WorldWideScience

Sample records for pre-operational safety appraisal

  1. Safety Culture in Pre-operational Phases of Nuclear Power Plant Projects

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-09-15

    An abundance of information exists on safety culture related to the operational phases of nuclear power plants; however, pre-operational phases present unique challenges. This publication focuses on safety culture during pre-operational phases that span the interval from before a decision to launch a nuclear power programme to first fuel load. It provides safety culture insights and focuses on eight generic issues: safety culture understanding; multicultural aspects; leadership; competencies and resource competition; management systems; learning and feedback; cultural assessments; and communication. Each issue is discussed in terms of: specific challenges; desired state; approaches and methods; and examples and resources. This publication will be of interest to newcomers and experienced individuals faced with the opportunities and challenges inherent in safety culture programmes aimed at pre-operational activities.

  2. Safety Culture in Pre-operational Phases of Nuclear Power Plant Projects

    International Nuclear Information System (INIS)

    2012-01-01

    An abundance of information exists on safety culture related to the operational phases of nuclear power plants; however, pre-operational phases present unique challenges. This publication focuses on safety culture during pre-operational phases that span the interval from before a decision to launch a nuclear power programme to first fuel load. It provides safety culture insights and focuses on eight generic issues: safety culture understanding; multicultural aspects; leadership; competencies and resource competition; management systems; learning and feedback; cultural assessments; and communication. Each issue is discussed in terms of: specific challenges; desired state; approaches and methods; and examples and resources. This publication will be of interest to newcomers and experienced individuals faced with the opportunities and challenges inherent in safety culture programmes aimed at pre-operational activities.

  3. Human actions in the pre-operational probabilistic safety analysis of Juragua Nuclear Power Plant

    International Nuclear Information System (INIS)

    Ferro, R.

    1995-01-01

    Human error is one of the main contributors to the biggest industrial disasters that the world has suffered in the last years. Safety probabilistic analysis techniques allow to consider, in the some study, the contribution of a facility's mechanical and human components safety, this guaranteeing a move integral assessment of these two factors although the PSA study of Juragua Nuclear Power Plant is carried out at a preoperational stage which causes important information limitations fos assessment of human reliability some considerations and suppositions in order to conduct treatment of human actions this stage were adopted. The present work describes the projected targets, approach applied and results obtained from the lakes of human reliability of this study

  4. Safety Culture Perspective. Managing the pre Managing the pre-operational phases of new NPPs and creating the safety culture

    International Nuclear Information System (INIS)

    Cowan, Pamela B.; Oh, Chaewoon; Dahlgren Persson, Kerstin; Carnino, Annick

    2008-01-01

    Nuclear safety is a key for the revival of nuclear energy future programmes. Lots of competent people will be needed worldwide for ensuring the safety of the installations both existing ones and future ones. Their expertise should range from design to operation, from regulatory role to operators, from fuel fabrication to waste disposal. The challenge in front of us will be to prepare for the right recruitment, the development of the needed expertise in order to face the demand in developed countries, in countries with economies in transition and in developing countries. Time allocated for the panel does not allow for covering all aspects but the panelists will cover some of the important aspects of the challenge in terms of needs, of new competencies, of learning from operation and licensing requirements including for new designs. The key objectives of the panel are: 1- Maintaining safe operation, learning from experience, licensing including aging management and re-licensing with safety improvements for existing installations: - Presentation by Junko Ogawa of the experience and lessons learned from the earthquake on Kashiwasaki Kariwa NPP: effects in terms of manpower involved in the investigation, effects on regulations and licensing, expertise used. - Presentation by Pamela Cowan of her experience in preparing licensing actions, regulatory compliance and interface with the Regulator for both operating plants and modern requirements for constructing new ones. 2 - Special training needed for the human aspect of safety: what are the challenges in areas of safety culture and management of safety: - Presentation by Chae Woon Oh of the Korean safety culture features developed nationally, at the regulator and at the operating organizations and their integration within the safety training programmes. - Presentation by Kerstin Dahlgren Person of the needs in terms of safety culture and safety management, in terms of expertise, practitioners and assessors. 3 - How to

  5. Safety Culture Perspective. Managing the pre Managing the pre-operational phases of new NPPs and creating the safety culture

    Energy Technology Data Exchange (ETDEWEB)

    Cowan, Pamela B. [Exelon Generation, 200 Exelon Way, 19348 Kennett Square, PA 19348 (United States); Oh, Chaewoon [Korea Institute of Nuclear Safety, 19 Gusung-Dong, Yuseong-Ku, 305-338 Daejeon (Korea, Republic of); Dahlgren Persson, Kerstin [International Atomic Energy Agency, Wagramer Strasse 5, PO BOX 100 A-1400 Vienna (Austria); Carnino, Annick [IAEA, Division of Nuclear Installation Safety, Wagramer Strasse 5, PO BOX 100 A-1400 Vienna (Austria)

    2008-07-01

    Nuclear safety is a key for the revival of nuclear energy future programmes. Lots of competent people will be needed worldwide for ensuring the safety of the installations both existing ones and future ones. Their expertise should range from design to operation, from regulatory role to operators, from fuel fabrication to waste disposal. The challenge in front of us will be to prepare for the right recruitment, the development of the needed expertise in order to face the demand in developed countries, in countries with economies in transition and in developing countries. Time allocated for the panel does not allow for covering all aspects but the panelists will cover some of the important aspects of the challenge in terms of needs, of new competencies, of learning from operation and licensing requirements including for new designs. The key objectives of the panel are: 1- Maintaining safe operation, learning from experience, licensing including aging management and re-licensing with safety improvements for existing installations: - Presentation by Junko Ogawa of the experience and lessons learned from the earthquake on Kashiwasaki Kariwa NPP: effects in terms of manpower involved in the investigation, effects on regulations and licensing, expertise used. - Presentation by Pamela Cowan of her experience in preparing licensing actions, regulatory compliance and interface with the Regulator for both operating plants and modern requirements for constructing new ones. 2 - Special training needed for the human aspect of safety: what are the challenges in areas of safety culture and management of safety: - Presentation by Chae Woon Oh of the Korean safety culture features developed nationally, at the regulator and at the operating organizations and their integration within the safety training programmes. - Presentation by Kerstin Dahlgren Person of the needs in terms of safety culture and safety management, in terms of expertise, practitioners and assessors. 3 - How to

  6. Technical Safety Appraisal of the Pinellas Plant

    International Nuclear Information System (INIS)

    1991-01-01

    This report presents the Technical Safety Appraisal (TSA) of the Pinellas Plant in Pinellas County, Florida. The plant is owned and controlled by the US Department of Energy and operated by General Electric Neutron Devices (GEND). The TSA was performed during the period January 15--31, 1989, in support of a Tiger Team Assessment which occurred during the period January 15 to February 2, 1989. The TSA provided the Safety and Health Subteam input to the Tiger Team Assessment. The completion of the assessment process includes: (1) submission of the Team's preliminary findings and concerns, in a Draft Report, to the Manager, Albuquerque Operations Office and to the site contractors at the conclusion of the onsite assessment; (2) review of the Draft Report for technical and factual accuracy; incorporation of the appropriate review comments, suggested changes, and modifications, as well as input from all interested Program Secretarial Offices; preparation of a draft Action Plan by the Albuquerque Operations Office to address the Concerns, and submittal of that Action Plan through the Program Office to ES ampersand H for their review and comment. The Secretary approved the final Action Plan on December 16, 1990, and directed its implementation. The comments and suggestions of the Program Secretarial Offices, the Operations Office, and the site contractor have been incorporated, as appropriate, in this report prior to its publication

  7. The IAEA Transport Safety Appraisal Service (TranSAS)

    International Nuclear Information System (INIS)

    Dicke, G.J.

    2004-01-01

    Representatives of all Member States of the IAEA meet once a year in September at the General Conference in Vienna, Austria, to consider and approve the Agency's programme and budget and to address matters brought before it by the Board of Governors, the Director General, or Member States. In September 1998 the General Conference adopted resolution GC(42)/RES/13 on the Safety of Transport of Radioactive Materials. In adopting that resolution the General Conference recognized that compliance with regulations that take account of the IAEA Regulations for the Safe Transport of Radioactive Material (the IAEA Transport Regulations) is providing a high level of safety during the transport of radioactive material. Good compliance requires that the regulations are implemented effectively. The General Conference therefore requested the IAEA Secretariat to provide a service for carrying out, at the request of any State, an appraisal of the implementation of the Transport Regulations by that State. In response to this request the Director General of the IAEA offered such an appraisal service to all States in letter J1.01.Circ, dated 10 December 1998. The first Transport Safety Appraisal Service (TranSAS) was undertaken and completed at the request of Slovenia in 1999. A report on the results of that appraisal was published and released for general distribution in the early fall of 1999. In each of the General Conferences since 1998, resolutions focused on transport safety have commended the Secretariat for establishing the TranSAS, commended those States that have requested the appraisal service and encouraged other States to avail themselves of this service see GC(43)/RES/11, GC(44)/RES/17, GC(45)/RES/10, GC(46)/RES/9 and GC(47)/RES/7. Six appraisals have been carried out to date as follows: Slovenia, Brazil, United Kingdom, Turkey, Panama and France. This presentation provides an overview of the Transport Safety Appraisal Service and summarizes the major findings from the

  8. The IAEA Transport Safety Appraisal Service (TranSAS)

    Energy Technology Data Exchange (ETDEWEB)

    Dicke, G.J. [International Atomic Energy Agency, Vienna (Austria)

    2004-07-01

    Representatives of all Member States of the IAEA meet once a year in September at the General Conference in Vienna, Austria, to consider and approve the Agency's programme and budget and to address matters brought before it by the Board of Governors, the Director General, or Member States. In September 1998 the General Conference adopted resolution GC(42)/RES/13 on the Safety of Transport of Radioactive Materials. In adopting that resolution the General Conference recognized that compliance with regulations that take account of the IAEA Regulations for the Safe Transport of Radioactive Material (the IAEA Transport Regulations) is providing a high level of safety during the transport of radioactive material. Good compliance requires that the regulations are implemented effectively. The General Conference therefore requested the IAEA Secretariat to provide a service for carrying out, at the request of any State, an appraisal of the implementation of the Transport Regulations by that State. In response to this request the Director General of the IAEA offered such an appraisal service to all States in letter J1.01.Circ, dated 10 December 1998. The first Transport Safety Appraisal Service (TranSAS) was undertaken and completed at the request of Slovenia in 1999. A report on the results of that appraisal was published and released for general distribution in the early fall of 1999. In each of the General Conferences since 1998, resolutions focused on transport safety have commended the Secretariat for establishing the TranSAS, commended those States that have requested the appraisal service and encouraged other States to avail themselves of this service see GC(43)/RES/11, GC(44)/RES/17, GC(45)/RES/10, GC(46)/RES/9 and GC(47)/RES/7. Six appraisals have been carried out to date as follows: Slovenia, Brazil, United Kingdom, Turkey, Panama and France. This presentation provides an overview of the Transport Safety Appraisal Service and summarizes the major findings from

  9. 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.

  10. Technical safety appraisal of the West Valley Demonstration Project

    International Nuclear Information System (INIS)

    1989-09-01

    This report presents the results of one in a series of Technical Safety Appraisals (TSAs) being conducted of DOE nuclear operations by the Assistant Secretary for Environment, Safety, and Health Office of Safety Appraisals TSAs are one of the ititiatives announced by the Secretary of Energy on September 18, 1985, to enhance the DOE environment, safety and health program. This report presents the results of a TSA of the West Valley Demonstration Project (WVDP). The appraisal was conducted by a team of exerts assembled by the DOE Office of Safety Appraisal and was conducted during onsite visits of June 26-30 and July 10-21, 1989. West Valley, about 30 miles south of Buffalo, New York is the location of the only commercial nuclear fuel reprocessing facility operated in the United States. Nuclear Fuels Services, Inc. (NFS) operated the plant from 1966 to 1972 and processed about 640 metric tons of spent reactor fuel. The reprocessing operation generated about 560,000 gallons of high-level radioactive waste, which was transferred into underground tanks for storage. In 1972 NFS closed the plant and subsequently decided not to reopen it

  11. Technical safety appraisal of the Idaho Chemical Processing Plant

    International Nuclear Information System (INIS)

    1992-05-01

    On June 27, 1989, Secretary of Energy, Admiral James D. Watkins, US Navy (Retired), announced a 10-point initiative to strengthen environment, safety, and health (ES ampersand H) programs and waste management operations in the Department of Energy (DOE). One of the initiatives involved conducting independent Tiger Team Assessments (TTA) at DOE operating facilities. A TTA of the Idaho National Engineering Laboratory (INEL) was performed during June and July 1991. Technical Safety Appraisals (TSA) were conducted in conjunction with the TTA as its Safety and Health portion. However, because of operational constraints the the Idaho Chemical Processing Plant (ICPP), operated for the DOE by Westinghouse Idaho Nuclear Company, Inc. (WINCO), was not included in the Safety and Health Subteam assessment at that time. This TSA, conducted April 12 - May 8, 1992, was performed by the DOE Office of Performance Assessment to complete the normal scope of the Safety and Health portion of the Tiger Team Assessment of the Idaho National Engineering Laboratory. The purpose of TSAs is to evaluate and strengthen DOE operations by verifying contractor compliance with DOE Orders, to assure that lessons learned from commercial operations are incorporated into facility operations, and to stimulate and encourage pursuit of excellence; thus, the appraisal addresses more issues than would be addressed in a strictly compliance-oriented appraisal. A total of 139 Performance Objectives have been addressed by this appraisal in 19 subject areas. These 19 areas are: organization and administration, quality verification, operations, maintenance, training and certification, auxiliary systems, emergency preparedness, technical support, packaging and transportation, nuclear criticality safety, safety/security interface, experimental activities, site/facility safety review, radiological protection, worker safety and health compliance, personnel protection, fire protection, medical services and natural

  12. 242-A Evaporator crystallizer facility integrated annual safety appraisal

    International Nuclear Information System (INIS)

    1991-01-01

    This report provides the results of the Fiscal Year (FY) 1991 Annual Integrated Safety Appraisal of the 242-A Evaporator Crystallizer Facility in the Hanford 200 East Area. The appraisal was conducted in December 1990 and January 1991, by the Waste Tank Safety Assurance (WTSA) organizations in conjunction with Radiological Engineering, Criticality Safety, Packaging and Shipping Safety, Emergency Preparedness, Environmental Compliance, and Quality Assurance. Reports of these eight organizations are presented as Sections 2 through 7 of this report. The purpose of the appraisal was to verify that the 242-A Evaporator meets US Department of Energy (DOE) and Westinghouse Hanford Company (WHC) requirements and current industry standards of good practice for the areas being appraised. A further purpose was to identify areas in which program effectiveness could be improved. In accordance with the guidance of WHC Management Requirements and Procedures (MRP)5.6, previously identified deficiencies which are being resolved by line management were not repeated as Findings or Observations unless progress or intended disposition was considered to be unsatisfactory

  13. Technical safety appraisal of the N-Reactor

    International Nuclear Information System (INIS)

    1986-07-01

    This report presents the results of a Technical Safety Appraisal conducted at the Hanford N-Reactor. A team of specialists gathered information for about three weeks on all areas related to safety at the plant. Operational practices, maintenance practices, training drills, and hardware condition were observed. Several recommendations are made in order to correct incomplete rule implementation, to correct hazardous practices, and to promote improvement in satisfactory areas

  14. B plant/WESF integrated annual safety appraisal

    International Nuclear Information System (INIS)

    Anderson, J.K.

    1990-12-01

    This report provides the results of the Fiscal Year 1990 Annual Integrated Safety Appraisal of the B Plant and Waste Encapsulation and Storage Facility in the Hanford Site 200 East Area. The appraisal was conducted in August and September 1990, by the Defense Waste Disposal Safety group, in conjunction with Health Physics and Emergency Preparedness. Reports of these three organizations for their areas of responsibility are presented. The purpose of the appraisal was to determine if the areas being appraised meet US Department of Energy (DOE) and Westinghouse Hanford Company (WHC) requirements and current industry standards of good practice. A further purpose was to identify areas in which program effectiveness could be improved. In accordance with the guidance of WHC Management Requirements and Procedures 5.6, previously identified deficiencies which are being resolved by line management were not repeated as Findings or Observations unless progress or intended disposition was considered to be unsatisfactory. The overall assessment is that there are no major safety problems associated with current operations. Programs are in place to provide the necessary safety controls, evaluations, overviews, and support. In most respects these programs are being implemented effectively. However, there are a number of deficiencies in details of program design and implementation. The appraisal identified a total of 23 Findings and 27 Observations of deficiencies. All Observations are Seriousness Category 3. Fifteen Findings were Category 2 and 8 were Category 3. Most of the Category 2 Findings were so categorized on the basis of noncompliance with mandatory DOE Orders or WHC policies and procedures, rather than potential risk to personnel

  15. Technical safety appraisal of the Hanford Tank Farm Facility

    International Nuclear Information System (INIS)

    Brinkerhoff, L.C.

    1989-05-01

    This report presents the results of one in a series of TSAs being conducted at DOE nuclear operations by the Assistant Secretary for Environment, Safety, and Health, Office of Safety Appraisals. TSAs are one of the initiatives announced by the Secretary of Energy on September 18, 1985, to enhance the DOE environment, safety and health program. This report provides the results of a TSA of the Tank Farm in the 200 East and 200 West Areas located on the Hanford site. The appraisal was conducted by a team of experts assembled by the DOE Office of Safety Appraisals and was conducted during onsite visits of March 20--24 and April 3--14, 1989. At the Tank Farm, the processing of spent reactor fuels to recover the useful radioactive products is accompanied by the production of radioactive waste. Because many of these wastes will retain radioactivity for many years, they must be safely handled, contained, and disposed with regard to protection of the environment, employees, and the public. Dilute low-level waste and five year ''cooled'' aging wastes are pumped to an evaporator for concentration. The radioactive liquid and solid wastes are stored in underground carbon steel tanks ranging in capacity from 55,000 to over one million gallons

  16. 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.

  17. Pre-operative evaluation for thorax surgery

    International Nuclear Information System (INIS)

    Silva Luis, Saenz; Morales, Oscar Alberto

    2002-01-01

    A pre-operative analysis of the function of the breathing system is made in the patient that will be taken to thorax surgery. The paper includes risk factors, pre-operative clinical evaluation and of breathing and cardiovascular system

  18. 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.

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

    International Nuclear Information System (INIS)

    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

  20. Pre-operative biliary drainage for obstructive jaundice

    Science.gov (United States)

    Fang, Yuan; Gurusamy, Kurinchi Selvan; Wang, Qin; Davidson, Brian R; Lin, He; Xie, Xiaodong; Wang, Chaohua

    2014-01-01

    % and 100%. There was no significant difference in mortality (40/265, weighted proportion 14.9%) in the pre-operative biliary drainage group versus the direct surgery group (34/255, 13.3%) (RR 1.12; 95% CI 0.73 to 1.71; P = 0.60). The overall serious morbidity was higher in the pre-operative biliary drainage group (60 per 100 patients in the pre-operative biliary drainage group versus 26 per 100 patients in the direct surgery group) (RaR 1.66; 95% CI 1.28 to 2.16; P = 0.0002). The proportion of patients who developed serious morbidity was significantly higher in the pre-operative biliary drainage group (75/102, 73.5%) in the pre-operative biliary drainage group versus the direct surgery group (37/94, 37.4%) (P jaundice. Pre-operative biliary drainage may increase the rate of serious adverse events. So, the safety of routine pre-operative biliary drainage has not been established. Pre-operative biliary drainage should not be used in patients undergoing surgery for obstructive jaundice outside randomised clinical trials. PMID:22972086

  1. Appraisal for Japan of the safety of transport of radioactive material. Provision for the application of the IAEA safety standards

    International Nuclear Information System (INIS)

    2006-01-01

    The IAEA's Statute authorizes it to provide for the application of its standards at the request of any State. The objective of a TranSAS appraisal is to assist any requesting State to achieve a high level of safety in the transport of radioactive material by reviewing its implementation of the Transport Regulations and by making recommendations for improvement where appropriate.The IAEA discharges this statutory function through a number of mechanisms, including rendering independent peer review appraisal services to determine the status of compliance with its standards. The appraisal for Japan in December 2005 on the safety of the transport of radioactive material is the seventh TranSAS mission since the inception of the service. This report presents its findings. The TranSAS appraisal team completed a comprehensive appraisal of the implementation of the Transport Regulations in Japan. The cooperation of the authorities in Japan, and of all those who participated in the discussions, was excellent and contributed to the success of the appraisal. The comprehensive legal framework, with responsibilities identified in considerable detail and with clear lines of authority to minimize overlap of responsibilities, provides a sound basis for the implementation of the Transport Regulations. Generally, the Transport Regulations are implemented in accordance with IAEA requirements. Some areas for possible improvement have been identified. These areas relate mainly to reduction of regulations, quality management systems, training, compliance assurance and lessening the administrative burden for incorporating amendments to the IMDG Code. The findings include a considerable number of good practices, in particular in the area of maritime transport

  2. Appraisal of Fire Safety Management Systems at Educational Buildings

    Directory of Open Access Journals (Sweden)

    Nadzim N.

    2014-01-01

    Full Text Available Educational buildings are one type of government asset that should be protected, and they play an important role as temporary communal meeting places for children, teachers and communities. In terms of management, schools need to emphasize fire safety for their buildings. It is well known that fires are not only a threat to the building’s occupants, but also to the property and the school environment. A study on fire safety management has been carried out on schools that have recently experienced fires in Penang. From the study, it was found that the school buildings require further enhancement in terms of both active and passive fire protection systems. For instance, adequate fire extinguishers should be provided to the school and the management should inspect and maintain fire protection devices regularly. The most effective methods to increase the level of awareness on fire safety are by organizing related programs on the management of fire safety involving all staff, teachers and students, educational talks on the dangers of fire and important actions to take in the event of an emergency, and, lastly, to appoint particular staff to join the management safety team in schools.

  3. Radioactivity in consumer products : radiation safety and regulatory appraisal

    International Nuclear Information System (INIS)

    Murthy, B.K.S.; Venkataraman, G.; Subrahmanym, P.

    1993-01-01

    Use of radioactive materials in consumer products is in vogue almost since the discovery of radioactivity. There has been a rapid growth in the use of radioactive material in various consumer products such as Ionization Chamber Smoke Detectors (ICSD), Static eliminators, etc. In addition, there are certain manufacturing processes wherein the Naturally Occurring Radioactive Material (NORM) get incorporated in the consumer products. Certain phosphatic fertilizers, titanium dioxide pigments, phospho gypsum plaster boards are some examples in this category. The manufacture and use of these products result in radiation dose to the public apart from radiation exposure to the personnel involved in the manufacturing process. Appropriate radiation control measures have to be taken in the design, manufacture and use of consumer products to ensure that the radiation doses to the public and the population at large do not exceed the relevant limits. While appropriate regulatory controls and surveillance are established for manufacture and use of certain products, these are still to be recognised and established in respect of certain other processes and products. The current status of radiation safety and regulatory control and the lack of these in respect of some products are discussed in this paper. (author). 5 refs

  4. Summary of Tiger Team Assessment and Technical Safety Appraisal recurring concerns in the Operations Area

    International Nuclear Information System (INIS)

    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 (11) 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 Operations concerns that were identified in each of the TSA report functional areas have been included in this summary with the corresponding TSA performance objective

  5. 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...

  6. Appraisal for France of the safety of the transport of radioactive material. Provision for the application of the IAEA safety standards

    International Nuclear Information System (INIS)

    2004-01-01

    The IAEA has the specific statutory function within the United Nations system of establishing standards of safety for the protection of health against exposure to ionizing radiation. As part of this mandate, the IAEA has issued Regulations for the Safe Transport of Radioactive Material, and has also established the Transport Safety Appraisal Service (TranSAS) to carry out, at the request of States, appraisals of the implementation of these regulations. The IAEA carried out such an appraisal in France from 27 March to 8 April 2004. The appraisal addressed all relevant transport activities in France, both national and international, for all modes of transport, with special emphasis on the maritime transport and air transport of radioactive material. This report summarizes the findings of the 13 independent experts who participated in the appraisal

  7. Summary of Tiger Team Assessment and Technical Safety Appraisal recurring concerns in the Maintenance Area

    International Nuclear Information System (INIS)

    1993-01-01

    Tiger Team Assessments and Technical Safety Appraisals (TSA) were reviewed and evaluated for concerns in the Maintenance Area (MA). Two hundred and thirty one (231) maintenance concerns were identified by the Tiger Team Assessments and TSA reports. These recurring concerns appear below. A summary of the Noteworthy Practices that were identified and a compilation of the maintenance concerns for each performance objective that were not considered as recurring are also included. Where the Tiger Team Assessment and TSA identified the operating contractor or facility by name, the concern has been modified to remove the name while retaining the intent of the comment

  8. Technical safety appraisal of buildings 9206 and 9212, Oak Ridge Y-12 plant

    International Nuclear Information System (INIS)

    1989-03-01

    This report covers the results of a Safety Performance Review of the Y-12 Plant conducted during the period July 25 through August 3, 1988. A Safety Performance Review is a followup to assess changes in performance since the 1986 Technical Safety Appraisal (TSA). This review is patterned after a TSA and covered the overall safety performance at Y-12, evaluating progress to date against standards of accepted practice. The review included coverage of actions taken in response to recommendations in the TSA conducted in July--August 1986. Remaining issues were identified through an assessment of safety program deficiencies and their root causes. For each of the 14 safety-related functional areas at the Y-12 Plant, results of this review are listed in Section V. These results include a discussion, conclusions, and any new safety concerns for each program. Appendix A contains a description of the system for categorizing concerns, and the concerns are summarily tabulated in Appendix B for all programs. Appendix C describes the contractor's response and current status of each of the 59 recommendations contained in the 1986 TSA

  9. Guidance for implementing an environmental, safety and health assurance program. Volume 2. A model plan for environmental, safety and health staff audits and appraisals

    International Nuclear Information System (INIS)

    Ellingson, A.C.

    1980-09-01

    This is 1 of 15 documents designed to illustrate how an Environmental, Safety and Health (ES and H) Assurance Program may be implemented. The generic definition of ES and H Assurance Programs is given in a companion document entitled An Environmental, Safety and Health Assurance Program Standard. This document is concerned with ES and H audit and appraisal activities of an ES and H Staff Organization as they might be performed in an institution whose ES and H program is based upon the ES and H Assurance Program Standard. An annotated model plan for ES and H Staff audits and appraisals is presented and discussed

  10. Pre-operative optimisation of lung function

    Directory of Open Access Journals (Sweden)

    Naheed Azhar

    2015-01-01

    Full Text Available The anaesthetic management of patients with pre-existing pulmonary disease is a challenging task. It is associated with increased morbidity in the form of post-operative pulmonary complications. Pre-operative optimisation of lung function helps in reducing these complications. Patients are advised to stop smoking for a period of 4–6 weeks. This reduces airway reactivity, improves mucociliary function and decreases carboxy-haemoglobin. The widely used incentive spirometry may be useful only when combined with other respiratory muscle exercises. Volume-based inspiratory devices have the best results. Pharmacotherapy of asthma and chronic obstructive pulmonary disease must be optimised before considering the patient for elective surgery. Beta 2 agonists, inhaled corticosteroids and systemic corticosteroids, are the main drugs used for this and several drugs play an adjunctive role in medical therapy. A graded approach has been suggested to manage these patients for elective surgery with an aim to achieve optimal pulmonary function.

  11. Pre-operative haematological investigations in paediatric orofacial ...

    African Journals Online (AJOL)

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

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

    International Nuclear Information System (INIS)

    Ruokola, E.

    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.)

  13. Implementation of Pre-Operative Checklist: An Effort to Reduce ...

    African Journals Online (AJOL)

    Implementation of Pre-Operative Checklist: An Effort to Reduce Delays in. Surgery and ... insight to develop a pre-operative checklist to ensure that patients were prepared for surgery and to minimize disruptions ... documentation audit was conducted in May 2014, showing 59% compliance in completing the checklist. Since.

  14. Pre-operative simulation of pediatric mastoid surgery with 3D-printed temporal bone models.

    Science.gov (United States)

    Rose, Austin S; Webster, Caroline E; Harrysson, Ola L A; Formeister, Eric J; Rawal, Rounak B; Iseli, Claire E

    2015-05-01

    As the process of additive manufacturing, or three-dimensional (3D) printing, has become more practical and affordable, a number of applications for the technology in the field of pediatric otolaryngology have been considered. One area of promise is temporal bone surgical simulation. Having previously developed a model for temporal bone surgical training using 3D printing, we sought to produce a patient-specific model for pre-operative simulation in pediatric otologic surgery. Our hypothesis was that the creation and pre-operative dissection of such a model was possible, and would demonstrate potential benefits in cases of abnormal temporal bone anatomy. In the case presented, an 11-year-old boy underwent a planned canal-wall-down (CWD) tympano-mastoidectomy for recurrent cholesteatoma preceded by a pre-operative surgical simulation using 3D-printed models of the temporal bone. The models were based on the child's pre-operative clinical CT scan and printed using multiple materials to simulate both bone and soft tissue structures. To help confirm the models as accurate representations of the child's anatomy, distances between various anatomic landmarks were measured and compared to the temporal bone CT scan and the 3D model. The simulation allowed the surgical team to appreciate the child's unusual temporal bone anatomy as well as any challenges that might arise in the safety of the temporal bone laboratory, prior to actual surgery in the operating room (OR). There was minimal variability, in terms of absolute distance (mm) and relative distance (%), in measurements between anatomic landmarks obtained from the patient intra-operatively, the pre-operative CT scan and the 3D-printed models. Accurate 3D temporal bone models can be rapidly produced based on clinical CT scans for pre-operative simulation of specific challenging otologic cases in children, potentially reducing medical errors and improving patient safety. Copyright © 2015 Elsevier Ireland Ltd. All rights

  15. Guidance for implementing an environmental, safety, and health assurance program. Volume 10. Model guidlines for line organization environmental, safety and health audits and appraisals

    International Nuclear Information System (INIS)

    Ellingson, A.C.

    1981-10-01

    This is 1 of 15 documents designed to illustrate how an Environmental, Safety and Health (ES and H) Assurance Program may be implemented. The generic definition of ES and H Assurance Programs is given in a companion document entitled An Environmental, Safety and Health Assurance Program Standard. The Standard specifies that the operational level of an institution must have an internal assurance function, and this document provides guidance for the audit/appraisal portion of the operational level's ES and H program. The appendixes include an ES and H audit checklist, a sample element rating guide, and a sample audit plan for working level line organization internal audits

  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

    BACKGROUND: Although persistent postherniotomy occurs in 5-10% of patients, pathogenic mechanisms remain debatable. Since pre-operative pain has been demonstrated to be a risk factor for persistent postherniotomy pain, pre-operative alterations in nociceptive function may be a potential pathogenic...... 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...... (7%), all whom experienced no pain or pain less than weekly. Only cool detection thresholds were significantly lower between the hernia vs. contralateral side (poperative groin hernia...

  17. Pre-Operational Seismic Walk-Through of NPPs in India

    International Nuclear Information System (INIS)

    Soni, R.S.; Mishra, R.K.; Agrawal, M.K.; Reddy, G.R.; Kushwaha, H.S.; Venkat Raj, V.; Badrinarayan, G.; Hawaldar, R.V.; Ingole, S.M.

    2002-01-01

    In nuclear power plants, it is essential to design the various safety and safety related systems and components of the plant in such a manner that they maintain their structural integrity as well as serve their functional performance during a seismic event. The pre-operational seismic walk-through helps in ensuring the installation of various seismic supports as per design intent, identifying the areas where supports are inadequate, identifying the interaction concerns between the systems of various safety classes and locating the various undesired loose, untied / unanchored components, tools, etc. used during the construction activity. A detailed procedure for the pre-operational seismic walk-through of the NPPs was therefore, prepared. Since the types and locations of seismic supports for the various systems and components of the plant had been already reviewed, the major emphasis during the walk-through was laid on their proper installation. (authors)

  18. 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.

  19. The potential benefit of pre-operative assessment of amputation ...

    African Journals Online (AJOL)

    The potential benefit of pre-operative assessment of amputation wound healing potential in peripheral vascular disease. M. Mars, R. P. Mills, J. V. Robbs. Abstract. Choosing the most distal amputation level that will heal is difficult in patients with peripheral vascular disease. From 1984 to 1988,965 patients underwent 1 563 ...

  20. 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.)

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

    DEFF Research Database (Denmark)

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

    2009-01-01

    (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...... 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....

  2. Safety and Security of Older Persons in Tehran, Iran: A Sociological Appraisal of Elder Abuse

    Science.gov (United States)

    Sheykhi, Mohammad Taghi

    2010-01-01

    The article explores and evaluates the quality of life, safety, and security of elderly people in Tehran City in Iran. In that, different dimensions of material and social well-being, and abuse of people of the age 65 and above, are assessed. Besides the human rights, the dignity, and the gradual decline of the elderly's social security are…

  3. The IRSN experience feedback for the transport package design safety appraisals

    International Nuclear Information System (INIS)

    Sert, G.

    2007-01-01

    The activity of transportation of radioactive materials is in constant evolution; air transport of radio elements for medical use is growing rapidly as well as transport of instruments equipped with radioactive sources for inspections of buildings (controls of presence of lead in paintings) and in industry (non destructive examination of welding by gammagraphy, controls of density on building sites). Transports associated with the recycling of plutonium for the production of electricity by nuclear energy are now accomplished in routine. Globally, 900.000 packages are shipped each year in France; among them, approximately 100.000 packages belong to the category for which design approval is required. To maintain a high level of safety for this activity by limiting the probability of occurrence, the severity and consequences of the incidents and accidents, strict rules are implemented by users under the control of the Safety Authority According to the systematic approach of defence in depth, which is defined by the three principles of safety in design, of operational reliability and of effectiveness of emergency response, the robustness of the design of the package is of primary importance. It is based on regulatory requirements relating to the functions of safety (containment of radioactivity, protection against radiation and prevention of the risks of criticality) that must be ensured by the package in conditions of transport as well as in accident conditions. These rules and the way of applying them evolve with time. Indeed, on the one hand the regulation is reexamined periodically; on the other hand, the technical knowledge on the behaviour of the packages subject to the above mentioned conditions and the means of evaluation of this behaviour progress permanently

  4. 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

  5. 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.

  6. 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.

  7. 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

  8. Assessment of site-scale hydrogeological modelling possibilities in crystalline hard rock for safety appraisal

    Energy Technology Data Exchange (ETDEWEB)

    Geier, J. [Cleanwater Hardrock Consulting, Corvallis, OR (United States); Luukkonen, A.

    2012-09-15

    This review describes the state-of-the-art in hydrogeological modelling for safety-case studies related to spent-fuel repositories in crystalline hard rock, focusing on issues of relevance for the KBS-3 disposal concept in Nordic environments. The review includes a survey of model capabilities and assumptions regarding groundwater flow processes, geological and excavation-related features, and boundary conditions for temperate, periglacial, and glacial climates. Modelling approaches are compared for research sites including the Stripa mine (Sweden), the Grimsel Test Site (Switzerland), the Whiteshell Underground Research Laboratory (Canada), the Aspo Hard Rock Laboratory and Simpevarp-Laxemar site (Sweden), the Forsmark site (Sweden), the Waste Isolation Pilot Plant site (USA), and Olkiluoto (Finland). Current hydrogeological models allow realistic representations, but are limited by availability of data to constrain their properties. Examples of calibrations of stochastic representations of heterogeneity are still scarce. Integrated models that couple flow and non-reactive transport are now well established, particularly those based on continuum representations. Models that include reactive transport are still mainly in the realm of research tools. Thus far, no single software tool allows fully coupled treatment of all relevant thermal, hydraulic, mechanical, and chemical transport processes in the bedrock, together with climate-related physical processes at the ground surface, and with explicit treatment of bedrock heterogeneity. Hence practical applications require combinations of models based on different simplifications. Key improvements can be expected in treatment of the unsaturated zone, simulation of heterogeneous infiltration at the surface, and hydromechanical coupling. Significant advances have already been made in the amounts and types of data that can be used in site-scale models, including large datasets to define topography and other surface

  9. 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.

  10. Implementation of pre-operational version of RODOS in Slovakia

    International Nuclear Information System (INIS)

    Duranova, T.; Janko, K.

    2000-01-01

    With support of the European Commission's Echo programme ''Implementation of the Rodeos Decision Support System for Off-Site Emergency Preparation and response in the Emergency centres in Poland and the Slovak Republics' '', Rodeos was implemented in the Slovak Republic. The main objective of the project - implemented by the Consortium of Ecton and STUK, with participation of VUJE and IAE - was to accelerate the implementation of the RODOS system within national emergency preparedness arrangements in Poland and the Slovak Republic. The main elements are: procure and install the computer hardware for the RODOS; establish dedicated communication lines; install and adapt RODOS software; test and verify the operability of the whole system; develop and implement procedures for the pre-operational integration of RODOS into national emergency arrangements; develop and implement maintenance procedures; develop and implement a training programme. (author)

  11. Implementation of pre-operational version of RODOS in Slovakia

    International Nuclear Information System (INIS)

    Duranova, T.

    2001-01-01

    With support from the European Commission's ECHO programme 'Implementation of the RODOS Decision Support System for Off-Site Emergency Preparation and response in the Emergency centres in Poland and the Slovak Republic', RODOS was implemented in the Slovak Republic. The main objective of the project which was implemented by the Consortium of ENCONET and STUK, with participation of VUJE and IAE, was to accelerate the implementation of the RODOS system within national emergency preparedness arrangements in Poland and the Slovak Republic. The main elements are: procure and install the computer hardware for the RODOS; establish dedicated communication lines; install and adapt RODOS software; test and verify the operability of the whole system; develop and implement procedures for the pre-operational integration of RODOS into national emergency arrangements; develop and implement maintenance procedures; develop and implement a training programme. (author)

  12. Pre-operative radiochemotherapy of locally advanced rectal cancer

    Institute of Scientific and Technical Information of China (English)

    Xiao-Nan Sun; Qi-Chu Yang; Jian-Bin Hu

    2003-01-01

    AIM: To evaluate results of pre-operative radiochemotherapy followed by surgery for 15 patients with locally advanced un-resectable rectal cancer.METHODS: 15 patients with advanced non-resectable rectal cancer were treated with pre-operative irriadiation of 40-46 Gy plus concomitant chemotherapy (5-FU+LV and 5′-DFuR) (RCS group). For comparison, 27 similar patients,treated by preoperative radiotherapy (40-50 Gy) plus surgery were served as control (RS group).RESULTS: No radiochemotherapy or radiotherapy was interrupted and then was delayed because of toxicities in both groups. The radical resectability rate was 73.3% in the RCS group and 37.0% (P=0.024) in RS group. Sphincter preservation rates were 26.6% and 3.7% respectively (P=0.028). Sphincter preservation rates of lower rectal cancer were 27.3 % and 0.0 % respectively (P=0.014). Response rates of RCS and RS groups were 46.7 % and 18.5 %(P=0.053). The tumor downstage rates were 8 (53.3%)and 9 (33.3%) in these groups (P=0.206). The 3-year overall survival rates were 66.7 % and 55.6% (P=0.485), and the disease free survival rates were 40.1% and 33.2%(P=0.663). The 3-year local recurrent rates were 26.7%and 48.1% (P=0.174). No obvious late effects were found in either groups.CONCLUSION: High resectability is possible following preoperative radiochemotherapy and can have more sphincters preserved. It is important to improve the quality of the patients′ life even without increasing the survival or local control rates. Preoperative radiotherapy with concomitant full course chemotherapy (5-Fu+LV and 5′-DFuR) is effective and safe.

  13. Current practices in economic appraisal

    NARCIS (Netherlands)

    Mossink, J.C.M.

    2000-01-01

    By means of economic appraisal, the costs and the benefits of health, environment and safety management can be made clear, both at the national level and at the company level. As such it is a tool in advocating good practices. This paper explores the possibilities of economic appraisal for policy

  14. Quality assurance of pre-operative assessment--a review of quality assurance activities related to pre-operative assessment in nine hospitals in The Netherlands

    NARCIS (Netherlands)

    Klazinga, N. S.; Helsloot, R.

    1989-01-01

    Pre-operative assessment of patients for surgery is one of the most prevalent topics for quality assurance by peer-review in Dutch hospitals. This article describes the experiences with pre-operative assessment in nine hospitals. It is discussed why preoperative assessment is performed, what tests

  15. 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....

  16. Connectome analysis for pre-operative brain mapping in neurosurgery

    Science.gov (United States)

    Hart, Michael G.; Price, Stephen J.; Suckling, John

    2016-01-01

    Abstract Object: Brain mapping has entered a new era focusing on complex network connectivity. Central to this is the search for the connectome or the brains ‘wiring diagram’. Graph theory analysis of the connectome allows understanding of the importance of regions to network function, and the consequences of their impairment or excision. Our goal was to apply connectome analysis in patients with brain tumours to characterise overall network topology and individual patterns of connectivity alterations. Methods: Resting-state functional MRI data were acquired using multi-echo, echo planar imaging pre-operatively from five participants each with a right temporal–parietal–occipital glioblastoma. Complex networks analysis was initiated by parcellating the brain into anatomically regions amongst which connections were identified by retaining the most significant correlations between the respective wavelet decomposed time-series. Results: Key characteristics of complex networks described in healthy controls were preserved in these patients, including ubiquitous small world organization. An exponentially truncated power law fit to the degree distribution predicted findings of general network robustness to injury but with a core of hubs exhibiting disproportionate vulnerability. Tumours produced a consistent reduction in local and long-range connectivity with distinct patterns of connection loss depending on lesion location. Conclusions: Connectome analysis is a feasible and novel approach to brain mapping in individual patients with brain tumours. Applications to pre-surgical planning include identifying regions critical to network function that should be preserved and visualising connections at risk from tumour resection. In the future one could use such data to model functional plasticity and recovery of cognitive deficits. PMID:27447756

  17. Connectome analysis for pre-operative brain mapping in neurosurgery.

    Science.gov (United States)

    Hart, Michael G; Price, Stephen J; Suckling, John

    2016-10-01

    Brain mapping has entered a new era focusing on complex network connectivity. Central to this is the search for the connectome or the brains 'wiring diagram'. Graph theory analysis of the connectome allows understanding of the importance of regions to network function, and the consequences of their impairment or excision. Our goal was to apply connectome analysis in patients with brain tumours to characterise overall network topology and individual patterns of connectivity alterations. Resting-state functional MRI data were acquired using multi-echo, echo planar imaging pre-operatively from five participants each with a right temporal-parietal-occipital glioblastoma. Complex networks analysis was initiated by parcellating the brain into anatomically regions amongst which connections were identified by retaining the most significant correlations between the respective wavelet decomposed time-series. Key characteristics of complex networks described in healthy controls were preserved in these patients, including ubiquitous small world organization. An exponentially truncated power law fit to the degree distribution predicted findings of general network robustness to injury but with a core of hubs exhibiting disproportionate vulnerability. Tumours produced a consistent reduction in local and long-range connectivity with distinct patterns of connection loss depending on lesion location. Connectome analysis is a feasible and novel approach to brain mapping in individual patients with brain tumours. Applications to pre-surgical planning include identifying regions critical to network function that should be preserved and visualising connections at risk from tumour resection. In the future one could use such data to model functional plasticity and recovery of cognitive deficits.

  18. Pre-operative skin preparation practices: results of the 2007 French national assessment.

    Science.gov (United States)

    Borgey, F; Thibon, P; Ertzscheid, M-A; Bernet, C; Gautier, C; Mourens, C; Bettinger, A; Aggoune, M; Galy, E; Lejeune, B; Kadi, Z

    2012-05-01

    Pre-operative skin preparation, aimed at reducing the endogenous microbial flora, is one of the main preventive measures employed to decrease the likelihood of surgical site infection. National recommendations on pre-operative management of infection risks were issued in France in 2004. To assess compliance with the French national guidelines for pre-operative skin preparation in 2007. A prospective audit was undertaken in French hospitals through interviews with patients and staff, and observation of professional practice. Compliance with five major criteria selected from the guidelines was studied: patient information, pre-operative showering, pre-operative hair removal, surgical site disinfection and documentation of these procedures. Data for 41,188 patients from all specialties at 609 facilities were analysed. Patients were issued with information about pre-operative showering in 88.2% of cases [95% confidence interval (CI) 87.9-88.5]. The recommended procedure for pre-operative showering, including hairwashing, with an antiseptic skin wash solution was followed by 70.3% of patients (95% CI 69.9-70.8); this percentage was higher when patients had received appropriate information (P pre-operative surgical hygiene, 82.3% of cases; and pre-operative site disinfection, 71.7% of cases. The essential content of the French guidelines seems to be understood, but reminders need to be issued. Some recommendations may need to be adapted for certain specialties. Copyright © 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  19. Pre-operative clinical assessment for anaesthesia and the effect of ...

    African Journals Online (AJOL)

    Background. HIV infection is common in South Africa, often remaining clinically latent and liable to be missed during clinical pre-operative assessment, despite the patient having a severe degree of immune compromise. Objectives. The primary objective was to determine the pre-operative physical status of patients ...

  20. Research for correction pre-operative MRI images of brain during operation using particle method simulation

    International Nuclear Information System (INIS)

    Shino, Ryosaku; Koshizuka, Seiichi; Sakai, Mikio; Ito, Hirotaka; Iseki, Hiroshi; Muragaki, Yoshihiro

    2010-01-01

    In the neurosurgical procedures, surgeon formulates a surgery plan based on pre-operative images such as MRI. However, the brain is transformed by removal of the affected area. In this paper, we propose a method for reconstructing pre-operative images involving the deformation with physical simulation. First, the domain of brain is identified in pre-operative images. Second, we create particles for physical simulation. Then, we carry out the linear elastic simulation taking into account the gravity. Finally, we reconstruct pre-operative images with deformation according to movement of the particles. We show the effectiveness of this method by reconstructing the pre-operative image actually taken before surgery. (author)

  1. Pre-Operative Lugol's Iodine Treatment in the Management of Patients Undergoing Thyroidectomy for Graves' Disease: A Review of the Literature.

