Sample records for subjects received pre-operative

  1. Should pre-operative left atrial volume receive more consideration in patients with degenerative mitral valve disease undergoing mitral valve surgery? (United States)

    Di Gioia, Giuseppe; Mega, Simona; Nenna, Antonio; Campanale, Cosimo Marco; Colaiori, Iginio; Scordino, Domenico; Ragni, Laura; Miglionico, Marco; Di Sciascio, Germano


    Severe primary mitral regurgitation (MR) carries a significant incidence of mortality and morbidity. Though a number of prognostic factors have been identified, the best timing for mitral valve repair is still debated. We assessed the role of Left Atrial Volume Indexed (LAVI) as predictor of adverse events after mitral valve surgery. 134 patients with severe MR were studied with a follow-up of 42±16months. Endpoints were Post-Operative Atrial Fibrillation (POAF), atrial and ventricular remodeling (LARR/LVRR) and correlation with outcome. POAF was defined as AF occurring within 2weeks and late AF (LAF) more than 2weeks after surgery. LARR was defined as LAVI reduction ≥15% and LVRR as any reduction of ventricular mass after surgery. Forty-one patients experienced POAF, 26 had LAF. Pre-operative LAVI was an independent risk factor for POAF (OR 1.03, CI [1.00-1.06], p=0.01), LAF (OR 1.03, CI [1.00-1.06], p=0.02), LARR and LVRR (OR 1.04, CI [1.01-1.07], p=0.002, respectively). LARR was found in 75 patients, while LVRR in 111. Patients with heart remodeling had less incidence of LAF and cardiac adverse events, better diastolic function and improved their NYHA class after surgery. LAVI should be given more weight into decision making for patients with MR as it predicts POAF and LAF and reverse atrial and ventricular remodeling, both associated to long-term outcome. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Predictors of Pre-operative Anxiety in Indian Children. (United States)

    Malik, Ritu; Yaddanpudi, Sandhya; Panda, Nidhi Bidyut; Kohli, Adarsh; Mathew, Preethy J


    To identify the predictors of pre-operative anxiety in school-going children in India. A prospective observational study was done at a tertiary care teaching hospital. Children aged 7-12 y scheduled for elective surgery and their parents were enrolled. Pre-operative anxiety in children and parents was assessed using STAI-C and STAI-P questionnaires respectively. The child's anxiety in pre-op room, at the time of parental separation and induction of anesthesia were assessed using m-YPAS scale. Possible predictors of anxiety under 'individual', 'social' and 'healthcare' domains were analyzed using logistic regression. The quality of mask induction of anesthesia was assessed using Induction Compliance Checklist. Sixty children completed the study successfully. Receiver operating characteristic (ROC) curve indicted mYPAS score ≥ 30 (observed score) to identify children with high anxiety as identified by STAI-C ≥37 (self-reported score). The incidence of high anxiety escalated from pre-operative time (48%) to the time of parental separation (72%) and increased further at anesthetic induction (95%). Parental anxiety (p = 0.03) and socioeconomic background (p = 0.03) were significant predictors of the child's pre-operative anxiety. The presence of >4 people at induction (p = 0.002), but not pre-operative anxiety, was found significantly more in children with poor quality of mask induction. The incidence of peri-operative anxiety in Indian children is significant. Parental anxiety and socioeconomic background were found significant predictors of high pre-operative anxiety in our set-up.

  3. Specialist pre-operative assessment clinics. (United States)

    Dhesi, J K; Swart, M


    While specialist pre-operative assessment is not new, its focus has evolved in response to more operations and changes in the surgical population. Patients are older and have more long-term medical comorbidities. At the same time, there has been a move from paternalistic medical decision-making to shared decision-making, based on an individual patient's choice or preference. Specialist pre-operative consultations have had to adapt to these changes by broadening their scope. Pre-operative clinics have a central role in shared decision-making, coordinating and planning care before, during and after surgery, including rehabilitation and discharge planning. Multiple specialties need to work together to deliver quality patient-centred care. © 2015 The Association of Anaesthetists of Great Britain and Ireland.

  4. Pre-operative fasting guidelines: an update

    DEFF Research Database (Denmark)

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


    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...

  5. Total knee replacement pre-operative education in a Singapore tertiary hospital: A best practice implementation project. (United States)

    Goh, Mien Li; Chua, Joo Yee; Lim, Ling


    To increase the competency of specialist outpatient clinic nurses in the provision of pre-operative total knee replacement (TKR) education, and ensure that all patients scheduled for elective TKR received the pre-operative education package. The project was implemented in three phases. Phase 1 entailed a baseline audit that analysed 30 randomized TKR patients who received pre-operative education. In Phase 2, the gaps and barriers in the project were discussed. Using best practice recommendations from the Joanna Briggs Institute, the project team leader collated and standardized the pre-operative education tools, which consisted of a pictorial booklet, a video and home care advice. A teaching plan guided the nurses to increase their understanding and improve practice using the education tools. The usefulness of education strategies and tools was discussed and these were improved over the proposed timeline. Phase 3 entailed a post-implementation audit to evaluate the provision of pre-operative education. Post implementation, nurses' competency in the provision of pre-operative TKR education increased from 18% to 91%. The number of patients who received the structured pre-operative education package increased from 27% to 50%. Overall, there was improvement in the provision of pre-operative TKR education to patients by clinic nurses using evidence-based best practice and a standardized education package. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. Subjective Probability of Receiving Harm as a Function of Attraction and Harm Delivered. (United States)

    Schlenker, Barry R.; And Others

    It was hypothesized that subjects who liked a source of potential harm would estimate the probability of receiving harm mediated by him as lower than would subjects who disliked the source. To test the hypothesis, subjects were asked to estimate the probability that a liked or disliked confederate would deliver an electric shock on each of 10…

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

    Directory of Open Access Journals (Sweden)

    V. V. Kurenkov


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

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

    Directory of Open Access Journals (Sweden)

    V. V. Kurenkov


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

  9. 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

  10. Appraisal of guidelines for pre-operative body wash. (United States)

    Edström, Elisabet; Westerberg, Lisa; Henricson, Maria

    The pre-operative body wash is a strategy for reducing post-operative infection. However, there is a lack of knowledge about its importance. The purpose of the present study was to evaluate the quality of guidelines for the pre-operative body wash using the AGREE instrument--35 guidelines containing instructions for the pre-operative body wash or preparation were included. The AGREE instrument was employed to establish a quality assessment framework that facilitated a comparison of the guidelines. The results were based on the six domains of the AGREE instrument, all of which were found to have low adherence. Descriptive statistics were used to present the assessment score. The AGREE instrument is useful for evaluating the quality of clinical guidelines. The development of evidence-based guidelines must include clinical activities. Further research is required to clarify the pre-operative body wash process and how it should be performed to reduce post-operative infection.

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

    DEFF Research Database (Denmark)

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


    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......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...... (7%), all whom experienced no pain or pain less than weekly. Only cool detection thresholds were significantly lower between the hernia vs. contralateral side (pPre-operative groin hernia...

  12. 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


    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.

