective Appraisal of a Virtual Environment

    NARCIS (Netherlands)

    Toet, A.; Spek, E.D. van der; Houtkamp, J.M.

    2010-01-01

    We investigated if cybersickness has an effect on the affective appraisal of a virtual environment (VE). For many applications it is essential that users experience the simulated environment in a similar way as the corresponding real one. Navigation through VEs is known to negatively influence the p

  20. Internet Use for Prediagnosis Symptom Appraisal by Colorectal Cancer Patients

    Science.gov (United States)

    Thomson, Maria D.; Siminoff, Laura A.; Longo, Daniel R.

    2012-01-01

    Background: This study explored the characteristics of colorectal cancer (CRC) patients who accessed Internet-based health information as part of their symptom appraisal process prior to consulting a health care provider. Method: Newly diagnosed CRC patients who experienced symptoms prior to diagnosis were interviewed. Brief COPE was used to…