    Science.gov (United States)

    Hope, Nicholas; Kelly, Andrew

    2017-02-01

    To undertake a review of the relevant English literature published on the pre-operative use of Lugol's iodine in the management of patients undergoing thyroidectomy for Graves' disease. We reviewed all relevant papers found through Ovid Medline, PubMed, EMBASE and the American Thyroid Association website. Searches were limited to the English language only. The critical appraisal tool CASP was used to help analyse the papers. Following this, the evidence was ranked using the Harbour and Miller classification of hierarchy. Four papers were deemed appropriate for analysis. The evidence contained within the review is considered weak. The literature available in the public domain regarding the use of iodinated solutions in the pre-operative period for those patients about to undergo thyroidectomy for Graves' disease is scant. Having undertaken an extensive literature review, we are of the opinion that the evidence on which the American Thyroid Association's guidance on the use of preoperative Lugol's iodine is based is tenuous. There appears to be little in the way of sound clinical evidence that post-operative outcomes are any different following a course of Lugol's iodine. Given the lack of robust clinical evidence regarding the clinical need for iodine solution in the pre-operative period, it appears clear that a larger, prospective, randomised controlled trial of all relevant outcomes - clinical and scientific - is required to answer whether or not patient preparation with Lugol's iodine is in fact necessary prior to operative intervention for Graves' disease.

  2. Pre-operative antibiotic use reduces surgical site infection.

    Science.gov (United States)

    Toor, Asad Ali; Farooka, Muhammad Waris; Ayyaz, Mahmood; Sarwar, Hassan; Malik, Awais Amjad; Shabbir, Faisal

    2015-07-01

    To assess the efficacy of World Health Organisation Surgical Safety Checklist as a simple, reliable and effective tool to ensure appropriate administration of intravenous antibiotics. The prospective interventional study was conducted in three phases at Mayo Hospital, Lahore, from May 2011 to January 2012. The first phase comprised baseline data collection, followed by implementation of World Health Organisation Surgical Safety Checklist, and finally post-implementation data collection. The duration of each phase was 3 months. Primary end points were discharge from hospital, 30 days or death of the patient. Of the 613 patients in the study, 303(49.4%) were in the pre-implementation phase and 310(50.5%) in post-implementation phase. Adherence of optimal administration of antibiotic increased from 114(37.6%) to 282(91%) (poperative infection fell from 99(32.7%) to 47(15.2%) (psite infection by more than half. Hospital stay was shortened by 1.3 days on average which results in considerable reduction in morbidity, mortality and costs.

  3. C-018H Pre-Operational Baseline Sampling Plan

    International Nuclear Information System (INIS)

    Guzek, S.J.

    1993-01-01

    The objective of this task is to field characterize and sample the soil at selected locations along the proposed effluent line routes for Project C-018H. The overall purpose of this effort is to meet the proposed plan to discontinue the disposal of contaminated liquids into the Hanford soil column as described by DOE (1987). Detailed information describing proposed transport pipeline route and associated Kaiser Engineers Hanford Company (KEH) preliminary drawings (H288746...755) all inclusive, have been prepared by KEH (1992). The information developed from field monitoring and sampling will be utilized to characterize surface and subsurface soil along the proposed C-018H effluent pipeline and it's associated facilities. Potentially existing contaminant levels may be encountered therefore, soil characterization will provide a construction preoperational baseline reference, develop personnel safety requirements, and determine the need for any changes in the proposed routes prior to construction of the pipeline

  4. Does pre-operative psychological distress affect patient satisfaction after primary total hip arthroplasty?

    Directory of Open Access Journals (Sweden)

    Nolan John

    2011-06-01

    Full Text Available Abstract Background There are concerns that pre-operative psychological distress might be associated with reduced patient satisfaction after total hip replacement (THR. Methods We investigated this in a multi-centre prospective study between January 1999 and January 2002. We dichotomised the patients into the mentally distressed (MHS ≤ 56 and the not mentally distressed (MHS > 56 groups based on their pre-operative Mental Health Score (MHS of SF36. Results 448 patients (340 not distressed and 108 distressed completed the patient satisfaction survey. Patient satisfaction rate at five year was 96.66% (415/448. There was no difference in patient satisfaction or willingness to have the surgery between the two groups. None of pre-operative variables predicted five year patient satisfaction in logistic regression. Conclusions Patient satisfaction after surgery may not be adversely affected by pre-operative psychological distress.

  5. 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

    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 statem...... (PES) convened a meeting to reappraise the safety of rhGH. The ouput of the meeting is a concise position statement.......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...

  6. Royal Decree of 6 February 1976 creating a Committee for appraisal of the safety of nuclear power plants

    International Nuclear Information System (INIS)

    1976-01-01

    The mandate of this Committee, appointed at the request of Parliament, is to make a broad analysis of the safety conditions connected with operation of land-based nuclear power plants and transport, storage and processing, if any, of radioactive materials so as to define the nuclear equipment policy in the 1980s. The analysis will be mainly concentrated on nuclear power but if it wishes, the Committee may make safety-related and environment-related comparisons with other forms of thermal generation. The Committee is composed of 21 members representing the different interested organisations and sectors and its work is scheduled to last approximately 2 years. (NEA) [fr

  7. 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.

  8. Light Duty Utility Arm system pre-operational (cold test) test plan

    International Nuclear Information System (INIS)

    Bennett, K.L.

    1995-01-01

    The Light Duty Utility (LDUA) Cold Test Facility, located in the Hanford 400 Area, will be used to support cold testing (pre- operational tests) of LDUA subsystems. Pre-operational testing is composed of subsystem development testing and rework activities, and integrated system qualification testing. Qualification testing will be conducted once development work is complete and documentation is under configuration control. Operational (hot) testing of the LDUA system will follow the testing covered in this plan and will be covered in a separate test plan

  9. 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.

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

    NARCIS (Netherlands)

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

    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

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

    International Nuclear Information System (INIS)

    Sestini, Stelvio; Castagnoli, Antonio; Pupi, Alberto; Sciagra, Roberto; Ammannati, Franco; Ramat, Silvia; Sorbi, Sandro; Mansi, Luigi

    2010-01-01

    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.)

  12. Pre-operative imaging of rectal cancer and its impact on surgical performance and treatment outcome.

    Science.gov (United States)

    Beets-Tan, R G H; Lettinga, T; Beets, G L

    2005-08-01

    To discuss the ability of pre-operative MRI to have a beneficial effect on surgical performance and treatment outcome in patients with rectal cancer. A description on how MRI can be used as a tool so select patients for differentiated neoadjuvant treatment, how it can be used as an anatomical road map for the resection of locally advanced cases, and how it can serve as a tool for quality assurance of both the surgical procedure and overall patient management. As an illustration the proportion of microscopically complete resections of the period 1993-1997, when there was no routine pre-operative imaging, is compared to that of the period 1998-2002, when pre-operative MR imaging was standardized. The proportion of R0 resections increased from 92.5 to 97% (p=0.08) and the proportion of resections with a lateral tumour free margin of >1mm increased from 84.4 to 92.1% (p=0.03). The incomplete resections in the first period were mainly due to inadequate surgical management of unsuspected advanced or bulky tumours, whereas in the second period insufficient consideration was given to extensive neoadjuvant treatment when the tumour was close to or invading the mesorectal fascia on MR. There are good indications that in our setting pre-operative MR imaging, along with other improvements in rectal cancer management, had a beneficial effect on patient outcome. Audit and discussion of the incomplete resections can lead to an improved operative and perioperative management.

  13. Assessing the effectiveness of a guideline recommendation for pre-operative radiochemotherapy in rectal cancer

    International Nuclear Information System (INIS)

    Manchon-Walsh, Paula; Borras, Josep Maria; Espinas, Josep Alfons; Aliste, Luisa

    2011-01-01

    Aim: To ascertain the degree of adherence to the guideline recommendation on pre-operative RT/ChT for stage-II and -III patients in Catalonian public hospitals, and its impact on local recurrence among rectal cancer patients. Methods: Data were derived from a multicentre retrospective cohort study of patients who underwent curative-intent surgery for primary rectal cancer at Catalonian public hospitals in 2005 and 2007. Results: The study covered 1229 patients with TNM stage-II or -III primary rectal cancer. Of these patients, 54.5% underwent pre-operative RT/ChT; 14.9% underwent post-operative RT (± chemotherapy); and 30.6% did not undergo any RT. The crude local recurrence rate at 2 years was 4.1% and the crude distant recurrence rate at 2 years was 6.5%. The results of the univariate analyses showed a local-recurrence hazard ratio of 1.84 for the group of patients that received no RT versus the group that received pre-operative RT/ChT (p < 0.01). Conclusions: This is the first population-based study in Catalonia to support the use of pre-operative RT/ChT in rectal cancer patients because, in line with the results of population-based studies reported from other countries, its application, compared to non-application of RT, was found to lead to a clear reduction in the probability of local recurrence.

  14. 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.)

  15. 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

    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 on...

  16. A comparison of radiological and historical findings in osteosarcomas following pre-operative chemotherapy

    International Nuclear Information System (INIS)

    Sommer, H.J.; Riebel, T.; Winkler, K.; Heise, U.; Delling, G.; Hamburg Univ.; Hamburg Univ.

    1985-01-01

    Since the introduction of pre-operative chemotherapy, osteosarcomas have shown a more favourable prognosis. Reaction of the tumour due to chemotherapy is judged pre-operative primarily by radiology (plain films, angiography, CT, scintigraphy). There is little evidence concerning the radiological appearances after pre-operative chemotherapy and morphological changes, particularly in respect of tumour regression. Specific radiological changes were therefore compared with pathological findings following chemotherapy and operation in 17 patients with osteosarcomas. Tumours were examined which showed radiological evidence of intra- and extra-osseous sclerosis or lysis and which still were classified as vital tumour tissue. Tumour planes were reconstructed from large histological sections of the operative specimen and compared with the radiological appearances. Sclerosis was found to be due to reactive new bone formation or to mineralisation of the osteosarcomatous tissue. Lysis correlated with persistent vital tumour, or in connective tissue. Nine out of ten cases, regarded as vital on radiological evidence, showed vital tumour cells on histological section. Lyses and scleroses were not reliable indications of the pre-operative state of the osteosarcoma following chemotherapy. On the other hand, combined qualitative radiological criteria for assesing tumour vitality, proved to be helpful. (orig.) [de

  17. A phase I trial of pre-operative radiotherapy for prostate cancer: Clinical and translational studies

    International Nuclear Information System (INIS)

    Supiot, Stephane; Shubbar, Shubber; Fleshner, Neil; Warde, Padraig; Hersey, Karen; Wallace, Kris; Cole, Heather; Sweet, Joan; Tsihlias, John; Jewett, Michael A.S.; Klotz, Laurence; Bristow, Robert G.

    2008-01-01

    Background and purpose: Selected patients undergoing radical prostatectomy for localized prostate cancer can be at high-risk for pT3 disease and require subsequent radiotherapy. In a phase I trial, we investigated the feasibility of pre-operative radiotherapy for this patient subset. Materials and methods: Eligibility criteria were: T1/T2N0M0 tumors plus (i) Gleason ≥ 7, PSA > 10 ng/ml and 15 ng/ml and less WAF associated with reduced cell proliferation. Conclusion: Intra-operative morbidity is low following short-course, pre-operative radiotherapy. A phase II trial is planned to fully document biochemical response with this combined-modality approach

  18. [Pre-operation evaluation and intra-operation management of cochlear implantation].

    Science.gov (United States)

    Zhang, Dao-xing; Hu, Bao-hua; Xiao, Yu-li; Shi, Bo-ning

    2004-10-01

    To summarize pre-operation evaluation experiences in cochlear implantation. Performing auditory evaluation and image analysis seriously in 158 severe hearing loss or total deaf cases before cochlear implantation, comparing their performance with the findings during and post operation. Among the total 158 cases, 116 cases with normal structure, 42 cases with the abnormal findings of the inner or middle ear. Stapedial gusher happened in 6 cases, 1 case was not predicted before operation. Except 1 case with serious malformation, the findings of other 157 cases in operation were consistent with the pre-operation evaluation. We helped all patients reconstruct auditory conduction with cochlear implantation, and the average hearing level up to 37.6 dB SPL. Performing image analysis seriously before operation and planning for operation according to HRCT can do great help to cochlear implantation. The operation under the HRCT instruction has less complications.

  19. Effect of pre-operative methylprednisolone on orthostatic hypotension during early mobilization after total hip arthroplasty

    DEFF Research Database (Denmark)

    Lindberg-Larsen, V; Petersen, P B; Jans, Ø

    2018-01-01

    a standardized mobilization protocol pre-operatively, 6, and 24 h after surgery. Systolic and diastolic arterial pressure and heart rate were measured non-invasively (Nexfin® ). The systemic inflammation was monitored by the C-reactive protein (CRP) response. RESULTS: At 6 h post-operatively, 11 (38%) versus 11......BACKGROUND: Orthostatic hypotension (OH) and intolerance (OI) are common after total hip arthroplasty (THA) and may delay early mobilization. The pathology of OH and OI includes a dysregulated post-operative vasopressor response, by a hitherto unknown mechanism. We hypothesized that OI could...... be related to the inflammatory stress response which is inhibited by steroid administration. Consequently, this study evaluated the effect of a pre-operative high-dose methylprednisolone on OH and OI early after THA. METHODS: Randomized, double-blind, placebo-controlled study in 59 patients undergoing...

  20. Pre operational background radiation monitoring around Kudankulam Nuclear Power Project site - a decade long experience

    International Nuclear Information System (INIS)

    Vijayakumar, B.; George, Thomas; Sundara Rajan, P.; Selvi, B.S.; Balamurugan, M.; Pandit, G.G.; Ravi, P.M.; Tripathi, R.M.

    2014-01-01

    Pre-operational environmental background radiation monitoring around nuclear power plants is very important to understand baseline values existing in the site and also to identify any hot spots of naturally occurring high background radiation areas and their sources. These baseline measurements will act as a benchmark for future comparison after the reactors go into operation. The radiation measurements are continued during the operational phase of the plant and the results are compared to see whether there is any impact of the operation of the plant on the environment. A comprehensive background radiation monitoring plan has been in vogue at site from 2004 to meet this objective. This paper describes the different monitoring strategies adopted around Kudankulam Nuclear Power Project site and throws light on the pre operational background radiation levels in the environment

  1. Effect of pre operative heart rate on post spinal hypotension in obsteric patients

    International Nuclear Information System (INIS)

    Khan, S.; Zahoor, M.U.; Zaid, A.Y.; Buland, K.

    2010-01-01

    The purpose of the study was to determine the association between of preoperative heart rate and post spinal hypotension in women undergoing cesarean section, Two hundred patients undergoing caesarean were included in the study selected on non probability convenience sampling technique, The patients were divided into two groups depending upon their pre operative heart rate. Spinal anesthesia was administered and number of patients developing hypotension was noted. Among 200 patients, who were included in the study; 112 were placed in group A and 88 were placed in group B depending on mean heart rate of 90 beats per minute or less or 91 beats per minute or more respectively. In group A 14 (11.86%) patients developed hypotension where as in group B 28 (31,82%) patients developed hypotension. Pre operative heart rate is significantly associated with post spinal hypotension in obstetric patients undergoing cesarean section. (author)

  2. Pre-operative assessment and post-operative care in elective shoulder surgery.

    Science.gov (United States)

    Akhtar, Ahsan; Macfarlane, Robert J; Waseem, Mohammad

    2013-01-01

    Pre-operative assessment is required prior to the majority of elective surgical procedures, primarily to ensure that the patient is fit to undergo surgery, whilst identifying issues that may need to be dealt with by the surgical or anaesthetic teams. The post-operative management of elective surgical patients begins during the peri-operative period and involves several health professionals. Appropriate monitoring and repeated clinical assessments are required in order for the signs of surgical complications to be recognised swiftly and adequately. This article examines the literature regarding pre-operative assessment in elective orthopaedic surgery and shoulder surgery, whilst also reviewing the essentials of peri- and post-operative care. The need to recognise common post-operative complications early and promptly is also evaluated, along with discussing thromboprophylaxis and post-operative analgesia following shoulder surgery.

  3. Pre-operative assessment of patients undergoing endoscopic, transnasal, transsphenoidal pituitary surgery.

    Science.gov (United States)

    Lubbe, D; Semple, P

    2008-06-01

    To demonstrate the importance of pre-operative ear, nose and throat assessment in patients undergoing endoscopic, transsphenoidal surgery for pituitary tumours. Literature pertaining to the pre-operative otorhinolaryngological assessment and management of patients undergoing endoscopic anterior skull base surgery is sparse. We describe two cases from our series of 59 patients undergoing endoscopic pituitary surgery. The first case involved a young male patient with a large pituitary macroadenoma. His main complaint was visual impairment. He had no previous history of sinonasal pathology and did not complain of any nasal symptoms during the pre-operative neurosurgical assessment. At the time of surgery, a purulent nasal discharge was seen emanating from both middle meati. Surgery was abandoned due to the risk of post-operative meningitis, and postponed until the patient's chronic rhinosinusitis was optimally managed. The second patient was a 47-year-old woman with a large pituitary macroadenoma, who presented to the neurosurgical department with a main complaint of diplopia. She too gave no history of previous nasal problems, and she underwent uneventful surgery using the endoscopic, transnasal approach. Two weeks after surgery, she presented to the emergency unit with severe epistaxis. A previous diagnosis of hereditary haemorrhagic telangiectasia was discovered, and further surgical and medical intervention was required before the epistaxis was finally controlled. Pre-operative otorhinolaryngological assessment is essential prior to endoscopic pituitary or anterior skull base surgery. A thorough otorhinolaryngological history will determine whether any co-morbid diseases exist which could affect the surgical field. Nasal anatomy can be assessed via nasal endoscopy and sinusitis excluded. Computed tomography imaging is a valuable aid to decisions regarding additional procedures needed to optimise access to the pituitary fossa.

  4. Clinical feasibility of pre-operative neurodevelopmental assessment of infants undergoing open heart surgery.

    Science.gov (United States)

    Campbell, Miranda; Rabbidge, Bridgette; Ziviani, Jenny; Sakzewski, Leanne

    2017-08-01

    Assessing the neurodevelopmental status of infants with congenital heart disease before surgery provides a means of identifying those at heightened risk of developmental delay. This study aimed to investigate factors impacting clinical feasibility of pre-operative neurodevelopmental assessment of infants undergoing early open heart surgery. Infants who underwent open heart surgery prior to 4 months of age participated in this cross-sectional study. The Test of Infant Motor Performance and Prechtl's Assessment of General Movements were undertaken on infants pre-operatively. When assessments could not be undertaken, reasons were ascribed to either infant or environmental circumstances. Demographic data and Aristotle scores were compared between groups of infants who did or did not undergo assessment. Binary logistic regression was used to explore associations. A total of 60 infants participated in the study. Median gestational age was 38.78 weeks (interquartile range: 36.93-39.72). Of these infants, 37 (62%) were unable to undergo pre-operative assessment. Twenty-four (40%) could not complete assessment due to infant-related factors and 13 (22%) due to environmental-related factors. For every point increase in the Aristotle Patient-Adjusted Complexity score, the infants likelihood of being unable to undergo assessment increased by 35% (odds ratio: 0.35; 95% confidence interval: 1.03-1.77, P = 0.03). Over half of the infants undergoing open heart surgery were unable to complete pre-operative neurodevelopmental assessment. The primary reason for this was infant-related medical instability. Findings suggest further research is warranted to investigate whether the Aristotle Patient-Adjusted Complexity score might serve as an indicator to inform developmental surveillance with this medically fragile cohort. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  5. General Introduction: PREVIMER, a French pre-operational coastal ocean forecasting capability.

    OpenAIRE

    Dumas, Franck; Pineau-guillou, Lucia; Lecornu, Fabrice; Le Roux, Jean-francois; Le Squere, Bruno

    2014-01-01

    Pre-operational system PREVIMER provides with coastal observations and forecasts along French coasts: currents, waves, sea levels, temperature, salinity, primary production and turbidity. These marine environmental data come from in situ observations, satellite images, and numerical models. They are centralized and archived in PREVIMER databases, then published on website (real time and historical data), and freely available to users, private companies as well as public administrations. This ...

  6. A histopathological effectiveness of pre-operative irradiation for biliary tract cancer

    International Nuclear Information System (INIS)

    Mizusaki, Kaoru

    1993-01-01

    There is almost no report on pre-operative irradiation therapy in biliary tract cancer. For the purpose of attaining improved operative results, pre-operative irradiation has so for been performed in our department. We experienced 106 cases of biliary tract cancer during the period from January 1982 to December 1990, including 30 cases treated by pre-operative irradiation. Among 30 cases, 20 cases, including 9 cases of gallbladder cancer and 11 cases of bile duct cancer, were resectable. Final histopathological findings were obtained in 8 cases of gallbladder cancer and 9 cases of bile duct cancer. The effectiveness of irradiation was evaluated according to the histopathological criteria proposed by Ohboshi and Shimosato in 1971. Four cases were Grade I, 2 cases were Grade IIA, and 2 cases were Grade IIB, and 1 case was Grade III of bile duct cancer. In both groups, no correlation was observed between the exposure doses and their effects. Although no correlation was noted between the degree of differentiation of tubular adenocarcinoma of microscopic pathological findings and the irradiation effects, 1 case of poorly differentiated tubular adenocarcinoma of the bile duct was evaluated as Grade III. Mucinous adenocarcinoma and papillary adenocarcinoma of the gallbladder were revealed to be Grade I. According to the main affected site of bile duct cancer, a good irradiation effect was obtained in patients with upper to middle bile duct cancer. The irradiation effect on the gallbladder and the bile duct wall was predominant on the mucous side but less effective on the serous side. From the histopathological findings, the effectiveness of pre-operative irradiation was suggested. These results suggested that the further clinical evaluation, such as rates of resection or prognostic outcome would be relevant. (author)

  7. Branchial cleft anomalies: accuracy of pre-operative diagnosis, clinical presentation and management.

    Science.gov (United States)

    Guldfred, L-A; Philipsen, B B; Siim, C

    2012-06-01

    To examine the accuracy of the pre-operative diagnosis of branchial cleft anomalies, and also to describe their occurrence, clinical presentation and management. Retrospective review of the records of patients diagnosed with a branchial cleft anomaly between 1997 and 2006. One hundred and twenty-six patients were included. Pre-operative diagnosis had a positive predictive value of 0.856 (95 per cent confidence interval, 0.771-0.918) and a sensitivity of 0.944 (95 per cent confidence interval, 0.869-0.979). These patients' demographic data, investigations, findings and management are presented, along with a possible strategy for dealing with solitary cystic masses in the neck. As pre-operative diagnosis has a positive predictive value of 86 per cent, cystic lesions in the neck should be presumed to be carcinomatous until proven otherwise. Branchial fistulae and sinuses seem to be a disease of childhood, while branchial cysts occur mainly in adults. Branchial cleft anomalies are equally frequent in men and women, and equally distributed on the left and right side of the neck.

  8. The use of CT scan in the pre-operative staging of bronchogenic carcinoma

    International Nuclear Information System (INIS)

    Pada, C.C.

    1992-01-01

    Surgery remains the treatment of choice in patients with localized bronchogenic carcinoma. Pre-operative identification of inoperability spares the patient from unnecessary surgery. This prospective study was carried out to determine the correctness of judgement regarding a patient's operability or inoperability based on the pre-operative staging of CT scan; to find out the sensitivity, specificity and overall accuracy of the CT scan in estimating tumor description, nodal status and metastatic spread to the chest. Staging was done by 3 senior radiologists aware of the diagnosis. Both the surgical and histopathologic findings and staging were gathered and used as measurement of truth in arriving at the CT scan's accuracy. Overall accuracy rate of CT scan in determining operability or inoperability is 80%; tumor description accuracy of assessment is 87% and nodal status estimation has an accuracy of 60%. Sensitivity of CT scan is assessment of metastatic spread to the chest is 93%. There is no statistically significant difference in the judgement of operability or interpretability by CT scan compared to surgical and histopathologic results. The CT scan is recommended as a valuable tool in the pre-operative staging of patients with bronchogenic carcinoma who are candidates for surgery. (auth.). 21 refs.; 8 tabs

  9. Pre-operative Asymptomatic Bacteriuria: A Risk Factor For Prosthetic Joint Infection?

    Science.gov (United States)

    Weale, R; El-Bakri, F; Saeed, Kordo

    2018-04-13

    Infection is a rare complication following implantation of prosthetic material into a joint. The impact of asymptomatic bacteriuria (ASB) before elective operations and the subsequent risk of prosthetic joint infection (PJI) are not well understood. • Assess the prevalence of ASB amongst patients undergoing total arthroplasty of the hip and knee. • Determine the rates of PJI diagnosed within two years of the arthroplasty and if ASB is an independent risk factor for developing PJI. Patients who had total/unicondylar knee or total hip arthroplasty were retrospectively reviewed over a five-year period. Pre-operative urine samples within one year of surgery were analysed and those with ASB identified. Primary outcome was prosthetic joint infection (PJI) within the first postoperative year. 5542 patients were included. 4368 had a pre-operative urine culture recorded. The prevalence of ASB was 140 of 4368 (3.2%). The overall PJI rate was 56 of 5542 (1.01%). Of those with a PJI, 33 had a pre-operative urine sample recorded. The infection rate in the ASB group was 5% (7 of 140), in the no-ASB group it was 0.61% (26 of 4228) and in the group without a urine sample it was 1.96% (23 of 1174) (p value prosthetic joint, suggestive the relationship is unlikely causal. Copyright © 2018. Published by Elsevier Ltd.

  10. Wilms' tumour: a comparison of surgical aspects in patients with or without pre-operative chemotherapy

    International Nuclear Information System (INIS)

    Safdar, C.A.; Aslam, M.; Awan, S.H.; Ahmed, I.; Badshah, S.

    2006-01-01

    To compare the technical aspects of Wilms' tumour (WT) surgery in patients with and without pre-operative chemotherapy. Patients of WT, presenting between January 1999 and December 2001, were treated, using the NWTSG protocol, with primary surgery (group I). Between January 2001 and December 2004, WT patients were treated according to SIOP protocol, with pre-operative chemotherapy followed by surgery (group II). Volume reduction with chemotherapy, duration of surgery, rupture of tumour, extent of excision, adherence and damage to surrounding structures, blood loss, complications, stay in hospital and event-free survival (EFS) were compared in the two groups. Out of 22 patients in group I, 19 (86.4%) underwent primary surgery. Of the 23 patients in group II, 21 (91.3%) received pre-operative chemotherapy followed by surgery. Average volume reduction in this group was 54% with chemotherapy. Difference in duration of surgery and blood loss was significantly low in group II (p=0.003 and p<0.001, respectively). In group I, rupture (6 vs 2), adherence (14 vs 10) and damage to surrounding structures (5 vs 2) were more. Complete macroscopic excision was possible in 90.5% of WT in group II as compared to 73.7% in group I. Immediate postoperative complications and length of hospital stay were similar in both groups. There was no difference in EFS. (author)

  11. Pre-operative fasting: a nationwide survey of German anaesthesia departments.

    Science.gov (United States)

    Breuer, J-P; Bosse, G; Seifert, S; Prochnow, L; Martin, J; Schleppers, A; Geldner, G; Soreide, E; Spies, C

    2010-03-01

    Shorter pre-operative fasting improves clinical outcome without an increased risk. Since October 2004, German Anaesthesiology Societies have officially recommended a fast of 2 h for clear fluids and 6 h for solid food before elective surgery. We conducted a nationwide survey to evaluate the current clinical practice in Germany. Between July 2006 and January 2007, standardized questionnaires were mailed to 3751 Anaesthesiology Society members in leading positions requesting anonymous response. The overall response rate was 66% (n=2418). Of those, 2148 (92%) claimed familiarity with the new guidelines. About a third (n=806, 34%) reported full adherence to the new recommendations, whereas 1043 (45%) reported an eased fasting practice. Traditional Nil per os after midnight was still recommended by 157 (7%). Commonest reasons reported for adopting the new guidelines were: 'improved pre-operative comfort' (84%), and 'increased patient satisfaction' (83%); reasons against were: 'low flexibility in operation room management' (19%), and 'increased risk of aspiration' (13%). Despite the apparent understanding of the benefits from reduced pre-operative fasting, full implementation of the guidelines remains poor in German anaesthesiology departments.

  12. The ultrastructure of tumor cells in patients with rectal cancer after pre-operative irradiation and intra-operative cryotherapy

    International Nuclear Information System (INIS)

    Vyinnik, Yu.O.; Kotenko, O.Je.; Nevzorov, V.P.; Chyibyisov, L.P.

    2000-01-01

    Electronic microscopy of the tumor cells was performed to confirm the efficacy of combined pre-operative gamma-therapy and intraoperative cryotherapy (CT). Pre-operative irradiation at the dose of 20 Gy accompanied by intra-operative cryotherapy caused the changes in the ultrastructure, the depth and degree of which allow to consider them destructive and irreversible

  13. Can the pre-operative Western Ontario and McMaster score predict patient satisfaction following total hip arthroplasty?

    Science.gov (United States)

    Rogers, B A; Alolabi, B; Carrothers, A D; Kreder, H J; Jenkinson, R J

    2015-02-01

    In this study we evaluated whether pre-operative Western Ontario and McMaster Universities (WOMAC) osteoarthritis scores can predict satisfaction following total hip arthroplasty (THA). Prospective data for a cohort of patients undergoing THA from two large academic centres were collected, and pre-operative and one-year post-operative WOMAC scores and a 25-point satisfaction questionnaire were obtained for 446 patients. Satisfaction scores were dichotomised into either improvement or deterioration. Scatter plots and Spearman's rank correlation coefficient were used to describe the association between pre-operative WOMAC and one-year post-operative WOMAC scores and patient satisfaction. Satisfaction was compared using receiver operating characteristic (ROC) analysis against pre-operative, post-operative and δ WOMAC scores. We found no relationship between pre-operative WOMAC scores and one-year post-operative WOMAC or satisfaction scores, with Spearman's rank correlation coefficients of 0.16 and -0.05, respectively. The ROC analysis showed areas under the curve (AUC) of 0.54 (pre-operative WOMAC), 0.67 (post-operative WOMAC) and 0.43 (δ WOMAC), respectively, for an improvement in satisfaction. We conclude that the pre-operative WOMAC score does not predict the post-operative WOMAC score or patient satisfaction after THA, and that WOMAC scores can therefore not be used to prioritise patient care. ©2015 The British Editorial Society of Bone & Joint Surgery.

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

    International Nuclear Information System (INIS)

    Lee, Kyu Chan; Ahn, Yong Chan; Park, Keun Chil

    1999-01-01

    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 2 ) on day 1 and oral Etoposide (50 mg/m 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-operative tumor

  15. 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

  16. Predictors of Success in Bariatric Surgery: the Role of BMI and Pre-operative Comorbidities.

    Science.gov (United States)

    da Cruz, Magda Rosa Ramos; Branco-Filho, Alcides José; Zaparolli, Marília Rizzon; Wagner, Nathalia Farinha; de Paula Pinto, José Simão; Campos, Antônio Carlos Ligocki; Taconeli, Cesar Augusto

    2017-11-10

    This is a retrospective review of 204 patients who underwent bariatric surgery. The impact of weight regain (WR), pre-operative comorbidities and BMI values on the recurrence of comorbidities was evaluated, and an equation was elaborated to estimate BMI at 5 years of bariatric surgery. Pre-operative data, after 1 year and after 5 years, was collected from the medical records. Descriptive analyses and bivariate hypothesis tests were performed first, and then, a generalised linear regression model with Tweedie distribution was adjusted. The hit rate and the Kendall coefficient of concordance (Kendall's W) of the equation were calculated. At the end, the Mann-Whitney test was performed between the BMI, WR and the presence of comorbidities, after a post-operative period of 5 years. The adjustment of the model resulted in an equation that estimates the mean value of BMI 5 years after surgery. The hit rate was 82.35% and the value of Kendall's W was 0.85 for the equation. It was found that patients with comorbidities presented a higher median WR (10.13%) and a higher mean BMI (30.09 kg/m 2 ) 5 years after the surgery. It is concluded that the equation is useful for estimating the mean BMI at 5 years of surgery and that patients with low pre-operative HDL and folic acid levels, with depression and/or anxiety and a higher BMI, have a higher BMI at 5 years of surgery and higher incidence of comorbid return and dissatisfaction with post-operative results.

  17. 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.

  18. Clinical target volume delineation in glioblastomas: pre-operative versus post-operative/pre-radiotherapy MRI

    Science.gov (United States)

    Farace, P; Giri, M G; Meliadò, G; Amelio, D; Widesott, L; Ricciardi, G K; Dall'Oglio, S; Rizzotti, A; Sbarbati, A; Beltramello, A; Maluta, S; Amichetti, M

    2011-01-01

    Objectives Delineation of clinical target volume (CTV) is still controversial in glioblastomas. In order to assess the differences in volume and shape of the radiotherapy target, the use of pre-operative vs post-operative/pre-radiotherapy T1 and T2 weighted MRI was compared. Methods 4 CTVs were delineated in 24 patients pre-operatively and post-operatively using T1 contrast-enhanced (T1PRECTV and T1POSTCTV) and T2 weighted images (T2PRECTV and T2POSTCTV). Pre-operative MRI examinations were performed the day before surgery, whereas post-operative examinations were acquired 1 month after surgery and before chemoradiation. A concordance index (CI) was defined as the ratio between the overlapping and composite volumes. Results The volumes of T1PRECTV and T1POSTCTV were not statistically different (248 ± 88 vs 254 ± 101), although volume differences >100 cm3 were observed in 6 out of 24 patients. A marked increase due to tumour progression was shown in three patients. Three patients showed a decrease because of a reduced mass effect. A significant reduction occurred between pre-operative and post-operative T2 volumes (139 ± 68 vs 78 ± 59). Lack of concordance was observed between T1PRECTV and T1POSTCTV (CI = 0.67 ± 0.09), T2PRECTV and T2POSTCTV (CI = 0.39 ± 0.20) and comparing the portion of the T1PRECTV and T1POSTCTV not covered by that defined on T2PRECTV images (CI = 0.45 ± 0.16 and 0.44 ± 0.17, respectively). Conclusion Using T2 MRI, huge variations can be observed in peritumoural oedema, which are probably due to steroid treatment. Using T1 MRI, brain shifts after surgery and possible progressive enhancing lesions produce substantial differences in CTVs. Our data support the use of post-operative/pre-radiotherapy T1 weighted MRI for planning purposes. PMID:21045069

  19. Standard protocol for conducting pre-operational environmental surveillance around nuclear facilities

    Energy Technology Data Exchange (ETDEWEB)

    Hegde, A G; Verma, P C; Rajan, M P [Health Safety and Environment Group, Bhabha Atomic Research Centre, Mumbai (India)

    2009-02-15

    This document presents the standard procedures for evaluation of site specific environmental transfer factors around NPP sites. The scope of this document is to provide standard protocol to be followed for conducting pre-operational environmental surveillance around nuclear facilities. Such surveillances have been proposed to be carried out by university professionals under DAE-BRNS projects. This document contains a common methodology in terms of sampling, processing, measurements and analysis of elemental/radionuclides, while keeping the site specific requirements also in place. (author)

  20. Standard protocol for conducting pre-operational environmental surveillance around nuclear facilities

    International Nuclear Information System (INIS)

    Hegde, A.G.; Verma, P.C.; Rajan, M.P.

    2009-02-01

    This document presents the standard procedures for evaluation of site specific environmental transfer factors around NPP sites. The scope of this document is to provide standard protocol to be followed for conducting pre-operational environmental surveillance around nuclear facilities. Such surveillances have been proposed to be carried out by university professionals under DAE-BRNS projects. This document contains a common methodology in terms of sampling, processing, measurements and analysis of elemental/radionuclides, while keeping the site specific requirements also in place. (author)

  1. Association between Pre-Operative Cefazolin Dose and Surgical Site Infection in Obese Patients.

    Science.gov (United States)

    Peppard, William J; Eberle, David G; Kugler, Nathan W; Mabrey, Danielle M; Weigelt, John A

    A fixed dose of cefazolin results in serum concentrations that decrease as body mass increases. Current national guidelines suggest a pre-operative cefazolin dose of two grams may be insufficient for patients ≥120 kg; thus a three gram dose is recommended. These recommendations, however, are based on pharmacokinetic rather than outcome data. We evaluate the efficacy of pre-operative cefazolin two gram and three gram doses as measured by the rate of surgical site infection (SSI). We conducted a retrospective review of adult patients ≥100 kg who were prescribed cefazolin as surgical prophylaxis between September 1, 2012 and May 31, 2013 at an academic medical center. Patients were excluded if cefazolin was prescribed but not administered, had a known infection at the site of surgery, or inappropriately received cefazolin prophylaxis based on surgical indication. The SSIs were identified by documentation of SSI in the medical record or findings consistent with the standard Centers for Disease Control and Prevention definition. Inpatient and outpatient records up to 90 days post-operative were reviewed for delayed SSI. Four hundred eighty-three surgical cases were identified in which pre-operative cefazolin was prescribed. Forty-seven patients were excluded leaving a total of 436 patients for final analysis: 152 in the cefazolin two gram group and 284 in the three gram group. Baseline demographics were similar between groups with a mean follow-up duration of 77 days for both groups. Unadjusted SSI rates were 7.2% and 7.4% (odds ratio [OR] 0.98, p = 0.95), for the two gram and three gram groups, respectively. When differences in follow-up between groups were considered and logistic regression was adjusted with propensity score, there remained no difference in SSI rates (OR 0.87, 95% confidence interval 0.36-2.06, p = 0.77). In otherwise similar obese surgical patients weighing ≥100 kg, the administration of a pre-operative cefazolin two gram dose is

  2. Is pre-operative imaging essential prior to ureteric stone surgery?

    Science.gov (United States)

    Youssef, F R; Wilkinson, B A; Hastie, K J; Hall, J

    2012-09-01

    The aim of this study was to identify patients not requiring ureteric stone surgery based on pre-operative imaging (within 24 hours) prior to embarking on semirigid ureteroscopy (R-URS) for urolithiasis. The imaging of all consecutive patients on whom R-URS for urolithiasis was performed over a 12-month period was reviewed. All patients had undergone a plain x-ray of the kidney, ureters and bladder (KUB), abdominal non-contrast computed tomography (NCCT-KUB) or both on the day of surgery. A total of 96 patients were identified for the study. Stone sizes ranged from 3 mm to 20 mm. Thirteen patients (14%) were cancelled as no stone(s) were identified on pre-operative imaging. Of the patients cancelled, 8 (62%) required NCCT-KUB to confirm spontaneous stone passage. One in seven patients were stone free on the day of surgery. This negates the need for unnecessary anaesthetic and instrumentation of the urinary tract, with the associated morbidity. Up-to-date imaging prior to embarking on elective ureteric stone surgery is highly recommended.

  3. Value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules.

    Science.gov (United States)

    Schwarz, Carsten; Schönfeld, Nicolas; Bittner, Roland C; Mairinger, Thomas; Rüssmann, Holger; Bauer, Torsten T; Kaiser, Dirk; Loddenkemper, Robert

    2013-01-01

    The diagnostic value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules (SPN) is still under debate among pneumologists, radiologists and thoracic surgeons. In a prospective observational manner, flexible bronchoscopy was routinely performed in 225 patients with SPN of unknown origin. Of the 225 patients, 80.5% had lung cancer, 7.6% had metastasis of an extrapulmonary primary tumour and 12% had benign aetiology. Unsuspected endobronchial involvement was found in 4.4% of all 225 patients (or in 5.5% of patients with lung cancer). In addition, flexible bronchoscopy clarified the underlying aetiology in 41% of the cases. The bronchoscopic biopsy results from the SPN were positive in 84 (46.5%) patients with lung cancer. Surgery was cancelled due to the results of flexible bronchoscopy in four cases (involvement of the right main bronchus (impaired pulmonary function did not allow pneumonectomy) n=1, small cell lung cancer n=1, bacterial pneumonia n=2), and the surgical strategy had to be modified to bilobectomy in one patient. Flexible bronchoscopy changed the planned surgical approach in five cases substantially. These results suggest that routine flexible bronchoscopy should be included in the regular pre-operative work-up of patients with SPN.

  4. Effect of stapedotomy on pre-operative tinnitus and its psychosomatic burden.

    Science.gov (United States)

    Bast, Florian; Mazurek, Birgit; Schrom, Thomas

    2013-12-01

    According to the literature, between 40 and 90% of otosclerosis patients suffering from hearing loss also suffer from tinnitus on the affected side. For a lot of these patients tinnitus represents a handicap that is just as debilitating as the hearing loss itself. The main goal of the surgical treatment of otosclerosis is a significant improvement in hearing loss, but frequent reports of reduced tinnitus after surgery suggest that this can be a positive side effect. All patients who underwent stapedotomy were initially included in the study. Retrospectively, the tinnitus questionnaire as compiled by Goebel and Hiller was sent to the patients, and 34 patients (37 ears) replied. The pre- and postoperative cases of tinnitus were divided into compensated and non-compensated tinnitus. In addition the following tinnitus-related factors were evaluated: emotional, cognitive and mental burden; intrusiveness of the tinnitus; hearing problems; somatic ailments; and sleep disturbances. Over 80% of the patients surveyed suffered from tinnitus pre-operation. The tinnitus disappeared or improved in over 60% of the cases after stapedotomy. In addition, the related factors surveyed also improved appreciably post surgery and reached a significant level in patients with compensated tinnitus. Besides a significant improvement in hearing loss the intensity and the psychosomatic burden of a pre-operative tinnitus can be reduced by stapedotomy. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  5. 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.)

  6. Pre-operational proof and leakage rate testing requirements for concrete containment structures for CANDU nuclear power plants

    International Nuclear Information System (INIS)

    1994-02-01

    This Standard provides the requirements for pre-operational proof tests and leakage rate tests of concrete containment structures of a containment system designed as Class Containment components. 1 fig

  7. 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.

  8. Pre-operative Functional Cardiovascular Reserve Is Associated with Acute Kidney Injury after Intervention.

    Science.gov (United States)

    Saratzis, A; Shakespeare, J; Jones, O; Bown, M J; Mahmood, A; Imray, C H E

    2017-05-01

    Acute kidney injury (AKI) is a common complication after endovascular intervention, associated with poor short and long-term outcomes. However, the mechanisms underlying AKI development remain poorly understood. The impact of pre-existing cardiovascular disease and low cardiovascular reserve (CVR) in AKI is unclear; it remains unknown whether AKI is primarily related to pre-existing comorbidity or to procedural parameters. The association between CVR and AKI after EVAR was therefore assessed. This is a case control study. From a database of 484 patients, 292 undergoing elective endovascular aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm (AAA) in two tertiary centres were included. Of these, 73 patients who had developed AKI after EVAR were case matched, based on pre-operative estimated glomerular filtration rate (eGFR; within 5 mL/min/1.73 m 2 ) and age, with patients who had not developed AKI. Cardiopulmonary exercise testing (CPET) was used to assess CVR using the anaerobic threshold (AT). Development of AKI was defined using the Kidney Disease Improving Outcomes (KDIGO) guidance. Associations between CVR (based on AT levels) and AKI development were then analysed. Pre-operative AT levels were significantly different between those who did and did not develop AKI (12.1±2.9 SD vs. 14.8±3.0 mL/min/kg, p < .001). In multivariate analysis, a higher level of AT (per 1 mL/min/kg) was associated with a lower odds ratio (OR) of 0.72 (95% CI, 0.63-0.82, p < .001), relative to AKI development. A pre-operative AT level of < 11 mL/min/kg was associated with post-operative AKI development in adjusted analysis, with an OR of 7.8 (95% CI, 3.75-16.51, p < .001). The area under the curve (receiver operating characteristic) for AT as a predictor of post-operative AKI was 0.81 (standard error, 0.06, 95% CI, 0.69-0.93, p < .001). Poor CVR was strongly associated with the development of AKI. This provides pathophysiological insights into the

  9. Accuracy of pre-operative hysteroscopic guided biopsy for predicting final pathology in uterine malignancies.

    Science.gov (United States)

    Martinelli, Fabio; Ditto, Antonino; Bogani, Giorgio; Signorelli, Mauro; Chiappa, Valentina; Lorusso, Domenica; Haeusler, Edward; Raspagliesi, Francesco

    2017-07-01

    To evaluate concordance (C) between pre-operative hysteroscopic-directed sampling and final pathology in uterine cancers. A retrospective cross-sectional evaluation of prospectively collected data of women who underwent hysterectomy for uterine malignancies and a previous hysteroscopic-guided biopsy was performed. Diagnostic concordance between pre-operative (hysteroscopic biopsy) and postoperative (uterine specimen) histology was evaluated. In endometrioid-endometrial cancers cases Kappa (k) statistics was applied to evaluate agreement for grading (G) between the preoperative and final pathology. A total 101 hysterectomies for uterine malignancies were evaluated. There were 23 non-endometrioid cancers: 7 serous (C:5/7, 71.4%); 10 carcinosarcomas (C:7/10, 70%, remaining 3 cases only epithelial component diagnosed); 3 clear cell (C:3/3, 100%); 3 sarcomas (C:3/3, 100%). In 78 cases an endometrioid endometrial cancer was found. In 63 cases there was a histological C (63/78, 80.8%) between hysteroscopic-guided biopsy and final pathology, while in 15 cases (19.2%) only hyperplasia (with/without atypia) was found preoperatively. Overall accuracy to detect endometrial cancer was 80.2%. In 50 out of 63 endometrial cancers (79.4%) grading was concordant. The overall level of agreement between preoperative and postoperative grading was "substantial" according to Kappa (k) statistics (k 0.64; 95% CI: 0.449-0.83; p < 0.001), as well as for G1 (0.679; 95% CI: 0.432-0.926; p < 0.001) and G3 (0.774; 94% CI: 0.534-1; p < 0.001), while for G2 (0.531; 95% CI: 0.286-0.777; p < 0.001) it was moderate. In our series we found an 80% C between pre-operative hysteroscopic-guided biopsy and final pathology, in uterine malignancies. Moreover, hysteroscopic biopsy accurately predicted endometrial cancer in 80% of cases and "substantially" predicted histological grading. Hysteroscopic-guided uterine sampling could be a useful tool to tailor treatment in patients with uterine

  10. Pre-operational monitoring and assessment of aquatic biota in environmental impact assessment studies

    International Nuclear Information System (INIS)

    Ghosh, T.K.