  13. Pre-operative biliary drainage for obstructive jaundice (United States)

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


    Background Patients with obstructive jaundice have various pathophysiological changes that affect the liver, kidney, heart, and the immune system. There is considerable controversy as to whether temporary relief of biliary obstruction prior to major definitive surgery (pre-operative biliary drainage) is of any benefit to the patient. Objectives To assess the benefits and harms of pre-operative biliary drainage versus no pre-operative biliary drainage (direct surgery) in patients with obstructive jaundice (irrespective of a benign or malignant cause). Search methods We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Clinical Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until February 2012. Selection criteria We included all randomised clinical trials comparing biliary drainage followed by surgery versus direct surgery, performed for obstructive jaundice, irrespective of the sample size, language, and publication status. Data collection and analysis Two authors independently assessed trials for inclusion and extracted data. We calculated the risk ratio (RR), rate ratio (RaR), or mean difference (MD) with 95% confidence intervals (CI) based on the available patient analyses. We assessed the risk of bias (systematic overestimation of benefit or systematic underestimation of harm) with components of the Cochrane risk of bias tool. We assessed the risk of play of chance (random errors) with trial sequential analysis. Main results We included six trials with 520 patients comparing pre-operative biliary drainage (265 patients) versus no pre-operative biliary drainage (255 patients). Four trials used percutaneous transhepatic biliary drainage and two trials used endoscopic sphincterotomy and stenting as the method of pre-operative biliary drainage. The risk of bias was high in all trials. The proportion of patients with malignant obstruction varied between 60

  14. [Impact of a pre-operative mobilisation program using the Viv-Arte training model based on kinesthetic mobilisation on mobility, pain, and post-operation length of stay of patients receiving an elective medial laparotomy: a prospective, randomised, controlled pilot study]. (United States)

    Haasenritter, Jörg; Eisenschink, Anna Maria; Kirchner, Elisabeth; Bauder-Missbach, Heidi; Brach, Michael; Veith, Jessica; Sander, Silvia; Panfil, Eva-Maria


    A medial incision is a common surgical technique to obtain access to the abdomen. Thereby, the muscles involved in movement are manipulated, leading to post-operative restrictions in mobility and pain determined by movement. The aim of this pilot study was to assess the impact of a pre-operative training session using the Viv-Arte model, which is based on kinesthetic mobilisation principles. The parameters to be measured were mobility, pain, and length of hospital stay for patients, who were undergoing elective medial laparotomy. In addition, the study tested the research design and to identify possible effect sizes. The method chosen was a prospective, randomised, controlled, and unblinded design. Twenty-seven patients were involved (median=63 years, 19 of the patients were male) who were to have a medial incision for cystectomy. The intervention involved pre-operative training of post-operative mobility techniques. Mobility was tested using the "Mobilitätstest für Patienten im Akutkrankenhaus (MOTPA) (Mobility test for patients in hospital)"; pain intensity was assessed using the visual analogue scale. The intervention and control groups were comparable for all variables. There were no significant differences in the two groups related to the objectives. It is possible that the study groups or the operationalisation were not appropriate for testing the effects of the intervention. It seems important to continue to develop instruments that are appropriate for measuring the effect of mobility-related interventions.

  15. Inadequacy of computed tomography for pre-operative planning of patellofemoral arthroplasty. (United States)

    Saffarini, Mo; Müller, Jacobus H; La Barbera, Giuseppe; Hannink, Gerjon; Cho, Kyung Jin; Toanen, Cécile; Dejour, David


    To evaluate the accuracy of preoperative planning for patellofemoral arthroplasty (PFA) by comparing: (1) virtual implant positioning simulated on pre-operative images versus (2) real implant positioning from post-operative images. The authors prospectively studied 15 patients that received a PFJ implant (Tornier, Montbonnot France). A pre-operative planning software was established to determine the size and position of the trochlear component. Pre-operative scans were used to perform virtual implantations by two different operators, which were then compared to the post-operative scans to calculate errors (ε) in implant positioning and intra-class correlation coefficients (ICC) for intra- and inter-observer repeatability. Analysis was performed for 13 patients, for whom agreement between virtual and real surgery was excellent for anteroposterior (AP) position (ICC = 0.84; ε max = 3.5 mm), fair for proximodistal (PD) position (ICC = 0.50; ε max  = 9.5 mm), and poor for mediolateral (ML) position (ICC = 0.07; ε max = 9.0 mm). It was fair for flexum-recurvatum (FR) alignment (ICC = 0.53; ε max = 8.2°), poor for varus-valgus (VV) alignment (ICC = 0.34; ε max = 10.0°), and internal-external (IE) rotation (ICC = 0.34; ε max = 10.6°). Pre-operative planning was insufficiently accurate to follow intra-operatively, the greatest errors being angular alignment (VV and FR). The clinical relevance of these findings is that PFA is difficult to plan pre/operatively due to non-visibility of cartilage on CT scans and to trochlear dysplasia in most cases. Prospective evaluation of operative tools on consecutive patients, Level III.

  16. 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 ...

  17. Pre-operative diagnosis of thyroid cancer: Clinical, radiological and ...

    African Journals Online (AJOL)

    ing of significant voice changes. Of the patients 14 had either metastatic disease or clinically detectable lymphadenopathy at presentation. Definite diagnosis of malignancy. (38 patients). In 38 cases there was a definite pre- operative diagnosis of thyroid cancer. These cases included all 10 of the patients with anaplastic ...

  18. Pre-operative counselling for laryngectomy patients: a systematic review. (United States)

    Fitzgerald, E; Perry, A


    This study aimed to undertake a systematic review of the literature about pre-operative counselling for laryngectomy patients, identify its practice and patient and (where possible) carer perceptions. A search strategy was formulated using a concept map and a Population, Intervention, Comparative Interaction and Outcomes ('PICO') schema. All publications from 1975 to 2015 reporting pre-operative counselling of laryngectomy patients were included. Papers were retrieved and critiqued, and those included were assigned a level of evidence (according to the Joanna Briggs Institute schema). Of the 56 papers retrieved, 21 were included in the review. The literature is limited: studies demonstrate bias and are of poor methodological quality. There are clear, persistent reports by patients and carers of shortfalls in clinical practice. Studies on pre-operative counselling for laryngectomees are flawed in design and represent weak levels of evidence. Pre-operative counselling has not been operationalised, resulting in differing paradigms being examined. Aggregation of data and/or results is not possible and the veracity of many studies is questioned.

  19. Effect of supplemental pre-operative fluid on postoperative nausea and vomiting. (United States)

    Ali, S Z; Taguchi, A; Holtmann, B; Kurz, A


    In a prospective, double-blind, randomised controlled trial, we studied the effects of pre-operative fluid load on post-operative nausea and vomiting. Eighty patients attending for laparoscopic cholecystectomy or gynaecological surgery were randomly allocated to receive 2 (conservative) or 15 (supplemental) Hartmann's solution intravenously, shortly before induction of anaesthesia. During the operation, fluid management was identical in both groups. During the first post-operative 24 h, post-operative nausea and vomiting occurred in 29 patients (73%) in the conservative fluid group and nine patients (23%) in the supplemental fluid group (p = 0.01). Supplemental pre-operative fluid is an inexpensive and safe therapy for reducing post-operative nausea and vomiting.