    2001-01-01

    Environmental Impact Assessment (EIA) is an ideal anticipatory mechanism which establishes quantitative values for parameters indicating the quality of the environment before, during and after the proposed developmental activity, thus allowing measures that ensure environmental compatibility in developmental process. EIA studies have been made mandatory in India by MoEF, GOI for expansion/modernization of any activity or development of new project. Biological assessment, under aquatic environment, is one of the major components of EIA and it requires systematic way of data collection. Generation of substantial baseline data can then be used for formulation of subsequent stages of EIA, viz. prediction, evaluation, impact statements and environmental management plan (EMP). However, a definite approach towards biological studies under EIA during pre-operational stage has not been outlined in available guidelines. (author)

  11. Pre-operational monitoring and assessment of aquatic biota in environmental impact assessment studies

    Energy Technology Data Exchange (ETDEWEB)

    Ghosh, T K [Ecotechnology Division, National Environmental Engineering Research Inst., Nagpur (India)

    2001-06-01

    Environmental Impact Assessment (EIA) is an ideal anticipatory mechanism which establishes quantitative values for parameters indicating the quality of the environment before, during and after the proposed developmental activity, thus allowing measures that ensure environmental compatibility in developmental process. EIA studies have been made mandatory in India by MoEF, GOI for expansion/modernization of any activity or development of new project. Biological assessment, under aquatic environment, is one of the major components of EIA and it requires systematic way of data collection. Generation of substantial baseline data can then be used for formulation of subsequent stages of EIA, viz. prediction, evaluation, impact statements and environmental management plan (EMP). However, a definite approach towards biological studies under EIA during pre-operational stage has not been outlined in available guidelines. (author)

  12. Pre-operative irradiation of eosinophilic granuloma in the parotid area

    International Nuclear Information System (INIS)

    Kitahara, Satoshi; Toda, Yukio; Nakajima, Hisami; Takeyama, Isamu; Sodemoto, Yukio; Endo, Masaru

    1983-01-01

    Eosinophilic granuloma is thought to originate in the reticuloendothelial system and cannot clearly be distinguished from the surrounding tissue during operation. An eosinophilic granuloma in the parotid area was removed after 25 days of irradiation at a dosage of 10.0 Gy per 3 days. A thin capsule of connective tissue was observed after the tumor was cut in half. Then, histopathological studies were performed on this connective tissue to determine the effect of the irradiation. Histopathologically, at the periphery of the tissue, atrophy of lymphocytes and destruction of the lymphoid tissue, which were thought to result in an increase in the connective tissue, were observed. It was concluded that a small dose of pre-operative radiation on eosinophilic granuloma in the parotid area made the tumor small and produced a capsule around the tumor. (author)

  13. 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.

  14. Clinical value of pre-operative embolization of maxillary artery for nasopharyngeal angiofibroma

    International Nuclear Information System (INIS)

    Zhu Wenke; Shan Hong; Zhu Kangshun; Jiang Zabo; Guan Shouhai; Huang Mingsheng; Li Zhengran; Shen Xinying

    2004-01-01

    Objective: To assess the clinical value of pre-operative embolization for nasopharyngeal angiofibroma. Methods: 13 patients with nasopharyngeal angiofibroma confirmed by surgery and biopsy were retrospectively analysed. Bilateral carotid artery angiography was performed for demonstration of the arterial supply of tumor. According to the size and different caliber of arteries, embolization were separately undertaken by different types of coil via 4.1 or 5F Head-Hunter catheter. The embolization efficacy, embolization was evaluated by amount of blood loss. Results: After coil embolization, no complication happened ranging 1-4 days (mean 2 days) in all 13 patients and then all the tumor masses were totally resected with mean blood loss of (584.6 ± 379.4) ml (range 250-1500 ml). Conclusions: Preoperative coils embolization is safe, reliable with less complication especially for reducing intraoperative blood loss and promoting the prognosis. (authors)

  15. Pre-operative anxiety. Effect of early or late position on the operating list.

    Science.gov (United States)

    Panda, N; Bajaj, A; Pershad, D; Yaddanapudi, L N; Chari, P

    1996-04-01

    The influence of the relative position on the operating list on pre-operative anxiety was studied in 60 adult female ASA 1 patients undergoing major surgery. Thirty patients were placed first on the operating list (group 1) and 30 were given a time 4-5 h later (group 2). Each patient was visited on the evening prior to surgery and again on the morning of surgery. Anxiety was measured at each visit by objective criteria and part 1 of the State-Trait Anxiety Inventory questionnaire. The pulse rate, systolic blood pressure and the State-Trait Anxiety Inventory questionnaire scores were higher on the second visit than on the first (p patients. This increase was greater in group 2 than in group 1 (p < 0.05). The evening anxiety scores were not correlated with those on the morning visit and could not predict them.

  16. Vascular involvement in pancreatic carcinoma. Pre-operative assessment by multislice CT angiography

    International Nuclear Information System (INIS)

    Ling Huawei; Guan Yongjing; Ding Bei; Lin Xiaozhu; Zhang Huan; Chen Kemin

    2002-01-01

    Objective: To study the value of multislice CT angiography (MSCTA) in the pre-operative assessment of vascular involvement in pancreatic carcinoma. Methods: 33 cases with pathologically proven pancreatic carcinoma underwent MSCTA prior to surgical intervention. The MSCTA findings in each of the 33 patients were evaluated prospectively by four radiologists. Vascular involvement of pancreatic carcinoma was validated at the time of surgery, which was a reference standard for comparison. Correlation was made between MSCTA findings and surgical results. Results: 11 out of 33 cases with pancreatic carcinoma were considered to be resectable by MSCTA with a positive predictive value of 82% in comparison with surgical findings. MSCTA also had high correlation with surgical results in assessing the non-resectability of pancreatic carcinoma (positive predictive value =95%). Conclusion: MSCTA could delineate the vascular involvement of pancreatic carcinoma with high accuracy and provided valuable information in the preoperative assessment of pancreatic carcinoma

  17. 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.

  18. Feasibility of pre-operative autologous blood donation in Indian patients with elective orthopaedic surgery.

    Science.gov (United States)

    Saluja, Karan; Marwaha, Neelam; Thakral, Beenu; Goni, Vijay; Sharma, R R; Puri, G D

    2006-11-01

    Pre-operative autologous blood donation (PABD) in elective orthopaedic surgeries is a well known procedure in the West. We initiated this programme at a tertiary care hospital in north India to study its feasibility in Indian patients. In a prospective case-control study, 144 patients undergoing primary total hip or knee replacement, inter-vertebral discectomy, mal-union and non-union reconstruction were educated and motivated to pre-donate. Patients fulfilling the inclusion criteria and making autologous donation formed the PABD group (n=22). Patients eligible for PABD, but unwilling to participate; age, sex, pre-operative haemoglobin and operative procedure matched acted as controls (n=27). Unit(s) collected was processed like an allogeneic unit. Unit(s) found reactive for infectious markers or not utilized was discarded. Mean blood losses, transfusion trigger, allogeneic exposure and wastage between the two groups were compared. Of the 144 patients motivated, 40 per cent of the eligible subjects pre-deposited. The main motivational factor was fear of getting infection from someone's blood. Cardiac events and anaemia prevented 61.8 per cent patients to participate. Of the 50 units ordered, autologous units with a mean of 1.4 units/patient contributed 62 per cent. For total hip and total knee replacement (THR and TKR), autologous units met 76.2 and 80 per cent respectively of the total blood requirement. A significant decrease in the allogeneic exposure was observed between PABD and control group (18.2 vs 66.7%); 32.3 per cent of the autologous units were discarded. Comprehensive PABD programme may be an effective method for reducing the need for allogeneic transfusion in patients undergoing joint replacement surgeries in our country, where transfusion transmitted infections due to high percentage of replacement donations and lack of sensitive assays for testing are still a cause for concern.

  19. Prediction of chronic post-operative pain: pre-operative DNIC testing identifies patients at risk.

    Science.gov (United States)

    Yarnitsky, David; Crispel, Yonathan; Eisenberg, Elon; Granovsky, Yelena; Ben-Nun, Alon; Sprecher, Elliot; Best, Lael-Anson; Granot, Michal

    2008-08-15

    Surgical and medical procedures, mainly those associated with nerve injuries, may lead to chronic persistent pain. Currently, one cannot predict which patients undergoing such procedures are 'at risk' to develop chronic pain. We hypothesized that the endogenous analgesia system is key to determining the pattern of handling noxious events, and therefore testing diffuse noxious inhibitory control (DNIC) will predict susceptibility to develop chronic post-thoracotomy pain (CPTP). Pre-operative psychophysical tests, including DNIC assessment (pain reduction during exposure to another noxious stimulus at remote body area), were conducted in 62 patients, who were followed 29.0+/-16.9 weeks after thoracotomy. Logistic regression revealed that pre-operatively assessed DNIC efficiency and acute post-operative pain intensity were two independent predictors for CPTP. Efficient DNIC predicted lower risk of CPTP, with OR 0.52 (0.33-0.77 95% CI, p=0.0024), i.e., a 10-point numerical pain scale (NPS) reduction halves the chance to develop chronic pain. Higher acute pain intensity indicated OR of 1.80 (1.28-2.77, p=0.0024) predicting nearly a double chance to develop chronic pain for each 10-point increase. The other psychophysical measures, pain thresholds and supra-threshold pain magnitudes, did not predict CPTP. For prediction of acute post-operative pain intensity, DNIC efficiency was not found significant. Effectiveness of the endogenous analgesia system obtained at a pain-free state, therefore, seems to reflect the individual's ability to tackle noxious events, identifying patients 'at risk' to develop post-intervention chronic pain. Applying this diagnostic approach before procedures that might generate pain may allow individually tailored pain prevention and management, which may substantially reduce suffering.

  20. Pre-operative renal volume predicts peak creatinine after congenital heart surgery in neonates.

    Science.gov (United States)

    Carmody, J Bryan; Seckeler, Michael D; Ballengee, Cortney R; Conaway, Mark; Jayakumar, K Anitha; Charlton, Jennifer R

    2014-10-01

    Acute kidney injury is common in neonates following surgery for congenital heart disease. We conducted a retrospective analysis to determine whether neonates with smaller pre-operative renal volume were more likely to develop post-operative acute kidney injury. We conducted a retrospective review of 72 neonates who underwent congenital heart surgery for any lesion other than patent ductus arteriosus at our institution from January 2007 to December 2011. Renal volume was calculated by ultrasound using the prolate ellipsoid formula. The presence and severity of post-operative acute kidney injury was determined both by measuring the peak serum creatinine in the first 7 days post-operatively and by using the Acute Kidney Injury Network scoring system. Using a linear change point model, a threshold renal volume of 17 cm³ was identified. Below this threshold, there was an inverse linear relationship between renal volume and peak post-operative creatinine for all patients (p = 0.036) and the subgroup with a single morphologic right ventricle (p = 0.046). There was a non-significant trend towards more acute kidney injury using Acute Kidney Injury Network criteria in all neonates with renal volume ≤17 cm³ (p = 0.11) and in the subgroup with a single morphologic right ventricle (p = 0.17). Pre-operative renal volume ≤17 cm³ is associated with a higher peak post-operative creatinine and potentially greater risk for post-operative acute kidney injury for neonates undergoing congenital heart surgery. Neonates with a single right ventricle may be at higher risk.

  1. Pre-operative Duplex Ultrasonography in Arteriovenous Fistula Creation: Intra- and Inter-observer Agreement.

    Science.gov (United States)

    Zonnebeld, Niek; Maas, Tommy M G; Huberts, Wouter; van Loon, Magda M; Delhaas, Tammo; Tordoir, Jan H M

    2017-11-01

    Although clinical guidelines on arteriovenous fistula (AVF) creation advocate minimum luminal arterial and venous diameters, assessed by duplex ultrasonography (DUS), the clinical value of routine DUS examination is under debate. DUS might be an insufficiently repeatable and/or reproducible imaging modality because of its operator dependency. The present study aimed to assess intra- and inter-observer agreement of DUS examination in support of AVF surgery planning. Ten end stage renal disease patients were included, to assess intra- and inter-observer agreement of pre-operative DUS measurements. All measurements were performed by two trained and experienced vascular technicians, blinded to measurement readings. From the routine DUS protocol, representative measurements (venous diameters, and arterial diameters and volume flow in the upper arm and forearm) were selected. For intra-observer agreement the measurements were performed in triplicate, with the probe released from the skin between each. Intraclass correlation coefficients were calculated for intra- and inter-observer agreement, and Bland-Altman plots used to graphically display mean measurement differences and limits of agreement. Ten patients (6 male, 59.4±19.7 years) consented to participate, and all predefined measurements were obtained. Intraclass correlation coefficients for intra-observer agreement of diameter measurements were at least 0.90 (95% CI 0.74-0.97; radial artery). Inter-observer agreement was at least 0.83 (0.46-0.96; lateral diameter upper arm cephalic vein). The Bland-Altman plots showed acceptable mean measurement differences and limits of agreement. In experienced hands, excellent intra- and inter-observer agreement can be reached for the discrete pre-operative DUS measurements advocated in clinical guidelines. DUS is therefore a reliable imaging modality to support AVF surgery planning. The content of DUS protocols, however, needs further standardisation. Copyright © 2017 European

  2. Improving operating room first start efficiency - value of both checklist and a pre-operative facilitator.

    Science.gov (United States)

    Panni, M K; Shah, S J; Chavarro, C; Rawl, M; Wojnarwsky, P K; Panni, J K

    2013-10-01

    There are multiple components leading to improved operating room efficiency. We undertook a project focusing on first case starts; accounting for each delay component on a global basis. Our hypothesis was there would be a reduction in first start delays after we implemented strategies to address the issues identified through this accounting process. An orange sheet checklist was implemented, with specific items that needed to be clear prior to roll back to the operating room (OR), and an OR facilitator was employed to intervene whenever there were any missing items needed for a specific patient. We present the data from this quality improvement project over an 18-month period. Initially, 10.07 (± 0.73) delayed first starts occurred per day but declined steadily over time to a low of 4.95 (± 0.38) per day after 6 months (-49.2 %, P < 0.001). By the end of the project, the most common reasons for delay still included late surgical attending (19%), schedule changes (14%) as well as 'other reasons' (13%), but with an overall reduction per day of each. Total anaesthesia delay initially totalled 11% of the first start delays, but was negligible (< 1%) at the project's completion. While we have a challenging operating room environment based on our patient population, multiple trainees in both the surgery and anaesthesiology teams: an orange sheet - pre-operative checklist in addition to a dedicated pre-operative facilitator; allowed us to make a substantial improvement in our first start on time starts. © 2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  3. Role of B-scan ultrasonography in pre-operative cataract patients.

    Science.gov (United States)

    Qureshi, Manzoor A; Laghari, Khalida

    2010-01-01

    To visualize the posterior portion of eye globe in dense cataract patients with B scan ultrasound, and to find out any posterior segment lesion in such pre-operative cases. We performed diagnostic B-scan ultrasound on 750 cataract patients before surgery. This was a prospective diagnostic study which was conducted in the Department of Opthalmology, Liaquat University Eye Hospital, Hyderabad Sind, Pakistan from January 2007 to July 2007. Detailed history and some basic eye examination techniques, like slit lamp and tonometry were done in two groups of patients, traumatic (71) and non traumatic(679). Patients in the age range of 1 to 79 years of both sexes were included. Patients having already posterior segment lesions and those who had previous history of ocular surgery were excluded from the study. An ultrasound machine Nidek Echo Scan Model US-3300 with a probe of direct contact was used. Out of 750 patients, 90 patients had posterior segment lesions. Among traumatic group of 71 patients, 39 (55%) had positive posterior segment lesions, while in the non traumatic group of 679 patients, only 51 (7%) cases had positive posterior segment lesions. Out of the 90 positive cases, 25 (3%) had retinal detachment, 14 (2%) had posterior vitreous detachment, 24 (3%) had vitreous hemorrhage, 12 (2%) were asteroid hyolosis, while posterior staphyloma and intra-ocular foreign body were found with the frequency of 9 (1.2%) and 6 (1%), respectively. We concluded that two dimensional B-scan ultrasound can be one of the diagnostic tool for the detection of hidden posterior segment lesions and can be performed routinely in pre-operative cataract patients, as this would help in surgical planning. In cases, where a two dimensional B-scan is not sufficient or helpful. a three dimensional ultrasound would be justified.

  4. Proposed radiological criteria for pre-operative determination of resectability in peritoneal-based malignancies

    International Nuclear Information System (INIS)

    Tan, Grace Hwei Ching; Chanyaputhipong, Jendana; Teo, Melissa Ching Ching; Kwek, Jin Wei; Hosseini, Reza; Tham, Chee Kian; Soo, Khee Chee

    2016-01-01

    The selection of patients for cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy infusion (HIPEC) is important, and relies heavily on imaging. However, it has been reported that Computer Tomographic (CT) scans may only achieve a low sensitivity of 33% for peritoneal disease. We propose a set of radiological criteria for pre-operative determination of resectability of peritoneal disease in peritoneal-based malignancies and validate this in our cohort of patients. A retrospective review of all patients who underwent laparotomy with a view for CRS and HIPEC, at the National Cancer Centre Singapore from January 2000 to April 2010, was performed. Intra-operative Peritoneal Cancer Index (PCI) scores were recorded. The pre-operative imaging was reviewed with a senior radiologist who was blinded, and recorded the radiological PCI scores (CT-PCI) and eight additional CT prognostic factors (CT-PF). The CT-PCI and CT-PF scores were then compared with the intra-operative findings to determine the radiological accuracy. The scores and the individual prognostic factors were then evaluated for their predictive ability for unresectability. Comparison of the CT-PCI and PCI scores showed a concordance correlation coefficient at 0.52 (95% CI 0.34–0.7). Accuracy was increased with the addition CT-PF. The presence of omental caking and ascites were predictors of unresectability. We propose a scoring system which is able to predict for unresectable disease with a specificity of 80% and a sensitivity of 62%. With our proposed criteria, and scoring system, the selection of patients for CRS and HIPEC can be improved, and unnecessary exploratory operations avoided.

  5. Overview of the role of pre-operative breast MRI in the absence of evidence on patient outcomes.

    Science.gov (United States)

    Sardanelli, Francesco

    2010-02-01

    The role of pre-operative breast MRI is outlined on the basis of the existing evidence in favor of a superior capability in comparison with mammography and sonography to detect ipsilateral and contralateral malignant lesions and to evaluate the disease extent, including the extensive intraductal component associated with invasive cancers. Patients with a potential higher anticipated benefit from pre-operative MRI can be identified as those: with mammographically dense breasts; with a unilateral multifocal/multicentric cancer or a synchronous bilateral cancer already diagnosed at mammography and sonography; with a lobular invasive cancer; at high-risk for breast cancer; with a cancer which shows a discrepancy in size of >1 cm between mammography and sonography; or under consideration for partial breast irradiation. More limited evidence exists in favor of MRI for evaluating candidates for total skin sparing mastectomy or for patients with Paget's disease. Irrespective of whether the clinical team routinely uses preoperative MRI or not: women newly diagnosed with breast cancer should always be informed of the potential risks and benefits of pre-operative MRI; results of pre-operative MRI should be interpreted taking into account clinical breast examination, mammography, sonography and verified by percutaneous biopsy; MRI-only detected lesions require MR-guidance for needle biopsy and pre-surgical localization, and these should be available or potentially accessible if pre-operative MRI is to be implemented; total therapy delay due to pre-operative MRI (including MRI-induced work-up) should not exceed one month; changes in therapy planning resulting from pre-operative MRI should be decided by a multidisciplinary team. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

  6. Agreement between pre-operative and intra-operative bacteriological samples in 85 chronic peri-prosthetic infections.

    Science.gov (United States)

    Matter-Parrat, V; Ronde-Oustau, C; Boéri, C; Gaudias, J; Jenny, J-Y

    2017-04-01

    Whether pre-operative microbiological sampling contributes to the management of chronic peri-prosthetic infection remains controversial. We assessed agreement between the results of pre-operative and intra-operative samples in patients undergoing single-stage prosthesis exchange to treat chronic peri-prosthetic infection. Agreement between pre-operative and intra-operative samples exceeds 75% in patients undergoing single-stage exchange of a hip or knee prosthesis to treat chronic peri-prosthetic infection. This single-centre retrospective study included 85 single-stage prosthesis exchange procedures in 82 patients with chronic peri-prosthetic infection at the hip or knee. Agreement between pre-operative and intra-operative sample results was evaluated. Changes to the initial antibiotic regimen made based on the intra-operative sample results were recorded. Of 149 pre-operative samples, 109 yielded positive cultures, in 75/85 cases. Of 452 intra-operative samples, 354 yielded positive cultures, in 85/85 cases. Agreement was complete in 54 (63%) cases and partial in 9 (11%) cases; there was no agreement in the remaining 22 (26%) cases. The complete agreement rate was significantly lower than 75% (P=0.01). The initial antibiotic regimen was inadequate in a single case. Pre-operative sampling may contribute to the diagnosis of peri-prosthetic infection but is neither necessary nor sufficient to confirm the diagnosis and identify the causative agent. The spectrum of the initial antibiotic regimen cannot be safely narrowed based on the pre-operative sample results. We suggest the routine prescription of a probabilistic broad-spectrum antibiotic regimen immediately after the prosthesis exchange, even when a pathogen was identified before surgery. IV, retrospective study. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  7. Combining task-evoked and spontaneous activity to improve pre-operative brain mapping with fMRI

    Science.gov (United States)

    Fox, Michael D.; Qian, Tianyi; Madsen, Joseph R.; Wang, Danhong; Li, Meiling; Ge, Manling; Zuo, Huan-cong; Groppe, David M.; Mehta, Ashesh D.; Hong, Bo; Liu, Hesheng

    2016-01-01

    Noninvasive localization of brain function is used to understand and treat neurological disease, exemplified by pre-operative fMRI mapping prior to neurosurgical intervention. The principal approach for generating these maps relies on brain responses evoked by a task and, despite known limitations, has dominated clinical practice for over 20 years. Recently, pre-operative fMRI mapping based on correlations in spontaneous brain activity has been demonstrated, however this approach has its own limitations and has not seen widespread clinical use. Here we show that spontaneous and task-based mapping can be performed together using the same pre-operative fMRI data, provide complimentary information relevant for functional localization, and can be combined to improve identification of eloquent motor cortex. Accuracy, sensitivity, and specificity of our approach are quantified through comparison with electrical cortical stimulation mapping in eight patients with intractable epilepsy. Broad applicability and reproducibility of our approach is demonstrated through prospective replication in an independent dataset of six patients from a different center. In both cohorts and every individual patient, we see a significant improvement in signal to noise and mapping accuracy independent of threshold, quantified using receiver operating characteristic curves. Collectively, our results suggest that modifying the processing of fMRI data to incorporate both task-based and spontaneous activity significantly improves functional localization in pre-operative patients. Because this method requires no additional scan time or modification to conventional pre-operative data acquisition protocols it could have widespread utility. PMID:26408860

  8. AP1000 passive core cooling system pre-operational tests procedure definition and simulation by means of Relap5 Mod. 3.3 computer code

    Energy Technology Data Exchange (ETDEWEB)

    Lioce, D., E-mail: donato.lioce@aen.ansaldo.it [Ansaldo Nucleare S.p.A., Corso F. M. Perrone 25, 16161, Genova (Italy); Asztalos, M., E-mail: asztalmj@westinghouse.com [Westinghouse Electric Company, Cranberry Twp, PA 16066 (United States); Alemberti, A., E-mail: alessandro.alemberti@aen.ansaldo.it [Ansaldo Nucleare S.p.A., Corso F. M. Perrone 25, 16161, Genova (Italy); Barucca, L. [Ansaldo Nucleare S.p.A., Corso F. M. Perrone 25, 16161, Genova (Italy); Frogheri, M., E-mail: monicalinda.frogheri@aen.ansaldo.it [Ansaldo Nucleare S.p.A., Corso F. M. Perrone 25, 16161, Genova (Italy); Saiu, G., E-mail: gianfranco.saiu@aen.ansaldo.it [Ansaldo Nucleare S.p.A., Corso F. M. Perrone 25, 16161, Genova (Italy)

    2012-09-15

    Highlights: Black-Right-Pointing-Pointer Two AP1000 Core Make-up Tanks pre-operational tests procedures have been defined. Black-Right-Pointing-Pointer The two tests have been simulated by means of the Relap5 computer code. Black-Right-Pointing-Pointer Results show the tests can be successfully performed with the selected procedures. - Abstract: The AP1000{sup Registered-Sign} plant is an advanced Pressurized Water Reactor designed and developed by Westinghouse Electric Company which relies on passive safety systems for core cooling, containment isolation and containment cooling, and maintenance of main control room emergency habitability. The AP1000 design obtained the Design Certification by NRC in January 2006, as Appendix D of 10 CFR Part 52, and it is being built in two locations in China. The AP1000 plant will be the first commercial nuclear power plant to rely on completely passive safety systems for core cooling and its licensing process requires the proper operation of these systems to be demonstrated through some pre-operational tests to be conducted on the real plant. The overall objective of the test program is to demonstrate that the plant has been constructed as designed, that the systems perform consistently with the plant design, and that activities culminating in operation at full licensed power including initial fuel load, initial criticality, and power increase to full load are performed in a controlled and safe manner. Within this framework, Westinghouse Electric Company and its partner Ansaldo Nucleare S.p.A. have strictly collaborated, being Ansaldo Nucleare S.p.A. in charge of the simulation of some pre-operational tests and supporting Westinghouse in the definition of tests procedures. This paper summarizes the work performed at Ansaldo Nucleare S.p.A. in collaboration with Westinghouse Electric Company for the Core Makeup Tank (CMT) tests, i.e. the CMTs hot recirculation test and the CMTs draindown test. The test procedure for the two

  9. AP1000 passive core cooling system pre-operational tests procedure definition and simulation by means of Relap5 Mod. 3.3 computer code

    International Nuclear Information System (INIS)

    Lioce, D.; Asztalos, M.; Alemberti, A.; Barucca, L.; Frogheri, M.; Saiu, G.

    2012-01-01

    Highlights: ► Two AP1000 Core Make-up Tanks pre-operational tests procedures have been defined. ► The two tests have been simulated by means of the Relap5 computer code. ► Results show the tests can be successfully performed with the selected procedures. - Abstract: The AP1000 ® plant is an advanced Pressurized Water Reactor designed and developed by Westinghouse Electric Company which relies on passive safety systems for core cooling, containment isolation and containment cooling, and maintenance of main control room emergency habitability. The AP1000 design obtained the Design Certification by NRC in January 2006, as Appendix D of 10 CFR Part 52, and it is being built in two locations in China. The AP1000 plant will be the first commercial nuclear power plant to rely on completely passive safety systems for core cooling and its licensing process requires the proper operation of these systems to be demonstrated through some pre-operational tests to be conducted on the real plant. The overall objective of the test program is to demonstrate that the plant has been constructed as designed, that the systems perform consistently with the plant design, and that activities culminating in operation at full licensed power including initial fuel load, initial criticality, and power increase to full load are performed in a controlled and safe manner. Within this framework, Westinghouse Electric Company and its partner Ansaldo Nucleare S.p.A. have strictly collaborated, being Ansaldo Nucleare S.p.A. in charge of the simulation of some pre-operational tests and supporting Westinghouse in the definition of tests procedures. This paper summarizes the work performed at Ansaldo Nucleare S.p.A. in collaboration with Westinghouse Electric Company for the Core Makeup Tank (CMT) tests, i.e. the CMTs hot recirculation test and the CMTs draindown test. The test procedure for the two selected tests has been defined and, in order to perform the pre-operational tests simulations, a

  10. Phase I dose escalating trial of hyperfractionated pre-operative chemoradiation for locally advanced rectal cancer

    International Nuclear Information System (INIS)

    Movsas, Benjamin; Hanlon, Alexandra L.; Lanciano, Rachelle; Scher, Richard M.; Weiner, Louis M.; Sigurdson, Elin R.; Hoffman, John P.; Eisenberg, Burton L.; Cooper, Harry S.; Provins, Susan; Coia, Lawrence R.

    1998-01-01

    Purpose: To determine the acute toxicity, post-operative complications, pathologic response and extent of downstaging to high dose pre-operative radiation using a hyperfractionated radiation boost and concurrent chemotherapy in a prospective Phase I trial. Materials and Methods: To be eligible for this study, patients had to have adenocarcinoma of the rectum less than 12 cm from the anal verge with either Stage T4 or T3 but greater than 4 cm or greater than 40% of the bowel circumference. All patients received 45 Gy pelvic radiation (1.8 Gy per fraction). Subsequent radiation was given to the region of the gross tumor with a 2 cm margin. This 'boost' treatment was given at 1.2 Gy twice daily to a total dose of 54.6 Gy for Level I, 57 Gy for Level II, and 61.8 Gy for Level III. 5-FU was given at 1g/m 2 over 24 hours for a four day infusion during the first and sixth weeks of radiation, with the second course concurrent with the hyperfractionated radiation. Surgical resection was carried out 4-6 weeks following completion of chemoradiation (in curative cases) and additional adjuvant chemotherapy consisting of 5-FU and Leucovorin was given for an additional 4 monthly cycles Days 1 through 5 beginning four weeks post surgery. Results: Twenty-seven patients, age 40-82 (median 61), completed the initial course of chemoradiation and are included in the analysis of toxicity. The median follow-up is 27 months (range 8-68). Eleven patients were treated to a dose of 54.6 Gy, nine patients to 57 Gy, and seven patients to 61.8 Gy. Twenty-one patients had T3 tumors, and six patients T4 tumors. Grade III acute toxicity from chemoradiation included proctitis (5 patients), dermatitis (9), diarrhea (five), leukopenia (1), cardiac (1). Grade IV toxicities included one patient with diarrhea (on dose Level I) and one patient (on dose Level III) with cardiac toxicity (unrelated to radiation). Surgical resection consisted of abdominal perineal resection in 16 and low anterior resection

  11. 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.

  12. 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.

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

    International Nuclear Information System (INIS)

    1995-01-01

    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

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

    International Nuclear Information System (INIS)

    McHugh, K.; Dudley, N.E.; Tam, P.

    1995-01-01

    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.)

  15. Phase I dose escalating trial of hyperfractinated pre-operative chemoradiation for locally advanced rectal cancer

    International Nuclear Information System (INIS)

    Movsas, Benjamin; Hanlon, Alexandra L.; Lanciano, Rachelle M.; Scher, Richard M.; Weiner, Louis M.; Sigurdson, Elin R.; Hoffman, John P.; Cooper, Harry S.; Provins, Susan; Coia, Lawrence R.

    1997-01-01

    PURPOSE: To determine the acute toxicity, post-operative complications, pathologic response and extent of downstaging to high dose pre-operative radiation using hyperfractionated radiation boost and concurrent chemotherapy in a prospective Phase I trial. MATERIALS and METHODS: To be eligible for this study, patients had to have adenocarcinoma of the rectum less than 12 cm from the anal verge with either Stage T4 or T3 but greater than 4 cm or greater than 40% of the bowel circumference. Pre-operative T-stage was based on digital rectal examination (DRE), endorectal ultrasound or Helmholtz coil pelvic MRI. All patients received 45 Gy pelvic radiation (1.8 Gy per fraction). Subsequent radiation was given to the region of the gross tumor with a 2 cm margin in all directions with the aid of CT simulation. This 'boost' treatment was given at 1.2 Gy twice daily to a total dose of 54.6 Gy for Level I, 57 Gy for Level II, and 61.8 Gy for Level III. 5-FU was given at 1g/m 2 over 24 hours for a four day infusion during the first and fifth weeks of radiation, with the second course concurrent with the hyperfractionated radiation. Surgical resection was to be carried out four to six weeks following completion of chemoradiation (in curative cases) and additional adjuvant chemotherapy consisting of 5-FU and Leucovorin was to be given for an additional four monthly cycles Days 1 through 5 beginning four weeks post surgery. RESULTS: Twenty-seven patients, age 40-82 (median 61), completed the initial course of chemoradiation and are included in the analysis of toxicity. The median follow-up is 24 months (range 8-39). Eleven patients were treated to a dose of 54.6 Gy, nine patients to 57 Gy, and seven patients to 61.8 Gy. Twenty-one patients had T3 tumors, and six patients T4 tumors. Median tumor length was 5 cm, median diameter 4 cm, and circumferential involvement greater than (1(3)) was present in 20 patients. Nine patients had primaries that were fixed or tethered on DRE. Grade

  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. Comparison of Pre-operative Central Corneal Thickness in Pediatric Cataract Cases versus Normal

    International Nuclear Information System (INIS)

    Khan, S.; Ali, M.; Zaheer, N.

    2014-01-01

    Objective: To compare the pre-operative central corneal thickness (CCT) in paediatric cataract patients with reference to normal control group. Study Design: A case control study. Place and Duration of Study: Paediatric Ophthalmology Clinic of Al-Shifa Trust Eye Hospital (ASTEH), Rawalpindi, from November 2009 to May 2010. Methodology: The study included 116 subjects with equal number of cases and controls. Demographic profile of all the subjects was noted followed by history and detailed ophthalmic examination. CCT was measured using an ultrasonic pachymeter (model Pac Scan 300). The mean of three measurements from the central cornea were recorded in microns. Results were analyzed using SPSS version 17.0. Results: Mean CCT values of the cases was 566.83 +- 37.646 microns while the control group had a mean CCT of 535.81 +- 24.466 microns. Difference between the CCT values of the two groups was highly significant (p < 0.001). Conclusion: Eyes with congenital cataracts have greater CCT values as compared to normal paediatric population. This factor must be kept in mind while interpreting intra-ocular pressure in such patients. (author)

  18. Pre-operative localization of parathyroid adenoma by Tc-99m-sestamibi scintigraphy (MIBI)

    International Nuclear Information System (INIS)

    Ramadan, Edward; Vishne, Tal H; Koren, Romelia; Lerner, Igor; Melloul, Moshe; Dreznik, Zeev

    2002-01-01

    The use of pre-operative imaging for localization of primary parathyroid adenoma may influence the duration and results of parathyroidectomy. The current study was aimed to evaluate the efficiency of localization of parathyroid adenoma by Tc-99m-sestamibi (MIBI) scintigraphy and compare the results with those achieved by the use of preoperative ultrasound. Seventy five patients, aged 25 to 83 years with primary hyperparathyroidism were operated due to primary adenoma in Rabin Medical Center from January 1995 to April 1997. Fifty of them had a preoperative MIBI scintigraphy and ultrasound for localization of parathyroid adenoma, while 25 had a preoperative ultrasound alone. Ultrasound identified correctly the adenoma in 84 percent of the cases, as compared to 96 percent identified by MIBI scintigraphy (p<0.01). MIBI scintigraphy shortened operation length from 120±20 min to 80±15 min (p<0.05) and reduced the number of frozen sections from 2.2±0.4 to 1.1±0.3 (p<0.001). MIBI scintigraphy is the most efficient modality for preoperative localization of parathyroid adenoma as compared to other imaging procedures, and can shorten operative time (Au)

  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. Planning and programming of pre-operational and in-service inspections

    International Nuclear Information System (INIS)

    Udaondo, M.S.

    1984-01-01

    After a brief mention of the actual scope of in-service inspection work, conclusions are presented that relate to the preparations for inspections, making use of experience acquired since 1972 at 11 nuclear power plants in Spain which have commissioned such studies from one particular organization, and analyses are given of the advantages to be gained therefrom. Three different aspects of preparations for inspections are considered: (a) man-hour estimates and the duration of in-service inspections; (b) the sequence of action during a pre-operational inspection (assuming a typical functional organization) from definition of the codes of practice and standards applicable up to the issue of the final report and the schedule for distribution of the annual work load to be invested in a typical project, as a result of combining the two previous estimates, and (c) the documentary aspect of preparations for an inspection during a scheduled outage, as related to the various documents to be drawn up and their contents. Reference is made to the general training to be given to the staff in charge of inspection activities so as to provide them with information on, and a perspective of, the in-service inspection jobs required. (author)

  1. 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.

  2. Pre-operational Study on Impact of Temelin NPP on Hydrosphere

    International Nuclear Information System (INIS)

    Hanslik, E.J.

    1999-01-01

    Beginning of the construction of Temelin Nuclear Power Plant (NPP) in south Bohemia (CR) dates back to 1986. It is planned that the first water-cooled reactor could be put into operation in 2000. A research project, funded from the national budget and carried out under supervision of the Czech Ministry of Environment, has been aimed at examining pre-operational environmental conditions (a reference level) in terms of concentrations of radioactive and non-radioactive polluting substances in components of the environment, particularly in hydrosphere, and at predicting possible impacts of future operation of Temelin NPP. Special attention paid to the hydrosphere is associated with requirements for protection of water quality in the Vltava River, which serves as water resource for Prague capital. The paper summarises selected interim results of the project, particularly those concerning per-operational environmental conditions and impacts predicted for standard operation of the plant. More detailed description of the results including possible impacts of the so called maximum project accident is presented in (1)

  3. 12 CFR 564.5 - Appraiser independence.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Appraiser independence. 564.5 Section 564.5 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY APPRAISALS § 564.5 Appraiser independence. (a) Staff appraisers. If an appraisal is prepared by a staff appraiser, that appraiser must be...

  4. Oral Nutrition as a Form of Pre-Operative Enhancement in Patients Undergoing Surgery for Colorectal Cancer

    NARCIS (Netherlands)

    Bruns, Emma R.J.; Argillander, Tanja E.; Heuvel, Van Den Baukje; Buskens, Christianne J.; Duijvendijk, Van Peter; Winkels, Renate M.; Kalf, Annette; Zaag, Van Der Edwin S.; Wassenaar, Eelco B.; Bemelman, Willem A.; Munster, Van Barbara C.

    2018-01-01

    Background: Nutritional status has major impacts on the outcome of surgery, in particular in patients with cancer. The aim of this review was to assess the merit of oral pre-operative nutritional support as a part of prehabilitation in patients undergoing surgery for colorectal cancer. Methods: A

  5. Oral Nutrition as a Form of Pre-Operative Enhancement in Patients Undergoing Surgery for Colorectal Cancer: A Systematic Review

    NARCIS (Netherlands)

    Bruns, Emma R. J.; Argillander, Tanja E.; van den Heuvel, Baukje; Buskens, Christianne J.; van Duijvendijk, Peter; Winkels, Renate M.; Kalf, Annette; van der Zaag, Edwin S.; Wassenaar, Eelco B.; Bemelman, Willem A.; van Munster, Barbara C.

    2018-01-01

    Background: Nutritional status has major impacts on the outcome of surgery, in particular in patients with cancer. The aim of this review was to assess the merit of oral pre-operative nutritional support as a part of prehabilitation in patients undergoing surgery for colorectal cancer. Methods: A

  6. Spatial and volumetric changes of retroperitoneal sarcomas during pre-operative radiotherapy

    International Nuclear Information System (INIS)

    Wong, Philip; Dickie, Colleen; Lee, David; Chung, Peter; O’Sullivan, Brian; Letourneau, Daniel; Xu, Wei; Swallow, Carol; Gladdy, Rebecca; Catton, Charles

    2014-01-01

    Purpose: To determine the positional and volumetric changes of retroperitoneal sarcomas (RPS) during pre-operative external beam radiotherapy (PreRT). Material and methods: After excluding 2 patients who received chemotherapy prior to PreRT and 15 RPS that were larger than the field-of-view of cone-beam CT (CBCT), the positional and volumetric changes of RPS throughout PreRT were characterized in 19 patients treated with IMRT using CBCT image guidance. Analysis was performed on 118 CBCT images representing one image per week of those acquired daily during treatment. Intra-fraction breathing motions of the gross tumor volume (GTV) and kidneys were measured in 22 RPS patients simulated using 4D-CT. Fifteen other patients were excluded whose tumors were incompletely imaged on CBCT or who received pre-RT chemotherapy. Results: A GTV volumetric increase (mean: 6.6%, p = 0.035) during the first 2 weeks (CBCT1 vs. CBCT2) of treatment was followed by GTV volumetric decrease (mean: 4%, p = 0.009) by completion of radiotherapy (CBCT1 vs. CBCT6). Internal margins of 8.6, 15 and 15 mm in the lateral, anterior/posterior and superior/inferior directions would be required to account for inter-fraction displacements. The extent of GTV respiratory motion was significantly (p < 0.0001) correlated with more superiorly positioned tumors. Conclusion: Inter-fraction CBCT provides important volumetric and positional information of RPS which may improve PreRT quality and prompt re-planning. Planning target volume may be reduced using online soft-tissue matching to account for interfractional displacements of GTVs. Important breathing motion occurred in superiorly placed RPS supporting the utility of 4D-CT planning

  7. Rescue pre-operative treatment with Lugol's solution in uncontrolled Graves' disease.

    Science.gov (United States)

    Calissendorff, Jan; Falhammar, Henrik

    2017-05-01

    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. 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. 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. 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. © 2017 The authors.

  8. Intrahepatic cholangiocarcinoma prognostic determination using pre-operative serum C-reactive protein levels

    International Nuclear Information System (INIS)

    Lin, Zi-Ying; Liang, Zhen-Xing; Zhuang, Pei-Lin; Chen, Jie-Wei; Cao, Yun; Yan, Li-Xu; Yun, Jing-Ping; Xie, Dan; Cai, Mu-Yan

    2016-01-01

    Serum C-reactive protein (CRP), an acute inflammatory response biomarker, has been recognized as an indicator of malignant disease progression. However, the prognostic significance of CRP levels collected before tumor removal in intrahepatic cholangiocarcinoma requires further investigation. We sampled the CRP levels in 140 patients with intrahepatic cholangiocarcinoma who underwent hepatectomies with regional lymphadenectomies between 2006 and 2013. A retrospective analysis of the clinicopathological data was performed. We focused on the impact of serum CRP on the patients’ cancer-specific survival and recurrence-free survival rates. High levels of preoperative serum CRP were significantly associated with well-established clinicopathologic features, including gender, advanced tumor stage, and elevated carcinoembryonic antigen and carbohydrate antigen 19-9 levels (P < 0.05). Univariate analysis demonstrated a significant association between high levels of serum CRP and adverse cancer-specific survival (P = 0.001) and recurrence-free survival (P < 0.001). In patients with stage I/II intrahepatic cholangiocarcinoma, the serum CRP level was a prognostic indicator for cancer-specific survival. In patients with stage I/II or stage III/IV, the serum CRP level was a prognostic indicator for recurrence-free survival (P < 0.05). Additionally, multivariate analysis identified serum CRP level in intrahepatic cholangiocarcinoma as an independent prognostic factor (P < 0.05). We confirmed a significant association of elevated pre-operative CRP levels with poor clinical outcomes for the tested patients with intrahepatic cholangiocarcinoma. Our results indicate that the serum CRP level may represent a useful factor for patient stratification in intrahepatic cholangiocarcinoma management

  9. Determinants of Pre-Operative Shoulder Imbalance in Patients with Adolescent Idiopathic Scoliosis

    Directory of Open Access Journals (Sweden)

    Hassan Ghandhari

    2017-01-01

    Full Text Available Background Disfiguring complications of adolescent idiopathic scoliosis (AIS could significantly affect the patients’ satisfaction. In this regard, shoulder imbalance has recently received much attention in spite of its poorly understood challenge. Objectives While the majority of previous studies have attempted to explore preoperative determinants of postoperative shoulder imbalance, in this study we aimed to investigate the factors correlated with the preoperative shoulder imbalance. Methods A total of 72 AIS patients with no previous history of corrective surgery took part in this study. The study sample comprised 63 females and 9 males with the mean age of 15.72 ± 3.08 years, ranging from 11 to 26 years. Shoulder imbalance parameters including T1 tilt, first rib angle (FRA, and clavicle angle (CA were assessed and their correlation with radiographic characteristics of the curves and patients’ demographic data including age and sex was evaluated. Results T1 tilt was more severe in males (mean -8.2° than females (mean -2.8° (P = 0.04. Moreover, a significant correlation was found between age and FRA (P = 0.04. A significant correlation was also observed between main thoracic (MT curve size and all the three parameters of shoulder imbalance (P < 0.001. The reverse correlation of T5 - T12 kyphosis angle with FRA was also significant (P = 0.04. Conclusions According to our results, in AIS, pre-operative radiographic shoulder imbalance could be affected by some curve parameters including MT and kyphosis size and demographic characteristics of patients including age and gender.

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

    Directory of Open Access Journals (Sweden)

    Jan Calissendorff

    2017-04-01

    Full Text Available 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.

  11. Radioactive waste safety appraisal. An international peer review of the licence application for the Australian near surface radioactive waste disposal facility. Report of the IAEA International Review Team

    International Nuclear Information System (INIS)

    2004-05-01

    Radioactive waste has been generated in Australia for a number of decades from the production and use of radioactive materials in medicine and industry, from the processing of various minerals containing natural radionuclides and from various research activities. It has been decided in the overall interest of safety and security to develop a radioactive waste disposal facility to accommodate the low level and short lived intermediate level waste, which make up the bulk of the waste, other than mining and minerals processing residues. A site selection process has been undertaken and environmental impact statement report prepared and approved. A licence application has been submitted to the national nuclear regulatory authority, the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) for siting, construction and operation of the facility. In order to assist the CEO of ARPANSA with his deliberations in this regard a request was made to the IAEA, in terms of its statutory mandate to establish international safety standards for radioactive waste safety and to provide for their application, to undertake an international peer review of the licence application and to advise the CEO accordingly. The outcome and recommendations of this peer review are presented in the report

  12. Combining task-evoked and spontaneous activity to improve pre-operative brain mapping with fMRI.

    Science.gov (United States)

    Fox, Michael D; Qian, Tianyi; Madsen, Joseph R; Wang, Danhong; Li, Meiling; Ge, Manling; Zuo, Huan-Cong; Groppe, David M; Mehta, Ashesh D; Hong, Bo; Liu, Hesheng

    2016-01-01

    Noninvasive localization of brain function is used to understand and treat neurological disease, exemplified by pre-operative fMRI mapping prior to neurosurgical intervention. The principal approach for generating these maps relies on brain responses evoked by a task and, despite known limitations, has dominated clinical practice for over 20years. Recently, pre-operative fMRI mapping based on correlations in spontaneous brain activity has been demonstrated, however this approach has its own limitations and has not seen widespread clinical use. Here we show that spontaneous and task-based mapping can be performed together using the same pre-operative fMRI data, provide complimentary information relevant for functional localization, and can be combined to improve identification of eloquent motor cortex. Accuracy, sensitivity, and specificity of our approach are quantified through comparison with electrical cortical stimulation mapping in eight patients with intractable epilepsy. Broad applicability and reproducibility of our approach are demonstrated through prospective replication in an independent dataset of six patients from a different center. In both cohorts and every individual patient, we see a significant improvement in signal to noise and mapping accuracy independent of threshold, quantified using receiver operating characteristic curves. Collectively, our results suggest that modifying the processing of fMRI data to incorporate both task-based and spontaneous activity significantly improves functional localization in pre-operative patients. Because this method requires no additional scan time or modification to conventional pre-operative data acquisition protocols it could have widespread utility. Copyright © 2015. Published by Elsevier Inc.

  13. Conducting effective performance appraisals.

    Science.gov (United States)

    2001-01-01

    According to experts, performance appraisals rate just below firing someone as the least favorite thing managers do. Many factors contribute to this view--one is that current systems do a poor job of evaluating performance and in fact often impede both evaluation and performance. When used as part of an ongoing supportive process of goal setting and feedback, performance appraisals can enhance performance and morale. One alternative to traditional employee evaluation methods is full-circle or 360-degree feedback. Contained in this issue are practical suggestions for preparing employees for performance appraisals which, when followed daily, encourage employees to put their best feet forward as part of their regular routine. Also included is a template specific to assessing the performance of clinical laboratory technologists . Additionally, numerous resources are provided to help you refine appraisal systems to fit your needs. Full-circle feedback is proving to be a boon to managers. It relieves them from being the exclusive "heavies" in evaluating performance, integrates appraisal input from several sources, and incorporates increasing employee skills, competencies, and satisfaction, thus improving productivity of people and processes. And aren't integration and continuous improvement what the laboratory is all about?

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

    OpenAIRE

    Businger, Adrian P; Laffer, Urban; Kaderli, Reto

    2012-01-01

    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 restrict...

  15. Appraisal of Transport Projects

    DEFF Research Database (Denmark)

    Jensen, Anders Vestergaard

    and robustness measures have been elaborated, which examine the subjective part of the MCDA (in form of criteria weights) and its role in decision support making. For this purpose both deterministic and stochastic sensitivity analyses have been developed. In addition, the focus has been formulating a framework...... into account the interests and preferences of different stakeholders. These various interests and preferences have been revealed by the use of decision conferencing, which engage the stakeholders and provide a common platform for understanding the decision problem. Leading up to this framework, this thesis has......, as robustness of a recommended solution is major concern in the final steps of decision making. As mentioned, the appraisal of transport projects is a complex issues involving conflict of various interests and this calls for new approaches to the practice of appraisal. The presented appraisal framework...

  16. A feasibility randomised controlled trial of pre-operative occupational therapy to optimise recovery for patients undergoing primary total hip replacement for osteoarthritis (PROOF-THR).

    Science.gov (United States)

    Jepson, Paul; Sands, Gina; Beswick, Andrew D; Davis, Edward T; Blom, Ashley W; Sackley, Catherine M

    2016-02-01

    To assess the feasibility of a pre-operative occupational therapy intervention for patients undergoing primary total hip replacement. Single blinded feasibility randomised controlled trial, with data collection prior to the intervention, and at 4, 12, and 26 weeks following surgery. Recruitment from two NHS orthopaedic outpatient centres in the West Midlands, UK. Patients awaiting primary total hip replacement due to osteoarthritis were recruited. Following pre-operative assessment, patients were individually randomised to intervention or control by a computer-generated block randomisation algorithm stratified by age and centre. The intervention group received a pre-surgery home visit by an occupational therapist who discussed expectations, assessed home safety, and provided appropriate adaptive equipment. The control group received treatment as usual. The study assessed the feasibility of recruitment procedures, delivery of the intervention, appropriateness of outcome measures and data collection methods. Health related quality of life and resource use were recorded at 4, 12 and 26 weeks. Forty-four participants were recruited, 21 were randomised to the occupational therapy intervention and 23 to usual care. Analysis of 26 week data included 18 participants in the intervention group and 21 in the control. The intervention was delivered successfully with no withdrawals or crossovers; 5/44 were lost to follow-up with further missing data for participation and resource use. The feasibility study provided the information required to conduct a definitive trial. Burden of assessment would need to be addressed. A total of 219 patients would be required in an efficacy trial. © The Author(s) 2015.

  17. The value of multislice spiral CT in the pre-operative diagnosis of cleft palate

    International Nuclear Information System (INIS)

    Tang Guangxi; Sun Lianfen; Zhang Xiaolin; Yu Chengxin; Lu Ji; Wang Xiaopeng; Li Liya; Yang Cheng; Wang Jun; Tian Yiqing

    2004-01-01

    Objective: To evaluate the practical value of multislice spiral CT (MSCT) in the preoperative diagnosis of cleft palate. Methods: Twenty patients with cleft palate were examined by using thin-slice (1.25 mm/4i) axial MSCT scanning and CT virtual endoscope (CTVE) imaging before and after operations. The cleft of each lesion was measured in the primary axial images. Results: Of the 20 cases, soft-and-hard cleft palate (grade II) was detected in 10 cases, with the clefts of soft palate between 1.5 cm and 2.2 cm, and the clefts of soft-and-hard palate between 1.2 cm and 2.0 cm. The right utter cleft palates were found in 3 cases with the clefts of soft palate between 2.0 cm and 2.5 cm, the clefts of soft-and-hard palate between 2.0 cm and 2.4 cm, and the clefts of hard palate between 1.8 cm and 2.2 cm. The left utter cleft palates (grade III) were found in 5 cases with the clefts of soft palate between 1.2 cm and 1.8 cm, the clefts of soft-and-hard palate between 0.9 cm and 2.0 cm, and the clefts of hard palate between 0.9 cm and 1.8 cm. The bilateral utter cleft palates (grade III) were detected in 2 cases with the clefts of soft palate between 2.1 cm and 2.3 cm, the clefts of soft-and-hard palate between 1.8 cm and 2.0 cm, and the clefts of hard palate between 1.9 cm and 2.3 cm. Conclusion: MSCT could excellently display the shape of all lesions before operation, especially the splitting degree of hard cleft palates in the axial images. Accurate measurements could be done for the cleft of different lesions in MSCT images. CTVE could clearly and directly show the shape of the lesion's interior surface. The pre-operative and post-operative images of each case could be perfectly compared by the combination of MSCT and CTVE

  18. The problem of appraising qualitative research

    OpenAIRE

    Dixon-Woods, M; Shaw, R; Agarwal, S; Smith, J

    2004-01-01

    

 Qualitative research can make a valuable contribution to the study of quality and safety in health care. Sound ways of appraising qualitative research are needed, but currently there are many different proposals with few signs of an emerging consensus. One problem has been the tendency to treat qualitative research as a unified field. We distinguish universal features of quality from those specific to methodology and offer a set of minimally prescriptive prompts to assist with the assessme...

  19. Appraisal of the correspondence of the safety improvement measures proposed for the Mochovce NPP with respect to the ones outlined in the TEO for the Juragua NPP

    International Nuclear Information System (INIS)

    Pereira Hernandez, Guillermo

    1996-01-01

    The work accomplished consisted in determining the correspondence or relationship between the safety improvement measures of the outlined for both plants as well as a preliminary analysis from which were determined. The measures which a deeper analysis is recommended to evaluate theirs possible addition to the group it is recommended to deepen with a view to take into considerations aspects of interest that in them are outlined and which could serve to enhance the approach or the linkage of the measures outlined in the TEO

  20. 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.

  1. Patient-specific surgical simulator for the pre-operative planning of single-incision laparoscopic surgery with bimanual robots.

    Science.gov (United States)

    Turini, Giuseppe; Moglia, Andrea; Ferrari, Vincenzo; Ferrari, Mauro; Mosca, Franco

    2012-01-01

    The trend of surgical robotics is to follow the evolution of laparoscopy, which is now moving towards single-incision laparoscopic surgery. The main drawback of this approach is the limited maneuverability of the surgical tools. Promising solutions to improve the surgeon's dexterity are based on bimanual robots. However, since both robot arms are completely inserted into the patient's body, issues related to possible unwanted collisions with structures adjacent to the target organ may arise. This paper presents a simulator based on patient-specific data for the positioning and workspace evaluation of bimanual surgical robots in the pre-operative planning of single-incision laparoscopic surgery. The simulator, designed for the pre-operative planning of robotic laparoscopic interventions, was tested by five expert surgeons who evaluated its main functionalities and provided an overall rating for the system. The proposed system demonstrated good performance and usability, and was designed to integrate both present and future bimanual surgical robots.

  2. A pre-operative group rehabilitation programme provided limited benefit for people with severe hip and knee osteoarthritis.

    Science.gov (United States)

    Wallis, Jason A; Webster, Kate E; Levinger, Pazit; Fong, Cynthia; Taylor, Nicholas F

    2014-01-01

    To determine if a pre-operative group rehabilitation programme can improve arthritis self-efficacy for people with severe hip and knee osteoarthritis. Single group, repeated measures design: 4-week baseline phase followed by a 6-week intervention phase of water exercise, and education with self-management strategies. The primary outcome was arthritis self-efficacy. The secondary outcomes were measures of pain (WOMAC), activity limitation (WOMAC), activity performance (30 s chair stand test, 10 m walk test) and health-related quality of life (EuroQol). Twenty participants (10 knee osteoarthritis and 10 hip osteoarthritis) with a mean age of 71 years (SD 7) attended 92% (SD 10%) of the scheduled sessions. All measures demonstrated baseline stability between two time points for measurements at week 1 and measurements at week 4. After the 6-week intervention programme there were no significant improvements for arthritis self-efficacy. There was a 12% increase for fast walking speed (mean increase of 0.14 m/s, 95% CI 0.07, 0.22). There were no significant improvements for other secondary outcomes. A pre-operative water-based exercise and educational programme did not improve arthritis self-efficacy, self-reported pain and activity limitation, and health-related quality of life for people with hip and knee osteoarthritis who were candidates for joint replacement. While there was a significant increase in one measure of activity performance (walking speed), these findings suggest the current programme may be of little value. Implications for Rehabilitation This pre-operative group rehabilitation programme for people with severe hip and knee osteoarthritis did not change arthritis self-efficacy, pain, activity limitation and health-related quality of life. This programme may have little value in preparing people for joint replacement surgery. The optimal pre-operative programme requires further design and investigation.

  3. Transcranial magnetic stimulation in the semi-quantitative, pre-operative assessment of patients undergoing spinal deformity surgery.

    Science.gov (United States)

    Glasby, Michael A; Tsirikos, Athanasios I; Henderson, Lindsay; Horsburgh, Gillian; Jordan, Brian; Michaelson, Ciara; Adams, Christopher I; Garrido, Enrique

    2017-08-01

    To compare measurements of motor evoked potential latency stimulated either magnetically (mMEP) or electrically (eMEP) and central motor conduction time (CMCT) made pre-operatively in conscious patients using transcranial and intra-operatively using electrical cortical stimulation before and after successful instrumentation for the treatment of adolescent idiopathic scoliosis. A group initially of 51 patients with adolescent idiopathic scoliosis aged 12-19 years was evaluated pre-operatively in the outpatients' department with transcranial magnetic stimulation. The neurophysiological data were then compared statistically with intra-operative responses elicited by transcranial electrical stimulation both before and after successful surgical intervention. MEPs were measured as the cortically evoked compound action potentials of Abductor hallucis. Minimum F-waves were measured using conventional nerve conduction methods and the lower motor neuron conduction time was calculated and this was subtracted from MEP latency to give CMCT. Pre-operative testing was well tolerated in our paediatric/adolescent patients. No neurological injury occurred in any patient in this series. There was no significant difference in the values of mMEP and eMEP latencies seen pre-operatively in conscious patients and intra-operatively in patients under anaesthetic. The calculated quantities mCMCT and eCMCT showed the same statistical correlations as the quantities mMEP and eMEP latency. The congruency of mMEP and eMEP and of mCMCT and eCMCT suggests that these measurements may be used comparatively and semi-quantitatively for the comparison of pre-, intra-, and post-operative spinal cord function in spinal deformity surgery.

  4. 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....... Moreover, several inconclusive results in the diagnostic biopsies reveal that attention must be paid on the suitability of pre-operative biopsies for EGFR mutation analysis....

  5. An observational cohort study on pre-operative investigations and referrals: How far are we following recommendations?

    Science.gov (United States)

    Karim, Habib Md Reazaul; Yunus, Md; Bhattacharyya, Prithwis

    2016-01-01

    Background and Aims: Pre-operative investigations are often required to supplement information for risk stratification and assessing reserve for undergoing surgery. Although there are evidence-based recommendations for which investigations should be done, clinical practice varies. The present study aimed to assess the pre-operative investigations and referral practices and compare it with the standard guidelines. Methods: The present observational study was carried out during 2014–appen2015 in a teaching institute after the approval from Institute Ethical Committee. A designated anaesthesiologist collected data from the completed pre-anaesthetic check-up (PAC) sheets. Investigations already done, asked by anaesthesiologists as well as referral services sought were noted and compared with an adapted master table prepared from standard recommendations and guidelines. Data were expressed in frequencies, percentage and statistically analysed using INSTAT software (GraphPad Prism software Inc., La Zolla, USA). Results: Seventy-five out of 352 patients (42.67% male, 57.33% female; American Society of Anesthesiologists physical status I to III) were included in this study. Nearly, all patients attended PAC with at least 5 investigations done. Of them, 89.33% were subjected to at least one unnecessary investigation and 91.67% of the referral services were not required which lead to 3.5 ( SD ±1.64) days loss. Anaesthesiologist-ordered testing was more focused than surgeons. Conclusion: More than two-third of pre-operative investigations and referral services are unnecessary. Anaesthesiologists are relatively more rational in ordering pre-operative tests yet; a lot can be done to rationalise the practice as well as reducing healthcare cost. PMID:27601737

  6. The sensitivity of pre-operative axillary staging in breast cancer: comparison of invasive lobular and ductal carcinoma.

    Science.gov (United States)

    Topps, A; Clay, V; Absar, M; Howe, M; Lim, Y; Johnson, R; Bundred, N

    2014-07-01

    Axillary ultrasound (AUS) with fine-needle aspiration (FNA) biopsy of abnormal lymph nodes is important for pre-operative staging and planning the surgical management of the axilla. Invasive lobular carcinoma (ILC) metastases are thought to be difficult to detect because the cells are small and on cytology resemble lymphocytes. To investigate this we directly compared the sensitivity of pre-operative axillary staging between ILC and invasive ductal carcinoma (IDC). Consecutive patients that presented in a single breast unit with pure IDC between April 2005 and December 2006 and pure ILC between January 2008 and December 2012 were retrospectively identified from pathology records. Pre-operative axillary ultrasound and FNA biopsy results were compared with post-operative histopathology from the sentinel node biopsy (SNB) or axillary lymph node dissection (ALND). A total of 275 and 142 axillae were identified in the IDC and ILC groups respectively. In the node positive patients there was no significant difference in the sensitivity of AUS (IDC vs. ILC; 58.7% vs. 52.8%). However, there was a significant difference in the sensitivity of ultrasound-guided FNA biopsy of abnormal nodes (IDC vs. ILC; 98.4% vs. 53.6%; p < 0.001). AUS has comparative sensitivities between IDC and ILC populations. In contrast, FNA biopsy of abnormal axillary nodes is clearly less sensitive in the ILC group. In these patients, who have abnormal AUS, we suggest that a core biopsy is required to improve the pre-operative staging and prevent unnecessary surgical procedures. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

    OpenAIRE

    Blankush, Joseph M.; Leitman, I. Michael; Soleiman, Aron; Tran, Trung

    2016-01-01

    Background: A chronic state of impaired glucose metabolism affects multiple components of the immune system, possibly leading to an increased incidence of post-operative infections. Such infections increase morbidity, length of stay, and overall cost. This study evaluates the correlation between elevated pre-operative glycosylated hemoglobin (HbA1c) and post-operative infections. Study design: Adult patients undergoing non-emergent procedures across all surgical subspecialties from January...

  8. A retrospective analysis of surgical site infections after chlorhexidine-alcohol versus iodine-alcohol for pre-operative antisepsis.

    Science.gov (United States)

    Charehbili, Ayoub; Swijnenburg, Rutger-Jan; van de Velde, Cornelis; van den Bremer, Jephta; van Gijn, Willem

    2014-06-01

    Surgical site infection (SSI) is the most common hospital-acquired infection in the Netherlands. There is little evidence in regard to differences in the efficacy of pre-operative topical antisepsis with iodine-alcohol as compared with chlorhexidine-alcohol for preventing SSI. We conducted a retrospective analysis at a single center, involving all patients who underwent breast, colon, or vascular surgery in 2010 and 2011, in which pre-operative disinfection of the skin was done with iodine-alcohol in 2010 and with chlorhexidine-alcohol in 2011. Demographic characteristics, surgical parameters, and rates of SSI were compared in the two groups of patients. Subgroup analyses were done for wound classification, wound type, and type of surgery performed. Associations of patient characteristics with SSI were also investigated. Data were analyzed with χ(2) tests, Student t-tests, and logistic regression analysis. No statistically significant difference was found in the rates of SSI in the two study groups, at 6.1% for the patients who underwent antisepsis with iodine-alcohol and 3.8% for those who underwent disinfection with chlorhexidine-alcohol (p=0.20). After multivariable analysis, an odds ratio (OR) of 0.68 (95% confidence interval [CI] 0.30-1.47) in favor of chlorhexidine-alcohol was found. Male gender, acute surgery, absence of antibiotic prophylaxis, and longer hospital length of stay (LOS) were all associated with SSI after pre-operative topical antisepsis. In this single-center study conducted over a course of one year with each of the preparations investigated, no difference in the rate of SSI was found after an instantaneous protocol change from iodine-alcohol to chlorhexidine-alcohol for pre-operative topical antisepsis.

  9. 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.

  10. Risk stratification by pre-operative cardiopulmonary exercise testing improves outcomes following elective abdominal aortic aneurysm surgery: a cohort study.

    Science.gov (United States)

    Goodyear, Stephen J; Yow, Heng; Saedon, Mahmud; Shakespeare, Joanna; Hill, Christopher E; Watson, Duncan; Marshall, Colette; Mahmood, Asif; Higman, Daniel; Imray, Christopher He

    2013-05-19

    In 2009, the NHS evidence adoption center and National Institute for Health and Care Excellence (NICE) published a review of the use of endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs). They recommended the development of a risk-assessment tool to help identify AAA patients with greater or lesser risk of operative mortality and to contribute to mortality prediction.A low anaerobic threshold (AT), which is a reliable, objective measure of pre-operative cardiorespiratory fitness, as determined by pre-operative cardiopulmonary exercise testing (CPET) is associated with poor surgical outcomes for major abdominal surgery. We aimed to assess the impact of a CPET-based risk-stratification strategy upon perioperative mortality, length of stay and non-operative costs for elective (open and endovascular) infra-renal AAA patients. A retrospective cohort study was undertaken. Pre-operative CPET-based selection for elective surgical intervention was introduced in 2007. An anonymized cohort of 230 consecutive infra-renal AAA patients (2007 to 2011) was studied. A historical control group of 128 consecutive infra-renal AAA patients (2003 to 2007) was identified for comparison.Comparative analysis of demographic and outcome data for CPET-pass (AT ≥ 11 ml/kg/min), CPET-fail (AT 11 ml/kg/min was associated with reduced perioperative mortality (open cases only), LOS, survival and inpatient costs (open and endovascular repair) for elective infra-renal AAA surgery.

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

    Science.gov (United States)

    Blankush, Joseph M; Leitman, I Michael; Soleiman, Aron; Tran, Trung

    2016-09-01

    A chronic state of impaired glucose metabolism affects multiple components of the immune system, possibly leading to an increased incidence of post-operative infections. Such infections increase morbidity, length of stay, and overall cost. This study evaluates the correlation between elevated pre-operative glycosylated hemoglobin (HbA1c) and post-operative infections. Adult patients undergoing non-emergent procedures across all surgical subspecialties from January 2010 to July 2014 had a preoperative HbA1c measured as part of their routine pre-surgical assessment. 2200 patient charts (1100 operative infection (superficial surgical site infection, deep wound/surgical space abscess, pneumonia, and/or urinary tract infection as defined by Centers for Disease Control criteria) within 30 days of surgery. Patients with HbA1c infection rate (3.8% in the HbA1c infection. Elevated HbA1c was, however, predictive of significantly increased risk of post-operative infection when associated with increased age (≥81 years of age) or dirty wounds. 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.

  12. 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...

  13. 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)....

  14. IEEE guide for planning of pre-operational testing programs for class 1E power systems for nuclear-power generating stations

    International Nuclear Information System (INIS)

    Anon.

    1976-01-01

    The Institute of Electrical and Electronics Engineers (IEEE) guide for pre-operational testing of Class 1E power systems for nuclear-power generating stations is presented. The guidelines apply to power systems both ac and dc supplies but not to the equipment which utilizes the ac and dc power. The pre-operational tests are performed after appropriate construction tests

  15. 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.

  16. Human actions treatment in the Juragua NPP pre-operational PSA

    International Nuclear Information System (INIS)

    Ferro Fernandez, R.

    1996-01-01

    The human reliability analysis is an important part of the Probabilistic Safety Analysis (PSA). Because Juragua NPP PSA has been accomplished during construction stage of the plant, no specific operational procedures nor experience for human reliability analysis task taking into account the worlds current methodologies in this field and the actual situation of the plant. This papers describes the approach we followed

  17. Pre-operative ultrasound identification of thyroiditis helps predict the need for thyroid hormone replacement after thyroid lobectomy.

    Science.gov (United States)

    Morris, Lilah F; Iupe, Isabella M; Edeiken-Monroe, Beth S; Warneke, Carla L; Hansen, Mandy O; Evans, Douglas B; Lee, Jeffrey E; Grubbs, Elizabeth G; Perrier, Nancy D

    2013-01-01

    To evaluate whether pre-operative thyroiditis identified by ultrasound (US) could help predict the need for thyroid hormone replacement (THR) following thyroid lobectomy. Data from patients who underwent thyroid lobectomy in 2006-2011, were not taking THR pre-operatively, and had ≥1 month of follow-up were reviewed retrospectively. THR was prescribed for relatively elevated thyroid-stimulating hormone (TSH) and hypothyroid symptoms. The Kaplan-Meier method was used to estimate the percentage of patients who required THR at 6, 12, 18, and 24 months postoperatively, and Cox proportional hazards regression models were used to evaluate prognostic factors for requiring post-thyroid lobectomy THR. During follow-up, 45 of 98 patients required THR. Median follow-up among patients not requiring THR was 11.6 months (range, 1.2 to 51.3 months). Six months after thyroid lobectomy, 22% of patients were taking THR (95% confidence interval [CI], 15-32%); the proportion increased to 46% at 12 months (95% CI, 36-57%) and 55% at 18 months (95% CI, 43-67%). On univariate analysis, significant prognostic factors for postoperative THR included a pre-operative TSH level >2.5 μ international units [IU]/mL (hazard ratio [HR], 2.8; 95% CI, 1.4-5.5; P = .004) and pathology-identified thyroiditis (HR, 2.4; 95% CI, 1.3-4.3; P = .005). Patients with both pre-operative TSH >2.5 μIU/mL and US-identified thyroiditis had a 5.8-fold increased risk of requiring postoperative THR (95% CI, 2.4-13.9; P2.5 μIU/mL significantly increases the risk of requiring THR after thyroid lobectomy. Thyroiditis can add to that prediction and guide pre-operative patient counseling and surgical decision making. US-identified thyroiditis should be reported and post-thyroid lobectomy patients followed long-term (≥18 months).

  18. Safety

    International Nuclear Information System (INIS)

    1998-01-01

    A brief account of activities carried out by the Nuclear power plants Jaslovske Bohunice in 1997 is presented. These activities are reported under the headings: (1) Nuclear safety; (2) Industrial and health safety; (3) Radiation safety; and Fire protection

  19. 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.

  20. 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

  1. 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

  2. Concern for pain in the pre-operative period- is the internet being used for information by patients?

    Science.gov (United States)

    Kurup, Viji; Dabu-Bondoc, Susan; Senior, Audrey; Dai, Feng; Hersey, Denise; Vadivelu, Nalini

    2014-02-01

    This study was conducted to provide information regarding prevalence of pain, type of provider managing pain, and use of Internet for information regarding pain, among patients coming for presurgical anesthesia consultation at a major academic institution. With IRB approval, patients were invited to participate in a voluntary and anonymous 14 question survey given to them when they presented for anesthesia consultation prior to their surgical procedure. The qualitative/categorical data were summarized by number (percentage [%]) and analyzed by Chi-square test or Fisher's exact test as appropriate. All data analyses were performed using the statistical software SAS, v9.2. A total of 1039 patients were asked to complete the survey and 670 patients returned their responses (response rate = 64.5%). 83% of patients had a history of prior surgery. 57% were concerned about postoperative pain. 30% of patients had chronic pain for more than 3 months pre-operatively. 16% of patients had looked online for information regarding pain. Pain physicians were involved in pain management only in 3.8% of these patients. Patients are presenting for surgery with significant pre-operative pain issues. Knowing this information pre-operatively will help healthcare personnel manage postsurgical pain more effectively. Patients are also using the Internet to obtain information regarding pain. As providers, there may be value to directing patients to reliable information online during consultation. As all physicians will eventually be managing chronic pain in their patients, pain education should be given priority in medical school curriculum. © 2013 World Institute of Pain.

  3. 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) operative SSI. Post-operatively, a serum glucose >128 mg/dL (OR 4.7; p=0.012) and hemoglobin 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.

  4. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis.

    Science.gov (United States)

    Smith, Toby; Pelpola, Kelum; Ball, Martin; Ong, Alice; Myint, Phyo Kyaw

    2014-07-01

    hip fracture is a common and serious condition associated with high mortality. This study aimed to identify pre-operative characteristics which are associated with an increased risk of mortality after hip fracture surgery. systematic search of published and unpublished literature databases, including EMBASE, MEDLINE, AMED, CINAHL, PubMed and the Cochrane Library, was undertaken to identify all clinical studies on pre-operative predictors of mortality after surgery in hip fracture with at least 3-month follow-up. Data pertaining to the study objectives was extracted by two reviewers independently. Where study homogeneity was evidence, a meta-analysis of pooled relative risk and 95% confidence intervals was performed for mortality against pre-admission characteristics. fifty-three studies including 544,733 participants were included. Thirteen characteristics were identified as possible pre-operative indicators for mortality. Following meta-analysis, the four key characteristics associated with the risk of mortality up to 12 months were abnormal ECG (RR: 2.00; 95% CI: 1.45, 2.76), cognitive impairment (RR: 1.91; 95% CI: 1.35, 2.70), age >85 years (RR: 0.42; 95% CI: 0.20, 0.90) and pre-fracture mobility (RR: 0.13; 95% CI: 0.05, 0.34). Other statistically significant pre-fracture predictors of increased mortality were male gender, being resident in a care institution, intra-capsular fracture type, high ASA grade and high Charlson comorbidity score on admission. this review has identified the characteristics of patients with a high risk of mortality after a hip fracture surgery beyond the peri-operative period who may benefit from comprehensive assessment and appropriate management. CRD42012002107. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. Pre-operative combined 5-FU, low dose leucovorin, and sequential radiation therapy for unresectable rectal cancer

    International Nuclear Information System (INIS)

    Minsky, B.D.; Cohen, A.M.; Kemeny, N.; Enker, W.E.; Kelsen, D.P.; Schwartz, G.; Saltz, L.; Dougherty, J.; Frankel, J.; Wiseberg, J.

    1993-01-01

    The authors performed a Phase 1 trial to determine the maximum tolerated dose of combined pre-operative radiation (5040 cGy) and 2 cycles (bolus daily x 5) of 5-FU and low dose LV (20 mg/m2), followed by surgery and 10 cycles of post-operative LV/5-FU in patients with unresectable primary or recurrent rectal cancer. Twelve patients were entered. The initial dose of 5-FU was 325 mg/m2. 5-FU was to be escalated while the LV remained constant at 20 mg/m2. Chemotherapy began on day 1 and radiation on day 8. The post-operative chemotherapy was not dose escalated; 5-FU: 425 mg/m2 and LV: 20 mg/m2. The median follow-up was 14 months (7--16 months). Following pre-operative therapy, the resectability rate with negative margins was 91% and the pathologic complete response rate was 9%. For the combined modality segment (preoperative) the incidence of any grade 3+ toxicity was diarrhea: 17%, dysuria: 8%, mucositis: 8%, and erythema: 8%. The median nadir counts were WBC: 3.1, HGB: 8.8, and PLT: 153000. The maximum tolerated dose of 5-FU for pre-operative combined LV/5-FU/RT was 325 mg/m2 with no escalation possible. Therefore, the recommended dose was less than 325 mg/m2. Since adequate doses of 5-FU to treat systemic disease could not be delivered until at least 3 months (cycle 3) following the start of therapy, the authors do not recommend that this 5-FU, low dose LV, and sequential radiation therapy regimen be used as presently designed. However, given the 91% resectability rate they remain encouraged with this approach. 31 refs., 1 fig., 2 tabs

  6. Cecal volvulus: a rare cause of bowel obstruction in a pediatric patient diagnosed pre-operatively by conventional imaging studies

    International Nuclear Information System (INIS)

    Vo, Nghia J.; O'Hara, Sara M.; Alonso, Maria H.

    2005-01-01

    Cecal volvulus is an acute surgical condition that is extremely rare in children, with a mortality rate of up to 40%. The clinical symptoms are often non-specific, and pediatric patients frequently have neurological deficits with associated communication difficulties, making the clinical diagnosis extremely challenging. Conventional radiographic imaging studies play a key role in the prospective diagnosis in children. We report a rare case of cecal volvulus in a 12-year-old boy who was diagnosed pre-operatively by abdominal radiographs and a contrast enema. (orig.)

  7. Cecal volvulus: a rare cause of bowel obstruction in a pediatric patient diagnosed pre-operatively by conventional imaging studies

    Energy Technology Data Exchange (ETDEWEB)

    Vo, Nghia J.; O' Hara, Sara M. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati (United States); Alonso, Maria H. [Cincinnati Children' s Hospital Medical Center, Division of Pediatric and Thoracic Surgery, Cincinnati, Ohio (United States)

    2005-11-01

    Cecal volvulus is an acute surgical condition that is extremely rare in children, with a mortality rate of up to 40%. The clinical symptoms are often non-specific, and pediatric patients frequently have neurological deficits with associated communication difficulties, making the clinical diagnosis extremely challenging. Conventional radiographic imaging studies play a key role in the prospective diagnosis in children. We report a rare case of cecal volvulus in a 12-year-old boy who was diagnosed pre-operatively by abdominal radiographs and a contrast enema. (orig.)

  8. Value of whole body bone scan in the pre-operative assessment in carcinoma of the breast

    Energy Technology Data Exchange (ETDEWEB)

    Hahn, P [Oerebro Regional Hospital (Sweden). Dept. of Oncology; Vikterloef, K J; Beckman, K W [Oerebro Regional Hospital (Sweden). Dept. of Radiation Physics; Rydman, H; Blom, O [Oerebro Regional Hospital (Sweden). Dept. of Diagnostic Radiology

    1979-01-01

    In 126 patients with primary breast cancer a patient moving whole-body bone scan was performed when they first presented. None of the patients in stage I had an evidence of skeletal metastases. Two patients (3%) of 62 in stage II and 4 patients (17%) in stage III had evidence of skeletal metastases. It appears that whole-body scanning is the most accurate, sensitive and convenient method of detecting osseous metastases and of staging breast cancer. This investigation should be carried out pre-operatively. Detection of early asymptomatic bony metastases will provide a better planning of treatment with rational approach.

  9. PRE-OPERATIVE HAIR REMOVAL WITH TRIMMERS AND RAZORS AND ITS IMPACT ON SURGICAL SITE INFECTIONS IN ELECTIVE INGUINAL HERNIA REPAIR

    Directory of Open Access Journals (Sweden)

    John S. Kurien

    2018-02-01

    Full Text Available BACKGROUND Despite major advances in infection control interventions, health care-associated infections (HAI remain a major public health problem and patient safety threat worldwide. The global data suggests that the SSI incidence rate varies from 0.5 to 20% depending upon the type of operation and underlying patient status. Several factors preoperative, intraoperative & postoperative, determine the occurrence of surgical site infections, Preoperative hair removal is considered as a risk for the development of surgical site infections. The objective of the study is to find out the difference in the incidence of surgical site infections in patients undergoing pre-operative hair removal by shaving with Razor blades and hair trimmers prior to elective inguinal hernia surgery. MATERIALS AND METHODS Written informed consent from 160 patients with no significant comorbidities planning to undergo elective inguinal hernia surgery at the general surgery wards in Government Medical College Kottayam and who were willing to participate in the study were to be obtained. 80 of them to undergo pre-operative hair removal with hair trimmers and 80 to undergo preoperative hair removal by shaving with razor blades on the day prior to the surgery randomised into two groups. During their stay in the postoperative ward the surgical wounds of the patients were examined daily for the development of erythema, pain, discharge, induration and gaping of the wound. The daily findings were noted down till the patient was discharged from the ward. The patients were again reassessed 2 weeks later, when they came for review in the Surgery OPD after their discharge from the ward; finally the patients were examined on the 30th day post-surgery to look for the clinical features of surgical site infections. RESULTS Out of the total 160 patients who were studied, 29 (18.1% of them had post-operative infection within 30 days, in the form of erythema, induration, discharge and gaping

  10. Pre-operative evaluation with MR in tetralogy of Fallot and pulmonary atresia with ventricular septal defect

    International Nuclear Information System (INIS)

    Holmqvist, C.; Hochbergs, P.; Bjoerkhem, G.; Brockstedt, S.; Laurin, S.

    2000-01-01

    To assess whether MR imaging could replace angiography in pre-operative evaluation of patients with tetralogy of Fallot and pulmonary atresia with ventricular septal defect (VSD), especially since the surgical correction was done earlier than was previously the rule. Fourteen patients with tetralogy of Fallot (n=10) or pulmonary atresia with VSD (n=4), mean age 7.5±4.4 months, were evaluated with angiocardiography and MR before definitive surgical correction. There was good diagnostic agreement between the two modalities when evaluating right ventricular outflow obstruction; 86% for valvular and 93% for supra valvular stenosis, but the agreement was somewhat lower for the sub valvular obstruction (57%). Surgery findings, however, were in favour of MR in 5 patients concerning the sub valvular right ventricular outflow tract obstruction. MR images identified all stenoses in the right and left pulmonary arteries, but overlooked one stenosis in the main pulmonary artery. MR could evaluate patency in all palliative shunts. Even in this young age group, MR imaging offers a good alternative to angiocardiography for the pre-operative evaluation of the right ventricular outflow tract, the main pulmonary artery and the proximal right and left pulmonary arteries, before definitive surgical correction of tetralogy of Fallot and pulmonary atresia with VSD

  11. Pre-operative evaluation with MR in tetralogy of Fallot and pulmonary atresia with ventricular septal defect

    Energy Technology Data Exchange (ETDEWEB)

    Holmqvist, C.; Hochbergs, P. [Univ. Hospital, Lund (Sweden). Dept of Diagnostic Radiology; Bjoerkhem, G. [Univ. Hospital, Lund (Sweden). Dept of Paediatrics; Brockstedt, S.; Laurin, S. [Univ. Hospital, Lund (Sweden). Dept of Diagnostic Radiology

    2000-01-01

    To assess whether MR imaging could replace angiography in pre-operative evaluation of patients with tetralogy of Fallot and pulmonary atresia with ventricular septal defect (VSD), especially since the surgical correction was done earlier than was previously the rule. Fourteen patients with tetralogy of Fallot (n=10) or pulmonary atresia with VSD (n=4), mean age 7.5{+-}4.4 months, were evaluated with angiocardiography and MR before definitive surgical correction. There was good diagnostic agreement between the two modalities when evaluating right ventricular outflow obstruction; 86% for valvular and 93% for supra valvular stenosis, but the agreement was somewhat lower for the sub valvular obstruction (57%). Surgery findings, however, were in favour of MR in 5 patients concerning the sub valvular right ventricular outflow tract obstruction. MR images identified all stenoses in the right and left pulmonary arteries, but overlooked one stenosis in the main pulmonary artery. MR could evaluate patency in all palliative shunts. Even in this young age group, MR imaging offers a good alternative to angiocardiography for the pre-operative evaluation of the right ventricular outflow tract, the main pulmonary artery and the proximal right and left pulmonary arteries, before definitive surgical correction of tetralogy of Fallot and pulmonary atresia with VSD.

  12. Sentinel node localisation using pre-operative lymphoscintigraphy and intraoperative gamma probe in early oral cavity cancer

    International Nuclear Information System (INIS)

    Ikram, M.; Akhtar, S.; Junaid, M.; Dhari, T.; Zaman, M.U.; Hussain, R.

    2013-01-01

    Objectives: To assess the diagnostic value of sentinel lymph node localisation using pre-operative lymphoscintigraphy and intra-operative gamma probe radio localisation in Pakistani patients suffering from early stage squamous cell carcinoma of the oral cavity. Methods: The prospective case series was conducted between September 2007 and April 2010 at the Aga Khan University Hospital, Karachi. It comprised patients with T1 and T2 oral cavity cancer with clinically and radiologically negative neck. Pre-operative lymphoscintigraphy was performed one day before surgery and intra-operative gamma probe was used to detect sentinel node. Final histo-pathological evaluation was taken as the gold standard. Results: The study comprised 42 patients: 32(76%) males and 10(24%) females. The primary tumour site was buccal mucosa in 25 (60%) patients, and tongue in 17 (40%). Sentinel lymph node was detected in 38 (90%) patients. On final histopathological identification, 7 (17%) patients had cancer in the neck nodes. In all patients with metastasis, sentinel lymph node technique correctly identified the involved neck level. None of the patients revealed metastasis in non-sentinel lymph nodes. Conclusion:Evidence suggested the use of sentinel node biopsy in patients with head and neck squamous cell carcinoma. (author)

  13. A comparison of laparoscopic and open surgery following pre-operative chemoradiation therapy for locally advanced lower rectal cancer

    International Nuclear Information System (INIS)

    Kusano, Toru; Inomata, Masafumi; Hiratsuka, Takahiro

    2014-01-01

    Although pre-operative chemoradiation therapy for advanced lower rectal cancer is a controversial treatment modality, it is increasingly used in combination with surgery. Few studies have considered the combination of chemoradiation therapy followed by laparoscopic surgery for locally advanced lower rectal cancer; therefore, this study aimed to assess the usefulness of this therapeutic combination. We retrospectively reviewed the medical records of patients with locally advanced lower rectal cancer treated by pre-operative chemoradiation therapy and surgery from February 2002 to November 2012 at Oita University. We divided patients into an open surgery group and a laparoscopic surgery group and evaluated various parameters by univariate and multivariate analyses. In total, 33 patients were enrolled (open surgery group, n=14; laparoscopic surgery group, n=19). Univariate analysis revealed that compared with the open surgery group, operative time was significantly longer, whereas intra-operative blood loss and intra-operative blood transfusion requirements were significantly less in the laparoscopic surgery group. There were no significant differences in post-operative complication and recurrence rates between the two groups. According to multivariate analysis, operative time and intra-operative blood loss were significant predictors of outcome in the laparoscopic surgery group. This study suggests that laparoscopic surgery after chemoradiation therapy for locally advanced lower rectal cancer is a safe procedure. Further prospective investigation of the long-term oncological outcomes of laparoscopic surgery after chemoradiation therapy for locally advanced lower rectal cancer is required to confirm the advantages of laparoscopic surgery over open surgery. (author)

  14. Core instrumentation and pre-operational procedures for core conversion HEU to LEU

    International Nuclear Information System (INIS)

    1984-02-01

    This report is intended for the reactor operator, to be used as a manual or checklist for general guidance on pre-startup activities that need to be addressed in preparation for conversion to Low Enriched Fuel (LEU). All nuclear, thermodynamic and safety calculations should have been performed prior to this stage of the core conversion process. During these calculations and certainly before ordering the new LEU fuel elements the reactor operator needs to very carefully consider additional important factors concerning the new fuel: fuel reliability, reliability of fuel fabricator, reprocessing contract or fuel element storage and disposal, economics of the new fuel cycle. At this stage, too, a preoperational experimental programme has to be developed and presented to the regulatory authorities for approval. This experimental programme could lead to additional requirements on: in-core instrumentation, out-of-core instrumentation or additional experimental devices. Detailed instructions on specific tests and measurements are not provided in this report since much information on the subject is available in the open literature

  15. 32 CFR 644.44 - Fee appraisals.

    Science.gov (United States)

    2010-07-01

    ... HANDBOOK Appraisal § 644.44 Fee appraisals. (a) Definitions and procedures. (1) The complete and.... The keynote of this approach lies in the sound development of a proper rate. The appraiser must have a...

  16. Investment appraisal using quantitative risk analysis.

    Science.gov (United States)

    Johansson, Henrik

    2002-07-01

    Investment appraisal concerned with investments in fire safety systems is discussed. Particular attention is directed at evaluating, in terms of the Bayesian decision theory, the risk reduction that investment in a fire safety system involves. It is shown how the monetary value of the change from a building design without any specific fire protection system to one including such a system can be estimated by use of quantitative risk analysis, the results of which are expressed in terms of a Risk-adjusted net present value. This represents the intrinsic monetary value of investing in the fire safety system. The method suggested is exemplified by a case study performed in an Avesta Sheffield factory.

  17. 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.

  18. SAFETY

    CERN Multimedia

    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...

  19. An appraisal profile of nostalgia.

    Science.gov (United States)

    van Tilburg, Wijnand A P; Bruder, Martin; Wildschut, Tim; Sedikides, Constantine; Göritz, Anja S

    2018-03-05

    The authors aimed to (a) identify the cognitive appraisals underlying nostalgia and (b) compare nostalgia with other emotions in terms of its appraisal profile. In Study 1, participants (N = 1,125) generated narratives. Next, they reported the level of nostalgia and 31 other emotions that these narratives elicited. Subsequently, participants evaluated the narrative events on several cognitive appraisals. Events that elicited nostalgia were pleasant, involved an irretrievable loss, felt psychologically distant, and were unique-an appraisal profile that differed from all other emotions. In Study 2 (N = 1,261), the authors experimentally varied these appraisals in a vignette paradigm and measured anticipated nostalgia and 10 other emotions. Participants anticipated most nostalgia when events were pleasant, involved irretrievable loss, were distant, and were unique-a profile shared only with longing. In Study 3 (N = 994), the authors used a guided autobiographical recall procedure in which they manipulated appraisals and measured the resultant emotions. Corroborating Studies 1-2, nostalgia was most intense for events that were pleasant, irretrievably lost, temporally distant, and unique. This appraisal profile was not shared by other emotions. The findings delineate the distinguishing cognitive appraisal profile of nostalgia. Nostalgia occupies a special place in the pantheon of emotions. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  20. Integrated Safety in ''SARAF'

    International Nuclear Information System (INIS)

    Dickstein, P.; Grof, Y.; Machlev, M.; Pernick, A.

    2004-01-01

    As of the very early stages of the accelerator project at the Soreq Nuclear Research Center ''SARAF'' a safety group was established which has been an inseparable participant in the planning and design of the new facility. The safety group comprises of teams responsible for the shielding, radiation protection and general industrial safety aspects of ''SARAF''. The safety group prepared and documented the safety envelope for the accelerator, dealing with the safety requirements and guidelines for the first, pre-operational, stages of the project. The safety envelope, though based upon generic principles, took into account the accelerator features and the expected modes of operation. The safety envelope was prepared in a hierarchical structure, containing Basic Principles, Basic Guidelines, General Principles for Safety Implementation, Safety Requirements and Safety Underlining Issues. The above safety envelope applies to the entire facility, which entails the accelerator itself and the experimental areas and associated plant and equipment utilizing and supporting the production of the accelerated particle beams

  1. Pre-operative Spermatic Cord Ultrasonography Helps to Reduce the Incidence of Metachronous Inguinal Hernia in Boys

    Directory of Open Access Journals (Sweden)

    Shoujiang Huang

    2018-06-01

    Full Text Available Background/purpose: Thickening of the spermatic cord is a clinical sign of an inguinal hernia. We therefore tested whether pre-operative spermatic cord ultrasonography could reduce the incidence of metachronous inguinal hernia (MIH.Methods: Boys under 2 years old with an initial unilateral inguinal hernia were enrolled in this study. In whom the width of the asymptomatic-sided spermatic cord was ≥0.5 cm, these patients underwent contralateral groin exploration. Age at initial operation, weight, initial operation side, the sonographic width of the spermatic cord, the operative findings and presence of MIH were recorded, and the relationship among them was studied. Boys in the US group underwent an open herniorrhaphy with pre-operative ultrasound examination; the non-US group included boys who did not undergo a pre-operative ultrasound examination. A receiver operator curve (ROC analysis was performed to evaluated predictive value of the sonographic width of the spermatic cord for contralateral hernia.Results: A total of 24 months' follow-up data were obtained from 1,793 boys (US group 1,162, non-US group 631. In the US group, the width of the hernia-sided spermatic cord (0.75 ± 0.18 cm was larger than the normal side (0.37 ± 0.05 cm, P < 0.001. And the width of normal side spermatic cord had no significant difference between the groups regarding other factors such as age and weight. In whom the width of the asymptomatic-sided spermatic cord was ≥0.5 cm, the corresponding incidence of CIH was 86.4% (57/66. The width of the spermatic cord predicted the presence of contralateral hernia with ROC area under the curve = 0.943 (95% CI = 0.919–0.966. The total incidence of MIH was 4.1% (74/1793. The incidence of MIH in the US group was 2.2% (25/1162 much lower than 7.8% (49/631 in the non-US group (P < 0.001. If the width of the asymptomatic-sided spermatic cord was 0.5 cm and 0.54 cm, the corresponding sensitivity was 0.682 and 0

  2. Association of pre-operative medication use with post-operative delirium in surgical oncology patients receiving comprehensive geriatric assessment.