  20. Trends in the use of pre-operative radiation for adenocarcinoma of the pancreas in the United States (United States)

    Burke, Erin E; Marmor, Schelomo; Portschy, Pamela R; Virnig, Beth A; Cho, Lawrence C; Tuttle, Todd M; Jensen, Eric H


    Background The benefit and timing of radiation therapy (RT) for patients undergoing a resection for pancreatic adenocarcinoma remains unclear. This study identifies trends in the use of radiation over a 10-year period and factors associated with the use of pre-operative radiation, in particular. Methods The Surveillance, Epidemiology and End Results registry was used to identify patients aged ≥18 years with pancreatic adenocarcinoma who underwent a surgical resection between 2000 and 2010. Logistic regression was used to identify time trends and factors associated with the use of pre-operative radiation. Results The overall use of radiation decreased with time among the 8474 patients who met the inclusion criteria. However, the use of pre-operative radiation increased from 1.8% to 3.9% (P ≤ 0.05). Factors significantly associated with receipt of pre-operative radiation were younger age, treatment in more recent years and having an advanced T-stage tumour. The 5-year hazard of death was significantly less for those who received pre-operative radiation versus surgery alone [hazard ratio (HR) 0.64, 95% confidence interval (CI) 0.55–0.74] and for those who received post-operative radiation versus surgery alone (HR 0.69, 95% CI 0.65–0.73). Discussion The use of pre-operative radiation significantly increased during the study period. However, the overall use of pre-operative radiation therapy remains low in spite of the potential benefits. PMID:25726950

  1. Videoconferencing for the pre-operative interaction between patient and surgeon. (United States)

    Del Signore, Anthony G; Dang, Rajan; Yerasi, Arjun; Iloreta, Alfred M; Malkin, Benjamin D


    We studied the use of videoconferencing for the pre-operative patient-surgeon interaction. Subjects were recruited from otolaryngology patients undergoing surgery at a tertiary hospital. They were randomised to a conventional face-to-face interaction with their surgeon or a videoconference call via tablet computer. Afterwards, subjects and surgeons completed questionnaires about the experience. Various time points in patient flow were also recorded. Thirty-one patients were enrolled and 25 completed the study; five surgeons participated. The mean overall patient satisfaction scores were similar in the face-to-face and videoconferencing groups (9.88 and 9.89, respectively), as were mean interaction times (119 and 82 s, respectively); neither difference was significant. The mean waiting times in the pre-operative holding area were not significantly different between the groups. Surgeons were satisfied with the videoconferencing and 60% indicated they were somewhat likely to incorporate the technology into their daily practice. Overall patient satisfaction with a pre-operative patient-surgeon interaction via videoconferencing did not differ significantly from that for a conventional face-to-face discussion. It is feasible to incorporate videoconferencing into a busy surgical practice and there is the potential for improved efficiency. © The Author(s) 2014 Reprints and permissions:

  2. Seroreversion in subjects receiving antiretroviral therapy during acute/early HIV infection. (United States)

    Hare, C Bradley; Pappalardo, Brandee L; Busch, Michael P; Karlsson, Annika C; Phelps, Bruce H; Alexander, Steven S; Bentsen, Christopher; Ramstead, Clarissa A; Nixon, Douglas F; Levy, Jay A; Hecht, Frederick M


    We assessed human immunodeficiency virus (HIV) antibody seroreversion among individuals initiating antiretroviral therapy (ART) during acute/early HIV infection and determined whether seroreversion was associated with loss of cytotoxic T lymphocyte responses. Subjects in a cohort with acute/early HIV infection (HIV type 1 ribonucleic acid levels of 24 weeks were selected. Two clinically available second-generation enzyme immunoassays (EIAs) and a confirmatory Western blot were used to screen subjects for antibody reversion. Those with negative screening test results underwent additional antibody testing, including a third-generation EIA, and were assessed for cytotoxic T lymphocyte responses. Of 87 subjects identified, 12 (14%) had negative antibody test results at the start of ART; all 12 had seroconversion, although 1 had seroconversion only on a third-generation EIA. Of the 87 subjects, 6 (7%) had seroreversion on at least 1 EIA antibody assay while receiving ART during a median follow-up of 90 weeks. The only clinical predictor of seroreversion was a low baseline "detuned" (less sensitive) antibody. Cytotoxic T lymphocyte responses to HIV Gag peptides were detected in 4 of 5 subjects with seroreversion who could be tested. All 5 who had seroreversion who stopped ART experienced virologic rebound and antibody evolution. HIV antibody seroconversion on second-generation EIA antibody tests may fail to occur when ART is initiated early. Seroreversion was not uncommon among subjects treated early, although cytotoxic T lymphocyte responses to HIV antigens remained detectable in most subjects. Antibody seroreversion did not indicate viral eradication. A third-generation EIA was the most sensitive test for HIV antibodies.

  3. A Novel, Dynamic Statistical Model for Predicting Patient Satisfaction with Fundoplication Based on Pre-Operative Symptom Patterns. (United States)

    Woodham, B L; Meng, R; Roberts, R H


    Fundoplication provides excellent control of gastro-oesophageal reflux disease (GORD), but there remain a number of unsatisfied patients who have proven difficult to identify pre-operatively. We hypothesised that pre-operative symptom patterns can predict of the risk of post-operative dissatisfaction. Pre-operative symptoms and post-operative satisfaction were measured using standardised questionnaires along with routine investigations. These data were used to calculate our novel pre-operative risk of dissatisfaction (PROD) score. Potential pre-operative prognostic markers were tested against the post-operative satisfaction data, including the objective investigations and the PROD score. The prognostic utility of the PROD score and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guideline was tested using receiver operating characteristic analysis to determine the area under the curve (AUC). An association was found between our PROD score and each of the satisfaction measures (n = 225, p operative satisfaction. The PROD score was found to be of greater prognostic utility than the SAGES guideline (n = 166, p < 0.001). The PROD score is a novel, easy-to-use test that can predict individual patient satisfaction with fundoplication.

  4. The Use of a Pre-operative Carbohydrate Drink in Patients with Diabetes Mellitus: A Prospective, Non-inferiority, Cohort Study. (United States)

    Laffin, Michael R; Li, Shuai; Brisebois, Rondald; Senior, Peter A; Wang, Haili


    Pre-operative fasting leads to insulin resistance and increased metabolic stress in non-diabetic patients. Consumption of a carbohydrate drink may alleviate these deleterious effects. Patients with diabetes mellitus represent over 15% of the surgical population, yet concerns over hyperglycemia and aspiration have excluded patients with diabetes mellitus from studies assessing the utility of pre-operative carbohydrate drinks. To assess for a clinically significant increase in pre-operative blood glucose concentration (defined as >2 mmol/L) in patients with diabetes consuming a pre-operative carbohydrate drink. A prospective observational non-inferiority cohort study of 106 subjects with diabetes mellitus was undertaken to assess the effect of consuming a pre-operative carbohydrate drink in surgical patients. All patients with diabetes mellitus undergoing surgery (including but not limited to cardiac, neurologic, urologic, and general surgical procedures) were enrolled. Subjects were instructed to consume two carbohydrate-rich drinks, one before sleeping the evening prior to surgery and another on the day of surgery. In total, 43% of subjects were fully compliant with the pre-operative carbohydrate drink regimen. There were no significant differences between the fully compliant and non-compliant subjects with respect to baseline characteristics. Consumption of a pre-operative carbohydrate drink was determined to be non-inferior to fasting in terms of pre-operative blood glucose concentration (absolute difference 0.23 mmol/L, 95% CI: -1.00 to 1.45 mmol/L, p non-inferiority operative blood glucose concentration, hyperglycemia, or length of stay. These findings function as a step toward ensuring pre-operative carbohydrate drinks are safe in patients with diabetes undergoing surgery.