    Science.gov (United States)

    Jeong, Young Mi; Lee, Eunsook; Kim, Kwang-Il; Chung, Jee Eun; In Park, Hae; Lee, Byung Koo; Gwak, Hye Sun

    2016-07-07

    Older patients undergoing surgery tend to have a higher frequency of delirium. Delirium is strongly associated with poor surgical outcomes. This study evaluated the association between pre-operative medication use and post-operative delirium (POD) in surgical oncology patients receiving comprehensive geriatric assessment (CGA). A total of 475 patients who were scheduled for cancer surgery and received CGA from January 2014 to June 2015 were included. Pre-operative medication review through CGA was conducted on polypharmacy (≥5 medications), delirium-inducing medications (DIMs), fall-inducing medications (FIMs), and potentially inappropriate medications (PIMs). POD was confirmed by psychiatric consultation, and DSM-V criteria were used for diagnosing delirium. The model fit of the prediction model was assessed by computing the Hosmer-Lemeshow goodness-of-fit test. Effect size was measured using the Nagelkerke R(2). Discrimination of the model was assessed by an analysis of the area under receiver operating curve (AUROC). Two models were constructed for multivariate analysis based on univariate analysis; model I included dementia and DIM in addition to age and sex, and model II included PIM instead of DIM of model I. Every one year increase of age increased the risk of POD by about 1.1-fold. DIM was a significant factor for POD after adjusting for confounders (AOR 12.78, 95 % CI 2.83-57.74). PIM was also a significant factor for POD (AOR 5.53, 95 % CI 2.03-15.05). The Hosmer-Lemeshow test results revealed good fits for both models (χ(2) = 3.842, p = 0.871 for model I and χ(2) = 8.130, p = 0.421 for model II). The Nagelkerke R(2) effect size and AUROC for model I was 0.215 and 0.833, respectively. Model II had the Nagelkerke R(2)effect size of 0.174 and AUROC of 0.819. These results suggest that pharmacists' comprehensive review for pre-operative medication use is critical for the post-operative outcomes like delirium in older patients.

  3. Safety

    International Nuclear Information System (INIS)

    2001-01-01

    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. Pre-operative radio-chemo-thermotherapy for advanced (T3-4) and/or recurrent rectal carcinomas

    International Nuclear Information System (INIS)

    Wust, P.; Gremmler, M.; Rau, B.; Loeffel, J.; Gellermann, J.; Stahl, H.; Vogl, T.; Riess, H.; Schlag, P.; Felix, R.

    1995-01-01

    Objective: Recent studies suggest that pre-operative radio-chemotherapy in locally advanced rectal cancer can increase resectability and local control (T4 stages), and might facilitate sphincter-preserving surgery (T3 stages). However, response rates are still unsatisfactory for radiotherapy alone, and are only slightly better for radio-chemotherapy. Radiofrequency hyperthermia has now achieved a technical stage already suitable for treating this tumor entity effectively in clinical practice. Therefore, a trimodal pre-operative approach for T3-4 rectal carcinomas has been investigated in a phase I/II study. Materials and Methods: A phase I/II study was conducted on 30 pts with advanced and/or recurrent rectal cancer. (7(30)) pts had recurrences, (9(30)) uT3, (14(30)) T4-stage of the primary. Initial tumor stage was assessed by endosonography, CT and occasionally MRI (T1-w ± Echovist, T2-w, proton density). Radiotherapy was delivered in prone position using a belly-board, three-field technique, standard blocks, 5x1.8 → 45 Gy in 5 weeks. In parallel, 5-FU (300-350 mg/kg, dose escalation) and folinic acid (50 mg) on days 1-5 and days 22-28. Regional hyperthermia was administered using the annular phased array applicator SIGMA-60 once a week. Index temperatures T x were deduced from thermal mapping scans in endocavitary/intratumoral catheters. Re-staging was done by endosonography and CT. Four weeks after radiotherapy, surgery was performed with preference to continence preserving operations. If the tumor remained unresectable, a boost to a total tumor dose of 60 Gy was claimed. Results: (7(30)) pts (23%) did not undergo resection because their tumors remained technically non-resectable: 4 pts with persistent local control of 12-18 mts, 2 pts with progressive disease, 1 pt with too short observation time. (23(30)) pts underwent surgery: only 1 R2-resection, 22 R0-resections. The patho-histological analysis documented 4 CR (17%) at the primary tumor, 12 PR

  5. C.T. scanning in the pre-operative assessment of non-small cell lung cancer

    International Nuclear Information System (INIS)

    Goldstraw, P.

    1986-01-01

    The concept of T.N.M. staging is now widely adopted, providing an international shorthand to describe tumour extent. Throughout this article the system referred to is that of the American Joint Committee on Cancer Staging and End Results Reporting. It is generally now accepted that Stage I and II patients with N.S.C.L.C. benefit from pulmonary resection, whilst those with Stage III tumours by virtue of T3 status, N2 disease or M stage other than zero, do not. There are exceptions to this rule and they are discussed in the relevant section. The authors therefore consider the role of C.T. scanning in pre-operative staging under the following headings. Tumour characteristics: 1) indicators of malignancy, 2) extra-pulmonary extension; Nodal metastases: 1) hilar, 2) mediastinal; Metastases to distant sites

  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. 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.

  8. Our experience with pre-operative haemostatic assessment of paediatric patients undergoing adenotonsillectomy at Federal Medical Centre, Makurdi

    Directory of Open Access Journals (Sweden)

    Amali Adekwu

    2016-01-01

    Full Text Available Background: In 2-4% of all patients requiring adenoidectomy, tonsillectomy or adenotonsillectomy, pre-operative screening tests for coagulation disorders are indicated to detect surgical bleeding complications. However, because of cost effect on the patients, the usefulness of these tests is being challenged. We therefore highlight our experience in paediatric patients undergoing adenoidectomy, tonsillectomy or both in our centre. Patients and Methods: This is a 3½-year analysis of the data of 165 paediatric patients who had adenoidectomy, tonsillectomy or both over the study period. The data collected included age, sex, procedure done and detailed clinical bleeding history. Results: A total of 165 children had either adenoidectomy or tonsillectomy, or both. There were 76 males and 89 females giving a male to female ratio of 1:1.2. Their ages ranged from 10 months to 18 years. Eighty-five (51.5% patients had adenotonsillectomy, 48 (29.1% and 32 (19.4% had only tonsillectomies and adenoidectomies, respectively. Only 11 (6.7% families volunteered the history of either prolonged bleeding with minor injury on the skin or occasional slight nose bleeding. Six (3.6% patients including 3 of the children with positive family history had posttonsillectomy bleed, out of which 4 (66.7% were moderate whereas the remaining 2 (33.3% were severe bleeding, which was not statistically significant (P = 0.041. The two cases of severe bleeding had fresh whole blood transfused whereas the rest that had no bleeding issues were discharged home 48 h postoperatively. Conclusion: Our experience in this study suggests that detailed bleeding history is necessary as well as pre-operative haemostatic assessment, if available and affordable for paediatric patients undergoing adenotonsillectomy.

  9. 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.

  10. 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 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.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.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.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.

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

    Science.gov (United States)

    Jeon, Christie Y; Furuya, E Yoko; Berman, Mitchell F; Larson, Elaine L

    2012-01-01

    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. 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. 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). 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.

  12. 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.

  13. Procedures for the systematic appraisal of operational radiation protection programmes

    International Nuclear Information System (INIS)

    1987-09-01

    The purpose of this document is to give guidance to management and regulators of organisations using ionizing radiations on a technique for systematically appraising their operational radiation protection programme in order that its adequacy and effectiveness can be objectively determined. The appraisal technique is based on analytical trees and can be used to examine either a whole programme, to determine its completion and adequacy or to examine one component of a programme in considerable detail. This document will not develop technical recommendations on particular radiation protection programmes. These will be found in the appropriate Safety Series document on operational radiation protection. 8 refs, figs

  14. The potential usefulness of the Response Index in positron emission tomography assessing the therapeutic effect of pre-operative chemotherapy for advanced colorectal cancer.

    Science.gov (United States)

    Nomura, Masatoshi; Takahashi, Hidekazu; Haraguchi, Naotsugu; Nishimura, Junichi; Hata, Taishi; Matsuda, Chu; Ikenaga, Masakazu; Yamamoto, Hirofumi; Murata, Kohei; Doki, Yuichiro; Mori, Masaki; Mizushima, Tsunekazu

    2017-12-01

    Pre-operative chemotherapy is an option for patients with local advanced rectal cancer, but the response rate to pre-operative chemotherapy with oxaliplatin is still low. If the therapeutic effect of pre-operative chemotherapy could be assessed, we may be able to convert to surgery early. The purpose of the present study was to validate the correlation between the maximum standardized uptake value (SUV max ) in 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) of the primary tumor and the therapeutic effect of pre-operative chemotherapy in advanced colorectal cancer. Retrospective cohort study from January 2011 to October 2015. We examined 28 patients with pathologically confirmed sigmoid or rectal cancer that underwent pre-operative chemotherapy and surgery. The correlation between Response Index (RI), calculated as (SUV max after chemotherapy)/(SUV max before chemotherapy), and the therapeutic effect on the primary tumor in advanced colorectal cancer. The degree of differentiation (p = 0.04), SUV max in the primary tumor after chemotherapy (p = 0.02), and RI (p = 0.008) were significant predictors of the therapeutic effect in univariate analysis. The areas under the ROC curve constructed with RI and therapeutic effect was 0.77. The optimal cut-off values for the RI in the responder group was effect of chemotherapy on advanced colorectal cancer. Thus, RI is potentially useful for predicting the therapeutic effect in advanced colorectal cancer.

  15. Pre-operative brachial plexus block compared with an identical block performed at the end of surgery: a prospective, double-blind, randomised clinical trial.

    Science.gov (United States)

    Holmberg, A; Sauter, A R; Klaastad, Ø; Draegni, T; Raeder, J C

    2017-08-01

    We evaluated whether pre-emptive analgesia with a pre-operative ultrasound-guided infraclavicular brachial plexus block resulted in better postoperative analgesia than an identical block performed postoperatively. Fifty-two patients undergoing fixation of a fractured radius were included. All patients received general anaesthesia with remifentanil and propofol. Patients were randomly allocated into two groups: a pre-operative block or a postoperative block with 0.5 ml.kg -1 ropivacaine 0.75%. After surgery, all patients received regular paracetamol plus opioids for breakthrough pain. Mean (SD) time to first rescue analgesic after emergence from general anaesthesia was 544 (217) min in the pre-operative block group compared with 343 (316) min in the postoperative block group (p = 0.015). Postoperative pain scores were higher and more patients required rescue analgesia during the first 4 h after surgery in the postoperative block group. There were no significant differences in plasma stress mediators between the groups. Analgesic consumption was lower at day seven in the pre-operative block group. Pain was described as very strong at block resolution in 27 (63%) patients and 26 (76%) had episodes of mild pain after 6 months. We conclude that a pre-operative ultrasound-guided infraclavicular brachial plexus block provides longer and better analgesia in the acute postoperative period compared with an identical postoperative block in patients undergoing surgery for fractured radius. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

  16. Sphincter preservation with pre-operative radiation therapy (RT) and coloanal anastomosis: long term follow-up

    International Nuclear Information System (INIS)

    Wagman, Raquel; Minsky, Bruce D.; Cohen, Alfred M.; Guillem, Jose G.; Paty, Philip B.

    1997-01-01

    PURPOSE: To determine the long term follow-up of sphincter preservation with pre-operative RT and coloanal anastomosis for rectal cancer. MATERIALS AND METHODS: A total of 36 pts (M:25, F:11) with invasive, clinically resectable, primary adenocarcinoma of the rectum were enrolled from 1/87 through 4/96 on a prospective Phase I/II trial. All patients were examined in the office by their operating surgeon prior to the start of RT and were judged clinically to require an abdominoperineal resection (APR) due to the proximity (but not invasion of) the tumor to the anal sphincter. By transrectal ultrasound, clinical T stage was T2:5, and T3:31. The median age was 55 years (range: 33-76 years), and the median distance from the anal verge was 4 cm (range: 3-7 cm). The median tumor size was 3.8 cm (range: 1.5-7 cm). Pts received 4680 cGy (180 cGy/day) to the whole pelvis followed by a boost to 5040 cGy followed by surgery 4-5 weeks later. Although no chemotherapy was delivered concurrently with RT, patients with pathologically positive pelvic nodes (13) or metastatic disease (6) received post-operative 5-FU based chemotherapy. All underwent fecal diversion which was closed 2-4 months post-op. Sphincter function was performed using a telephone survey according to the MSKCC sphincter function scale (Excellent: 1-2 bowel movements/day, no soilage, Good: 3-4 bowel movements/day, and/or mild soilage, fair: Episodic > 4 bowel movements/day, and/or moderate soilage, and Poor: incontinence). Actuarial calculations were performed using the Kaplan-Meier method. The median follow-up was 56 months (range: 4-121 months). RESULTS: Of the 35 patients who underwent surgery (1 pt with unresectable liver mets did not undergo surgery) (27(35)) (77%) were able to undergo a coloanal anastomosis and the pathological complete response rate was 14%. Post-operative complications included 1 (3%) partial anastamotic disruption, 2 (6%) rectal stenosis, and 1 (3%) pelvic abscess. For the total group of

  17. Uranium-mill appraisal program

    International Nuclear Information System (INIS)

    Everett, R.J.; Cain, C.L.

    1982-08-01

    The results of special team appraisals at NRC-licensed uranium mills in the period May to November 1981 are reported. Since the Three Mile Island accident, NRC management has instituted a program of special team appraisals of radiation protection programs at certain NRC-licensed facilities. These appraisals were designed to identify weaknesses and strengths in NRC-licensed programs, including those areas not covered by explicit regulatory requirements. The regulatory requirements related to occupational radiation protection and environmental monitoring at uranium mills have been extensively upgraded in the past few years. In addition, there was some NRC staff concern with respect to the effectiveness of NRC licensing and inspection programs. In response to this concern and to changes in mill requirements, the NRC staff recommended that team appraisals be conducted at mills to determine the adequacy of mill programs, the effectiveness of the new requirements, and mill management implementation of programs and requirements. This report describes the appraisal scope and methodology as well as summary findings and conclusions. Significant weaknesses identified during the mill appraisals are discussed as well as recommendations for improvements in uranium mill programs and mill licensing and inspection

  18. Prognostic influence of pre-operative C-reactive protein in node-negative breast cancer patients.

    Directory of Open Access Journals (Sweden)

    Isabel Sicking

    Full Text Available The importance of inflammation is increasingly noticed in cancer. The aim of this study was to analyze the prognostic influence of pre-operative serum C-reactive protein (CRP in a cohort of 148 lymph node-negative breast cancer patients. The prognostic significance of CRP level for disease-free survival (DFS, metastasis-free survival (MFS and overall survival (OS was evaluated using univariate and multivariate Cox regression, also including information on age at diagnosis, tumor size, tumor grade, estrogen receptor (ER, progesterone receptor (PR and human epidermal growth factor receptor 2 (HER2 status, proliferation index (Ki67 and molecular subtype, as well as an assessment of the presence of necrosis and inflammation in the tumor tissue. Univariate analysis showed that CRP, as a continuous variable, was significantly associated with DFS (P = 0.002, hazard ratio [HR] = 1.04, 95% confidence interval [CI] = 1.02-1.07 and OS (P = 0.036, HR= 1.03, 95% CI = 1.00-1.06, whereas a trend was observed for MFS (P = 0.111. In the multivariate analysis, CRP retained its significance for DFS (P = 0.033, HR= 1.01, 95% CI = 1.00-1.07 as well as OS (P = 0.023, HR= 1.03, 95% CI = 1.00-1.06, independent of established prognostic factors. Furthermore, large-scale gene expression analysis by Affymetrix HG-U133A arrays was performed for 72 (48.6% patients. The correlations between serum CRP and gene expression levels in the corresponding carcinoma of the breast were assessed using Spearman's rank correlation, controlled for false-discovery rate. No significant correlation was observed between CRP level and gene expression indicative of an ongoing local inflammatory process. In summary, pre-operatively elevated CRP levels at the time of diagnosis were associated with shorter DFS and OS independent of established prognostic factors in node-negative breast cancer, supporting a possible link between inflammation and

  19. A comparative study of MR imaging scores and MR perfusion imaging in pre-operative grading of intracranial gliomas

    International Nuclear Information System (INIS)

    Wu Honglin; Chen Junkun; Zhang Zongjun; Lu Guangming; Chen Ziqian; Wang Wei; Ji Xueman; Tang Xiaojun; Li Lin

    2005-01-01

    Objective: To compare the accuracy of MR imaging scores with MR perfusion imaging in pre-operative grading of intracranial gliomas. Methods: Thirty patients with intracranial gliomas (8 low-grade and 22 high-grade, according to WHO criteria) were examined with MR perfusion imaging pre-operatively. The lesions were evaluated by using an MR imaging score based on nine criteria. rCBV of the lesions were calculated by comparing the CBV of the lesion and that of contralateral normal white matter. The scores and ratios in high-grade and low-grade tumours were compared. Results: The MR imaging score of low grade (grades I and II) gliomas (0.67±0.29) were significantly lower than that of grades III (1.32 ± 0.47) (t=-3.48, P=0.003) and IV (1.56 ± 0.20) (t=-7.36, P=0.000) gliomas. There was no statistical difference when MR imaging scores of grades III and IV gliomas (t=-1.39, P=0.182) were compared. The maximum rCBV ratio of low grade (grades I and II) gliomas (2.38 ± 0.66 ) were significantly lower than that of grades III (5.81 ± 3.20) (t=-3.57, P=0.003) and IV (6.99 ± 2.47) (t=-5.09, P=0.001). There was no statistical difference when rCBV ratios of grades III and IV (t =-0.93, P=0.365) gliomas were compared. The accuracy of MR imaging scores in the noninvasive grading of untreated gliomas was all most the same as that of MR perfusion imaging (90.00% vs 89.29%). Conclusion: The MR imaging scores and MR perfusion imaging are two very useful tools in the evaluation of the histopathologic grade of cerebral gliomas. The overall accuracy in the noninvasive grading of gliomas may be imp roved if MR imaging scores and MR perfusion imaging are combined. (authors)

  20. 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

  1. 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

  2. Pre-operational monitoring program of Ra-226 in biological material in uranium mining and milling areas

    International Nuclear Information System (INIS)

    Souza Pereira, Wagner de; Azevedo Py Junior, Delcy de; Kelecom, Alphonse; Iatesta, Antonio

    2008-01-01

    The environmental licensing processes of 'Santa Quiteria' uranium mining and milling unit are being carried out nowadays. The pre-operational radiological environmental monitoring program is part of those processes, which has the objective of determining the background for further comparisons and evaluation of radiological environmental impact of the operation unit. This work shows the results of Ra-226 determination in the most consumed farm products of the region, which are black beans, corn and milk. These data are compared with data available in the literature. Measurement results of Ra-226 in black beans vary from 3.3 x 10 -2 Bq/Kg to 9.1 x 10 -2 Bq/Kg; in corn, the results vary from 8.0 x 10 -3 Bq/Kg to 4.6 x 10 -2 Bq/Kg; in milk the results vary from 1.0 x 10 -3 Bq/Kg to 7.0 x 10 -3 Bq/Kg that represents the smallest variation range. All of these results are in good agreement with literature reported data. (author)

  3. 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.

  4. 3D surface rendering of images from multiple MR pulse sequences in the pre-operative evaluation of hepatic lesions

    International Nuclear Information System (INIS)

    Bjerner, T.; Johansson, L.; Ahlstroem, H.; Haglund, U.

    1998-01-01

    Purpose: To develop a method for making three-dimensional (3D) reconstructions of liver vessels and hepatic lesions from different MR data sets. Material and Methods: To reduce the time required for segmentation and reconstructions, we used T1, T2 and phase contrast angiography, optimised for liver, lesion and vessels respectively. Following segmentation and reconstruction, the different volumes were combined on the same workstation and presented to the surgeon. Results and Conclusion: Segmentation and reconstruction took 1-2 h. To be able to combine the volumes from the different data sets, certain criteria had to be fulfilled: (a) the field of view had to be constant; (b) the same volume had to be scanned every time which meant that the slice thickness and the number of slices could be adjusted as long as the volume covered was the same; and (c) the positioning of each volume had to be identical between every scan. The resulting 3D reconstruction gave the surgeon a clear appreciation of the different lesions and their relation to the different liver segments in the pre-operative planning of hepatic resections. (orig.)

  5. Does Pre-Operative Multiple Immunosuppressive Therapy Associate with Surgical Site Infection in Surgery for Ulcerative Colitis.

    Science.gov (United States)

    Uchino, Motoi; Ikeuchi, Hiroki; Bando, Toshihiro; Hirose, Kei; Hirata, Akihiro; Chohno, Teruhiro; Sasaki, Hirofumi; Takahashi, Yoshiko; Takesue, Yoshio; Hida, Nobuyuki; Hori, Kazutoshi; Nakamura, Shiro

    2015-01-01

    Almost all surgeries for ulcerative colitis (UC) are performed under immunosuppressive conditions. Immunomodulators or biologics, with the exception of corticosteroids, do not appear to be risk factors for post-operative infectious complications. However, many patients are on multiagent immunosuppressive therapy at the time of surgery. Therefore, we evaluated the influence of pre-operative multiple immunosuppressives on the occurrence of surgical site infection (SSI) in UC. We reviewed surveillance data from 181 patients who underwent restorative proctocolectomy between January 2012 and March 2014. The incidences of SSI and the possible risk factors among patients receiving different immunosuppressive therapies were compared and analyzed. The incidence of incisional (INC) SSI was 13.3% and that of organ/space (O/S) SSI was 7.2%. The number of immunosuppressives did not significantly correlate with each incidence. Total prednisolone administration ≥12,000 mg (OR 2.6) and an American Society of Anesthesiologists score ≥3 (OR 2.8) were shown to be independent risk factors for overall SSI, whereas corticosteroid use in INC SSI (OR 17.4) and severe disease (OR 5.2) and a large amount of blood loss (OR 3.9) in O/S SSI were identified as risk factors. Although a correlation between multiple immunosuppressive therapy and SSIs was not found, it is not recommended that all patients be treated with multiple immunosuppressive therapy. Treatment strategy should be applied based on the patient's condition. © 2015 S. Karger AG, Basel.

  6. 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.

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

    NARCIS (Netherlands)

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

    2014-01-01

    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

  8. 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.

  9. 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

    2018-01-01

    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...

  10. 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

  11. Patient-specific instrumentation for total knee arthroplasty does not match the pre-operative plan as assessed by intra-operative computer-assisted navigation.

    Science.gov (United States)

    Scholes, Corey; Sahni, Varun; Lustig, Sebastien; Parker, David A; Coolican, Myles R J

    2014-03-01

    The introduction of patient-specific instruments (PSI) for guiding bone cuts could increase the incidence of malalignment in primary total knee arthroplasty. The purpose of this study was to assess the agreement between one type of patient-specific instrumentation (Zimmer PSI) and the pre-operative plan with respect to bone cuts and component alignment during TKR using imageless computer navigation. A consecutive series of 30 femoral and tibial guides were assessed in-theatre by the same surgeon using computer navigation. Following surgical exposure, the PSI cutting guides were placed on the joint surface and alignment assessed using the navigation tracker. The difference between in-theatre data and the pre-operative plan was recorded and analysed. The error between in-theatre measurements and pre-operative plan for the femoral and tibial components exceeded 3° for 3 and 17% of the sample, respectively, while the error for total coronal alignment exceeded 3° for 27% of the sample. The present results indicate that alignment with Zimmer PSI cutting blocks, assessed by imageless navigation, does not match the pre-operative plan in a proportion of cases. To prevent unnecessary increases in the incidence of malalignment in primary TKR, it is recommended that these devices should not be used without objective verification of alignment, either in real-time or with post-operative imaging. Further work is required to identify the source of discrepancies and validate these devices prior to routine use. II.

  12. 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.

  13. 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.

  14. Pre-operative and intra-operative detection of axillary lymph node metastases in 108 patients with invasive lobular breast cancer undergoing mastectomy.

    Science.gov (United States)

    Novak, Jerica; Besic, Nikola; Dzodic, Radan; Gazic, Barbara; Vogrin, Andrej

    2018-02-05

    Despite the recent changes in the treatment of the axilla in selected breast cancer patient, positive sentinel lymph node (SLN) in patients undergoing mastectomy still necessitates axillary lymph node dissection (ALND). In invasive lobular carcinoma (ILC), pre-operative detection of the lymph node metastasis may be demanding due to its unique morphology. The aim of this study was to examine the benefit of preoperative axillary ultrasound (AUS), ultrasound-guided fine-needle aspiration biopsy (US-FNAB), and intra-operative imprint cytology (IIC), in order to avoid two-stage axillary surgery in patients with ILC undergoing mastectomy. The object of this study were 102 patients (median age 52, range 34-73 years) with clinically non-suspicious axilla in whom 108 mastectomies were performed after a pre-operative AUS investigation. Whenever a metastasis was detected in a sentinel lymph node, ALND was done. Reports of the pre-operative AUS investigation, US-FNAB, and IIC were compared with definitive histopathological reports of surgical specimens. In 46 cases lymph node metastases were diagnosed. AUS suspicious lymph nodes were found in 29/108 cases and histopathology confirmed metastases in 22/30 cases. US-FNAB was performed in 29 cases with AUS suspicious lymph nodes. Cytology proved metastases in 11/29 cases. Histopathology confirmed metastases in 10/11 cases with only isolated tumor cells found in one case. IIC investigation was performed in 63 cases and in 10/27 cases metastases were confirmed by histopathology. Pre-operative AUS, US-FNAB, and/or IIC investigation enabled ALND during a single surgical procedure in 20/46 patients with metastases in lymph nodes. Pre-operative AUS, US-FNAB, and/or IIC are/is beneficial in patients with ILC planned for mastectomy in order to decrease the number of two stage axillary procedures.

  15. Nuclear health and safety

    International Nuclear Information System (INIS)

    1990-04-01

    This report summarizes the responsiveness of DOE and contractors to findings contained in DOE technical safety appraisals and environmental surveys. These appraisals and surveys have been done at DOE facilities and sites to find out the extent of the environmental, safety, and health problems and to prioritize them for corrective action. As of January 1990, DOE computer data showed over 1,700 safety and health problems and almost 1,300 environmental problems. The majority of these problems, however, have not yet been corrected. GAO also looked at the extent to which DOE has developed a computerized tracking system to monitor the status of its environmental, safety, and health problems. GAO found that the computer system lacks important information, such as various field office and independent appraisals. Inclusion of this information would provide a more complete picture of the problems at the site

  16. 9 CFR 50.9 - Appraisals.

    Science.gov (United States)

    2010-01-01

    ... part must be appraised at their fair market value by an appraiser selected by APHIS. APHIS may decline... veterinarian in charge may grant a reasonable time for the presentation of their registration papers. [67 FR...

  17. Using Expectancy Theory to Explain Performance Appraisal ...

    African Journals Online (AJOL)

    pc

    2018-03-05

    Mar 5, 2018 ... appraisal conducting style, the relation between the performance appraisal system and task ... the article first explains the theory model which is based expectancy theory. II. ... which in return lead to rewards. According to [12],.

  18. 12 CFR 564.3 - Appraisals required; transactions requiring a State certified or licensed appraiser.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Appraisals required; transactions requiring a State certified or licensed appraiser. 564.3 Section 564.3 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY APPRAISALS § 564.3 Appraisals required; transactions requiring a State...

  19. 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...

  20. 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...

  1. 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

  2. 7 CFR 4279.144 - Appraisals.

    Science.gov (United States)

    2010-01-01

    ... value of the collateral. All real property appraisals associated with Agency guaranteed loanmaking and... appraise the property in question. All appraisals will include consideration of the potential effects from... value of the collateral. For additional guidance and information concerning the completion of real...

  3. 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…

  4. Carcinoembryonic antigen (CEA) level, CEA ratio, and treatment outcome of rectal cancer patients receiving pre-operative chemoradiation and surgery

    International Nuclear Information System (INIS)

    Yang, Kai-Lin; Chang, Shih-Ching; Chu, Lee-Shing; Wang, Ling-Wei; Yang, Shung-Haur; Liang, Wen-Yih; Kuo, Ying-Ju; Lin, Jen-Kou; Lin, Tzu-Chen; Chen, Wei-Shone; Jiang, Jeng-Kae; Wang, Huann-Sheng

    2013-01-01

    To investigate serum carcinoembryonic antigen (CEA) as a prognostic factor for rectal cancer patients receiving pre-operative chemoradiotherapy (CRT). Between 2000 and 2009, 138 patients with advanced rectal cancer receiving CRT before surgery at our hospital were retrospectively classified into 3 groups: pre-CRT CEA <6 ng/ml (group L; n = 87); pre-CRT CEA ≥ 6 ng/ml and post-CRT CEA <6 ng/ml (group H-L; n = 32); and both pre- and post-CRT CEA ≥ 6 ng/ml (group H-H; n = 19). CEA ratio (defined as post-CRT CEA divided by pre-CRT CEA), post-CRT CEA level and other factors were reviewed for prediction of pathologic complete response (pCR). Five-year disease-free survival (DFS) was better in groups L (69.0%) and H-L (74.5%) than in group H-H (44.9%) (p = 0.024). Pathologic complete response was observed in 19.5%, 21.9% and 5.3% of groups L, H-L and H-H respectively (p = 0.281). Multivariate analysis showed that ypN stage and pCR were independent prognostic factors for DFS and that post-CRT CEA level was independently predictive of pCR. As a whole, post-CRT CEA <2.61 ng/ml predicted pCR (sensitivity 76.0%; specificity 58.4%). For those with pre-CRT CEA ≥6 ng/ml, post-CRT CEA and CEA ratio both predicted pCR (sensitivity 87.5%, specificity 76.7%). In patients with pre-CRT serum CEA ≥6 ng/ml, those with “normalized” CEA levels after CRT may have similar DFS to those with “normal” (<6 ng/ml) pre-CRT values. Post-CRT CEA level is a predictor for pCR, especially in those with pre-CRT CEA ≥6 ng/ml

  5. 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

  6. Safety

    International Nuclear Information System (INIS)

    Jones, P.M.S.

    1987-01-01

    Aspects of fission reactors are considered - control, heat removal and containment. Brief descriptions of the reactor accidents at the SL-1 reactor (1961), Windscale (1957), Browns Ferry (1975), Three Mile Island (1979) and Chernobyl (1986) are given. The idea of inherently safe reactor designs is discussed. Safety assessment is considered under the headings of preliminary hazard analysis, failure mode analysis, event trees, fault trees, common mode failure and probabalistic risk assessments. These latter can result in a series of risk distributions linked to specific groups of fault sequences and specific consequences. A frequency-consequence diagram is shown. Fatal accident incidence rates in different countries including the United Kingdom for various industries are quoted. The incidence of fatal cancers from occupational exposure to chemicals is tabulated. Human factors and the acceptability of risk are considered. (U.K.)

  7. 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

  8. The impact of pre-operative weight loss on incidence of surgical site infection and readmission rates after total joint arthroplasty.

    Science.gov (United States)

    Inacio, Maria C S; Kritz-Silverstein, Donna; Raman, Rema; Macera, Caroline A; Nichols, Jeanne F; Shaffer, Richard A; Fithian, Donald C

    2014-03-01

    This study characterized a cohort of obese total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients (1/1/2008-12/31/2010) and evaluated whether a clinically significant amount of pre-operative weight loss (5% decrease in body weight) is associated with a decreased risk of surgical site infections (SSI) and readmissions post-surgery. 10,718 TKAs and 4066 THAs were identified. During the one year pre-TKA 7.6% of patients gained weight, 12.4% lost weight, and 79.9% remained the same. In the one year pre-THA, 6.3% of patients gained weight, 18.0% lost weight, and 75.7% remained the same. In TKAs and THAs, after adjusting for covariates, the risk of SSI and readmission was not significantly different in the patients who gained or lost weight pre-operatively compared to those who remained the same. © 2013.

  9. Pre-operative CT angiography and three-dimensional image post processing for deep inferior epigastric perforator flap breast reconstructive surgery.

    Science.gov (United States)

    Lam, D L; Mitsumori, L M; Neligan, P C; Warren, B H; Shuman, W P; Dubinsky, T J

    2012-12-01

    Autologous breast reconstructive surgery with deep inferior epigastric artery (DIEA) perforator flaps has become the mainstay for breast reconstructive surgery. CT angiography and three-dimensional image post processing can depict the number, size, course and location of the DIEA perforating arteries for the pre-operative selection of the best artery to use for the tissue flap. Knowledge of the location and selection of the optimal perforating artery shortens operative times and decreases patient morbidity.

  10. Clinical utility of routine pre-operative axillary ultrasound and fine needle aspiration cytology in patient selection for sentinel lymph node biopsy.

    Science.gov (United States)

    Rattay, T; Muttalib, M; Khalifa, E; Duncan, A; Parker, S J

    2012-04-01

    In patients with operable breast cancer, pre-operative evaluation of the axilla may be of use in the selection of appropriate axillary surgery. Pre-operative axillary ultrasound (US) and fine needle aspiration cytology (FNAC) assessments have become routine practice in many breast units, although the evidence base is still gathering. This study assessed the clinical utility of US+/-FNAC in patient selection for either axillary node clearance (ANC) or sentinel lymph node biopsy (SLNB) in patients undergoing surgery for operable breast cancer. Over a two-year period, 348 patients with a clinically negative axilla underwent axillary US. 67 patients with suspicious nodes on US also underwent FNAC. The sensitivity and specificity of axillary investigations to determine nodal involvement were 56% (confidence interval: 47-64%) and 90% (84-93%) for US alone, and 76% (61-87%) and 100% (65-100%) for FNAC combined with US, respectively. With a positive US, the post-test probability was 78%. A negative US carried a post-test probability of 25%. When FNAC was positive, the post-test probability was greater than unity. A negative FNAC yielded a post-test probability of 52%. All patients with positive FNAC and most patients with suspicious US were listed for axillary node clearance (ANC) after consideration at the multi-disciplinary team (MDT) meeting. With pre-operative axillary US+/-FNAC, 20% of patients were saved a potential second axillary procedure, facilitating a reduction in the overall re-operation rate to 12%. In this study, a positive pre-operative US+/-FNAC directs patients towards ANC. When the result is negative, other clinico-pathological factors need to be taken into account in the selection of the appropriate axillary procedure. Copyright © 2011 Elsevier Ltd. All rights reserved.

  11. The ability of conservation and seriation in the transition from the pre-operational stage to the stage of concrete logical operations

    OpenAIRE

    Zadnikar Rupnik, Daša

    2016-01-01

    In the theoretical part of the thesis I closely addressed the Piaget's theory from the field of children's thinking. I described four stages of cognitive development as defined by Piaget. I focused on cognitive operations which are characteristic of the transition from the pre-operational stage to the stage of concrete logical operations, namely conservation and seriation. I summarized certain reviews of the Piaget's theory and described the use of the Piaget's theory in education. A part of ...

  12. Electronuclear reactors - EDF. Synthesis of study appraisal and of modifications associated with the safety re-examination of 1300 MWe reactors after 30 years of operation (VD3 1300)

    International Nuclear Information System (INIS)

    Bigot, Franck

    2014-01-01

    This report states the opinion of the IRSN on the adequacy of safety improvements adopted by EDF and of the update of the safety demonstration, as well as their consistency with guidelines defined for this safety re-examination; on the modalities defined by EDF to assess the compliance and status of installations (topics related to the ageing of containment enclosure and vessels being excluded); on the adequacy of the validation performed by EDF in terms of organisational and human factors for the whole set of modifications related to reactor ageing management and obsolescence management (notably those related to the modernisation of control rooms); on the acceptability of modifications declared by EDF in April 2014 on issues related to design, implementation and exploitation with respect to elements of the Code of the Environment. Thus, the report addresses: the safety demonstration update and adopted improvements (studies of operating conditions and their radiological consequences with respect to the different identified risks, design of systems which are important for safety and civil works components, aggressions with an external or internal origin, probabilistic safety studies), the installation compliance and status (decennial tests, program of additional investigations), the modernisation of the control room and social, organisational and human aspects, and equipment modifications. A table in appendix indicates the different topics of the VD 1300 safety re-examination, the associated published IRSN opinions and reports, and the associated ASN letters. Another appendix contains a set of recommendations regarding rules, methods and accident studies for the Safety Report, for the primary circuit dilution risks, for the radiological consequences of severe accidents, for the safety of the nuclear fuel stored in a pool, for the modernisation of the control room and the organisational and human factors, for equipment modifications, and for different parts of the

  13. Pre-Operative Prediction of Advanced Prostatic Cancer Using Clinical Decision Support Systems: Accuracy Comparison between Support Vector Machine and Artificial Neural Network

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Youn; Moon, Sung Kyoung; Hwang, Sung Il; Sung, Chang Kyu; Cho, Jeong Yeon; Kim, Seung Hyup; Lee, Hak Jong [Seoul National University College of Medicine, Seoul (Korea, Republic of); Jung, Dae Chul [National Cancer Center, Ilsan (Korea, Republic of); Lee, Ji Won [Kangwon National University College of Medicine, Chuncheon (Korea, Republic of)

    2011-10-15

    The purpose of the current study was to develop support vector machine (SVM) and artificial neural network (ANN) models for the pre-operative prediction of advanced prostate cancer by using the parameters acquired from transrectal ultrasound (TRUS)-guided prostate biopsies, and to compare the accuracies between the two models. Five hundred thirty-two consecutive patients who underwent prostate biopsies and prostatectomies for prostate cancer were divided into the training and test groups (n = 300 versus n 232). From the data in the training group, two clinical decision support systems (CDSSs-[SVM and ANN]) were constructed with input (age, prostate specific antigen level, digital rectal examination, and five biopsy parameters) and output data (the probability for advanced prostate cancer [> pT3a]). From the data of the test group, the accuracy of output data was evaluated. The areas under the receiver operating characteristic (ROC) curve (AUC) were calculated to summarize the overall performances, and a comparison of the ROC curves was performed (p < 0.05). The AUC of SVM and ANN is 0.805 and 0.719, respectively (p = 0.020), in the pre-operative prediction of advanced prostate cancer. Te performance of SVM is superior to ANN in the pre-operative prediction of advanced prostate cancer.

  14. Pre-operative radiotherapy in soft tissue tumors: Assessment of response by static post-contrast MR imaging compared to histopathology

    International Nuclear Information System (INIS)

    Einarsdottir, H.; Wejde, J.; Bauer, H.C.F.

    2000-01-01

    To evaluate if static post-contrast MR imaging was adequate to assess tumor viability after pre-operative radiotherapy in soft tissue sarcoma. Post-contrast MR imaging of 36 soft tissue sarcomas performed 0 - 54 days (median 13 days) after pre-operative radiotherapy, were retrospectively reviewed and compared to post-operative histopathology reports. The contrast enhancement of the tumor was visually graded as minor, moderate or extensive. From the post-operative histopathology reports, three types of tumor response to radiotherapy were defined: Poor, intermediate or good. The size of the tumors before and after radiation was compared. Even if most viable tumors enhanced more than non-viable tumors, there was major overlapping and significant contrast enhancement could be seen in tumors where histopathological examination revealed no viable tumor tissue. Based on histopathology, there were 12 good responders; 8 of these showed minor, 3 moderate and 1 extensive contrast enhancement on MR imaging. Sixteen tumors had an intermediate response; 3 showed minor, 8 moderate and 5 extensive enhancement. Eight tumors had poor response; none showed minor enhancement, 3 moderate and 5 extensive enhancement. Both increase and Decrease in tumor size was seen in lesions with a good therapy response. Static post-contrast MR imaging cannot reliably assess tumor viability after pre-operative radiotherapy in soft tissue sarcoma. In tumors with no viable tumor tissue, moderate and extensive contrast enhancement can be seen

  15. Long-term impact of pre-operative physical rehabilitation protocol on the 6-min walk test of patients with adolescent idiopathic scoliosis: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    V.L. dos Santos Alves

    2015-05-01

    Full Text Available Background: Monitored physical activities in patients with adolescent idiopathic scoliosis (AIS have been shown to improve physical performance, endurance and cardiopulmonary function and may be assessed by the 6-min walk test (6MWT. We aimed to evaluate the long-term results of the 6MWT after a rehabilitation protocol employed before surgical correction for AIS. Methods: This prospective randomized clinical trial studied the impact of a 4-month pre-operative physical rehabilitation protocol on post-operative cardiopulmonary function and physical endurance, by using the 6MWT, in patients with AIS submitted to surgical correction, comparing them to matched controls without physical rehabilitation. Studied variables were heart and respiratory rate, systolic and diastolic blood pressure, peripheral blood oxygen saturation, Borg score, and distance walked. Patients were assessed at baseline, after 4 months of rehabilitation, and 3, 6 and 12 months post-operatively. Results: A total of 50 patients with AIS were included in the study and allocated blindly, by simple randomization, into either one of the two groups, with 25 patients each: study group (pre-operative physical rehabilitation and control group. The physical rehabilitation protocol promoted significant progressive improvement in heart and respiratory rate, peripheral blood oxygen saturation, distance walked, and level of effort assessed by the Borg scale after surgery. Conclusions: Post-surgical recovery, evaluated by 6MWT, was significantly better in patients who underwent a 4-month pre-operative physical rehabilitation protocol. Keywords: Scoliosis, Exercise, Exercise movement techniques, Exercise therapy, Exercise test

  16. Pre-Operative Skin Antisepsis with Chlorhexidine Gluconate and Povidone-Iodine to Prevent Port-Site Infection in Laparoscopic Cholecystectomy: A Prospective Study.

    Science.gov (United States)

    Spaziani, Erasmo; Di Filippo, Annalisa; Orelli, Simone; Fiorini, Flavia; Spaziani, Martina; Tintisona, Orlando; Torcasio, Angelo; De Cesare, Alessandro; Picchio, Marcello

    2018-04-01

    Skin preparation with antiseptic agents is commonly recommended for incisional site cleansing before surgery. We present the result of a prospective case series submitted to a scheduled pre-operative antiseptic procedure combining chlorhexidine gluconate and povidone-iodine before elective laparoscopic cholecystectomy. Consecutive patients underwent pre-operative standardized cleansing of the operation site combining chlorhexidine gluconate and povidone-iodine. Patients were reviewed one week and four weeks post-operatively. Post-operative infection was observed in seven patients (4.3%). All observed infections were port-site infections, always located at the level of the umbilical incision. In all cases infections involved skin and subcutaneous tissue. Staphylococcus aureus was isolated in five patients (71.4%) and miscellaneous aerobic gram-positive bacteria in two subjects (28.6%). Post-operative hospital stay was the only factor significantly associated with the development of port-site infections. Port-site infections are a common complication after elective laparoscopic cholecystectomy. The proposed pre-operative disinfection procedure is effective in reducing port-site infections. Reducing hospital stay may contribute to limiting the occurrence of this complication.

  17. A prospective, randomised, controlled study examining binaural beat audio and pre-operative anxiety in patients undergoing general anaesthesia for day case surgery.

    Science.gov (United States)

    Padmanabhan, R; Hildreth, A J; Laws, D

    2005-09-01

    Pre-operative anxiety is common and often significant. Ambulatory surgery challenges our pre-operative goal of an anxiety-free patient by requiring people to be 'street ready' within a brief period of time after surgery. Recently, it has been demonstrated that music can be used successfully to relieve patient anxiety before operations, and that audio embedded with tones that create binaural beats within the brain of the listener decreases subjective levels of anxiety in patients with chronic anxiety states. We measured anxiety with the State-Trait Anxiety Inventory questionnaire and compared binaural beat audio (Binaural Group) with an identical soundtrack but without these added tones (Audio Group) and with a third group who received no specific intervention (No Intervention Group). Mean [95% confidence intervals] decreases in anxiety scores were 26.3%[19-33%] in the Binaural Group (p = 0.001 vs. Audio Group, p Binaural beat audio has the potential to decrease acute pre-operative anxiety significantly.

  18. 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

    NARCIS (Netherlands)

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

    2017-01-01

    Objective: 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

  19. 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...

  20. Perceived nuclear risk, organizational commitment, and appraisals of management: A study of nuclear power plant personnel

    International Nuclear Information System (INIS)

    Kivimaeki, M.; Kalimo, R.; Salminen, S.

    1995-01-01

    This study examined to what extent nuclear risk perceptions, organizational commitment (OC), and appraisals of management are associated with each other among nuclear power plant personnel. The sample consisted of 428 nuclear power plant workers who completed a questionnaire at their workplace. Perceived nuclear risk and OC were most closely related to the appraisals of the top management of the organization. As the trust in and satisfaction with the top management increased, perceived nuclear safety and acceptance of the organizational goals and values heightened. This result is discussed in the context of industrial safety management. 29 refs., 2 tabs

  1. The Power of Developmental Performance Appraisal

    Directory of Open Access Journals (Sweden)

    Nasser Salim Alghanabousi

    2013-02-01

    Full Text Available Development of employee performance is a must that any organization should take into account to be a successful in achieving its goals. However, the tools of developing that performance are varying based on the type of the organization and the nature of the work performed. Performance appraisal is one of the effective tools that help the organization to measure the accomplishment of its goals, if implemented effectively. In education, it became evident that performance appraisal of educators is an essential element of the development of any educational institution. To make the performance appraisal fruitful, the development element should be dominant in the sense that other elements of the appraisal should serve the broad aim of the appraisal process. Therefore, a well-designed and comprehensive system is needed to cover all the aspects of appraisal process that include of the goals, criteria, instruments, and continuous support.

  2. 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 ...

  3. 76 FR 72306 - Federal Housing Administration (FHA) Appraiser Roster: Appraiser Qualifications for Placement on...

    Science.gov (United States)

    2011-11-23

    ... disciplinary action in any state in which the appraiser is certified; * * * * * (c) * * * (1) Appraisers subject to state disciplinary action. An appraiser whose state certification in any state has been revoked, suspended, or surrendered as a result of a state disciplinary action is automatically suspended from the...

  4. Positive emotion, appraisal, and the role of appraisal overlap in positive emotion co-occurrence.

    Science.gov (United States)

    Tong, Eddie M W; Jia, Lile

    2017-02-01

    Appraisal research has traditionally focused on negative emotions but has not addressed issues concerning the relationships between several positive emotions and appraisals in daily life and the extent to which co-occurrence of positive emotions can be explained by overlap in appraisals. Driven by a priori hypotheses on appraisal-emotion relationships, this study investigated 12 positive emotions and 13 appraisal dimensions using Ecological Momentary Assessment. The results provide strong evidence that positive emotions and appraisals correlate significantly in daily life. Importantly, we found that the positive emotions' overlap on theoretically relevant, as compared to irrelevant, appraisals was stronger and more predictive of their co-occurrence. Furthermore, appraisal overlap on theoretically relevant appraisals predicted the co-occurrence of positive emotions even when the appraisal of pleasantness was excluded, indicating that positive emotions do not co-occur just by virtue of their shared valence. Our findings affirmed and refined the appraisal profiles of positive emotions and underscore the importance of appraisals in accounting for the commonality and differences among positive emotions. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  5. 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…

  6. Appraisal of Meconium at Delivery

    Science.gov (United States)

    Paes, Bosco A.; Thompson, Penelope

    1992-01-01

    A critical appraisal of the scientific literature on managing mesconium in labor identified 15 studies which were used to evaluate intervention strategies. Only four were randomized trials: two on the use of amnioinfusion in labor, one on the technique of bulb versus DeLee catheter suction of the newborn, and one on the need for endotracheal intubation and suction in meconium-stained neonates. Current practice is dictated by the most favorable tradeoff between benefit and risk because of limited scientific evidence. PMID:21221284

  7. Pre-operative anxiety in patients undergoing coronary artery bypass graft surgery – A cross-sectional study

    Directory of Open Access Journals (Sweden)

    C. Ramesh

    Full Text Available Background: Coronary artery bypass graft surgery is an important treatment for the patients with coronary artery disease to reduce angina and enhance the quality of life. Anxiety is a usual reaction to a stressful situation and is existing in patients awaiting surgery. Objective: The objective of the study was to assess pre-operative anxiety in patients who were undergoing coronary artery bypass graft surgery. Methods: A cross-sectional study consisting of 140 patients undergoing coronary artery bypass graft surgery were included in the study using a convenience sampling technique in a tertiary care referral hospital. The data was collected using state-trait anxiety inventory. The data were entered into SPSS (version – 20.0 for windows and descriptive and inferential statistics were performed. Results: The study enrolled 140 (117 males and 23 females patients. Their mean age was 57.29 ± 8.14 (range 35–70 years. Most of the patients 118 (84% had preoperative anxiety before coronary artery bypass graft surgery. There was an association found between gender and anxiety with Pearson chi-square value of 11.57 (p < 0.001. Discussion: Patients undergoing coronary artery bypass graft surgery is experiencing the high level of pre-operative anxiety and females had higher anxiety than the males. Identification of the pre-operative anxiety in patients undergoing CABG surgery is essential because it helps the health professionals and nurses to develop effective and appropriate interventions. Keywords: Preoperative period, Anxiety, Coronary artery bypass, Perioperative care

  8. A single pre-operative antibiotic dose is as effective as continued antibiotic prophylaxis in implant-based breast reconstruction: A matched cohort study.

    Science.gov (United States)

    Townley, William A; Baluch, Narges; Bagher, Shaghayegh; Maass, Saskia W M C; O'Neill, Anne; Zhong, Toni; Hofer, Stefan O P

    2015-05-01

    Infections following implant-based breast reconstruction can lead to devastating consequences. There is currently no consensus on the need for post-operative antibiotics in preventing immediate infection. This study compared two different methods of infection prevention in this group of patients. A retrospective matched cohort study was performed on consecutive women undergoing implant-based breast reconstruction at University Health Network, Toronto (November 2008-December 2012). All patients received a single pre-operative intravenous antibiotic dose. Group A received minimal interventions and Group B underwent maximal prophylactic measures. Patient (age, smoking, diabetes, co-morbidities), oncologic and procedural variables (timing and laterality) were collected. Univariate and multivariate logistic regression were performed to compare outcomes between the two groups. Two hundred and eight patients underwent 647 implant procedures. After matching the two treatment groups by BMI, 94 patients in each treatment group yielding a total of 605 implant procedures were selected for analysis. The two groups were comparable in terms of patient and disease variables. Post-operative wound infection was similar in Group A (n = 11, 12%) compared with Group B (n = 9, 10%; p = 0.8). Univariate analysis revealed only pre-operative radiotherapy to be associated with the development of infection (0.004). Controlling for the effect of radiotherapy, multivariate analysis demonstrated that there was no statistically significant difference between the two methods for infection prevention. Our findings suggest that a single pre-operative dose of intravenous antibiotics is equally as effective as continued antibiotic prophylaxis in preventing immediate infection in patients undergoing implant-based breast reconstructions. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  9. 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.

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

    Science.gov (United States)

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

    2017-09-01

    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. Twenty-six patients were included in this non-inferiority trial. Software permitted matching of the pre-operative MRI scan (and therefore calculated prosthesis position) to a pre-operative CT scan and then to a post-operative full-leg CT scan to determine deviations from pre-op planning in all three anatomical planes. For the femoral component, mean absolute deviations from planning were 1.8° (SD 1.3), 2.5° (SD 1.6) and 1.6° (SD 1.4) in the frontal, sagittal and transverse planes, respectively. For the tibial component, mean absolute deviations from planning were 1.7° (SD 1.2), 1.7° (SD 1.5) and 3.2° (SD 3.6) in the frontal, sagittal and transverse planes, respectively. Absolute mean deviation from planned mechanical axis was 1.9°. The a priori specified null hypothesis for equivalence testing: the difference from planning is >3 or plan in all planes, except for the tibial rotation in the transverse plane. Possible explanations for outliers are discussed and highlight the importance for adequate training surgeons before they start using PSPG in their day-by-day practise. Prospective cohort study, Level II.

  11. Premedication with gabapentin, alprazolam or a placebo for abdominal hysterectomy: Effect on pre-operative anxiety, post-operative pain and morphine consumption

    Directory of Open Access Journals (Sweden)

    Tim Thomas Joseph

    2014-01-01

    Full Text Available Background and Aims : Utility of gabapentin for pre-operative anxiolysis as compared to commonly administered alprazolam is not evident. The aim of the present study was to compare the effects of pre-operative oral gabapentin 600 mg, alprazolam 0.5 mg or a placebo on pre-operative anxiety along with post-operative pain and morphine consumption. Methods: Seventy five patients scheduled for abdominal hysterectomy under general anaesthesia were included. Groups gabapentin, alprazolam and placebo, received oral gabapentin 600 mg, alprazolam 0.5 mg and one capsule of oral B-complex forte with Vitamin C respectively, on the night prior to surgery and 2 h prior to surgery. Visual analogue scale (VAS was used to measure the anxiety and post-operative pain. All patients received patient-controlled analgesia. Statistical tests used were Kruskal-Wallis test, Wilcoxon signed rank test and one-way ANOVA. Results: Alprazolam provided significant anxiolysis (median [interquartile range] baseline VAS score 35 [15.5, 52] to 20 [6.5, 34.5] after drug administration; P = 0.007. Gabapentin did not provide significant decrease in anxiety (median [interquartile range] VAS score 21 [7.5, 41] to 20 [6.5, 34.5]; P = 0.782. First analgesic request time (median [interquartile range in minutes] was longer in group gabapentin (17.5 [10, 41.25] compared to group placebo (10 [5, 15] (P = 0.019 but comparable to that in group alprazolam (15 [10, 30]. Cumulative morphine consumption at different time periods and total morphine consumption (mean [standard deviation] at the end of study period (38.65 [18.04], 39.91 [15.73], 44.29 [16.02] mg in group gabapentin, alprazolam and placebo respectively were comparable. Conclusion: Gabapentin 600 mg does not have significant anxiolytic effect compared to alprazolam 0.5 mg. Alprazolam 0.5 mg was found to be an effective anxiolytic in the pre-operative period. Neither alprazolam nor gabapentin, when compared to placebo showed any opioid

  12. Proposal of a post-prostatectomy clinical target volume based on pre-operative MRI: volumetric and dosimetric comparison to the RTOG guidelines

    International Nuclear Information System (INIS)

    Croke, Jennifer; Maclean, Jillian; Nyiri, Balazs; Li, Yan; Malone, Kyle; Avruch, Leonard; Kayser, Cathleen; Malone, Shawn

    2014-01-01

    Recurrence rates following radiotherapy for prostate cancer in the post-operative adjuvant or salvage setting remain substantial. Previous work from our institution demonstrated that published prostate bed CTV guidelines frequently do not cover the pre-operative MRI defined prostate. Inadequate target delineation may contribute to the high recurrence rates, but increasing target volumes may increase dose to organs at risk. We propose guidelines for delineating post-prostatectomy target volumes based upon an individual’s co-registered pre-operative MRI. MRI-based CTVs and PTVs were compared to those created using the RTOG guidelines in 30 patients. Contours were analysed in terms of absolute volume, intersection volume (Jaccard Index) and the ability to meet the RADICALS and QUANTEC rectal and bladder constraints (tomotherapy IMRT plans with PTV coverage of V98% ≥98%). CTV MRI was a mean of 18.6% larger than CTV RTOG: CTV MRI mean 138 cc (range 72.3 - 222.2 cc), CTV RTOG mean 116.3 cc (range 62.1 - 176.6 cc), (p < 0.0001). The difference in mean PTV was only 4.6%: PTV MRI mean 386.9 cc (range 254.4 – 551.2), PTV RTOG mean 370 cc (range 232.3 - 501.6) (p = 0.05). The mean Jaccard Index representing intersection volume between CTVs was 0.72 and 0.84 for PTVs. Both criteria had a similar ability to meet rectal and bladder constraints. Rectal DVH: 77% of CTV RTOG cases passed all RADICALS criteria and 37% all QUANTEC criteria; versus 73% and 40% for CTV MRI (p = 1.0 for both). Bladder DVH; 47% of CTV RTOG cases passed all RADICALS criteria and 67% all QUANTEC criteria, versus 57% and 60% for CTV MRI (p = 0.61for RADICALS, p = 0.79 for QUANTEC). CTV MRI spares more of the lower anterior bladder wall than CTV RTOG but increases coverage of the superior lateral bladder walls. CTV contours based upon the patient’s co-registered pre-operative MRI in the post-prostatectomy setting may improve coverage of the individual’s prostate bed without substantially increasing

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

    OpenAIRE

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

    2017-01-01

    Objective 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. Design 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 ...

  14. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: MANAGEMENT OF ACROMEGALY PATIENTS: WHAT IS THE ROLE OF PRE-OPERATIVE MEDICAL THERAPY?

    Science.gov (United States)

    Fleseriu, Maria; Hoffman, Andrew R; Katznelson, Laurence

    2015-06-01

    Acromegaly is a complex disease characterized by growth hormone (GH) excess originating in most cases from a pituitary tumor. The goals of treatment include removing the tumor or reducing tumor burden, normalizing GH secretion and insulin-like growth factor 1 levels, and preserving normal pituitary function if possible. Surgery by an experienced neurosurgeon is still considered first-line therapy, especially in cases with small tumors. In the last few decades, significant progress in the development of selective pharmacologic agents has greatly facilitated the management of active acromegaly, with agents such as somatostatin-receptor ligands (SRLs), GH-receptor antagonists, and dopamine agonists. In addition to adjuvant treatment, pre-operative medical therapy and primary therapy in de novo patients are increasingly employed. A United States National Library of Medicine PubMed search (through July 2014) was conducted for the following terms: acromegaly, pre-operative medical therapy, somatostatin-receptor ligands, and somatostatin analogs. Articles not in English and those not in peer-reviewed journals were excluded. In reviewing pertinent articles, focus was placed on biochemical and other postoperative outcomes of medical therapy. An analysis of the full effect of pre-operative use of SRLs on surgical outcomes (remission rates and peri-operative complications) is limited by heterogeneity of methodology, low overall surgical cure rates, and different study designs. The assumption that SRL use prior to surgery reduces peri-operative surgical risk has yet to be proven. A variable degree of tumor shrinkage with preoperative SRLs is observed. Likewise, SRL treatment 3 months before surgery may improve surgical remission rates in the short term; however, positive results do not persist in the long term. We consider that medical therapy before surgery could play a role in carefully selected patients, but treatment should be individualized. Primary medical therapy with a

  15. 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

  16. Spent fuel storage options: a critical appraisal

    International Nuclear Information System (INIS)

    Singh, K.P.; Bale, M.G.

    1990-01-01

    The delayed decisions on nuclear fuel reprocessing strategies in the USA and other countries have forced the development of new long-term irradiated fuel storage techniques, to allow a larger volume of fuel to be held on the nuclear station site after removal from the reactor. The nuclear power industry has responded to the challenge by developing several viable options for long-term onsite storage, which can be employed individually or in tandem. They are: densification of storage in the existing spent fuel pool; building another fuel pool facility at the plant site; onsite cask park, and on site vault clusters. Desirable attributes of a storage option are: Safety: minimise the number of fuel handling steps; Economy: minimise total installed, and O and M cost; Security: protection from anti-nuclear protesters; Site adaptability: available site space, earthquake characteristics of the region and so on; Non-intrusiveness: minimise required modifications to existing plant systems; Modularisation: afford the option to adapt a modular approach for staged capital outlays; and Maturity: extent of industry experience with the technology. A critical appraisal is made of each of the four aforementioned storage options in the light of these criteria. (2 figures, 1 table, 4 references) (Author)

  17. Social appraisal influences recognition of emotions.

    Science.gov (United States)

    Mumenthaler, Christian; Sander, David

    2012-06-01

    The notion of social appraisal emphasizes the importance of a social dimension in appraisal theories of emotion by proposing that the way an individual appraises an event is influenced by the way other individuals appraise and feel about the same event. This study directly tested this proposal by asking participants to recognize dynamic facial expressions of emotion (fear, happiness, or anger in Experiment 1; fear, happiness, anger, or neutral in Experiment 2) in a target face presented at the center of a screen while a contextual face, which appeared simultaneously in the periphery of the screen, expressed an emotion (fear, happiness, anger) or not (neutral) and either looked at the target face or not. We manipulated gaze direction to be able to distinguish between a mere contextual effect (gaze away from both the target face and the participant) and a specific social appraisal effect (gaze toward the target face). Results of both experiments provided evidence for a social appraisal effect in emotion recognition, which differed from the mere effect of contextual information: Whereas facial expressions were identical in both conditions, the direction of the gaze of the contextual face influenced emotion recognition. Social appraisal facilitated the recognition of anger, happiness, and fear when the contextual face expressed the same emotion. This facilitation was stronger than the mere contextual effect. Social appraisal also allowed better recognition of fear when the contextual face expressed anger and better recognition of anger when the contextual face expressed fear. 2012 APA, all rights reserved

  18. 12 CFR 34.45 - Appraiser independence.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Appraiser independence. 34.45 Section 34.45 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY REAL ESTATE LENDING AND... appraiser shall be engaged directly by the regulated institution or its agent, and have no direct or...

  19. 12 CFR 722.5 - Appraiser independence.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Appraiser independence. 722.5 Section 722.5 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING CREDIT UNIONS APPRAISALS... interest, financial or otherwise, in the property. If the only qualified persons available to perform an...

  20. Appraisal patterns of envy and related emotions

    NARCIS (Netherlands)

    van de Ven, N.; Zeelenberg, M.; Pieters, R.

    2012-01-01

    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

  1. Performance appraisal of coaches: Acomparative study | Surujlal ...

    African Journals Online (AJOL)

    Within the sport environment, the performance appraisal of coaches continues to be an issue. The performance appraisal of coaches is critical to sport organizations since major decisions like rewarding or terminating coaches is based on it. The purpose of this study was to examine whether any differences exist with regard ...

  2. 45 CFR 1160.12 - Appraisal procedures.

    Science.gov (United States)

    2010-10-01

    ... the amount of partial loss, or damage to, or any reduction in the fair market value as a result..., any reduction in the fair market value of, the indemnified item(s). The appraisers' agreement with... appropriate, such reduction in the fair market value. Disputes between the appraisers with respect to partial...

  3. 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.

  4. The appraisal of clinical guidelines in dentistry.

    Science.gov (United States)

    Glenny, Anne-Marie; Worthington, Helen V; Clarkson, Jan E; Esposito, Marco

    2009-01-01

    To appraise the reported processes involved in the development of published dental guidelines. Electronic databases were searched to identify guidelines making recommendations for any health professional within dentistry. All included guidelines were appraised using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. A total of 105 guidelines met the inclusion criteria. The appraised guidelines showed lack of rigour in their development (median score 14.3%; range 0% to 100%). Only 10 (9.5%) were coded as 'strongly recommend' by at least two assessors. If recommendations within clinical guidelines are to be relied upon, the methods used in their development must be explicit and free from bias. When using the AGREE checklist to make decisions on whether or not to implement individual sets of guidelines, the findings of the present assessment reinforce the need for more than two assessors to be included in the appraisal of each set of guidelines.

  5. Application of finite element analysis in pre-operative planning for deformity correction of abnormal hip joints--a case series.

    Science.gov (United States)

    Rhyu, K H; Kim, Y H; Park, W M; Kim, K; Cho, T-J; Choi, I H

    2011-09-01

    In experimental and clinical research, it is difficult to directly measure responses in the human body, such as contact pressure and stress in a joint, but finite element analysis (FEA) enables the examination of in vivo responses by contact analysis. Hence, FEA is useful for pre-operative planning prior to orthopaedic surgeries, in order to gain insight into which surgical options will result in the best outcome. The present study develops a numerical simulation technique based on FEA to predict the surgical outcomes of osteotomy methods for the treatment of slipped capital femoral epiphyses. The correlation of biomechanical parameters including contact pressure and stress, for moderate and severe cases, is investigated. For severe slips, a base-of-neck osteotomy is thought to be the most reliable and effective surgical treatment, while any osteotomy may produce dramatic improvement for moderate slips. This technology of pre-operative planning using FEA can provide information regarding biomechanical parameters that might facilitate the selection of optimal osteotomy methods and corresponding surgical options.

  6. Pre-operative Screening and Manual Drilling Strategies to Reduce the Risk of Thermal Injury During Minimally Invasive Cochlear Implantation Surgery.

    Science.gov (United States)

    Dillon, Neal P; Fichera, Loris; Kesler, Kyle; Zuniga, M Geraldine; Mitchell, Jason E; Webster, Robert J; Labadie, Robert F

    2017-09-01

    This article presents the development and experimental validation of a methodology to reduce the risk of thermal injury to the facial nerve during minimally invasive cochlear implantation surgery. The first step in this methodology is a pre-operative screening process, in which medical imaging is used to identify those patients that present a significant risk of developing high temperatures at the facial nerve during the drilling phase of the procedure. Such a risk is calculated based on the density of the bone along the drilling path and the thermal conductance between the drilling path and the nerve, and provides a criterion to exclude high-risk patients from receiving the minimally invasive procedure. The second component of the methodology is a drilling strategy for manually-guided drilling near the facial nerve. The strategy utilizes interval drilling and mechanical constraints to enable better control over the procedure and the resulting generation of heat. The approach is tested in fresh cadaver temporal bones using a thermal camera to monitor temperature near the facial nerve. Results indicate that pre-operative screening may successfully exclude high-risk patients and that the proposed drilling strategy enables safe drilling for low-to-moderate risk patients.

  7. 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.)

  8. Neither pre-operative education or a minimally invasive procedure have any influence on the recovery time after total hip replacement.

    Science.gov (United States)

    Biau, David Jean; Porcher, Raphael; Roren, Alexandra; Babinet, Antoine; Rosencher, Nadia; Chevret, Sylvie; Poiraudeau, Serge; Anract, Philippe

    2015-08-01

    The purpose of this study was to evaluate pre-operative education versus no education and mini-invasive surgery versus standard surgery to reach complete independence. We conducted a four-arm randomized controlled trial of 209 patients. The primary outcome criterion was the time to reach complete functional independence. Secondary outcomes included the operative time, the estimated total blood loss, the pain level, the dose of morphine, and the time to discharge. There was no significant effect of either education (HR: 1.1; P = 0.77) or mini-invasive surgery (HR: 1.0; 95 %; P = 0.96) on the time to reach complete independence. The mini-invasive surgery group significantly reduced the total estimated blood loss (P = 0.0035) and decreased the dose of morphine necessary for titration in the recovery (P = 0.035). Neither pre-operative education nor mini-invasive surgery reduces the time to reach complete functional independence. Mini-invasive surgery significantly reduces blood loss and the need for morphine consumption.

  9. 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

  10. Critical appraisal of published literature

    Science.gov (United States)

    Umesh, Goneppanavar; Karippacheril, John George; Magazine, Rahul

    2016-01-01

    With a large output of medical literature coming out every year, it is impossible for readers to read every article. Critical appraisal of scientific literature is an important skill to be mastered not only by academic medical professionals but also by those involved in clinical practice. Before incorporating changes into the management of their patients, a thorough evaluation of the current or published literature is an important step in clinical practice. It is necessary for assessing the published literature for its scientific validity and generalizability to the specific patient community and reader's work environment. Simple steps have been provided by Consolidated Standard for Reporting Trial statements, Scottish Intercollegiate Guidelines Network and several other resources which if implemented may help the reader to avoid reading flawed literature and prevent the incorporation of biased or untrustworthy information into our practice. PMID:27729695

  11. Critical appraisal of published literature

    Directory of Open Access Journals (Sweden)

    Goneppanavar Umesh

    2016-01-01

    Full Text Available With a large output of medical literature coming out every year, it is impossible for readers to read every article. Critical appraisal of scientific literature is an important skill to be mastered not only by academic medical professionals but also by those involved in clinical practice. Before incorporating changes into the management of their patients, a thorough evaluation of the current or published literature is an important step in clinical practice. It is necessary for assessing the published literature for its scientific validity and generalizability to the specific patient community and reader′s work environment. Simple steps have been provided by Consolidated Standard for Reporting Trial statements, Scottish Intercollegiate Guidelines Network and several other resources which if implemented may help the reader to avoid reading flawed literature and prevent the incorporation of biased or untrustworthy information into our practice.

  12. The appraisal rationalisation of real estate expertise

    Directory of Open Access Journals (Sweden)

    Marina Ciuna

    2013-12-01

    Full Text Available The Italian appraisal practice is characterized by valuations developed in subjective opinions formulated by the valuers, according to the experience and the competence rather than on the survey of the market data of comparable properties. This practice makes up for the lack of information on the real estate market and to the consequent absence of systematic collections of market data. This tradition is in the cadastral appraisal for the rural (1886 and urban properties (1939. The assessed income is appraised for a representative property and wide to all the other properties with arbitrary scores (pure number. The assessed value is derived from the income with fixed multipliers. The reform of the cadastral appraisals (2013 provides the employment of predetermined statistic functions rather than the automated valuation models applied in the mass appraisal. There are therefore ample spaces to rationalize the Italian valuations. For the market appraisal the process of rationalization is based on the comparison between the expertise and the market comparison approach. For the cadastral appraisal the process of rationalization is based on the statistic application to the fixed functions with the survey of a sample of market prices and the ratios study according to the valuation standards.

  13. Pre-operative high sensitive C-reactive protein predicts cardiovascular events after coronary artery bypass grafting surgery: A prospective observational study

    Directory of Open Access Journals (Sweden)

    Balciunas Mindaugas

    2009-01-01

    Full Text Available C-reactive protein is a powerful independent predictor of cardiovascular events in patients with coronary artery disease. The relation between C-reactive protein (CRP concentration and in-hospital outcome, after coronary artery bypass grafting (CABG, has not yet been established. The study aims to evaluate the predictive value of pre-operative CRP for in-hospital cardiovascular events after CABG surgery. High-sensitivity CRP (hs-CRP levels were measured pre-operatively on the day of surgery in 66 patients scheduled for elective on pump CABG surgery. Post-operative cardiovascular events such as death from cardiovascular causes, ischemic stroke, myocardial damage, myocardial infarction and low output heart failure were recorded. During the first 30 days after surgery, 54 patients were free from observed events and 14 developed the following cardiovascular events: 10 (15% had myocardial damage, four (6% had low output heart failure and two (3% suffered stroke. No patients died during the follow-up period. Serum concentration of hs-CRP ≥ 3.3 mg/l (cut-off point obtained by ROC analysis was related to higher risk of post-operative cardiovascular events (36% vs 6%, P = 0.01, myocardial damage (24% vs 6%, P = 0.04 and low output heart failure (12% vs 0%, P = 0.04. Multivariate logistic regression analysis showed that hs-CRP ≥ 3.3 mg/l ( P = 0.002, O.R.: 19.3 (95% confidence interval (CI 2.9-128.0, intra-operative transfusion of red blood cells ( P = 0.04, O.R.: 9.9 (95% C.I. 1.1-85.5 and absence of diuretics in daily antihypertensive treatment ( P = 0.02, O.R.: 15.1 (95% C.I. 1.4-160.6 were independent predictors of combined cardiovascular event. Patients having hs-CRP value greater or equal to 3.3 mg/l pre-operatively have an increased risk of post-operative cardiovascular events after on pump coronary artery bypass grafting surgery.

  14. 12 CFR 564.4 - Minimum appraisal standards.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Minimum appraisal standards. 564.4 Section 564.4 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY APPRAISALS § 564.4 Minimum appraisal standards. For federally related transactions, all appraisals shall, at a minimum: (a...

  15. 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…

  16. 9 CFR 52.3 - Appraisal of swine.

    Science.gov (United States)

    2010-01-01

    ... an APHIS employee alone. (b) The appraisal of swine will be based on the fair market value as determined by the meat or breeding value of the animals. Animals may be appraised in groups, provided that where appraisal is by the head, each animal in the group is the same value per head, and where appraisal...

  17. 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.

  18. Is there a role for pre-operative contrast-enhanced magnetic resonance imaging for radical surgery in malignant pleural mesothelioma?

    Science.gov (United States)

    Stewart, Duncan; Waller, David; Edwards, John; Jeyapalan, Kanagaratnam; Entwisle, James

    2003-12-01

    To assess the use of contrast-enhanced magnetic resonance imaging (CEMRI) in addition to computed tomography in the pre-operative assessment of patients for radical surgery in malignant pleural mesothelioma. Over a 45-month period, 51 of 76 patients assessed (69 men and seven women), underwent extra-pleural pneumonectomy or radical pleurectomy/decortication. Post-operative pathological stage was correlated with radiological staging, with particular emphasis on tumour resectability. Seventeen (22%) patients were found on CEMRI to have unresectable, but histologically unconfirmed disease, not previously seen on CT. Fifty-one (67%) patients proceeded to radical surgery, but pathological nodal data were incomplete in three, so excluding these patients from further analyses. The median pre-operative interval after CEMRI was 17 days. Two patients were found to have unexpectedly extensive disease at thoracotomy, thus the sensitivity of CEMRI for prediction of resectability was 97%. Using the International Mesothelioma Interest Group system, tumour stage was correctly predicted by CEMRI in 48% of patients, but understaged in 50% of cases, largely due to the underestimation of pericardial involvement, but this did not affect resectability and had no significant effect on prognosis. Nodal stage was correctly identified in 60% of patients. CEMRI was successful in predicting pathological tumour stage T3 or less (sensitivity of 85%; specificity of 100%), but less so in identifying tumour stage T2 or less (sensitivity of 23%; specificity of 96%) or N2 nodal disease (sensitivity 66%; specificity 73%). CEMRI is most useful in the differentiation of T3 and T4 disease and may be unnecessary at earlier stages. Its multiplanar tumour localisation abilities are of value in the assessment of resectability. It is unlikely to contribute significantly to nodal staging, but it remains a valuable adjunct in the selection of patients for radical surgery.

  19. 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.

  20. Additional value of diffusion-weighted imaging to evaluate multifocal and multicentric breast cancer detected using pre-operative breast MRI

    Energy Technology Data Exchange (ETDEWEB)

    Song, Sung Eun; Park, Eun Kyung; Cho, Kyu Ran; Cho, Sung Bum [Korea University Anam Hospital, Korea University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seo, Bo Kyoung [Korea University Ansan Hospital, Korea University College of Medicine, Department of Radiology, Ansan (Korea, Republic of); Woo, Ok Hee [Korea University Guro Hospital, Korea University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Jung, Seung Pil [Korea University Anam Hospital, Korea University College of Medicine, Department of Surgery, Seoul (Korea, Republic of)

    2017-11-15

    To investigate whether diffusion-weighted imaging (DWI) aids pre-operative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to evaluate additional lesions in breast cancer patients. DCE-MRI and DWI were performed on 131 lesions, with available histopathological results. The apparent diffusion coefficient (ADC) of each lesion was measured, and the cut-off value for differentiation between malignant and benign lesions was calculated. A protocol combining the ADC cut-off value with DCE-MRI was validated in a cohort of 107 lesions in 77 patients. When an ADC cut-off value of 1.11 x 10{sup -3} mm{sup 2}/s from the development cohort was applied to the additional lesions in the validation cohort, the specificity increased from 18.9% to 67.6% (P < 0.001), and the diagnostic accuracy increased from 61.7% to 82.2% (P = 0.05), without significant loss of sensitivity (98.6% vs. 90.0%, P = 0.07). The negative predictive values of lesions in the same quadrant had decreased, as had those of lesions ≥1 cm in diameter. The ADC cut-off value in the validation cohort was 1.05 x 10{sup -3} mm{sup 2}/s. Additional implementation of DWI for breast lesions in pre-operative MRI can help to obviate unnecessary biopsies by increasing specificity. However, to avoid missing cancers, clinicians should closely monitor lesions located in the same quadrant or lesions ≥1 cm. (orig.)

  1. Pre-operative use of dexamethasone does not reduce incidence or intensity of bleaching-induced tooth sensitivity. A triple-blind, parallel-design, randomized clinical trial.

    Science.gov (United States)

    da Costa Poubel, Luiz Augusto; de Gouvea, Cresus Vinicius Deppes; Calazans, Fernanda Signorelli; Dip, Etyene Castro; Alves, Wesley Veltri; Marins, Stella Soares; Barcelos, Roberta; Barceleiro, Marcos Oliveira

    2018-04-25

    This study evaluated the effect of the administration of pre-operative dexamethasone on tooth sensitivity stemming from in-office bleaching. A triple-blind, parallel-design, randomized clinical trial was conducted on 70 volunteers who received dexamethasone or placebo capsules. The drugs were administered in a protocol of three daily 8-mg doses of the drug, starting 48 h before the in-office bleaching treatment. Two bleaching sessions with 37.5% hydrogen peroxide gel were performed with a 1-week interval. Tooth sensitivity (TS) was recorded on visual analog scales (VAS) and numeric rating scales (NRS) in different periods up to 48 h after bleaching. The color evaluations were also performed. The absolute risk of TS and its intensity were evaluated by using Fisher's exact test. Comparisons of the TS intensity (NRS and VAS data) were performed by using the Mann-Whitney U test and a two-way repeated measures ANOVA and Tukey's test, respectively. In both groups, a high risk of TS (Dexa 80% x Placebo 94%) was detected. No significant difference was observed in terms of TS intensity. A whitening of approximately 3 shade guide units of the VITA Classical was detected in both groups, which were statistically similar. It was concluded that the administration pre-operatively of dexamethasone, in the proposed protocol, does not reduce the incidence or intensity of bleaching-induced tooth sensitivity. The use of dexamethasone drug before in-office bleaching treatment does not reduce incidence or intensity of tooth sensitivity. NCT02956070.

  2. Blood management and transfusion strategies in 600 patients undergoing total joint arthroplasty: an analysis of pre-operative autologous blood donation.

    Science.gov (United States)

    Perazzo, Paolo; Viganò, Marco; De Girolamo, Laura; Verde, Francesco; Vinci, Anna; Banfi, Giuseppe; Romagnoli, Sergio

    2013-07-01

    Blood loss during total joint arthroplasty strongly influences the time to recover after surgery and the quality of the recovery. Blood conservation strategies such as pre-operative autologous blood donation and post-operative cell salvage are intended to avoid allogeneic blood transfusions and their associated risks. Although widely investigated, the real effectiveness of these alternative transfusion practices remains controversial. The surgery reports of 600 patients undergoing total joint arthroplasty (312 hip and 288 knee replacements) were retrospectively reviewed to assess transfusion needs and related blood management at our institute. Evaluation parameters included post-operative blood loss, haemoglobin concentration measured at different time points, ASA score, and blood transfusion strategies. Autologous blood donation increased the odds of receiving a red blood cell transfusion. Reinfusion by a cell salvage system of post-operative shed blood was found to limit adverse effects in cases of severe post-operative blood loss. The peri-operative net decrease in haemoglobin concentration was higher in patients who had predeposited autologous blood than in those who had not. The strengths of this study are the high number of cases and the standardised procedures, all operations having been performed by a single orthopaedic surgeon and a single anaesthesiologist. Our data suggest that a pre-operative autologous donation programme may often be useless, if not harmful. Conversely, the use of a cell salvage system may be effective in reducing the impact of blood transfusion on a patient's physiological status. Basal haemoglobin concentration emerged as a useful indicator of transfusion probability in total joint replacement procedures.

  3. Distribution of MRI signal alterations of the cartilage endplate in pre-operated patients with special focus on recurrent lumbar disc herniation

    International Nuclear Information System (INIS)

    Becker, G.T.; Liphofer, J.; Koester, O.; Willburger, R.E.; Schmid, G.

    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.)

  4. 32 CFR 644.42 - Appraisal report.

    Science.gov (United States)

    2010-07-01

    ... appraisal report shall be divided into four parts as outlined below: PART I—INTRODUCTION 1. TITLE PAGE. This... photograph. The use of color film and photographs is encouraged, especially wherein development cost either...

  5. Theoretical foundations of shareholders' right to appraisal

    Directory of Open Access Journals (Sweden)

    Vasiljević Mirko

    2017-01-01

    Full Text Available Shareholders' right to appraisal represents a controversial topic of corporation law, which is why a relatively small number of countries accept it. In this article, the authors analyze the goals that are supposed to be achieved with the introduction of shareholders' appraisal rights. In this respect, traditional and modern explanations for the introduction or maintaining of this right have been presented. In the second part of this article, shareholders' right to appraisal has been critically examined, mostly from corporations' perspective. Afterwards, several potential causes of inefficiency of using this right have been identified. Perceiving pros and cons of shareholders' right to appraisal is of particular importance for Serbia, in order to draw a conclusion about harmonization of our legislative solutions with the theoretical foundations of this right.

  6. APPRAISAL ANALYSIS IN FREEDOM WRITERS MOVIE

    Directory of Open Access Journals (Sweden)

    Nani Hidayati

    2017-02-01

    Full Text Available This study attempts to find out conveyed messages in the movie from the realization of the appraisal and narrative structure as well as to describe the use of the Appraisal System to express LaGravenese's (a Attitudes, (bEngagement & (c Graduation towards the main characters in Freedom Writers movie screenplay. Using both quantitative and qualitative descriptive approach for discourse appraisal system analysis, the result of this study reveals several messages of tolerance, earning respect and trust, honor diversity, and striving for success and trust from the realization of Appraisal and Narrative Structure either in the dialogues or monologues of Freedom Writers’ characters. The result from the Appraisal Devices realizing (a Attitudes reveals that LaGravenese likes to express characters’ negative emotion explicitly than implicitly. He likes to express characters’ negative capability than other kinds of Judgments. He appreciates the characters using more Negative Value which denotes that in his opinion, they see each other negatively. (bEngagement used in the screenplay describes that he emphasizes more on characters’ denial towards each other’s opinion and existence with the use of more Disclaim Heterogloss in the screenplay. (cGraduation used in the screenplay describes that the use of more Sharpening Focus indicates he emphasizes on characters’ category boundary more than scaling of intensity. Keywords: Appraisal Devices, Attitude, Engagement, and Graduation.

  7. 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.

  8. Regulatory requirements for demonstration of the achieved safety level at the Mochovce NPP before commissioning

    International Nuclear Information System (INIS)

    Lipar, M.

    1997-01-01

    A review of regulatory requirements for demonstration of the achieved safety level at the Mochovce NPP before commissioning is given. It contains licensing steps in Slovakia during commissioning; Status and methodology of Mochovce safety analysis report; Mochovce NPP safety enhancement program; Regulatory body policy towards Mochovce NPP safety enhancement; Recent development in Mochovce pre-operational safety enhancement program review and assessment process; Licensing steps in Slovakia during commissioning

  9. The value of FDG positron emission tomography/computerised tomography (PET/CT) in pre-operative staging of colorectal cancer: a systematic review and economic evaluation.

    Science.gov (United States)

    Brush, J; Boyd, K; Chappell, F; Crawford, F; Dozier, M; Fenwick, E; Glanville, J; McIntosh, H; Renehan, A; Weller, D; Dunlop, M

    2011-09-01

    In the UK, colorectal cancer (CRC) is the third most common malignancy (behind lung and breast cancer) with 37,514 cases registered in 2006: around two-thirds (23,384) in the colon and one-third (14,130) in the rectum. Treatment of cancers of the colon can vary considerably, but surgical resection is the mainstay of treatment for curative intent. Following surgical resection, there is a comprehensive assessment of the tumour, it's invasion characteristics and spread (tumour staging). A number of imaging modalities are used in the pre-operative staging of CRCs including; computerised tomography (CT), magnetic resonance imaging, ultrasound imaging and positron emission tomography (PET). This report examines the role of CT in combination with PET scanning (PET/CT 'hybrid' scan). The research objectives are: to evaluate the diagnostic accuracy and therapeutic impact of fluorine-18-deoxyglucose (FDG) PET/CT for the pre-operative staging of primary, recurrent and metastatic cancer using systematic review methods; undertake probabilistic decision-analytic modelling (using Monte Carlo simulation); and conduct a value of information analysis to help inform whether or not there is potential worth in undertaking further research. For each aspect of the research - the systematic review, the handsearch study and the economic evaluation - a database was assembled from a comprehensive search for published and unpublished studies, which included database searches, reference lists search and contact with experts. In the systematic review prospective and retrospective patient series (diagnostic cohort) and randomised controlled trials (RCTs) were eligible for inclusion. Both consecutive series and series that are not explicitly reported as consecutive were included. Two reviewers extracted all data and applied the criteria independently and resolved disagreements by discussion. Data to populate 2 × 2 contingency tables consisting of the number of true positives, true negatives

  10. Aguila pre-operations plan

    International Nuclear Information System (INIS)

    Simons, D.; Pongratz, M.; Duran, M.; Barasch, G.

    1979-09-01

    Aguila, a small-rocket experiment addressing the structuring of ionospheric plasmas, is described. A Terrier-Malemute two-stage rocket will be launched approximately north from Kauai Test Facility after sunset between October 8 and October 21, 1979, universal time. Aguila will deposit three barium clouds: before apogee at about 360 and 520 km, and just after apogee at 560 km. These clouds will be photoionized by the sun and observed using intensified-camera and television systems and photometers that are sensitive to barium line radiations. These observations will be made from ground stations on Mt. Haleakala, Maui, and at the launch site. Each cloud's striation time and subsequent behavior will elucidate mechanisms believed to drive ionospheric-plasma morphology

  11. 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,…

  12. 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 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.

  13. [Importance of parathyroid SPECT and 99mTc scintigraphy, and of clinical, laboratorial, ultrasonographic and citologic correlation in the pre-operative localization of the parathyroid adenoma - pictorial assay].

    Science.gov (United States)

    Oliveira, Marco Antônio Condé de; Maeda, Sérgio Setsuo; Dreyer, Patrícia; Lobo, Alberto; Andrade, Victor Piana de; Hoff, Ana O; Biscolla, Rosa Paula Mello; Smanio, Paola; Brandão, Cynthia M A; Vieira, José G

    2010-06-01

    In patients with primary hyperparathyroidism, candidates for surgical intervention, the parathyroid pre-operative localization is of fundamental importance in planning the appropriate surgical approach. The additional acquisition of SPECT and Technetium-99m images, during parathyroid scintigraphy with Sestamibi, is not common practice. Usually, only planar image acquisition, 15 minutes prior and 2 hours after radiopharmaceutical administration, is performed. In our experience, the complete protocol in parathyroid scintigraphy increases the accuracy of pre-operative parathyroid localization. The complete utilization of all available nuclear medicine methods (SPECT e 99mTc) and image interpretation in a multidisciplinary context can improve the accuracy of parathyroid scintigraphy.

  14. 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

    International Nuclear Information System (INIS)

    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

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

    International Nuclear Information System (INIS)

    Na, Sae Jung; Chung, Yong An; Maeng, Lee So; Kim, Ki Jun; Sohn, Kyung Myung; Kim, Sung Hoon; Sohn, Hyung Sun; Chung, Soo Kyo

    2009-01-01

    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

  16. Translating the 2-dimensional mammogram into a 3-dimensional breast: Identifying factors that influence the movement of pre-operatively placed wire.

    Science.gov (United States)

    Park, Ko Un; Nathanson, David

    2017-08-01

    Pre-operative measurements from the skin to a wire-localized breast lesion can differ from operating room measurements. This study was designed to measure the discrepancies and study factors that may contribute to wire movement. Prospective data were collected on patients who underwent wire localization lumpectomy. Clip and hook location, breast size, density, and direction of wire placement were the main focus of the analysis. Wire movement was more likely with longer distance from skin to hook or clip, larger breast size (especially if "fatty"), longer time between wire placement and surgery start time, and medial wire placement in larger breast. Age, body mass index, presence of mass, malignant diagnosis, tumor grade, and clip distance to the chest wall were not associated with wire movement. A longer distance from skin to hook correlated with larger specimen volume. Translation of the lesion location from a 2-dimensional mammogram into 3-dimensional breasts is sometimes discrepant because of movement of the localizing wire. Breast size, distance of skin to clip or hook, and wire exit site in larger breasts have a significant impact on wire movement. This information may guide the surgeon's skin incision and extent of excision. © 2017 Wiley Periodicals, Inc.

  17. Pre operational levels of 137Cs and 90Sr in seawater and sea foods in Gulf of Mannar near Kudankulam Nuclear Power Plant

    International Nuclear Information System (INIS)

    Vijayakumar, B.; Thomas, G.; Rajan, P.S.; Selvi, B.S.; Balamurugan, M.; Ravi, P.M.; Tripathy, R.M.

    2014-01-01

    The first unit of Kudankulam Nuclear Power Project (KKNPP) attained first criticality on July 13, 2013 and synchronized to the grid on October 22, 2013. The first unit achieved the full rated power of 1000 MWe on June 7, 2014. The second unit of KKNPP is under advanced stage of commissioning and hot run of the plant is expected shortly. Commercial operational of the first unit is expected soon. It is imperative to establish the pre operational levels of Fall out nuclides like 137 Cs and 90 Sr in and around Kudankulam site, especially sea waters and sea food samples as these nuclides are produced in the reactor as fission products. Nevertheless, they are retained in the fuel matrix itself as the reactors host a multiple layered barrier to prevent the escape of these radionuclides into the environment by adopting the philosophy of defense in depth. Benchmarking the levels of these nuclides in the aquatic domain will help in future comparison of the levels of these nuclides after the plants start operation in addition to generating the regional database in south eastern tip of the sea

  18. [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.

  19. 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

  20. Religion, Psychology and Globalisation Process: Attitudinal Appraisal

    Directory of Open Access Journals (Sweden)

    Emmanuel Orok Duke

    2016-10-01

    Full Text Available A key consequence of globalisation is the integrative approach to reality whereby emphasis is placed on interdependence. Religion being an expression of human culture is equally affected by this cultural revolution. The main objective of this paper is to examine how religious affiliation, among Christians, influences attitudes towards the application of psychological sciences to the assuagement of human suffering. The sociological theory of structural functionalism was deployed to explain attitudinal appraisal. Ethnographic methodology, through quantitative analysis of administered questionnaire, was also used. The study reveals that religious tenets largely shape attitudinal appraisal and redefine the borders of globalisation’s metanarratives.

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

    African Journals Online (AJOL)

    aware of the purposes of the current teacher performance appraisal. However, the ... building, and expensive equipment (Daniel,. 2009). ... development of teachers, teachers' job ...... Appraisers' tend to rate high a person who is similar.

  2. Cross-cultural effects on the perception and appraisal of approaching motorcycles at junctions

    OpenAIRE

    Lee, YM; Sheppard, E; Crundall, D

    2015-01-01

    Crundall et al. (2008) reported that perceptual errors (failing to perceive) and not appraisal errors (failing to make a correct judgment about safety) are likely to explain the relatively high number of right of way violation accidents involving motorcycles in relation to cars. Two experiments were conducted to investigate the effect of exposure to motorcycles on these types of errors by comparing drivers from Malaysia where motorcycles are very common with drivers from the UK where motorcyc...

  3. The System of Employee Appraisal in a Company

    OpenAIRE

    Vaverová, Lucie

    2011-01-01

    This bachelor study called "The System of Employee Appraisal in a Company" deals with a general subscription of a personal process "Employee appraisal". It describes the principles of the system of employee appraisal and also covers the conditions necessary for its efficiency and operation. The bachelor study is focused on the system of employee appraisal centrally implemented in company ČEZ, a. s. This system is analyzed and compared with generally stated theoretical principles. The study in...