  5. Facilitating pre-operative assessment guidelines representation using SNOMED CT. (United States)

    Ahmadian, Leila; Cornet, Ronald; de Keizer, Nicolette F


    To investigate whether SNOMED CT covers the terms used in pre-operative assessment guidelines, and if necessary, how the measured content coverage can be improved. Pre-operative assessment guidelines were retrieved from the websites of (inter)national anesthesia-related societies. The recommendations in the guidelines were rewritten to "IF condition THEN action" statements to facilitate data extraction. Terms were extracted from the IF-THEN statements and mapped to SNOMED CT. Content coverage was measured by using three scores: no match, partial match and complete match. Non-covered concepts were evaluated against the SNOMED CT editorial documentation. From 6 guidelines, 133 terms were extracted, of which 71% (n=94) completely matched with SNOMED CT concepts. Disregarding the vague concepts in the included guidelines SNOMED CT's content coverage was 89%. Of the 39 non-completely covered concepts, 69% violated at least one of SNOMED CT's editorial principles or rules. These concepts were categorized based on four categories: non-reproducibility, classification-derived phrases, numeric ranges, and procedures categorized by complexity. Guidelines include vague terms that cannot be well supported by terminological systems thereby hampering guideline-based decision support systems. This vagueness reduces the content coverage of SNOMED CT in representing concepts used in the pre-operative assessment guidelines. Formalization of the guidelines using SNOMED CT is feasible but to optimize this, first the vagueness of some guideline concepts should be resolved and a few currently missing but relevant concepts should be added to SNOMED CT. Copyright © 2010 Elsevier Inc. All rights reserved.

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

    DEFF Research Database (Denmark)

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


    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......]) and assessments were correlated to patients' reports of intensity and frequency of spontaneous pain in the groin area. RESULTS: Forty-two patients were examined, whereof one was excluded since no hernia was found intraoperatively. Mechanical pain threshold was inversely correlated with spontaneous pain intensity...... (7%), all whom experienced no pain or pain less than weekly. Only cool detection thresholds were significantly lower between the hernia vs. contralateral side (phernia...

  7. The subjective experiences of people who regularly receive depot neuroleptic medication in the community. (United States)

    Phillips, L; McCann, E


    Little has been written on the subjective experiences of people who receive depot injections in the community. The authors of this paper have identified distinct gaps in the literature in terms of the views of service users regarding this particular intervention. Existing studies tend to focus upon the side effects of depot neuroleptic medication and the attitudes of Community Mental Health Nurses (CMHNs) towards administering depot medication and issues of compliance and non-compliance. Mental health nurses are frequently perceived as adhering solely to a biomedical approach to patient care in their practice and the therapeutic aspects of their role is frequently unacknowledged. This paper explores how, within the process of giving a depot injection, CMHNs are able to carry out an assessment of their client's needs as well as being someone who is consistent, reliable and supportive. This means that the process of giving a depot injection may be considered as a therapeutic intervention. Qualitative data were obtained through the administration of a semi-structured interview schedule that was constructed and consisted of a range of questions that elicited service users views and opinions related to their experiences of receiving depot neuroleptic medication in the community. The relationship between patient and nurse, as this study reveals, was one that was not only therapeutic, but also provided a forum where psychosocial and clinical issues could be discussed and explored. Crucially, the service users felt they did have a role and an influence in the delivery of their care.

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

    Directory of Open Access Journals (Sweden)

    Desrochers Randal


    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.

  9. Breast cancer development in transsexual subjects receiving cross-sex hormone treatment. (United States)

    Gooren, Louis J; van Trotsenburg, Michael A A; Giltay, Erik J; van Diest, Paul J


    Transsexual people receive cross-sex hormones as part of their treatment, potentially inducing hormone-sensitive malignancies. To examine the occurrence of breast cancer in a large cohort of Dutch male and female transsexual persons, also evaluating whether the epidemiology accords with the natal sex or the new sex. Number of people with breast cancer between 1975 and 2011. We researched the occurrence of breast cancer among transsexual persons 18-80 years with an exposure to cross-sex hormones between 5 to >30 years. Our study included 2,307 male-to-female (MtF) transsexual persons undergoing androgen deprivation and estrogen administration (52,370 person-years of exposure), and 795 female-to-male (FtM) subjects receiving testosterone (15,974 total years of exposure). Among MtF individuals one case was encountered, as well as a probable but not proven second case. The estimated rate of 4.1 per 100,000 person-years (95% confidence interval [CI]: 0.8-13.0) was lower than expected if these two cases are regarded as female breast cancer, but within expectations if viewed as male breast cancer. In FtM subjects, who were younger and had shorter exposure to cross-sex hormones compared with the MtF group, one breast cancer case occurred. This translated into a rate of 5.9 per 100,000 person-years (95% CI: 0.5-27.4), again lower than expected for female breast cancer but within expected norms for male breast cancer. The number of people studied and duration of hormone exposure are limited but it would appear that cross-sex hormone administration does not increase the risk of breast cancer development, in either MtF or FtM transsexual individuals. Breast carcinoma incidences in both groups are comparable to male breast cancers. Cross-sex hormone treatment of transsexual subjects does not seem to be associated with an increased risk of malignant breast development. © 2013 International Society for Sexual Medicine.

  10. Identifying and assessing anxiety in pre-operative patients. (United States)

    Pritchard, Michael John

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

  11. Pre-operative anxiety and nursing care - Through two students'case studies on surgical patients -


    林, 優子; 岡崎, 恵; 角, 公美子; 佐藤, 美恵


    Pre-operative nursing is to care and educate a patient so that he/she can undergo an operation at ease and in safety and recover quickly after surgery. One of the pre-operative nursing is to relieve anxiety. It's very important for pre-operative nursing to assess pre-operative anxiety and do the nursing action according to patient's anxiety level. Nursing student seems to have muchunderstanding of pre-operative anxiety through observing a patient's behavior, talking with a patient, and caring...

  12. A survey of UK peri-operative medicine: pre-operative care. (United States)

    Bougeard, A-M; Brent, A; Swart, M; Snowden, C


    The majority of UK hospitals now have a Local Lead for Peri-operative Medicine (n = 115). They were asked to take part in an online survey to identify provision and practice of pre-operative assessment and optimisation in the UK. We received 86 completed questionnaires (response rate 75%). Our results demonstrate strengths in provision of shared decision-making clinics. Fifty-seven (65%, 95%CI 55.8-75.4%) had clinics for high-risk surgical patients. However, 80 (93%, 70.2-87.2%) expressed a desire for support and training in shared decision-making. We asked about management of pre-operative anaemia, and identified that 69 (80%, 71.5-88.1%) had a screening process for anaemia, with 72% and 68% having access to oral and intravenous iron therapy, respectively. A need for peri-operative support in managing frailty and cognitive impairment was identified, as few (24%, 6.5-34.5%) respondents indicated that they had access to specific interventions. Respondents were asked to rank their 'top five' priority topics in Peri-operative Medicine from a list of 22. These were: shared decision-making; peri-operative team development; frailty screening and its management; postoperative morbidity prediction; and primary care collaboration. We found variation in practice across the UK, and propose to further explore this variation by examining barriers and facilitators to improvement, and highlighting examples of good practice. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

  13. The Effects of Pre-Operative Enteral Nutrition from Nasal Feeding Tubes on Gastric Outlet Obstruction. (United States)

    Chen, Zhi-Hua; Lin, Su-Yong; Dai, Qi-Bao; Hua, Jin; Chen, Shao-Qin


    We examined gastric outlet obstruction (GOO) patients who received two weeks of strengthening pre-operative enteral nutrition therapy (pre-EN) through a nasal-jejenal feeding tube placed under a gastroscope to evaluate the feasibility and potential benefit of pre-EN compared to parenteral nutrition (PN). In this study, 68 patients confirmed to have GOO with upper-gastrointestinal contrast and who accepted the operation were randomized into an EN group and a PN group. The differences in nutritional status, immune function, post-operative complications, weight of patients, first bowel sound and first flatus time, pull tube time, length of hospital stay (LOH), and cost of hospitalization between pre-operation and post-operation were all recorded. Statistical analyses were performed using the chi square test and t-test; statistical significance was defined as p pneumonia, and a shorter first bowel sound time, first flatus time, and post-operation hospital stay than the PN group. Pre-EN through a nasal-jejunum feeding tube and placed under a gastroscope in GOO patients was safe, feasible, and beneficial to the nutrition status, immune function, and gastrointestinal function, and sped up recovery, while not increasing the cost of hospitalization.