  4. 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

  5. 12 CFR 528.2a - Nondiscriminatory appraisal and underwriting.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Nondiscriminatory appraisal and underwriting. 528.2a Section 528.2a Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY NONDISCRIMINATION REQUIREMENTS § 528.2a Nondiscriminatory appraisal and underwriting. (a) Appraisal. No savings...

  6. Problems of Clinical Nurse Performance Appraisal System: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Nasrin Nikpeyma

    2014-03-01

    Conclusion: The findings of this study reveal that the nurse performance appraisal system confronts with various problems. Some of these problems are related to organizational context while the others concerned structure, process and results of the performance appraisal system. In order to achieve high quality of patient care as the final goal of performance appraisal, changing and revision of this system is necessary.

  7. 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…

  8. Pre-operative rectal indomethacin for reduction of postoperative nausea and vomiting after laparoscopic cholecystectomy: a double-blind randomized clinical trial

    International Nuclear Information System (INIS)

    Pazouki, A.; Cheraghali, R.; Saeedimotahhar, H.; Jesmi, F.

    2015-01-01

    To evaluate the effect of pre-operative indomethacin suppository on postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Study Design: A double blind placebo-controlled randomized clinical trial. Place and Duration of Study: Hazrat Rasoul Akram Hospital, Tehran, Iran, from February 2010 to September 2012. Methodology: One hundred and thirty patients, scheduled for laparoscopic cholecystectomy, were randomly divided into case and control groups. Sixty-five patients received indomethacin suppository and 70 patients received rectal placebo in the case and control groups respectively. All patients underwent the same protocol in laparoscopic surgery and anesthesia, then nausea and vomiting was recorded after 1, 6, 12 and 24 hours postoperatively and compared between the two groups. Independent-sample t-test or Mann-Whitney tests were used for statistical analysis. Level of statistical significance was set at P = 0.05. Results: Patients' nausea was statistically lower in the case group at the 1st hour (43.1 vs. 92.9%), 6th hour (20.0 vs. 68.6%) and 12th hour (7.7 vs. 24.3%) after surgery (for all periods, P < 0.001). Fewer patients in the case group experienced vomiting at the first (13.8 vs. 51.4%) and 6th hour (0 vs. 20%) after surgery (for both P < 0.001). The use of pethidine was also statistically less in the case group in the same hours after surgery (for all of them, P < 0.001). Conclusion: Rectal indomethacin before laparoscopic cholecystectomy led to lower postoperative nausea and vomiting. (author)

  9. Pre-operative Carotid Plaque Echolucency Assessment has no Predictive Value for Long-Term Risk of Stroke or Cardiovascular Death in Patients Undergoing Carotid Endarterectomy.

    Science.gov (United States)

    de Waard, D; de Borst, G J; Bulbulia, R; Pan, H; Halliday, A

    2017-08-01

    In patients with carotid stenosis receiving medical treatment, carotid plaque echolucency has been thought to predict risk of future stroke and of other cardiovascular events. This study evaluated the prognostic value of pre-operative plaque echolucency for future stroke and cardiovascular death in patients undergoing carotid endarterectomy in the first Asymptomatic Carotid Surgery Trial (ACST-1). In ACST-1, 1832/3120 patients underwent carotid endarterectomy (CEA), of whom 894 had visual echolucency assessment according to the Gray-Weale classification. During follow-up patients were monitored both for peri-procedural (i.e. within 30 days) death, stroke, or MI, and for long-term risk of stroke or cardiovascular death. Unconditional maximum likelihood estimation was used to calculate odds ratios of peri-procedural risk and Kaplan-Meier statistics with log-rank test were used to compare cumulative long-term risks. Of 894 operated patients in whom echolucency was assessed, 458 plaques (51%) were rated as echolucent and peri-procedural risk of death/stroke/MI in these patients was non-significantly higher when compared with patients with non-echolucent plaques (OR 1.48 [95% CI 0.76-2.88], p = .241). No differences were found in the 10 year risk of any stroke (30/447 [11.6%] vs. 29/433 [11.0%], p = .900) or cardiovascular (non-stroke) death (85/447 [27.9%] vs. 93/433 [32.1%], p = .301). In ACST-1, carotid plaque echolucency assessment in patients undergoing CEA offered no predictive value with regard to peri-operative or long-term stroke risk or of cardiovascular (non-stroke) death. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  10. Handbook for Conducting Standard CMMI Appraisal Method for Process Improvement (SCAMPI) B and C Appraisals, Version 1.1

    National Research Council Canada - National Science Library

    Hayes, Will; Miluk, Gene; Ming, Lisa; Glover, Margaret; Bisgrove, Jane; Cort, Corrine; Penn, Lynn; Jacobson, Nils; Beynon, Don; Allgood, Bruce

    2005-01-01

    The Standard CMMI Appraisal Method for Process Improvement (SCAMPI) provides a well-defined, publicly available set of methodologies for providing appraisals relative to Capability Maturity Model (trademark) Integration (CMMI) models...

  11. Focusing on appraisals: how and why anger and fear influence driving risk perception.

    Science.gov (United States)

    Lu, Jingyi; Xie, Xiaofei; Zhang, Ruogu

    2013-06-01

    The present research explores how and why anger and fear influence driving risk perception. Based on appraisal tendency framework, researchers hypothesized that anger and fear would influence driving risk perception in opposite directions due to their differences in appraisals. Study 1 showed that anger reduced risk perception, whereas fear increased it. In Studies 2, 3, and 4, the researchers adopted the paradigm of reappraisal to investigate the causes of the opposite effects found in Study 1. Consistent with our hypothesis, appraisals accounted for these effects: After reappraisals along the dimensions of certainty (Study 2), control (Study 3), and responsibility (Study 4), the different effects between anger and fear on driving risk perception diminished or disappeared. In addition, fearful or angry experience mediated the effects of reappraisals on driving risk perception. The findings highlight the necessity to differentiate anger and fear in road safety management. Additionally, the current research also provides feasible methods (e.g., certainty, control, or responsibility reappraisal) to intervene in driving risk perception, which is important for driving safety. Copyright © 2013 National Safety Council and Elsevier Ltd. All rights reserved.

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

    African Journals Online (AJOL)

    Lokoja, a medium sized community in the Middle Belt of Nigeria experienced a massive influx of population in the last twelve years. This study examined housing problems that resulted thereafter. Through a participatory appraisal using group discussion and brainstorming, transect walk and matrix ranking, a sampled ...

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

    African Journals Online (AJOL)

    Nekky Umera

    Whether in research, development or policy analysis, in social, forestry, irrigation ... Action, Participatory Rural Appraisal involves interaction between the planners and the ..... Park, Obasanjo Layout, the Kogi People Consumer Shops as well as the confluence .... The institutional arrangements under which a person gains ...

  14. 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.

  15. Implementing performance appraisal : Exploring the employee experience

    NARCIS (Netherlands)

    Farndale, E.; Kelliher, C.

    2013-01-01

    Line managers play an important role as implementers of performance appraisal, enacting procedures designed by the HR function. However, the actual employee experience of these procedures (which may differ from how they were intended or enacted) in terms of perceptions of justice in the process is

  16. Embodied Appraisals and Non-emotional States

    Czech Academy of Sciences Publication Activity Database

    Hvorecký, Juraj

    2010-01-01

    Roč. 20, č. 3 (2010), s. 215-223 ISSN 1210-3055 R&D Projects: GA AV ČR(CZ) KJB900090802 Institutional research plan: CEZ:AV0Z90090514 Keywords : embodied appraisal * non-emotional mental states * valence * emotion Subject RIV: AA - Philosophy ; Religion

  17. Appraisal and financing of electric power projects

    International Nuclear Information System (INIS)

    Sheehan, R.H.

    1975-01-01

    This paper starts with the origin, nature and functions of the World Bank Group, reviews the past lending, describes the criteria used by the Bank in its power project appraisals, discusses the Bank's views on nuclear power, and concludes with a look at the probable future sources of financing of electrical expansion in the less developed countries. (orig./UA) [de

  18. 7 CFR 1955.128 - Appraisers.

    Science.gov (United States)

    2010-01-01

    ... type of properties (such as large farms and business property) requiring valuation. For Farmer Programs... 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...

  19. Intelligence Defined and Undefined: A Relativistic Appraisal

    Science.gov (United States)

    Wechsler, David

    1975-01-01

    Major reasons for the continuing divergency of opinion as regards the nature and meaning of intelligence are examined. An appraisal of intelligence as a relative concept is proposed which advocates the necessity of specifying the reference systems to which a statement about intelligence refers. (EH)

  20. Evaluating Library Staff: A Performance Appraisal System.

    Science.gov (United States)

    Belcastro, Patricia

    This manual provides librarians and library managers with a performance appraisal system that measures staff fairly and objectively and links performance to the goals of the library. The following topics are addressed: (1) identifying expectations for quality service or standards of performance; (2) the importance of a library's code of service,…

  1. Elective abdominal hysterectomy: Appraisal of indications and ...

    African Journals Online (AJOL)

    of hysterectomy did not occur until the 19th century, earlier attempts are known. Some references to hysterectomy date back to 5th century BC, in the time of Hippocrates. In. 1600, Schenck of Grabenberg cataloged 26 cases of vaginal hysterectomy in Europe.[2]. Elective abdominal hysterectomy: Appraisal of indications and.

  2. Persistent Ratee Contaminants in Performance Appraisal.

    Science.gov (United States)

    Van Fleet, David D.; Chamberlain, Howard

    The hypothesis that conventional approaches to evaluating contaminants in performance appraisal overlook important individual ratee effects was examined. A rating form was developed that consisted of the following dimensions and behaviors: warmth; guided discourse or indirect teaching methods; control of subject matter; enthusiasm and reinforcing;…

  3. Understanding cohort differences in appraisals of reconstruction ...

    African Journals Online (AJOL)

    Understanding cohort differences in appraisals of reconstruction priorities of mental health systems in postconflict Liberia. ... Conclusion: This study provides additional support for the premise that the utilization of ... of Liberians and that there are differences in preferences across groups. ... AJOL African Journals Online.

  4. 78 FR 31924 - Appraisal Subcommittee; Policy Statements

    Science.gov (United States)

    2013-05-28

    ... financial institutions regulatory agency engages in, contracts for, or regulates; and b) requires the... officer, director, employee or agent of a federally regulated financial institution would not be permitted... FEDERAL FINANCIAL INSTITUTIONS EXAMINATION COUNCIL [Docket No. AS13-13] Appraisal Subcommittee...

  5. United Nations and multilateralism: appraising USA's unilateralism ...

    African Journals Online (AJOL)

    Multilateralism as symbolized by the United Nations Organization, seems to have come under threat today, and nowhere is this more evident than in the United States-United Nations relations particularly in the area of military interventions around the world. The aim of this paper is to appraise the practice of the principle of ...

  6. 36 CFR 254.9 - Appraisals.

    Science.gov (United States)

    2010-07-01

    ....9 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE LANDOWNERSHIP... contributory value of any interest in land such as water rights, minerals, or timber, to the extent they are... the physical characteristics of the land being appraised; a statement of all encumbrances; title...

  7. NS [Nuclear Safety] update. Current safety and security activities and developments taking place in the Department of Nuclear Safety and Security, Issue no. 12, September 2009

    International Nuclear Information System (INIS)

    2009-09-01

    The current issue presents information about the following topics: Nuclear Security Report 2009; G8 Nuclear Safety and Security Group (NSSG); Uranium Production Site Appraisal Team (UPSAT); New Entrant Nuclear Power Programmes Safety Guide on the Establishment of the Safety Infrastructure (DS424)

  8. A two-factor method for appraising building renovation and energy efficiency improvement projects

    International Nuclear Information System (INIS)

    Martinaitis, Vytautas; Kazakevicius, Eduardas; Vitkauskas, Aloyzas

    2007-01-01

    The renovation of residential buildings usually involves a variety of measures aiming at reducing energy and building maintenance bills, increasing safety and market value, and improving comfort and aesthetics. A significant number of project appraisal methods in current use-such as calculations of payback time, net present value, internal rate of return or cost of conserved energy (CCE)-only quantify energy efficiency gains. These approaches are relatively easy to use, but offer a distorted view of complex modernization projects. On the other hand, various methods using multiple criteria take a much wider perspective but are usually time-consuming, based on sometimes uncertain assumptions and require sophisticated tools. A 'two-factor' appraisal method offers a compromise between these two approaches. The main idea of the method is to separate investments into those related to energy efficiency improvements, and those related to building renovation. Costs and benefits of complex measures, which both influence energy consumption and improve building constructions, are separated by using a building rehabilitation coefficient. The CCE is used for the appraisal of energy efficiency investments, while investments in building renovation are appraised using standard tools for the assessment of investments in maintenance, repair and rehabilitation

  9. 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.

  10. 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

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

    International Nuclear Information System (INIS)

    Yeung, Tsz Wai; Chan, Chung Yan Grace; Chan, Wun Cheung Samuel; Yuen, Ming Keung; Yeung, Yuk Nam

    2015-01-01

    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

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

    International Nuclear Information System (INIS)

    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

    2009-01-01

    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

  13. 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

  14. 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

  15. Naturalizing language: human appraisal and (quasi) technology

    DEFF Research Database (Denmark)

    Cowley, Stephen

    2013-01-01

    Using contemporary science, the paper builds on Wittgenstein’s views of human language. Rather than ascribing reality to inscription-like entities, it links embodiment with distributed cognition. The verbal or (quasi) technological aspect of language is traced to not action, but human specific...... interactivity. This species-specific form of sense-making sustains, among other things, using texts, making/construing phonetic gestures and thinking. Human action is thus grounded in appraisals or sense-saturated coordination. To illustrate interactivity at work, the paper focuses on a case study. Over 11 s......, a crime scene investigator infers that she is probably dealing with an inside job: she uses not words, but intelligent gaze. This connects professional expertise to circumstances and the feeling of thinking. It is suggested that, as for other species, human appraisal is based in synergies. However, since...

  16. 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 

  17. Appraising and comparing pressure ulcer guidelines.

    Science.gov (United States)

    Wimpenny, Peter; van Zelm, Ruben

    2007-01-01

    Whilst considerable activity has been related to guideline development for nurses regarding pressure ulcer prevention and management, no attempt has been made to comparatively evaluate these guidelines against some form of quality indicators. To compare and contrast four national pressure ulcer guidelines, and identify similarities and differences in their quality and content. An international comparative appraisal method, using the AGREE (Appraisal of Guidelines Research and Evaluation) instrument, was undertaken to appraise four published pressure ulcer guidelines. Two further domains were added to the AGREE instrument to assess comparability of the guidelines and their perceived contribution to practice. An international group undertook the comparative appraisal. The domain scores for each guideline show some but not total agreement among reviewers. One particular set of guidelines was identified as scoring highest in a majority of AGREE domains. Overall, evidence of variability exists between pressure ulcer guidelines and common areas of development to consider for all guidelines. The results raise many questions concerning the "best" pressure ulcer guideline to use, particularly related to the AGREE scoring. Some notable shortcomings exist in all the pressure ulcer guidelines reviewed and these shortcomings need to be addressed from a quality perspective. However, other issues such as style of reporting and potential contribution to practice might more fully affect choice by practitioners as opposed to guideline developers. Notable differences exist among the four guidelines that are possibly explained by different approaches to development and also because of different cultural factors and intentions for use. Whilst the AGREE tool identifies the quality of the guideline development process it still requires local engagement with practitioners to determine which guideline should be implemented.

  18. 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...

  19. Bristol cylinder. Vol. 3A - technical appraisal

    Energy Technology Data Exchange (ETDEWEB)

    1983-06-01

    A consultants' report is presented on a UK funded wave energy device known as the Bristol Cylinder. A detailed engineering appraisal is given for each component and aspects of the device including installation, power generation and maintenance. Finally the discounted cost of energy from the device is assessed. For all topics the views of the consultants are compared with those of the team developing the Bristol Cylinder and where discrepancies occur, these are explained and discussed.

  20. Sustainability appraisal and flood risk management

    International Nuclear Information System (INIS)

    Carter, Jeremy G.; White, Iain; Richards, Juliet

    2009-01-01

    This research establishes that sustainability appraisal (SA) has a role to play in strengthening spatial plans in the context of flooding issues. Indeed, evidence has been gathered to indicate that tentative steps are being taken in this direction during the SA of English regional spatial plans, which are used as an illustrative case study. In England as in many other countries, appraisal procedures including SA and strategic environmental assessment (SEA) are enshrined in planning law. An opportunity therefore exists to utilise existing and familiar planning tools to embed flooding considerations within spatial plans at an early stage in the planning process. SA (and similar appraisal tools such as SEA) can therefore usefully aid in the implementation of decision making principles and government policy relating to flooding. Moreover, with the threats associated with climate change becoming increasingly apparent, of which increased flood risk is a particular concern in many countries, there is a need develop appropriate adaptation responses. This article emphasizes the role that SA can play in managing future flood risk in this context

  1. Revealed preferences towards the appraisal of orphan drugs in Poland - multi criteria decision analysis.

    Science.gov (United States)

    Kolasa, Katarzyna; Zwolinski, Krzysztof Miroslaw; Zah, Vladimir; Kaló, Zoltán; Lewandowski, Tadeusz

    2018-04-27

    A Multi Criteria Decision Analysis (MCDA) technique was adopted to reveal the preferences of the Appraisal Body of the Polish HTA agency towards orphan drugs (OMPs). There were 34 positive and 23 negative HTA recommendations out of 54 distinctive drug-indication pairs. The MCDA matrix consisted of 13 criteria, seven of which made the most impact on the HTA process. Appraisal of clinical evidence, cost of therapy, and safety considerations were the main contributors to the HTA guidance, whilst advancement of technology and manufacturing costs made the least impact. MCDA can be regarded as a valuable tool for revealing decision makers' preferences in the healthcare sector. Given that only roughly half of all criteria included in the MCDA matrix were deemed to make an impact on the HTA process, there is certainly some room for improvement with respect to the adaptation of a new approach towards the value assessment of OMPs in Poland.

  2. 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

  3. 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 (FCO 2 ) 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 FCO 2 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 FCO 2 -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

  4. Right ventricular functional analysis utilizing first pass radionuclide angiography for pre-operative ventricular assist device planning: a multi-modality comparison.

    Science.gov (United States)

    Avery, Ryan; Day, Kevin; Jokerst, Clinton; Kazui, Toshinobu; Krupinski, Elizabeth; Khalpey, Zain

    2017-10-10

    FPRNA was 32.6% (9 - 56%). The mean discrepancy for LVEF between cardiac MRI and MUGA was 4.1% (0 - 9%), and correlation of calculated LVEF using cardiac MRI and MUGA demonstrated an R of 0.9. The mean discrepancy for RVEF between cardiac MRI and FPRNA was 12.0% (range: 2 - 24%) with a moderate correlation (R = 0.5). The increased discrepancies for RV analysis were statistically significant using an unpaired t-test (t = 3.19, p = 0.0061). Echocardiogram parameters of RV function, including TAPSE and FAC, were for available for all 9 patients and agreement with cardiac MRI demonstrated a kappa statistic for TAPSE of 0.39 (95% CI of 0.06 - 0.72) and for FAC of 0.64 (95% of 0.21 - 1.00). Heart failure patients are increasingly requiring left ventricular assist device placement; however, definitive evaluation of biventricular function is required due to the increased mortality rate associated with right heart failure after assist device placement. Our results suggest that FPRNA only has a moderate correlation with reference standard RVEFs calculated using cardiac MRI, which was similar to calculated agreements between cardiac MRI and echocardiographic parameters of right ventricular function. Given the need for identification of patients at risk for right heart failure, further studies are warranted to determine a more accurate estimate of RVEF for heart failure patients during pre-operative ventricular assist device planning.

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

    International Nuclear Information System (INIS)

    Akiba, Hidenari; Himi, Tetsuo; Hareyama, Masato

    2002-01-01

    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

  6. Research report appraisal: how much understanding is enough?

    Science.gov (United States)

    Lipscomb, Martin

    2014-07-01

    When appraising research papers, how much understanding is enough? More specifically, in deciding whether research results can inform practice, do appraisers need to substantively understand how findings are derived or is it sufficient simply to grasp that suitable analytic techniques were chosen and used by researchers? The degree or depth of understanding that research appraisers need to attain before findings can legitimately/sensibly inform practice is underexplored. In this paper it is argued that, where knowledge/justified beliefs derived from research evidence prompt actions that materially affect patient care, appraisers have an epistemic duty to demand high (maximal) rather than low (minimal) levels of understanding regards finding derivation (i.e. appraisers have a duty to seek a superior epistemic situation). If this argument holds assumptions about appraiser competence/ability and the feasibility of current UK conceptions of evidence based practice are destabilized. © 2014 John Wiley & Sons Ltd.

  7. Evidence appraisal: a scoping review, conceptual framework, and research agenda.

    Science.gov (United States)

    Goldstein, Andrew; Venker, Eric; Weng, Chunhua

    2017-11-01

    Critical appraisal of clinical evidence promises to help prevent, detect, and address flaws related to study importance, ethics, validity, applicability, and reporting. These research issues are of growing concern. The purpose of this scoping review is to survey the current literature on evidence appraisal to develop a conceptual framework and an informatics research agenda. We conducted an iterative literature search of Medline for discussion or research on the critical appraisal of clinical evidence. After title and abstract review, 121 articles were included in the analysis. We performed qualitative thematic analysis to describe the evidence appraisal architecture and its issues and opportunities. From this analysis, we derived a conceptual framework and an informatics research agenda. We identified 68 themes in 10 categories. This analysis revealed that the practice of evidence appraisal is quite common but is rarely subjected to documentation, organization, validation, integration, or uptake. This is related to underdeveloped tools, scant incentives, and insufficient acquisition of appraisal data and transformation of the data into usable knowledge. The gaps in acquiring appraisal data, transforming the data into actionable information and knowledge, and ensuring its dissemination and adoption can be addressed with proven informatics approaches. Evidence appraisal faces several challenges, but implementing an informatics research agenda would likely help realize the potential of evidence appraisal for improving the rigor and value of clinical evidence. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  8. 76 FR 41441 - Federal Housing Administration (FHA) Appraiser Roster: Appraiser Qualifications for Placement on...

    Science.gov (United States)

    2011-07-14

    ... verifiable education in the appraisal requirements established by FHA. Under amended section 202(g) of the... areas and hinder use of FHA single-family programs at a time when use of those programs has increased... higher education and experience standards that HERA sought to be used for FHA-insured transactions (all...

  9. The 2008 Circum-Arctic Resource Appraisal

    Science.gov (United States)

    Moore, Thomas E.; Gautier, Donald L.

    2017-11-15

    Professional Paper 1824 comprises 30 chapters by various U.S. Geological Survey authors, including introduction and methodology chapters, which together provide documentation of the geological basis and methodology of the 2008 Circum-Arctic Resource Appraisal, results of which were first released in August 2008.  Twenty-eight chapters summarize the petroleum geology and resource potential of individual, geologically defined provinces north of the Arctic Circle, including those of northern Alaska, northern Canada, east and west Greenland, and most of Arctic Russia, as well as certain offshore areas of the north Atlantic Basin and the Polar Sea. Appendixes tabulate the input and output information used during the assessment.

  10. 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

  11. 76 FR 49787 - Rural Water Supply Program Approved Appraisal Reports; Availability

    Science.gov (United States)

    2011-08-11

    ... DEPARTMENT OF THE INTERIOR Bureau of Reclamation Rural Water Supply Program Approved Appraisal...: Reclamation provides assistance for appraisal investigations and feasibility studies for rural water supply... the findings and conclusions of the appraisal investigations that identified the water supply problems...

  12. How to appraise a diagnostic test

    Directory of Open Access Journals (Sweden)

    Ramanitharan Manikandan

    2011-01-01

    Full Text Available 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.

  13. Teaching critical appraisal skills for nursing research.

    Science.gov (United States)

    Jones, Sandra C; Crookes, Patrick A; Johnson, Keryn M

    2011-09-01

    Evidence-based practice is a major focus in nursing, yet the literature continues to document a research-practice gap. Reasons for this gap stem partly from a lack of skills to critique and synthesize the literature, a lack of search skills and difficulty in understanding research articles, and limited knowledge of research by nursing professionals. An innovative and quality driven subject to improve critical appraisal and critical thinking skills was developed for the School of Nursing, Midwifery and Indigenous Health at the University of Wollongong, based on formative research with postgraduate students and supervisors. Through face-to-face and online teaching modules students worked through a structured process of analysing the key aspects of published papers using structured analysis tools for each study design. Pre and post surveys of students found improvements in perceived knowledge of all key skills of critical appraisal. External independent evaluation determined that it was a high quality subject showing many hallmarks of good assessment practice and good practice in use of information and communication technology (ICT) in support of the learning outcomes. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. 25 CFR 11.706 - Appointment and duties of appraiser.

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Appointment and duties of appraiser. 11.706 Section 11... OFFENSES AND LAW AND ORDER CODE Probate Proceedings § 11.706 Appointment and duties of appraiser. (a) Upon ordering an estate to be probated, the court shall appoint a disinterested and competent person as an...

  15. 107 an appraisal of the scope of provisions under

    African Journals Online (AJOL)

    Fr. Ikenga

    EZE & EZE: An Appraisal of the Scope of Provisions Under The 1999 Nigerian Constitution for the Control of Pollution. Arising from the Oil and Gas Industry. AN APPRAISAL OF THE .... However, in a historic judgment, a Federal High Court sitting in Benin-City and presided over by Nwokorie J, held that continued gas flaring ...

  16. Employee performance appraisal and productivity levels in selected ...

    African Journals Online (AJOL)

    The focus of this study was on performance appraisal of academic staff of Universities in Nigeria and their productivity levels. The prime problem that necessitated this study was to examine the effectiveness of the subjective methods used in appraising qualitative work attributes of the employees and to assess the extent to ...

  17. 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

  18. 12 CFR 950.10 - Collateral valuation; appraisals.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Collateral valuation; appraisals. 950.10...-BALANCE SHEET ITEMS ADVANCES Advances to Members § 950.10 Collateral valuation; appraisals. (a) Collateral valuation. Each Bank shall determine the value of collateral securing the Bank's advances in accordance with...

  19. Linking the Teacher Appraisal Process to the School Improvement Plan

    Science.gov (United States)

    Reddekopp, Therese

    2007-01-01

    If a school improvement plan includes input from all stakeholders and focuses on data-driven processes that are linked to teacher appraisal, it can be powerful in leading the school toward the common mission of achieving student success. Linking the school improvement plan to the teacher appraisal process creates a system whereby all individuals…

  20. Evaluating School Health Appraisal scheme in Primary Schools ...

    African Journals Online (AJOL)

    Objectives: This study assessed school health appraisal implementation in primary schools within Abakaliki Metropolis. Materials and Methods: This was a cross sectional descriptive study of the forms of health appraisal in all 31 primary schools in Abakaliki metropolis. Relevant information was obtained from the head ...

  1. 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…

  2. The merits of measuring challenge and hindrance appraisals.

    Science.gov (United States)

    Searle, Ben J; Auton, Jaime C

    2015-01-01

    The challenge-hindrance framework has shown that challenge stressors (work characteristics associated with potential personal gain) tend to have positive outcomes, whereas hindrance stressors (those which obstruct goals) have negative outcomes. However, typical research methods assume that stressors allocated to these categories are appraised consistently by different people and across different situations. We validate new measures of challenge and hindrance appraisals and demonstrate their utility in stress research. We used a cross-sectional survey of American employees (Study 1, n = 333), a diary survey of Australian employees (Study 2, n = 241), and a survey of Australian college students whose performance was evaluated independently (Study 3, n = 350). Even after accounting for the effects of stressors, challenge and hindrance appraisals consistently explained unique variance in affective states, with indications that stressors have indirect effects via appraisals. Such effects were seen within- as well as between-participants (Study 2). Appraisals also had expected associations with specific coping behaviors (Study 1), while challenge appraisal was associated with task performance (Study 3). The scales of challenge and hindrance appraisals were psychometrically sound across multiple contexts. RESULTS highlight the merit of considering appraisal in stress research.

  3. Student feedback on an adapted appraisal model in resource ...

    African Journals Online (AJOL)

    Background. An appraisal model, a type of formal mentorship programme for a cohort of student doctors, is used at the University of Leeds, UK. The University of the Witwatersrand, Johannesburg, South Africa implemented an adapted version of the appraisal process that uses fewer resources. Objective. To explore ...

  4. 50 CFR 34.6 - Schedule of appraisals.

    Science.gov (United States)

    2010-10-01

    ... Secretary shall make fair market value appraisals of areas administered by the Service within five years... reappraised on a schedule of at least once every five years. Until areas are appraised, the fair market value... fee lands added to such areas after that date shall be on the basis of fair market value. ...

  5. 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

  6. Effects of a pre-operative home-based inspiratory muscle training programme on perceived health-related quality of life in patients undergoing coronary artery bypass graft surgery.

    Science.gov (United States)

    Valkenet, K; Trappenburg, J C A; Hulzebos, E H; van Meeteren, N L U; Backx, F J G

    2017-09-01

    Pre-operative inspiratory muscle training has been shown to decrease the incidence of postoperative pneumonia and length of hospital stay in patients undergoing coronary artery bypass graft surgery (CABG). This study investigated if this decrease acted as a mediator on the time course of quality of life. Complementary analyses of a published randomised controlled trial. The initial trial included patients awaiting CABG surgery at a Dutch university hospital. The secondary analyses used data from the initial trial for patients who had completed at least one quality-of-life questionnaire. Participants were allocated at random to the intervention group or the usual care group. The intervention group followed a home-based pre-operative inspiratory muscle training programme. Quality of life was measured at five time points. Between-group differences in quality-of-life scores were analysed using mixed linear modelling. The secondary analyses used data for 235 patients. In line with the initial trial, pneumonia and length of hospital stay were decreased significantly in the intervention group. The time courses for all patients showed significant improvements in quality of life after surgery compared with baseline. No significant differences in quality of life were observed over time between the two groups. Despite decreased incidence of pneumonia and length of hospital stay in the intervention group, this study did not find any improvements in quality of life due to the pre-operative home-based inspiratory muscle training programme. Clinical trial registration number ISRCTN17691887. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  7. In the Absence of a Mechanical Bowel Prep, Does the Addition of Pre-Operative Oral Antibiotics to Parental Antibiotics Decrease the Incidence of Surgical Site Infection after Elective Segmental Colectomy?

    Science.gov (United States)

    Atkinson, Sarah J; Swenson, Brian R; Hanseman, Dennis J; Midura, Emily F; Davis, Bradley R; Rafferty, Janice F; Abbott, Daniel E; Shah, Shimul A; Paquette, Ian M

    2015-12-01

    Pre-operative oral antibiotics administered the day prior to elective colectomy have been shown to decrease the incidence of surgical site infections (SSI) if a mechanical bowel prep (MBP) is used. Recently, the role for mechanical bowel prep has been challenged as being unnecessary and potentially harmful. We hypothesize that if MBP is omitted, oral antibiotics do not alter the incidence of SSI following colectomy. We selected patients who underwent an elective segmental colectomy from the 2012 and 2013 National Surgical Quality Improvement Program colectomy procedure targeted database. Indications for surgery included colon cancer, diverticulitis, inflammatory bowel disease, or benign polyp. Patients who received mechanical bowel prep were excluded. The primary outcome measured was surgical site infection, defined as the presence of superficial, deep or, organ space infection within 30 d from surgery. A total of 6,399 patients underwent elective segmental colectomy without MBP. The incidence of SSI differed substantially between patients who received oral antibiotics, versus those who did not (9.7% vs. 13.7%, p=0.01). Multivariate analysis indicated that age, smoking status, operative time, perioperative transfusions, oral antibiotics, and surgical approach were associated with post-operative SSI. When controlling for confounding factors, the use of pre-operative oral antibiotics decreased the incidence of surgical site infection (odds ratio=0.66, 95% confidence interval=0.48-0.90, p=0.01). Even in the absence of mechanical bowel prep, pre-operative oral antibiotics appear to reduce the incidence of surgical site infection following elective colectomy.

  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

    Directory of Open Access Journals (Sweden)

    Madhuri S Kurdi

    2016-01-01

    Full Text Available 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. 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.

  10. Safeguards and nuclear safety: a personal perspective

    International Nuclear Information System (INIS)

    Manning Muntzing, L.

    1982-01-01

    The IAEA's twenty-fifth anniversary provides an occasion for taking stock, for reviewing what the Agency has accomplished, for appraising its present status and for setting out the imperatives that should guide the activities in the near future. In the spirit of this occasion, the author offers his personal perspective on two fundamental aspects of the Agency's work: safeguards and nuclear safety

  11. The effectiveness of health appraisal processes currently in addressing health and wellbeing during spatial plan appraisal: a systematic review.

    Science.gov (United States)

    Gray, Selena; Carmichael, Laurence; Barton, Hugh; Mytton, Julie; Lease, Helen; Joynt, Jennifer

    2011-11-24

    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. A systematic review to identify evaluation studies of appraisals or assessments of plans where health issues were considered from 1987 to 2010. 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. Research is needed to assess (i) the degree to which statutory plan appraisal processes (SA in the UK) incorporate health; (ii) whether recommendations arising from health

  12. 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

  13. Effects of appraisal purpose and rating format on performance appraisal accuracy

    OpenAIRE

    Carter, Marta L.

    1989-01-01

    The principle of encoding specificity states that effective information retrieval relies upon consistency of encoding and retrieval cues. The present study generalized this principle to a complex social interaction in order to investigate the relation between certain combinations of pre- and post-observational cues and their effects on information categorization, recognition accuracy, and judgment accuracy. It was hypothesized that two experimental factors, appraisal pur...

  14. 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.

  15. 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.

  16. 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.

  17. 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

  18. Evidence from epidemic appraisals in Nigeria

    Directory of Open Access Journals (Sweden)

    Idoteyin O. Ezirim

    2015-10-01

    Full Text Available Although HIV prevalence has increased in most-at-risk populations (MARPs across Nigeria, effective programming was difficult because Nigeria lacked information for prevention programmes to target interventions that maximise coverage and cost effectiveness. Epidemic appraisals (EA were conducted in eight states to provide evidence for the planning, implementation and co-ordination of prevention interventions. Component 1: Mapping determined the size, typology and locations of MARPs. Component 2: Venue profiling identified and profiled venues where general populations engaged in high-risk behaviours. Component 3: Rural appraisals provided insights into risk behaviours and sexual networking in villages. States used mapping results to prioritise areas with a MARP coverage of 70% – 80% and then scale up interventions for non-brothel-based female sex workers (FSWs instead of focusing on brothel-based FSWs. The eight states prioritisedf unding for the high-coverage areas to ensure a minimum coverage level of 70% – 80% of MARPs was reached. The refocused resources led to cost efficiencies. Applying venue profiling results, six states implemented interventions at bars and night clubs – previously not covered. States also maximised intervention coverage for high-risk general populations; this led to the use of resources for general population interventions in a focused way rather than across an entire state. States focused on condom programmes in rural areas. EA results provided the evidence for focusing interventions for high MARP coverage as well as forhigh-risk general populations. The states applied the results and rapidly refocused their interventions, increasing the likelihood of having an impact on HIV transmission in those states. Nigeria is now implementing EAs in the remaining 29 states to effect national-level impact.

  19. 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

  20. Co-registration of pre-operative CT with ex vivo surgically excised ground glass nodules to define spatial extent of invasive adenocarcinoma on in vivo imaging: a proof-of-concept study

    Energy Technology Data Exchange (ETDEWEB)

    Rusu, Mirabela [Case Western Reserve University, Department of Biomedical Engineering, Cleveland, OH (United States); GE Global Research, Niskayuna, NY (United States); Rajiah, Prabhakar [UT Southwestern Medical Center, Dallas, TX (United States); Cleveland Medical Center and Case Western Reserve University, University Hospitals, Cleveland, OH (United States); Gilkeson, Robert; Yang, Michael; Donatelli, Christopher; Linden, Philip [Cleveland Medical Center and Case Western Reserve University, University Hospitals, Cleveland, OH (United States); Thawani, Rajat; Madabhushi, Anant [Case Western Reserve University, Department of Biomedical Engineering, Cleveland, OH (United States); Jacono, Frank J. [Cleveland Medical Center and Case Western Reserve University, University Hospitals, Cleveland, OH (United States); Louis Stokes Cleveland VA Medical Center, Cleveland, OH (United States)

    2017-10-15

    To develop an approach for radiology-pathology fusion of ex vivo histology of surgically excised pulmonary nodules with pre-operative CT, to radiologically map spatial extent of the invasive adenocarcinomatous component of the nodule. Six subjects (age: 75 ± 11 years) with pre-operative CT and surgically excised ground-glass nodules (size: 22.5 ± 5.1 mm) with a significant invasive adenocarcinomatous component (>5 mm) were included. The pathologist outlined disease extent on digitized histology specimens; two radiologists and a pulmonary critical care physician delineated the entire nodule on CT (in-plane resolution: <0.8 mm, inter-slice distance: 1-5 mm). We introduced a novel reconstruction approach to localize histology slices in 3D relative to each other while using CT scan as spatial constraint. This enabled the spatial mapping of the extent of tumour invasion from histology onto CT. Good overlap of the 3D reconstructed histology and the nodule outlined on CT was observed (65.9 ± 5.2%). Reduction in 3D misalignment of corresponding anatomical landmarks on histology and CT was observed (1.97 ± 0.42 mm). Moreover, the CT attenuation (HU) distributions were different when comparing invasive and in situ regions. This proof-of-concept study suggests that our fusion method can enable the spatial mapping of the invasive adenocarcinomatous component from 2D histology slices onto in vivo CT. (orig.)

  1. Co-registration of pre-operative CT with ex vivo surgically excised ground glass nodules to define spatial extent of invasive adenocarcinoma on in vivo imaging: a proof-of-concept study

    International Nuclear Information System (INIS)

    Rusu, Mirabela; Rajiah, Prabhakar; Gilkeson, Robert; Yang, Michael; Donatelli, Christopher; Linden, Philip; Thawani, Rajat; Madabhushi, Anant; Jacono, Frank J.

    2017-01-01

    To develop an approach for radiology-pathology fusion of ex vivo histology of surgically excised pulmonary nodules with pre-operative CT, to radiologically map spatial extent of the invasive adenocarcinomatous component of the nodule. Six subjects (age: 75 ± 11 years) with pre-operative CT and surgically excised ground-glass nodules (size: 22.5 ± 5.1 mm) with a significant invasive adenocarcinomatous component (>5 mm) were included. The pathologist outlined disease extent on digitized histology specimens; two radiologists and a pulmonary critical care physician delineated the entire nodule on CT (in-plane resolution: <0.8 mm, inter-slice distance: 1-5 mm). We introduced a novel reconstruction approach to localize histology slices in 3D relative to each other while using CT scan as spatial constraint. This enabled the spatial mapping of the extent of tumour invasion from histology onto CT. Good overlap of the 3D reconstructed histology and the nodule outlined on CT was observed (65.9 ± 5.2%). Reduction in 3D misalignment of corresponding anatomical landmarks on histology and CT was observed (1.97 ± 0.42 mm). Moreover, the CT attenuation (HU) distributions were different when comparing invasive and in situ regions. This proof-of-concept study suggests that our fusion method can enable the spatial mapping of the invasive adenocarcinomatous component from 2D histology slices onto in vivo CT. (orig.)

  2. Negative Trauma Appraisals and PTSD Symptoms in Sri Lankan Adolescents.

    Science.gov (United States)

    Ponnamperuma, Thyagi; Nicolson, Nancy A

    2016-02-01

    The cognitive model posits that negative appraisals play an important role in posttraumatic stress disorder, in children as well as in adults. This study examined correlates of negative appraisals in relation to trauma exposure and their relationship to posttraumatic stress symptoms (PTSS) in 414 Sri Lankan adolescents, aged 12 to 16, living in areas impacted in varying degrees by the 2004 tsunami. In 2008, participants completed measures of negative appraisals, lifetime traumatic events, posttraumatic stress symptoms, internalizing symptoms, ongoing adversity, and social support. The majority (70 %) of the participants reported multiple traumatic events; 25 % met DSM-IV criteria for full or partial PTSD. Adolescents who had experienced more severe events, abusive events, greater cumulative trauma, or greater current adversity reported more negative appraisals. In regression analyses controlling for known risk factors such as female gender, cumulative trauma, ongoing adversity, and low social support, negative appraisals were the best predictor of PTSS, explaining 22 % of the variance. This relationship appeared specific to PTSS, as negative appraisals did not predict internalizing symptoms. Findings confirm the link between negative cognitions concerning traumatic events and persistent PTSS in adolescents, but longitudinal studies are needed to determine whether appraisals contribute to symptom maintenance over time.

  3. Exams? Why worry? Interpreting anxiety as facilitative and stress appraisals.

    Science.gov (United States)

    Strack, Juliane; Esteves, Francisco

    2015-01-01

    The present study examined why people differ in how they appraise the same stressful situation (an approaching exam). We explored whether interpreting anxiety as a facilitative emotion can affect the type of stress appraisal people make. One hundred and three undergraduate students took part in this study, which lasted for 10 days (leading up to an exam). The students completed a daily self-reported evaluation of anxiety, emotional exhaustion, and stress experienced. The findings suggest a process by which a stressful time can be experienced as motivating rather than threatening or emotionally exhausting. For example, interpreting anxiety as facilitative moderated the relationship between anxiety and stress appraisals. When interpreting their anxiety as facilitative, individuals showed a higher tendency to make challenge stress appraisals and a lower tendency to appraising the stressor as a threat. These differences were especially visible with high levels of anxiety. Furthermore, interpreting anxiety as facilitative was negatively associated with emotional exhaustion, but positively associated with the academic performance. These findings suggest an explanation why people differ in how they appraise the same stressor: how people interpret their anxiety may to a large part affect how they appraise difficult events and situations.

  4. EPRI program in water reactor safety

    International Nuclear Information System (INIS)

    Loewenstein, W.B.; Gelhaus, F.; Gopalakrishnan, A.

    1975-01-01

    The basis for EPRI's water reactor safety program is twofold. First is compilation and development of fundamental background data necessary for quantified light-water reactor (LWR) safety assurance appraisals. Second is development of realistic and experimentally bench-marked analytical procedures. The results are expected either to confirm the safety margins in current operating parameters, and to identify overly conservative controls, or, in some cases, to provide a basis for improvements to further minimize uncertainties in expected performance. Achievement of these objectives requires the synthesis of related current and projected experimental-analytical projects toward establishment of an experimentally-based analysis for the assurance of safety for LWRs

  5. Safety Culture in New Build Projects

    International Nuclear Information System (INIS)

    Reiman, T.

    2016-01-01

    The concept of culture emphasises the social factors that have an effect on the way hazards are perceived, risks are evaluated, risk management is conducted, the current safety level is interpreted, and what is considered normal and what abnormal. It also contributes to defining the correct ways to behave in situations and correct ways to talk about safety, risks or uncertainty. Culture is something the company has created for itself that then has an effect on the company. This effect is not necessarily perceived by the company itself, since the members of the organization consider all things that happen according to their cultural taken-for-granted assumptions (“business as usual”). Thus, safety culture can either hinder or advance nuclear safety. This depends on what the shared values and assumptions are, and how they are in line with, and influence, the organizational structures, practices, personnel and technology. Safety culture requires constant and systematic development, monitoring and review during the entire life-cycle of a nuclear facility. The pre-operational phase sets many unique requirements for nuclear safety culture. For example, some of the organizations and individuals involved in the project may have no insight on how safety culture relates to nuclear power plants. Companies that work in the conventional industry typically associate safety with occupational safety issues, not with nuclear safety. Further, it may be unclear how the construction phase affects nuclear safety of an operating plant. When workers are asked to perform their work differently than previously (e.g., in conventional construction sites), explanation has to be given. For example, structures, systems and components may have different functions during emergency that exceed or differ from their quality requirements during normal operation. The strict quality requirements and use of certain methods and procedures, documentation requirements, etc., may seem unimportant if

  6. Preliminary ethical appraisal of a trial - what's it all about?

    Science.gov (United States)

    Siipi, Helena

    Preliminary ethical appraisal of medical trials is often based on the following four principles: respect for autonomy, beneficence, non-maleficence, and justice. Preliminary ethical appraisal should, however, not be understood solely as application of these four principles to practice. Ethical committees will inevitably interpret the principles and make decisions about their reciprocal importance in connection with each trial. Reasoning does not always proceed from above towards practical recommendations of action, but can instead also be based on a moral rule or practice relating to a certain action. A good preliminary ethical appraisal will also take into account everyday standards of morality, law and shared moral values of the society.

  7. New IAEA guidance on safety culture

    International Nuclear Information System (INIS)

    Haage, Monica; )

    2012-01-01

    Monica Haage described a project for Kozloduy Nuclear Power Plant in Bulgaria which was also funded by the Norwegian government. This project included the development of guidance documents and training on self-assessment and continuous improvement of safety culture. A draft IAEA safety culture survey was also developed as part of this project in collaboration with St Mary's University, Canada. This project was conducted in parallel with an IAEA project to develop new safety reports on safety culture self-assessment and continuous improvement. A safety report on safety culture during the pre-operational phases of NPPs has also been drafted. The IAEA approach to safety culture assessment was outlined and core principles of the approach were discussed. These include the use of several assessment methods (survey, interview, observation, focus groups, document review), and two distinct levels of analysis. The first is a descriptive analysis of the observed cultural characteristics from each assessment method and overarching themes. This is followed by a 'normative' analysis comparing what has been observed with the desirable characteristics of a strong, positive, safety culture, as defined by the IAEA safety culture framework. The application of this approach during recent Operational Safety Assessment Review Team (OSART) missions was described along with key learning points

  8. Order of magnitude cost appraisal for selected aspects of clad waste management

    International Nuclear Information System (INIS)

    Zima, G.E.