  14. Reproducibility of non-standardised autonomic function testing in the pre-operative assessment screening clinic*. (United States)

    Keet, S W M; Bulte, C S E; Boer, C; Bouwman, R A


    By convention, autonomic function tests are undertaken under standard test conditions that limit their implementation during routine pre-operative assessment. We therefore evaluated the comparability of autonomic function tests under both non-standardised and standardised test conditions in 20 healthy male subjects. Autonomic function was assessed using an ECG monitor and a continuous non-invasive blood pressure measurement device. Under non-standardised conditions, intraclass correlation for heart rate variability analysis was good for the low and high frequency bands (0.87; 95% CI 0.58-0.96 and 0.83; 95% CI 0.56-0.94, respectively), but moderate (0.65; 95% CI 0.14-0.86) for the very low frequency band; reproducibility was high for the expiration/inspiration ratio (0.89; 95% CI 0.71-0.96), Valsalva ratio (0.76; 95% CI 0.37-0.91) and handgrip test (0.76; 95% CI 0.35-0.91) (all pstandardised conditions was comparable to the above values. We demonstrated that reproducibility for most autonomic tests under non-standardised conditions is acceptable and suggest that implementation of these tests during pre-operative assessment may be feasible. © 2010 The Authors. Anaesthesia © 2010 The Association of Anaesthetists of Great Britain and Ireland.

  15. Pre-operative nutrition support in patients undergoing gastrointestinal surgery. (United States)

    Burden, Sorrel; Todd, Chris; Hill, James; Lal, Simon


    Post-operative management in gastrointestinal (GI) surgery is becoming well established with 'Enhanced Recovery After Surgery' protocols starting 24 hours prior to surgery with carbohydrate loading and early oral or enteral feeding given to patients the first day following surgery. However, whether or not nutritional intervention should be initiated earlier in the preoperative period remains unclear. Poor pre-operative nutritional status has been linked consistently to an increase in post-operative complications and poorer surgical outcome. To review the literature on preoperative nutritional support in patients undergoing gastrointestinal surgery (GI). The searches were initially run in March 2011 and subsequently updated in February 2012. Databases including all EBM Reviews (Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA and NHSEED) MEDLINE, EMBASE, AMED, British Nursing Index Archive using OvidSP were included and a search was run on each database separately after which duplicates were excluded. The inclusion criteria were randomised controlled trials that evaluated pre-operative nutritional support in GI surgical participants using a nutritional formula delivered by a parenteral, enteral or oral route. The primary outcomes included post-operative complications and length of hospital stay. Two observers screened the abstracts for inclusion in the review and performed data extraction. Bias was assessed for each of the included studies using the bias assessment tables in the Cochrane Software Review Manager (version 5.1, Cochrane Collaboration). The trials were analysed using risk ratios with Mantel-Haenszel in fixed effects methods displayed with heterogeneity. Meta-analyses were undertaken on trials evaluating immune enhancing (IE) nutrition, standard oral supplements, enteral and parenteral nutrition (PN) which were administered pre-operatively.Study characteristics were summarised in tables. Dichotomous and ratio data were entered into meta-analyses for

  16. Pre-operative traction for hip fractures in adults. (United States)

    Handoll, Helen Hg; Queally, Joseph M; Parker, Martyn J


    fixation failure. Three minor adverse effects (sensory disturbance and skin blisters) related to skin traction were reported.One of the above trials included both skin and skeletal traction groups. This trial and one other compared skeletal traction with skin traction and found no important differences between these two methods, although the initial application of skeletal traction was noted as being more painful and more costly. From the evidence available, the routine use of traction (either skin or skeletal) prior to surgery for a hip fracture does not appear to have any benefit. However, the evidence is also insufficient to rule out the potential advantages for traction, in particular for specific fracture types, or to confirm additional complications due to traction use.Given the increasing lack of evidence for the use of pre-operative traction, the onus should now be on clinicians who persist in using pre-operative traction to either stop using it or to use it only in the context of a well-designed randomised controlled trial.

  17. 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


    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.

  18. Feasibility and effectiveness of pre-operative inspiratory muscle training in patients undergoing oesophagectomy: a pilot study. (United States)

    Dettling, Daniela S; van der Schaaf, Marike; Blom, Rachel L G M; Nollet, Frans; Busch, Olivier R C; van Berge Henegouwen, Mark I


    Patients undergoing oesophageal surgery have a high risk for post-operative complications including pulmonary infections. Recently, physical therapy has shifted from the post-operative to the pre-operative phase to diminish post-operative complications and to shorten hospital stay. The purpose of this pilot study was to investigate the feasibility and initial effectiveness of pre-operative inspiratory muscle training (IMT) on the incidence of pneumonia in patients undergoing oesophagectomy. A pragmatic non-randomized controlled trial was conducted among all patients who underwent an oesophagectomy between January 2009 and February 2010. Patients in the intervention group received IMT prior to surgery. Feasibility was assessed on the basis of the occurrence of adverse effects during testing or training and patient satisfaction. Initial effectiveness on respiratory function was evaluated by maximal inspiratory pressure (MIP) and endurance, the incidence of post-operative pneumonia and length of hospital stay. Eighty-three patients were included, of which 44 received pre-operative IMT. No adverse effects were observed. IMT was well tolerated and appreciated. In the intervention group, the median MIP and endurance improved significantly after IMT by 32% and 41%, respectively (p pneumonia and the length of hospital stay were comparable for the intervention and the conventional care groups (pneumonia, 25% vs. 23% [p = 0.84]; hospitalization, 13.5 vs. 12 days [p = 0.08]). Pre-operative IMT is feasible in patients with oesophageal carcinoma and significantly improves respiratory muscle function. This, however, did not result in a reduction of post-operative pneumonia in patients undergoing oesophagectomy. Copyright © 2012 John Wiley & Sons, Ltd.