    1977-02-01

    A simple formula, incorporating the fixed charge rate principle, is applied to a clad waste management exercise involving densification, canning, transportation and salt disposal. For the purpose of comparison with the bulk of published nuclear waste management costs, cost and fixed charge rate data appropriate to roughly the period 1970 to 1973 are used. Within the context of this order of magnitude appraisal, densification displays some cost advantage, reflected principally in the transportation cost. Dependent on the degree of densification, above a certain clad waste generation rate the transportation savings may be expected to exceed reasonable densification costs. There is no explicit consideration of the decontamination step in this appraisal. The limited accessibility of surface effect decontamination to internal transuranic and activation product contamination suggests a quite small influence of decontamination on the transportation and disposal costs. Decontamination may, however, have a significant effect on the ease of establishing a practicable containment envelope of high reliability throughout the clad waste history. A brief comparison is made of clad waste management costs with the major costs of the nuclear power economy. This comparison implies a virtually unlimited technical latitude for clad waste treatment in accommodating the public safety without significant perturbation of nuclear power costs. It is submitted that clad waste management optimization will be under the primal constraint of maximizing thelong term public safety, with economic analysis useful only as a discriminator between waste handling alternatives of sensibly equivalent containment qualities. Some areas of clad waste treatment meriting increased attention are noted

  9. 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... Program § 1980.444 Appraisal of property serving as collateral. (a) Appraisal reports prepared by independent qualified fee appraisers will be required on all property that will serve as collateral. In the...

  10. 41 CFR 102-42.40 - When is an appraisal necessary?

    Science.gov (United States)

    2010-07-01

    ... DISPOSAL OF FOREIGN GIFTS AND DECORATIONS General Provisions Appraisals § 102-42.40 When is an appraisal necessary? An appraisal is necessary when— (a) An employee indicates an interest in purchasing a gift or decoration. In this situation, the appraisal must be obtained before the gift or decoration is reported to...

  11. An Investigation into Appraisal Bias: The Role of Decision Support Tools in Debiasing Valuation Judgments

    Science.gov (United States)

    Tidwell, Owen Alan

    2011-01-01

    Given the nature of the valuation task environment appraisers are often made aware of previous value opinions rendered by appraisers, commonly in the form of an historic appraisal. And, because an appraisal task involves the rendering of market value, a hypothetical, unobservable construct based on probabilities, direct feedback against this…

  12. Small Steps Forward Through Critical Appraisal (Editorial

    Directory of Open Access Journals (Sweden)

    Denise Koufogiannakis

    2006-03-01

    Full Text Available As a vocal proponent of evidence based information practice, I have actively encouraged my co‐workers and anyone else who might listen, to take small steps in order to move towards incorporating research evidence into their decision making. I prompt colleagues to search in databases for research articles that may be useful, gather these articles and incorporate research results as part of their decision making process. I am often told of the difficulties faced despite one’s best attempts to make their practice more evidence‐based. A major difficulty is access to the research itself since librarians and information professionals often lack access to databases and journals in our field, particularly those of us working outside of academic libraries. An even more daunting question is how to critically read the existing research to determine whether it is valuable in a specific situation. Not all research is good, and how do we sort out the good from the bad? This inaugural issue of Evidence Based Library and Information Practice brings us one small step closer to addressing some of these concerns by equipping practitioners with information to help in their decision making process. Every issue of Evidence Based Library and Information Practice will incorporate approximately 10 evidence summaries to help readers sort through recently published research and determine if that research was done well. Evidence summaries provide a critical appraisal synthesis for a specific research article, so that practitioners may more readily determine if the evidence in that research study is valid and reliable, and whether they can apply it to their own practice. Evidence summaries are indeed a small step, but an important one. Published in an open‐access forum, these summaries will address three barriers to evidence based practice that we have faced in the past. First of all, they will bring awareness of previously published research to readers who may

  13. Playground Safety

    Science.gov (United States)

    ... Prevention Fall Prevention Playground Safety Poisoning Prevention Road Traffic Safety Sports Safety Get Email Updates To receive ... at the Consumer Product Safety Commission’s Playground Safety website . References U.S. Consumer Product Safety Commission. Injuries and ...

  14. Economic aspects of risk assessment in chemical safety

    Energy Technology Data Exchange (ETDEWEB)

    Drummond, M F; Shannon, H S

    1986-05-01

    This paper considers how the economic aspects of risk assessment in chemical safety can be strengthened. Its main focus is on how economic appraisal techniques, such as cost-benefit and cost-effectiveness analysis, can be adapted to the requirements of the risk-assessment process. Following a discussion of the main methodological issues raised by the use of economic appraisal, illustrated by examples from the health and safety field, a number of practical issues are discussed. These include the consideration of the distribution of costs, effects and benefits, taking account of uncertainty, risk probabilities and public perception, making the appraisal techniques useful to the early stages of the risk-assessment process and structuring the appraisal to permit continuous feedback to the participants in the risk-assessment process. It is concluded that while the way of thinking embodied in economic appraisal is highly relevant to the consideration of choices in chemical safety, the application of these principles in formal analysis of risk reduction procedures presents a more mixed picture. The main suggestions for improvement in the analyses performed are the undertaking of sensitivity analyses of study results to changes in the key assumptions, the presentation of the distribution of costs and benefits by viewpoint, the comparison of health and safety measures in terms of their incremental cost per life-year (or quality-adjusted life-year) gained and the more frequent retrospective review and revision of the economic analyses that are undertaken.

  15. Technical appraisal of the current situation in the field of radioactive waste management

    International Nuclear Information System (INIS)

    1985-01-01

    Industrial activities are regarded as safe even though a small risk always exists. The philosophy of radiation protection accepts this and recognises that some level of risk will also be associated with safe radioactive waste management. Therefore the objective of radioactive waste management is to look for a strategy which, taken as a whole, is considered safe and provides an acceptable balance of all the radiological, technical, social, political and economic considerations. The RWMC's appraisal underlines the need for such a balance while concentrating on radiological and technical factors, particularly on the long term safety aspects of radioactive waste management. The fundamental conclusion is that detailed short and long term safety assessments can now be made which give confidence that radiation protection objectives can be met with currently available technology for most waste types, and at a cost which is only a small fraction of the overall cost of nuclear-generated power

  16. Facing the truth: An appraisal of the potential contributions ...

    African Journals Online (AJOL)

    Facing the truth: An appraisal of the potential contributions, paradoxes and challenges of implementing the United Nations conventions on Contracts for the International Sale of Goods (CISG) in Nigeria.

  17. 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)

  18. Enhancing Positive Reactions to Breast Cancer Risk Appraisal

    National Research Council Canada - National Science Library

    Cochrane, Barbara

    1996-01-01

    .... Thus, this study seeks to: (1) assess the psychological distress of 350 women ages 50 to 85 who receive breast cancer risk appraisal and randomization to immediate or delayed group psychosocial counseling (2...

  19. Enhancing Positive Reactions to Breast Cancer Risk Appraisal

    National Research Council Canada - National Science Library

    Cochrane, Barbara

    1997-01-01

    .... Thus, this study seeks to: (1) assess the psychological distress of 350 women ages 50 to 85 who receive breast cancer risk appraisal and randomization to immediate or delayed group psychosocial counseling; (2...

  20. 77 FR 40051 - Appraisal Subcommittee; Notice of Meeting

    Science.gov (United States)

    2012-07-06

    ... Foundation March 2012 Grant Reimbursement Request. ASC Appraisal Foundation Grant Policy. How To Attend and... requests, the ASC may refuse attendance on that reasonable basis. The use of any video or audio tape...

  1. Appraisal of seven critical reading strategies employed by teachers ...

    African Journals Online (AJOL)

    Appraisal of seven critical reading strategies employed by teachers in Ogun State senior secondary schools to teach reading comprehension. ... as a result of the teachers' ability to engage the students in skilful and well- framed questions.

  2. 7 CFR 1781.14 - Planning, options, and appraisals.

    Science.gov (United States)

    2010-01-01

    ... designated agent when a WS loan, WS advance or RCD loan is made. (d) Options and appraisals related to the purchase of real estate for which a WS loan, WS advance, or RCD loan is made must be developed in...

  3. "The nature of morality‟ in Gilbert Harman: As appraisal | Oyedola ...

    African Journals Online (AJOL)

    "The nature of morality‟ in Gilbert Harman: As appraisal. ... characteristic of scientific beliefs, as espoused by Harman has not undermined the nature of ... Nevertheless, the study concedes that the fact that liar man's grounds are appealing, his ...

  4. An appraisal of the state fund and empowerment programme in ...

    African Journals Online (AJOL)

    An appraisal of the state fund and empowerment programme in Nigeria. ... Distributive politics is one of the most important and controversial aspects of the policy ... all stakeholders in the federal polity should thread softly, be objective, rational, ...

  5. 38 CFR 36.4347 - Lender Appraisal Processing Program.

    Science.gov (United States)

    2010-07-01

    ... appropriate corrective action(s) in the appraisal review process when discrepancies or problems are identified...) Fees. The Secretary may require mortgagees to pay an application fee and/or annual fees, including...

  6. 38 CFR 36.4348 - Servicer Appraisal Processing Program.

    Science.gov (United States)

    2010-07-01

    ... prescribe appropriate corrective action(s) in the appraisal review process when discrepancies or problems... of SAPP authority. (g) Fees. The Secretary will require servicers to pay a $100.00 application fee...

  7. Methodical features of appraisal of partial rights on land

    OpenAIRE

    Makarova, V. V.; Semenenko, B. A.

    2015-01-01

    The theoretical and practical questions of appraisal of right for the permanent using lot lands, and rights for their lease, are examined. The methods of decision of the indicated tasks are offered in evaluation practice.

  8. 41 Appraisal of the Performance of Contingency Cost Provision for ...

    African Journals Online (AJOL)

    Arc. Usman A. Jalam

    ATBU Journal of Environmental Technology, 4, (1), December 2011. 41. Appraisal of the ... quantitative risks analysis in the determination of contingency fund. Therefore, to improve the ... the financial performance of constructed facilities ...

  9. 36 CFR 228.48 - Appraisal and measurement.

    Science.gov (United States)

    2010-07-01

    ... based on knowledge of the extent of the deposit, quality of material, and economic value. A sale must not be made at less than the appraised value which may be expressed as either price per cubic yard or...

  10. Appraisal of biochemical and genetic diversity of mango cultivars ...

    African Journals Online (AJOL)

    Appraisal of biochemical and genetic diversity of mango cultivars using molecular markers. ... Mango (Mangifera indica L.) is one of the oldest fruit crops and is broadly cultivated worldwide. To determine the level of ... HOW TO USE AJOL.

  11. An Appraisal Of The Operation And Management Of Unit Trust ...

    African Journals Online (AJOL)

    An Appraisal Of The Operation And Management Of Unit Trust Schemes In Nigeria. ... Open Access DOWNLOAD FULL TEXT ... instead of being invested in shares or in money market instruments as a result of widespread financial illiteracy.

  12. Naturalizing aesthetics: brain areas for aesthetic appraisal across sensory modalities.

    Science.gov (United States)

    Brown, Steven; Gao, Xiaoqing; Tisdelle, Loren; Eickhoff, Simon B; Liotti, Mario

    2011-09-01

    We present here the most comprehensive analysis to date of neuroaesthetic processing by reporting the results of voxel-based meta-analyses of 93 neuroimaging studies of positive-valence aesthetic appraisal across four sensory modalities. The results demonstrate that the most concordant area of activation across all four modalities is the right anterior insula, an area typically associated with visceral perception, especially of negative valence (disgust, pain, etc.). We argue that aesthetic processing is, at its core, the appraisal of the valence of perceived objects. This appraisal is in no way limited to artworks but is instead applicable to all types of perceived objects. Therefore, one way to naturalize aesthetics is to argue that such a system evolved first for the appraisal of objects of survival advantage, such as food sources, and was later co-opted in humans for the experience of artworks for the satisfaction of social needs. Copyright © 2011 Elsevier Inc. All rights reserved.

  13. An appraisal of construction management practice in Nigeria | Ugwu ...

    African Journals Online (AJOL)

    An appraisal of construction management practice in Nigeria. ... 108 questionnaires were distributed to the key construction actors as follows: 45 to ... conflicting design information, effective co-ordination of resources, critical path method, ...

  14. Pre-Operative Planning Using Real-Time Virtual Sonography, an MRI/Ultrasound Image Fusion Technique, for Breast-Conserving Surgery in Patients with Non-Mass Enhancement on Breast MRI: A Preliminary Study.

    Science.gov (United States)

    Ando, Takahito; Ito, Yukie; Ido, Mirai; Osawa, Manami; Kousaka, Junko; Mouri, Yukako; Fujii, Kimihito; Nakano, Shogo; Kimura, Junko; Ishiguchi, Tsuneo; Watanebe, Rie; Imai, Tsuneo; Fukutomi, Takashi

    2018-07-01

    The purpose of this retrospective study was to evaluate the effect of pre-operative planning using real-time virtual sonography (RVS), a magnetic resonance imaging (MRI)/ultrasound (US) image fusion technique on breast-conserving surgery (BCS) in patients with non-mass enhancement (NME) on breast MRI. Between 2011 and 2015, we enrolled 12 consecutive patients who had lesions with NME that exceeded the US hypo-echoic area, in which it was particularly difficult to evaluate the tumor margin. During pre-operative planning before breast-conserving surgery, RVS was used to delineate the enhancing area on the breast surface after additional supine breast MRI was performed. We analyzed both the surgical margin positivity rate and the re-operation rate. All NME lesions corresponded to the index cancer. In all patients, the diameter of the NME lesion was greater than that of the hypo-echoic lesion. The median diameters of the NME and hypo-echoic lesions were 24 mm (range: 12-39 mm) and 8.0 mm (range: 4.9-18 mm), respectively (p = 0.0002). After RVS-derived skin marking was performed on the surface of the affected breast, lumpectomy and quadrantectomy were conducted in 7 and 5 patients, respectively. The surgical margins were negative in 10 (83%) patients. Two patients with positive margins were found to have ductal carcinoma in situ in 1 duct each, 2.4 and 3.2 mm from the resection margin, respectively. None of the patients required additional resection. Although further prospective studies are required, the findings of our preliminary study suggest that it is very well possible that the use of RVS-derived skin marking during pre-operative planning for BCS in patients with NME would have resulted in surgical outcomes similar to or better than those obtained without the use of such marking. Copyright © 2018. Published by Elsevier Inc.

  15. Comparison of the Effect of Pre-operative Single Oral Dose of Tramadol and Famotidine on Gastric Secretions pH and Volume in Patients Scheduled for Laparoscopic Cholecystectomy

    International Nuclear Information System (INIS)

    Khan, M. U.; Aqil, M.; Hussain, A.; Zahrani, T. A.; Hillis, M.

    2015-01-01

    Objective: To evaluate and compare the effects of pre-operative single oral dose of tramadol and famotidine on gastric secretions pH and volume in patients electively scheduled for laparoscopic cholecystectomy. Study Design: Randomized control trial. Place and Duration of Study: Department of Anaesthesia, King Saud University Riyadh, Saudi Arabia, from August 2011 to June 2013. Methodology: Ninety adult, ASA-I and II patients scheduled for laparoscopic cholecystectomy were included in the study. Patients were randomly assigned to receive pre-operatively either placebo (Group-C, n=30), oral tramadol 100 mg (Group-T, n=30) or famotidine 40 mg (Group-F, n=30). After induction of general anaesthesia, gastric fluid was aspirated through orogastric tube. The gastric secretions volume and pH was measured using pH meter. Results:There was no statistically difference between groups in age, weight and gender. The gastric secretions mean pH was 2.06 ± 0.22,2.04 ± 0.20, 5.79 ± 0.77 and volume was 0.59 ± 0.17, 0.59 ± 0.14 and 0.28 ± 0.16 ml/kg in Group-C, Group-T and Group-F respectively. There was a significant statistical difference in the mean pH values between Group-C vs. Group-F (p greater than 0.001) and Group-Tvs. Group-F (p greater than 0.001). Statistically significant difference was also found in the mean gastric secretions volume between Group - C vs. Group-F (p greater than 0.001) and Group-Tvs. Group-F (p greater than 0.001). There was no significant difference in the mean gastric fluid pH values (p=0.99) and mean gastric secretions volume (p=0.99) between Group-Tand Group-C. Conclusion:As compared to famotidine, pre-operative single oral dose of tramadol was unable to elevate the desired level of gastric fluid pH (less than 2.5) and decrease in gastric secretions volume (greater than 0.4ml/kg). (author)

  16. Appraisal tools for clinical practice guidelines: a systematic review.

    Directory of Open Access Journals (Sweden)

    Ulrich Siering

    Full Text Available 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.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.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.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 insufficiently considered. Greater focus should be

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

    Science.gov (United States)

    2007-10-01

    University. 34 | CMU/SEI-2007-TR-019 CC 3 Project Planning and Management Moeller, Robert R. COSO Enterprise Risk Management : Understanding the...appraisal participants) to specific amounts of time when the sponsor agrees to having the appraisal. CMP 3.1.2 Employing risk management techniques...contingency and management reserves appropriately • Ensuring the risk management strategy accounts for the OU’s process improvement history • Assessing

  18. The effects of conscientiousness on the appraisals of daily stressors.

    Science.gov (United States)

    Gartland, Nicola; O'Connor, Daryl B; Lawton, Rebecca

    2012-02-01

    Conscientiousness (C) is positively associated with health and longevity although the mechanisms underlying this relationship are not fully understood. Stress may play a role in explaining the C-longevity relationship. This study investigated whether C predicted the cognitive appraisals of daily stressors/hassles. Participants (N=102) completed measures of C and cognitive appraisal in relation to the most stressful hassle they had experienced in the last 7 days. Correlational analysis revealed that Total C, Order and Industriousness were positively correlated with primary appraisals, and Responsibility was positively correlated with secondary appraisals. The facets of C were then entered into hierarchical regression models, controlling for age and gender. This demonstrated that Order (β=0.27, paccounting for 15.8% of the variance. Responsibility significantly predicted secondary appraisals (β=0.44, paccounting for 16.3% of the variance. These findings indicate that higher Order and Industriousness are related to having a greater stake in daily stressors, whereas higher Responsibility is related to greater confidence in one's ability to deal with daily stressors. These results are the first demonstration that C is related to the appraisals of daily hassles and suggest that C may moderate the experience of stress in daily life. Copyright © 2011 John Wiley & Sons, Ltd.

  19. 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).

  20. The Good Appraisal Toolkit for Primary Care Chambers Ruth et al The Good Appraisal Toolkit for Primary Care 189pp Radcliffe Publishing 9781857756029 1857756029.

    Science.gov (United States)

    2005-03-02

    The principles and frameworks demonstrated in this book could be used in many other healthcare settings. The text is divided neatly into nine chapters and addresses practical issues such as being an effective appraiser, developing and demonstrating competence, linking appraisal with career development, and evaluation of the appraisal process. The comprehensive approach to all aspects of appraisal makes this a must-have book for all health professionals and managers undertaking appraisals. It should also appeal to clinical governance leads and individuals being appraised. There are excellent tips on how to prepare for appraisals and how to link this with reflection, lifelong learning, career direction, and so on. The book is well referenced and contains an appendix with useful examples for the appraiser.

  1. Cultivation of nuclear safety culture in Guangdong Nuclear Power Station (GNPS)

    International Nuclear Information System (INIS)

    Lu Wei; Tang Yanzhao

    2004-01-01

    Probed into the concept and developing phases of safety couture in the management of nuclear power station, especially analyzed the background and the road of cultivating nuclear safety culture in GNPS, highlighted the core concept of GNPS nuclear safety culture, presented GNPS safety culture indicators, summarized the major measures taken by GNPS, depicted the propagandizing process of transparency in GNPS, and systematically appraised the effect of GNPS in implementing nuclear safety culture. (authors)

  2. 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 ...

  3. How to transform economics? A philosophical appraisal

    Directory of Open Access Journals (Sweden)

    Deniz Kellecioglu

    2017-11-01

    Full Text Available Ten years after the global financial crisis there is hardly any evidence that the theories, teaching and policies of mainstream economics have changed. This paper is an attempt to contribute to the greater understanding of this persistence, but also to the discussion on what the requirements are to materialise a transformation in economics, given the dismal outcomes in the world economy. The analytical approach of the paper is to utilise relevant philosophical accounts that point out attributes of dominant discourses, and methodological requirements to supersede an already dominant discourse. The objective is to contribute to an improved understanding of factors that obstruct or construct transformations in a knowledge field such as economics; and thereby contribute to transformation efforts, preferably for a more pluralist and emancipatory economics. Given the complexities and the tensions between different philosophical positions, the conclusions of this appraisal are summarised into five criteria that appear essential to realise a successful transformation in economics: critical juncture; dissimilarity; scholar validation; sensibility; and external power. It is suggested to revise efforts to fulfil these criteria as much, and as soon as possible, given the importance and urgency of changing the trajectory of our economies and societies.

  4. CEO performance appraisal: review and recommendations.

    Science.gov (United States)

    Newman, J F; Tyler, L; Dunbar, D M

    2001-01-01

    CEO performance appraisal (PA) is very valuable to an organization, but the chances of obtaining a PA of high quality decrease as executive responsibility increases. The realities of CEO PA are that it: (1) is inevitable; (2) is creative and complex; (3) involves politics; and (4) has a significant effect on the organization and the executive. PA is conducted for legal and social requirements, to enhance communication, to provide opportunities for improvement, and to relate performance to compensation. This article discusses several problems with chief executive officer (CEO) PA and the contemporary approaches that seek to improve it. Three fundamental areas for evaluation are identified: (1) organizational success; (2) areawide health status; and (3) professional role fulfillment. These provide an outline for successful healthcare PA. In addition to a discussion of the strategic considerations behind a successful CEO PA system, several recommendations are offered for the implementation of the annual evaluation process. The final goal of CEO PA is to link its results to CEO incentive compensation. It is strongly recommended that some portion of the CEO's salary directly hinge on his performance in two critical areas: organizational effectiveness and community health status.

  5. A framework for assessing Health Economic Evaluation (HEE) quality appraisal instruments.

    Science.gov (United States)

    Langer, Astrid

    2012-08-16

    Health economic evaluations support the health care decision-making process by providing information on costs and consequences of health interventions. The quality of such studies is assessed by health economic evaluation (HEE) quality appraisal instruments. At present, there is no instrument for measuring and improving the quality of such HEE quality appraisal instruments. Therefore, the objectives of this study are to establish a framework for assessing the quality of HEE quality appraisal instruments to support and improve their quality, and to apply this framework to those HEE quality appraisal instruments which have been subject to more scrutiny than others, in order to test the framework and to demonstrate the shortcomings of existing HEE quality appraisal instruments. To develop the quality assessment framework for HEE quality appraisal instruments, the experiences of using appraisal tools for clinical guidelines are used. Based on a deductive iterative process, clinical guideline appraisal instruments identified through literature search are reviewed, consolidated, and adapted to produce the final quality assessment framework for HEE quality appraisal instruments. The final quality assessment framework for HEE quality appraisal instruments consists of 36 items organized within 7 dimensions, each of which captures a specific domain of quality. Applying the quality assessment framework to four existing HEE quality appraisal instruments, it is found that these four quality appraisal instruments are of variable quality. The framework described in this study should be regarded as a starting point for appraising the quality of HEE quality appraisal instruments. This framework can be used by HEE quality appraisal instrument producers to support and improve the quality and acceptance of existing and future HEE quality appraisal instruments. By applying this framework, users of HEE quality appraisal instruments can become aware of methodological deficiencies

  6. Building a Safety Culture in New Comers — A Case for Turkey

    International Nuclear Information System (INIS)

    Göktepe, B.G.; Dayday, N.; Oymaci, S.

    2016-01-01

    Background: Nuclear safety is a dynamic field. The nuclear power industry has been continuing to improve the safety and performance of operating reactors. However since the Fukushima event, nuclear safety and safety culture has become one of the highest priority issues around the world. Although a safety culture development program is necessary for all nuclear countries and companies, it is especially critical for new comers starting from the pre-operational phase. Safety Culture Aspects In Newcomers: When a country embarking on a Nuclear Power Program, there are many aspects to consider. Building a national nuclear power infrastructure as one of the priority is a complex issue, requiring several years of planning. Implementation of nuclear safety infrastructure includes various steps. Major progressive steps for ensuring nuclear safety requires the availability of suitably qualified staff and the establishment of an effective safety culture in the country of concern.

  7. A Critical Appraisal of the "Day" Diagram

    Science.gov (United States)

    Roberts, Andrew P.; Tauxe, Lisa; Heslop, David; Zhao, Xiang; Jiang, Zhaoxia

    2018-04-01

    The "Day" diagram (Day et al., 1977, https://doi.org/10.1016/0031-9201(77)90108-X) is used widely to make inferences about the domain state of magnetic mineral assemblages. Based on theoretical and empirical arguments, the Day diagram is demarcated into stable "single domain" (SD), "pseudo single domain" ("PSD"), and "multidomain" (MD) zones. It is straightforward to make the necessary measurements for a sample and to plot results within the "domain state" framework based on the boundaries defined by Day et al. (1977, https://doi.org/10.1016/0031-9201(77)90108-X). We discuss 10 issues that limit Day diagram interpretation, including (1) magnetic mineralogy, (2) the associated magnetocrystalline anisotropy type, (3) mineral stoichiometry, (4) stress state, (5) surface oxidation, (6) magnetostatic interactions, (7) particle shape, (8) thermal relaxation, (9) magnetic particle mixtures, and (10) definitional/measurement issues. In most studies, these variables are unknowns and cannot be controlled for, so that hysteresis parameters for single bulk samples are nonunique and any data point in a Day diagram could result from infinite combinations of relevant variables. From this critical appraisal, we argue that the Day diagram is fundamentally ambiguous for domain state diagnosis. Widespread use of the Day diagram has also contributed significantly to prevalent but questionable views, including underrecognition of the importance of stable SD particles in the geological record and reinforcement of the unhelpful PSD concept and of its geological importance. Adoption of approaches that enable correct domain state diagnosis should be an urgent priority for component-specific understanding of magnetic mineral assemblages and for quantitative rock magnetic interpretation.

  8. An appraisal of the quality of published qualitative dental research.

    Science.gov (United States)

    Masood, Mohd; Thaliath, Ebin T; Bower, Elizabeth J; Newton, J Timothy

    2011-06-01

    To appraise the quality of published qualitative research in dentistry and identify aspects of quality, which require attention in future research. Qualitative research studies on dental topics were appraised using the critical appraisal skills programme (CASP) appraisal framework for qualitative research. The percentage of CASP criteria fully met during the assessment was used as an indication of the quality of each paper. Individual criteria were not weighted. Forty-three qualitative studies were identified for appraisal of which 48% had a dental public health focus. Deficiencies in detail of reporting, research design, methodological rigour, presentation of findings, reflexivity, credibility of findings and relevance of study were identified. Problems with quality were apparent irrespective of journal impact factor, although papers from low impact factor journals exhibited the most deficiencies. Journals with the highest impact factors published the least qualitative research. The quality of much of the qualitative research published on dental topics is mediocre. Qualitative methods are underutilized in oral health research. If quality guidelines such as the CASP framework are used in the context of a thorough understanding of qualitative research design and data analysis, they can promote good practice and the systematic assessment of qualitative research. © 2010 John Wiley & Sons A/S.

  9. Sex differences in the appraisal of traumatic events and psychopathology.

    Science.gov (United States)

    Kucharska, Justyna

    2017-09-01

    The current study is an investigation of the relationship between the appraisal of traumatic events and mental disorder symptoms: internalizing symptoms and externalizing/substance-abuse symptoms. Cumulative trauma over the lifetime was taken into account. Also, specific effects related to traumatic events of various types (i.e., betrayal trauma, accident involving a family member, physical violence, and natural disaster) were assessed. Participants, 190 young men and 277 young women, were asked to evaluate the strength with which the traumatic event impacted their lives. It was hypothesized that the relationship between traumatic experiences and mental disorder symptoms would be stronger in women than in men, and also that cognitive appraisal, in interaction with gender, would be related to the severity of the symptoms. Women showed higher levels of internalizing symptoms, but lower levels of externalizing/substance-abuse symptoms than men. Still, the correlation between cumulative trauma and both types of symptoms was stronger in women. For all types of trauma, women reported a stronger negative appraisal of the event than men. Interaction of sex and cognitive appraisal was demonstrated to be related to the severity of internalizing disorders. In the present study, women, as compared with men, evaluated traumatic events more negatively (for all types of trauma) and the relationship between trauma and mental disorder symptoms was also stronger in women. These results show the importance of the appraisal of trauma in the development of psychiatric symptoms in women and men following trauma. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  10. 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.

  11. 16. PRE-OPERATIVE BLADDER IRRIGATION

    African Journals Online (AJOL)

    Esem

    effectiveness of using preoperative bladder irrigation with 1% povidone iodine in reducing ... consenting patient who presented to the department of surgery for open ..... infections in a tertiary care center in south-western. Nigeria. International ...

  12. 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

  13. 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.

  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. A Critical Appraisal of the `Day' Diagram

    Science.gov (United States)

    Roberts, A. P.; Tauxe, L.; Heslop, D.

    2017-12-01

    The `Day' diagram [Day et al., 1977; doi:10.1016/0031-9201(77)90108-X] is used widely to infer the mean domain state of magnetic mineral assemblages. The Day plot coordinates are the ratios of the saturation remanent magnetization to saturation magnetization (Mrs/Ms) and the coercivity of remanence to coercivity (Bcr/Bc), as determined from a major hysteresis loop and a backfield demagnetization curve. Based on theoretical and empirical arguments, Day plots are typically demarcated into stable single domain (SD), `pseudosingle domain' (`PSD'), and multidomain (MD) zones. It is a simple task to determine Mrs/Ms and Bcr/Bc for a sample and to assign a mean domain state based on the boundaries defined by Day et al. [1977]. Many other parameters contribute to variability in a Day diagram, including surface oxidation, mineral stoichiometry, stress state, magnetostatic interactions, and mixtures of magnetic particles with different sizes and shapes. Bulk magnetic measurements usually lack detailed independent evidence to constrain each free parameter, which makes the Day diagram fundamentally ambiguous. This raises questions about its usefulness for diagnosing magnetic particle size variations. The Day diagram is also used to make inferences about binary mixing of magnetic particles, where, for example, mixtures of SD and MD particles give rise to a bulk `PSD' response even though the concentration of `PSD' grains could be zero. In our assessment of thousands of hysteresis measurements of geological samples, binary mixing occurs in a tiny number of cases. Ternary, quaternary, and higher order mixing are usually observed. Also, uniaxial SD and MD end-members are nearly always inappropriate for considering mixing because uniaxial SD particles are virtually non-existent in igneous rocks. Thus, use of mixing lines in Day diagrams routinely provides unsatisfactory representations of particle size variations. We critically appraise the Day diagram and argue that its many

  16. The Efficacy of Performance Appraisal to Increase Employees’ Job Satisfaction

    Directory of Open Access Journals (Sweden)

    Iranita Hervi Mahardayani

    2016-08-01

    Full Text Available This research aims to find out the effectiveness of implementation performance appraisal toward job satisfaction of employees UMKM Bordir Dahlia in Kabupaten Kudus. Sampling was done by using population studies to 16 employees of UMKM embroidery Dahlia Kudus. The type of this research is quantitative with pra experiment approached by One group pre and posttest design method. Data analysis on this research using non parametric with different test techniques Wilcoxon t-tes. The analysis result of different test scale job satisfaction before and after handling obtained Z = - 1,268, with p = 0,205 (p>0,05, so that there is no differences on job satisfaction on employees of embroidery Dahlia before and after treatment by giving performance appraisal. It means treatment by giving performance appraisal unable to increase employees job satisfaction. Therefore, the hypothesis on this research is rejected.

  17. Why is discrimination stressful? The mediating role of cognitive appraisal.

    Science.gov (United States)

    King, Kimberly R

    2005-08-01

    This study attempts to shed light on past findings that experiences of racial and gender discrimination are associated with poor psychological and physical health outcomes by investigating the role of cognitive appraisal as a mediator of the relationship between experiences of discrimination and affective stress reactions. African American female college students (N = 115) imagined themselves in an audiotaped scenario in which they overheard 2 European American male classmates make negative evaluations of them. Participants then completed measures of causal attributions, cognitive appraisal, and affective stress reactions. Multiple regression analyses supported the hypotheses that attributions to racism and to discrimination that combines racism and sexism were associated with increased stress reactions. This relationship was mediated by cognitive appraisals of centrality. (c) 2005 APA

  18. COMMUNICATION OPENNESS IN PERFORMANCE APPRAISAL SYSTEMS ENHANCING JOB SATISFACTION

    Directory of Open Access Journals (Sweden)

    ISMAIL Azman

    2014-06-01

    Full Text Available The aim of this paper is to investigate the relationship between communication openness in performance appraisal systems and job satisfaction. A survey method was employed to gather data from employees who have worked in a privatized postal company in Sarawak, Malaysia. SmartPLS version 2.0 was used to determine the validity and reliability of instrument and test the research hypotheses. The outcomes of SmartPLS path model showed that explanation and feedback were positively and significantly related to job satisfaction. This result confirms that the ability of appraisers to clearly explain the performance appraisal practices and adequately provide feedback in determining performance scores have been important predictors of appraises’ job satisfaction in the studied organization. Further, this study provides discussion, implications and conclusion.

  19. Artificial Neural Networks and the Mass Appraisal of Real Estate

    Directory of Open Access Journals (Sweden)

    Gang Zhou

    2018-03-01

    Full Text Available With the rapid development of computer, artificial intelligence and big data technology, artificial neural networks have become one of the most powerful machine learning algorithms. In the practice, most of the applications of artificial neural networks use back propagation neural network and its variation. Besides the back propagation neural network, various neural networks have been developing in order to improve the performance of standard models. Though neural networks are well known method in the research of real estate, there is enormous space for future research in order to enhance their function. Some scholars combine genetic algorithm, geospatial information, support vector machine model, particle swarm optimization with artificial neural networks to appraise the real estate, which is helpful for the existing appraisal technology. The mass appraisal of real estate in this paper includes the real estate valuation in the transaction and the tax base valuation in the real estate holding. In this study we focus on the theoretical development of artificial neural networks and mass appraisal of real estate, artificial neural networks model evolution and algorithm improvement, artificial neural networks practice and application, and review the existing literature about artificial neural networks and mass appraisal of real estate. Finally, we provide some suggestions for the mass appraisal of China's real estate.

  20. FASP, an analytic resource appraisal program for petroleum play analysis

    Science.gov (United States)

    Crovelli, R.A.; Balay, R.H.

    1986-01-01

    An analytic probabilistic methodology for resource appraisal of undiscovered oil and gas resources in play analysis is presented in a FORTRAN program termed FASP. This play-analysis methodology is a geostochastic system for petroleum resource appraisal in explored as well as frontier areas. An established geologic model considers both the uncertainty of the presence of the assessed hydrocarbon and its amount if present. The program FASP produces resource estimates of crude oil, nonassociated gas, dissolved gas, and gas for a geologic play in terms of probability distributions. The analytic method is based upon conditional probability theory and many laws of expectation and variance. ?? 1986.

  1. Safety management: a few techniques and their application

    International Nuclear Information System (INIS)

    Soundararajan, S.

    2016-01-01

    Industrial safety practice has grown in its stature tremendously since the age of industrial revolution. A number of modern techniques are available to strengthen design safety features, to review operational safety, and to critically appraise and upgrade practices of occupational safety and health management. This talk focuses on three prominent yet simple techniques and their usefulness in the overall safety management of a workplace. Any industrial set-up undergoes different stages in its life cycle-conceptual design, actual design, construction, fabrication and installation, commissioning, operation, shutdown/re-start up and decommissioning. Checklist procedure is a safety tool that can be applied at any of these stages. Thus it is a quite useful technique in safety management and accident prevention. It can serve as a form of approval from one step to another in the course of any routine or specific task. Safety Audit or Safety Review is a critical safety management appraisal tool. It gives a reasonable indication of how well a company's safety programme works, how hazards are recognised, how well employees are motivated and so on. It gives a clear picture about where a company stands as far as framing and implementation of its SHE policy is concerned. Each of the above tools is complementing each other and required to be applied at appropriate juncture in sustaining good safety management system at the workplace

  2. 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 receptors and auto

  3. Auto Safety

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Auto Safety KidsHealth / For Parents / Auto Safety What's in this ... by teaching some basic rules. Importance of Child Safety Seats Using a child safety seat (car seat) ...

  4. Nonlinear Appraisal Modeling: An Application of Machine Learning to the Study of Emotion Production

    OpenAIRE

    Meuleman, Ben; Scherer, Klaus R.

    2013-01-01

    Appraisal theory of emotion claims that emotions are not caused by "raw" stimuli, as such, but by the subjective evaluation (appraisal) of those stimuli. Studies that analyzed this relation have been dominated by linear models of analysis. These methods are not ideally suited to examine a basic assumption of many appraisal theories, which is that appraisal criteria interact to differentiate emotions, and hence show nonlinear effects. Studies that did model interactions were either l...

  5. 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)…

  6. 12 CFR 564.8 - Appraisal policies and practices of savings associations and subsidiaries.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Appraisal policies and practices of savings associations and subsidiaries. 564.8 Section 564.8 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY APPRAISALS § 564.8 Appraisal policies and practices of savings associations and...

  7. 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…

  8. (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,

  9. 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..., requirements, or expectations for the employees they supervise to ensure that they clearly link to...

  10. 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…

  11. Automatic Affective Appraisal of Sexual Penetration Stimuli in Women with Vaginismus or Dyspareunia

    NARCIS (Netherlands)

    Huijding, Jorg; Borg, Charmaine; Weijmar-Schultz, Willibrord; de Jong, Peter J.

    Introduction. Current psychological views are that negative appraisals of sexual stimuli lie at the core of sexual dysfunctions. It is important to differentiate between deliberate appraisals and more automatic appraisals, as research has shown that the former are most relevant to controllable

  12. 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...

  13. 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 be...

  14. An appraisal of undergraduate curriculum of technical education in ...

    African Journals Online (AJOL)

    The purpose of this study was to appraise the curriculum of technical teacher education in terms of its compatibility to the goals of the programme. A sample of three Universities offering technical teacher programme was used for the study. Components of the technical teacher education curriculum in each institution were ...

  15. 49 CFR 24.103 - Criteria for appraisals.

    Science.gov (United States)

    2010-10-01

    ...-year sales history of the property. (See appendix A, § 24.103(a)(1).) (ii) All relevant and reliable..., § 24.103(a).) (iii) A description of comparable sales, including a description of all relevant physical..., signature, and certification of the appraiser. (b) Influence of the project on just compensation. The...

  16. Quantum theories of the early universe - a critical appraisal

    International Nuclear Information System (INIS)

    Hu, B.L.

    1988-01-01

    A critical appraisal of certain general problems in the study of quantum processes in curved space as applied to the construction of theories of the early universe is presented. Outstanding issues in different cosmological models and the degree of success of different quantum processes in addressing these issues are summarized. (author)

  17. MAPS evaluation report and procedures governing interviews and performance appraisals

    CERN Multimedia

    HR Department

    2006-01-01

    Following various improvements to the MAPS report and to the procedures governing interviews and performance appraisals (announced in the CERN Bulletin 48-49/2005), a third information session has been organized for all staff members on Tuesday, 31 January at 10 a.m.: AB Auditorium P (864-1-D02), Human Resources Department Tel. 73566

  18. Dimensions in Appraising Fatigue in Relation to Performance

    NARCIS (Netherlands)

    Dam, A. van; Keijsers, G.P.J.; Eling, P.A.T.M.

    2011-01-01

    Studies on the relation between fatigue and performance often fail to find a strong and direct link, implying that multiple factors may be involved. A literature search on the fatigue-performance relationship suggests that two different conceptual frameworks are employed concerning the appraisal of

  19. Performance appraisal: carrot or stick? | Quinn | South African ...

    African Journals Online (AJOL)

    To be critically reflective, practitioners need to gather feedback about their performance so that they can reflect on it and develop themselves in those areas in which weaknesses are recognised. The Academic Development Centre staff agreed to participate in a departmental Performance Appraisal process in order to ...

  20. 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

  1. An Appraisal of the Axiological Dimension of Sexual Relationships ...

    African Journals Online (AJOL)

    In other words, one could say that the attitudes of adolescents towards dating, masturbation or even sexual intercourse are rather negative. Significantly, however, the crux of this article is to establish and appraise the axiological dimension of the permissive sexual relationship with affection, thereafter, suggests ways of ...

  2. 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…

  3. Taking a Second Look at Economic Stabilization Policy: Appraisal ...

    African Journals Online (AJOL)

    Taking a Second Look at Economic Stabilization Policy: Appraisal and issues. ... International Journal of Development and Management Review ... It draws from a background of arguments of different schools of thought on which of the two approaches is better suited for controlling the economy of nations in order to achieve ...

  4. 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.

  5. Productivity Implications of Employee Performance Appraisal System : A Critical Survey.

    OpenAIRE

    Dr. VSR Subramaniam

    2004-01-01

    The Productivity of any organisation is directly correlated to the Effectiveness of the Employee Performance Appraisal System, subject to the Effectiveness of the Support Systems, depending upon the type of organizational business. INFERENCE : Technology, Systems and Manpower are linked in an inter- related circle focusing towards Productivity =============================================================== DOCTORAL (Ph.D) RESEARCH WORK OF DR.VSR.SUBRAMANIAM IN JAMNALAL BAJAJ INSTITUTE OF MANA...

  6. An APPRAISAL analysis of the language of real estate advertisements

    African Journals Online (AJOL)

    This article focuses on the linguistic choices made by estate agencies in their advertisements of houses, and how these choices compare across two competing agencies in Grahamstown, South Africa – Remax Frontier and Pam Golding Properties. Using Martin and White's (2005) APPRAISAL system, it investigates the ...

  7. 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

  8. Appraisal of in-service trainee teachers' competency on applications ...

    African Journals Online (AJOL)

    Most procedures used to obtain information about student learning are subsumed under assessment. This study appraised in-service trainee teachers' competency on applications of principles of test items writing. One Study Centre was purposively drawn from the National Teachers' Institute for the study. A sample of 33 ...

  9. 116 Appraisal as a Determinant for Adequate Compensation in ...

    African Journals Online (AJOL)

    User

    2012-01-24

    Jan 24, 2012 ... The fundamental question this work seeks to answer. Appraisal as a Determinant for ..... Organizations should invest richly on people and strive to ... Human Resource Management, New York, McGraw. Hill/Irwin. Drucker P. E. ...

  10. 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

  11. An appraisal of information and communication technologies as new ...

    African Journals Online (AJOL)

    An appraisal of information and communication technologies as new media tools for language teaching and learning in tertiary institutions in Nigeria. ... ICTs, the teacher-student interaction in the learning process is situated within a dynamic pedagogical context that could go beyond the four walls of a traditional classroom.

  12. Integrated performance appraisal of Daylight-Europe case study buildings

    NARCIS (Netherlands)

    Hensen, J.L.M.; Clarke, J.A.; Hand, J.W.; Johnson, K.; Wittchen, K.; Madsen, C.; Compagnon, R.

    1996-01-01

    This paper describes the approach taken within the EC’s Daylight-Europe project to apply combined thermal/daylight simulations to existing building designs which are representative of European types and climate contexts. The outputs from the performance appraisals are then incorporated within design

  13. Caregiving Appraisal in Family Caregivers of Older Adults

    Directory of Open Access Journals (Sweden)

    Akram Farhadi

    2016-04-01

    Conclusion: Caregiving appraisal is a multidimensional concept, which has positive and negative aspects. By taking into account all aspects of this concept, one can better understand and ultimately has a more comprehensive assessment of the status of caregivers, and implement effective interventions towards improving the health of this group.

  14. Job Analysis, Job Descriptions, and Performance Appraisal Systems.

    Science.gov (United States)

    Sims, Johnnie M.; Foxley, Cecelia H.

    1980-01-01

    Job analysis, job descriptions, and performance appraisal can benefit student services administration in many ways. Involving staff members in the development and implementation of these techniques can increase commitment to and understanding of the overall objectives of the office, as well as communication and cooperation among colleagues.…

  15. The appraisal of mathematics teachers in Ghana | Fletcher | African ...

    African Journals Online (AJOL)

    This study examined the nature and existing methods of teacher appraisal in Ghana. 441 secondary mathematics teachers participated, of whom 193 teach the subject at the junior secondary level and 248 teach it at the senior secondary level. In addition, 44 Ghana Education Service Officials and 6 Heads of secondary ...

  16. Appraisal of the Performance of Contingency Cost Provision for ...

    African Journals Online (AJOL)

    The paper appraised performance of contingency allowance in addressing projects' cost risk. To achieve this aim, impact of contingency provision in some selected building projects were evaluated. Data for the study was collected by means of checklist from 40 completed projects' files. Furthermore, 100 questionnaires on ...

  17. A Preliminary Appraisal Of The Composition And Industrial ...

    African Journals Online (AJOL)

    A preliminary appraisal of the composition and geotechnical properties of clay deposits at Tumfure, Rukwu and Tashar Garba in Udubo area, northeastern Nigeria has been undertaken and results related to their industrial suitability. Mineralogical studies indicate that the clay is mainly kaolinitic while quartz and feldspar are ...

  18. 32 CFR 644.47 - Appraisal of other interests.

    Science.gov (United States)

    2010-07-01

    ... improvements will include, in addition to complete coverage of all factors influencing the use of the property... construction. (ii) Complete cost data as to original purchase price and Government construction. (iii) Detailed... inspected, it will be so noted in the appraisal report. The decision concerning the necessity for a physical...

  19. Book appraisal: history of dentistry in Nigeria | Michael ... - Ibadan

    African Journals Online (AJOL)

    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 ...

  20. Admissibility of hearsay evidence in criminal trials: an appraisal of ...

    African Journals Online (AJOL)

    Admissibility of hearsay evidence in criminal trials: an appraisal of the Ethiopian legal framework. ... Haramaya Law Review ... Despite Ethiopia following a common law approach regarding evidentiary principles, rules and procedural safeguards in criminal trials, the country does not have a codified and compiled evidence ...