  19. Pre-operative traction for fractures of the proximal femur. (United States)

    Parker, M J; Handoll, H H G


    Pre-operative traction following an acute hip fracture remains standard practice in some hospitals. To evaluate the effects of traction applied to the injured limb prior to surgery for a fractured hip. Different methods of applying traction (skin or skeletal) were considered. We searched the Cochrane Musculoskeletal Injuries Group's specialised register (February 2003), the Cochrane Controlled Trials Register (The Cochrane Library Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to 2003 Week 8), CINAHL (1982 to February 2003), the National Research Register Issue 1, 2003, conference proceedings and reference lists of articles. Date of most recent search: February 2003. All randomised or quasi-randomised trials comparing either skin or skeletal traction with no traction, or skin with skeletal traction for patients with an acute hip fracture prior to surgery. Both reviewers independently assessed trial quality, using a nine item scale, and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, the data are presented graphically. Eight randomised trials, mainly of moderate quality, involving a total of 1349 predominantly elderly patients, were identified and included in the review. The inclusion in this review update of a newly available trial resulted in no important change in the results or conclusions. Seven trials compared traction with no traction. Although no data pooling was possible, overall these provided no evidence of benefit from traction, either in the relief of pain, ease of fracture reduction or quality of fracture reduction at time of surgery. One of these trials included both skin and skeletal traction groups. This trial and one other compared skeletal traction with skin traction and found no important differences between these two methods, although the initial application of skeletal traction was noted as being more painful and more costly. From the evidence available, the routine use of

  20. Measuring Quality of Life in Stroke Subjects Receiving an Implanted Neural Prosthesis for Drop Foot

    NARCIS (Netherlands)

    Kottink, Anke I.; IJzerman, Maarten Joost; Hermens, Hermanus J.; Groothuis-Oudshoorn, Catharina Gerarda Maria; Kottink, A.I.R.


    The aim was to determine if the treatment of a drop foot by means of an implantable two-channel peroneal nerve stimulator improves health-related quality of life (HRQoL). All subjects were measured at baseline and after a follow-up period of 12 and 26 weeks. Twenty-nine stroke survivors with chronic

  1. Value of pre-operative breast MRI for the size assessment of ductal carcinoma in situ (United States)

    Proulx, Francesca; Correa, José A; Ferré, Romuald; Omeroglu, Atilla; Aldis, Ann; Meterissian, Sarkis


    Objective: To retrospectively evaluate the accuracy of pre-operative breast MRI and mammography in determining the size of ductal carcinoma in situ (DCIS) compared with the histopathological results. Methods: 79 patients [mean age: 56.5 (standard deviation 10.2) years] with pathologically proven DCIS (79 lesions) obtained a bilateral mammogram and a pre-operative contrast-enhanced MRI. The accuracy of MRI and mammography to detect tumour size were estimated and compared, using histopathological size as the gold standard, on the subjects with measurements with both modalities (n = 60). Results: MRI detected 67 (85%) lesions, mammography detected 72 (91%) and both modalities detected 60 (76%). Median DCIS size detected by mammography vs MRI was smaller (1.55 vs 1.65 cm). Out of these 60 cases, compared with the histopathological size, the accuracy of MRI and mammography was 0.66 and 0.56, respectively (p = 0.045). MRI showed better accuracy than mammography for younger patients (age ≤ 50 years, p = 0.003). For tumour nuclear grade, there was a statistically significant difference for the intermediate level, with higher accuracy for MRI (p = 0.03). Conclusion: MRI was more accurate than mammography in DCIS size assessment when visible, particularly in lesions of intermediate grade and in patients less than 50 years of age. Advances in knowledge: Breast MRI may help in management of DCIS of intermediate grade and in females less than 50 years of age. PMID:26568438

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

    Directory of Open Access Journals (Sweden)

    Habib Md Reazaul Karim


    Full Text Available 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 2014-2015 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.

  3. Pediatric pulmonologists approach to the pre-operative management of the asthmatic child. (United States)

    Armoni-Domany, Keren; Gut, Guy; Soferman, Ruth; Sivan, Yakov


    No consensus guidelines exist for the respiratory treatment of asthmatic children referred for elective surgery. The aim of this study was to evaluate the attitude of pediatric pulmonologists regarding the pre-operative management of these children. A survey of pre-operative management of asthmatic children was conducted. All 48 certified pediatric pulmonologists in Israel completed a questionnaire that comprised 20 questions regarding their approach to pre-operative management including six case scenarios with a variety of clinical situations and treatments of children with asthma. Response rate was 100%. All believed that pre-operative treatment should be considered in all asthmatic children. Almost 50% suggested that a pediatric pulmonologist should be consulted in all pre-operative assessments. 50% recommended consultation only in individual cases. Overall, results showed a very wide variability between responders especially in pre-school and poorly controlled school children. The variability referred to the use of bronchodilators, inhaled corticosteroids and their combination during the pre-operative days, the addition of systemic CS and the length of pre-operative treatment. Almost all participants suggested either the initiation or augmentation of pre-operative treatment in high risk situations. This data demonstrate an important variability among pediatric pulmonologists in Israel regarding the practice of pre-operative treatment of infants and children with asthma especially for the less controlled and high risk children. This is most probably explained by the paucity of evidence-based data and the lack of established guidelines. Consensus guidelines for the pre-operative management of asthmatic children are needed.

  4. Multivariate normally distributed biomarkers subject to limits of detection and receiver operating characteristic curve inference. (United States)

    Perkins, Neil J; Schisterman, Enrique F; Vexler, Albert


    Biomarkers are of ever-increasing importance to clinical practice and epidemiologic research. Multiple biomarkers are often measured per patient. Measurement of true biomarker levels is limited by laboratory precision, specifically measuring relatively low, or high, biomarker levels resulting in undetectable levels below, or above, a limit of detection (LOD). Ignoring these missing observations or replacing them with a constant are methods commonly used although they have been shown to lead to biased estimates of several parameters of interest, including the area under the receiver operating characteristic (ROC) curve and regression coefficients. We developed asymptotically consistent, efficient estimators, via maximum likelihood techniques, for the mean vector and covariance matrix of multivariate normally distributed biomarkers affected by LOD. We also developed an approximation for the Fisher information and covariance matrix for our maximum likelihood estimations (MLEs). We apply these results to an ROC curve setting, generating an MLE for the area under the curve for the best linear combination of multiple biomarkers and accompanying confidence interval. Point and confidence interval estimates are scrutinized by simulation study, with bias and root mean square error and coverage probability, respectively, displaying behavior consistent with MLEs. An example using three polychlorinated biphenyls to classify women with and without endometriosis illustrates how the underlying distribution of multiple biomarkers with LOD can be assessed and display increased discriminatory ability over naïve methods. Properly addressing LODs can lead to optimal biomarker combinations with increased discriminatory ability that may have been ignored because of measurement obstacles. Published by Elsevier Inc.

  5. Exact closed form expressions for outage probability of GSC receivers over Rayleigh fading channel subject to self-interference

    KAUST Repository

    Nam, Sungsik


    Previous work on performance analyses of generalized selection combining (GSC) RAKE receivers based on the signal to noise ratio focused on the development of methodologies to derive exact closed-form expressions for various performance measures. However, some open problems related to the performance evaluation of GSC RAKE receivers still remain to be solved such that an assessment of the impact of self-interference on the performance of GSC RAKE receivers. To have a full and exact understanding of the performance of GSC RAKE receivers, the outage probability of GSC RAKE receivers needs to be analyzed as closed-form expressions. The major difficulty in this problem is to derive some joint statistics of ordered exponential variates. With this motivation in mind, we capitalize in this paper on some new order statistics results to derive exact closed-form expressions for outage probability of GSC RAKE receivers subject to self-interference over independent and identically distributed Rayleigh fading channels. © 2010 IEEE.

  6. The effects of receiver placement on probe microphone, performance, and subjective measures with open canal hearing instruments. (United States)

    Alworth, Lynzee N; Plyler, Patrick N; Reber, Monika Bertges; Johnstone, Patti M


    Open canal hearing instruments differ in method of sound delivery to the ear canal, distance between the microphone and the receiver, and physical size of the devices. Moreover, RITA (receiver in the aid) and RITE (receiver in the ear) hearing instruments may also differ in terms of retention and comfort as well as ease of use and care for certain individuals. What remains unclear, however, is if any or all of the abovementioned factors contribute to hearing aid outcome. To determine the effect of receiver location on performance and/or preference of listeners using open canal hearing instruments. An experimental study in which subjects were exposed to a repeated measures design. Twenty-five adult listeners with mild sloping to moderately severe sensorineural hearing loss (mean age 67 yr). Participants completed two six-week trial periods for each device type. Probe microphone, objective, and subjective measures (quiet, noise) were conducted unaided and aided at the end of each trial period. Occlusion effect results were not significantly different between the RITA and RITE instruments; however, frequency range was extended in the RITE instruments, resulting in significantly greater maximum gain for the RITE instruments than the RITA instruments at 4000 and 6000 Hz. Objective performance in quiet or in noise was unaffected by receiver location. Subjective measures revealed significantly greater satisfaction ratings for the RITE than for the RITA instruments. Similarly, preference in quiet and overall preference were significantly greater for the RITE than for the RITA instruments. Although no occlusion differences were noted between instruments, the RITE did demonstrate a significant difference in reserve gain before feedback at 4000 and 6000 Hz. Objectively; no positive benefit was noted between unaided and aided conditions on speech recognition tests. These results suggest that such testing may not be sensitive enough to determine aided benefit with open canal


    Hallagin, Cassidy; Garrison, J Craig; Creed, Kalyssa; Bothwell, James M; Goto, Shiho; Hannon, Joseph


    Pre-operative quadriceps strength may have a positive influence on post-operative function and outcomes at time of return to sport. Little consideration has been given to quadriceps strength during the early post-operative timeframes. Twelve-week post-operative anterior cruciate ligament reconstruction (ACL-R) is considered a critical time point for progression in the rehabilitation process. There is currently limited research looking at the relationship between clinical measurements pre-operatively and at 12-weeks following ACL-R. The primary purpose of this study was to examine the differences between Y-Balance Test Lower Quarter (YBT-LQ) and isokinetic quadriceps strength tested pre-operatively and post-operatively following ACL-R (12-weeks). Within subject, repeated measures. Thirty-nine participants (15.6 ± 1.5 y/o) were diagnosed with an ACL tear and were undergoing rehabilitation to return to a sport requiring cutting and pivoting were included. YBT-LQ and isokinetic quadriceps strength were assessed pre-operatively and at 12-weeks after ACL-R. YBT-LQ composite scores were calculated bilaterally and isokinetic quadriceps strength was tested using the Biodex Multi-Joint Testing and Rehabilitation System. Paired T-tests were used to determine mean group differences between YBT-LQ and isokinetic quadriceps strength scores pre-operatively and at 12-weeks post-operative. A Pearson Correlation was performed to determine relationships between variables at both time points. There was a significant improvement in YBT-LQ composite scores from pre-operative to 12-weeks post-operative on both the involved (Pre-operative: 89.0 ± 7.7; 12-weeks: 94.1 ± 7.1, poperative: 92.6 ± 6.2; 12-weeks: 97.6 ± 6.8, poperative to 12-weeks on the involved limb (Pre-operative: 82.3 ftlbs ± 38.6; 12-weeks: 67.9 ftlbs±27.4, poperative: 117.3ftlbs ± 42.0; 12-weeks: 121.7ftlbs ± 41.5, p = 0.226). Involved limb quadriceps strength decreases from

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

    Directory of Open Access Journals (Sweden)

    Nolan John


    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.

  9. effect of pre-operative sub-lingual misoprostol versus intravenous ...

    African Journals Online (AJOL)


    Sep 9, 2012 ... EFFECT OF PRE-OPERATIVE SUB-LINGUAL MISOPROSTOL VERSUS INTRAVENOUS OXYTOCIN ON CAESAREAN. OPERATION BLOOD LOSS ... infusion of oxytocin in reducing blood loss at Caesarean section operation. However, occurrence of ..... WHO Reproductive Health Library; Geneva: World.

  10. Association of pre-operative brain pathology with post-operative delirium in a cohort of non-small cell lung cancer patients undergoing surgical resection. (United States)

    Root, James C; Pryor, Kane O; Downey, Robert; Alici, Yesne; Davis, Marcus L; Holodny, Andrei; Korc-Grodzicki, Beatriz; Ahles, Tim


    Post-operative delirium is associated with pre-operative cognitive difficulties and diminished functional independence, both of which suggest that brain pathology may be present in affected individuals prior to surgery. Currently, there are few studies that have examined imaging correlates of post-operative delirium. To our knowledge, none have examined the association of delirium with existing structural pathology in pre-operative cancer patients. Here, we present a novel, retrospective strategy to assess pre-operative structural brain pathology and its association with post-operative delirium. Standard of care structural magnetic resonance imaging (MRIs) from a cohort of surgical candidates prior to surgery were analyzed for white matter hyperintensities and cerebral atrophy. We identified 23 non-small cell lung cancer patients with no evidence of metastases in the brain pre-operatively, through retrospective chart review, who met criteria for post-operative delirium within 4 days of surgery. 24 age- and gender-matched control subjects were identified for comparison to the delirium sample. T1 and fluid-attenuated inversion recovery sequences were collected from standard of care pre-operative MRI screening and assessed for white matter pathology and atrophy. We found significant differences in white matter pathology between groups with the delirium group exhibiting significantly greater white matter pathology than the non-delirium group. Measure of cerebral atrophy demonstrated no significant difference between the delirium and non-delirium group. In this preliminary study utilizing standard of care pre-operative brain MRIs for assessment of structural risk factors to delirium, we found white matter pathology to be a significant risk factor in post-operative delirium. Limitations and implications for further investigation are discussed. Copyright © 2013 John Wiley & Sons, Ltd.

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

    DEFF Research Database (Denmark)

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


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

  12. Does pre-operative magnetic resonance imaging of the lumbar multifidus muscle predict clinical outcomes following lumbar spinal decompression for symptomatic spinal stenosis? (United States)

    Zotti, Mario G T; Boas, F Vilas; Clifton, T; Piche, M; Yoon, W W; Freeman, B J C


    To investigate whether pre-operative magnetic resonance imaging (MRI) of the lumbar multifidus muscle (LMM) would predict clinical outcomes following lumbar spinal decompression for symptomatic spinal stenosis. A prospective cohort of patients with symptomatic neurogenic claudication, documented spinal stenosis on pre-operative MRI underwent spinal decompression. All subjects completed standardised outcome measures (Core Outcome Measures Index (COMI), Oswestry Disability Index (ODI v2.1) pre-operatively, 1 and 2 years post-surgery. Surgery was performed using a standardised lumbar spinous process osteotomy for access, followed by a decompression of the central canal, lateral recess and foraminal zones as indicated by the pre-operative MRI. Lumbar MRI scans were evaluated by two independent observers who assessed the axial CSA of the LMM bilaterally and the degree of muscle atrophy according to the Kader classification (2000). Changes in COMI and ODI scores at 1 and 2 years were investigated for statistically significant correlations with CSA of LMM and Kader grading. Statistical analyses utilised Student's t test, kappa coefficient for inter-observer agreement and Bland-Altman Limits of Agreement (BALOA). 66 patients (41 female) aged between 29 and 86 years underwent single-level decompression in 44, two-level decompression in 16 and three-level decompression in 6 cases. No significant correlation was observed between improvements in ODI and COMI relative to age, degree of stenosis, posterior fat thickness or psoas CSA. Those subjects with the greatest LMM atrophy relative to psoas CSA and L5 vertebral body area on pre-operative MRI had the least absolute improvement in both ODI and COMI scores (p = 0.006). Reduced LMM CSA (operative CSA of LMM appeared to be a more reliable predictor of post-operative clinical outcomes compared to the Kader Grading Score. This is the first study to investigate the prognostic value of pre-operative MRI appearance and CSA of

  13. Interval estimation for the area under the receiver operating characteristic curve when data are subject to error. (United States)

    Li, Yanhong; Koval, John J; Donner, Allan; Zou, G Y


    The area (A) under the receiver operating characteristic curve is commonly used to quantify the ability of a biomarker to correctly classify individuals into two populations. However, many markers are subject to measurement error, which must be accounted for to prevent understating their effectiveness. In this paper, we develop a new confidence interval procedure for A which is adjusted for measurement error using either external or internal replicated measurements. Based on the observation that A is a function of normal means and variances, we develop the procedure by recovering variance estimates needed from confidence limits for normal means and variances. Simulation results show that the procedure performs better than the previous ones based on the delta-method in terms of coverage percentage, balance of tail errors and interval width. Two examples are presented. Copyright © 2010 John Wiley & Sons, Ltd.

  14. Interexaminer reliability of the electromagnetic radiation receiver for determining lumbar spinal joint dysfunction in subjects with low back pain

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    Gemmell, H.A.; Jacobson, B.H.; Edwards, S.W.; Heng, B.J.


    Twenty subjects (6 male, 14 female) with low back pain were examined by two experienced and licensed chiropractic doctors (E1 and E2). Both examiners examined the patients using a Toftness Electromagnetic Radiation Receiver (EMRR) and by manual palpation (MP) of the spinous processes. Interexaminer reliability was calculated at three sites (L3, L4, L5) for the following combinations: (a) E1,MP--E2,MP; (b) E1,EMRR--E2,EMRR; (c) E1,MP--E2,EMRR; and (d) E2,MP--E1,EMRR, and intraexaminer reliability was calculated for the following variables: (e) E1,MP--E1,EMRR; and (f) E2,MP--E2,EMRR. Results of a Kappa coefficient analysis for interexaminer reliability of the stated combinations and at the specific sites were: (a) -0.071, 0.400, 0.200; (b) -0.013, 0.100, -0.120; (c) 0.286, 0.300, 0.200; (d) -0.081, 0.000, 0.048. These results predominantly indicate a poor to fair interexaminer reliability. The results of a Kappa coefficient analysis for intraexaminer reliability of the stated combinations were: (e) 0.111, 0.400, 0.737; (f) 0.000, 0.100, 0.368. These results indicate a poor to fair reliability. It was concluded that in subjects with low back pain the EMRR may not be a reliable indicator of spinal joint dysfunction.

  15. A within-group design of nontreatment seeking 5-HTTLPR genotyped alcohol-dependent subjects receiving ondansetron and sertraline. (United States)

    Kenna, George A; Zywiak, William H; McGeary, John E; Leggio, Lorenzo; McGeary, Chinatsu; Wang, Shirley; Grenga, Andrea; Swift, Robert M


    Serotonergic mechanisms are associated with the development of alcohol dependence (AD), however, studies evaluating serotonergic medications have produced conflicting results. One hypothesis suggests that differential response may be due to a functional polymorphism of the 5-HTTLPR promoter region of the serotonin re-uptake transporter (5-HTT). The L/L genotype is postulated to be associated with early onset alcoholism and the S/S or S/L genotypes associated with late onset alcoholism. The aim of this study was to match and mismatch L/L, S/S, or S/L genotypes with administration of ondansetron and sertraline. Fifteen nontreatment seeking alcohol-dependent individuals were randomized to 1 of 2 counterbalanced arms to receive either 200 mg/d of sertraline or ondansetron 0.5 mg/d for 3 weeks followed by an alcohol self-administration experiment (ASAE), then received placebo for 3 weeks followed by a second ASAE. Participants then received the alternate drug for 2 weeks followed by a third ASAE. At the first ASAE compared to sertraline, ondansetron significantly improved drinking outcomes for the L/L genotype for the ASAE volume consumed (100% reduction based on between-subjects comparison, t = 2.35), and for drinks per drinking day during the 7 days prior to the ASAE (79% reduction and t = 4.34). Compared with ondansetron for S/S or S/L genotypes, outcomes at ASAE 1 for sertraline and S/S or S/L genotypes are opposite than hypothesized. Overall, subjects reduced drinking across their participation in the trial, as there appears to be an order effect. This study suggests that ondansetron may reduce alcohol consumption in alcohol-dependent individuals who have the L/L genotype as measured naturalistically and during the ASAE. By contrast there was no support that sertraline reduces alcohol use in individuals who have S/S or S/L genotypes. Evidence in the literature suggests that AD in some individuals may be influenced by a gene by socio-environmental interaction making

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

    Directory of Open Access Journals (Sweden)

    Hassan Ghandhari


    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.

  17. Sleep-wake difficulties in community-dwelling cancer patients receiving palliative care: subjective and objective assessment. (United States)

    Bernatchez, Marie Solange; Savard, Josée; Savard, Marie-Hélène; Aubin, Michèle; Ivers, Hans


    Prevalence rates of sleep difficulties in advanced cancer patients have varied widely across studies (12 to 96%), and none of these employed a diagnostic interview to distinguish different types of sleep-wake disorders. Moreover, very limited information is available on subjective and objective sleep parameters in this population. Our study was conducted in palliative cancer patients and aimed to assess rates of sleep-wake disorders and subsyndromal symptoms and to document subjective and objective sleep-wake parameters across various types of sleep-wake difficulties. The sample was composed of 51 community-dwelling cancer patients receiving palliative care and having an Eastern Cooperative Oncology Group score of 2 or 3. Relevant sections of the Duke Interview for Sleep Disorders were administered over the phone. An actigraphic recording and a daily sleep diary were completed for 7 consecutive days. Overall, 68.6% of the sample had at least one type of sleep-wake difficulty (disorder or symptoms): 31.4% had insomnia and 29.4% had hypersomnolence as their main sleep-wake problem. Participants with insomnia as their main sleep difficulty had greater disruptions of subjective sleep parameters, while objectively-assessed sleep was more disrupted in patients with hypersomnolence comorbid with another sleep-wake difficulty. Significance of the Results: The high rates of sleep-wake difficulties found in this study indicate a need to screen more systematically for sleep-wake disorders, including insomnia and hypersomnolence, in both palliative care research and clinical practice, and to develop effective nonpharmacological interventions specifically adapted to this population.

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

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


    Post-operative pulmonary complications are a significant problem following open upper abdominal surgery. Preliminary evidence suggests that a single pre-operative physiotherapy education and preparatory lung expansion training session alone may prevent respiratory complications more effectively than supervised post-operative breathing and coughing exercises. However, the evidence is inconclusive due to methodological limitations. No well-designed, adequately powered, randomised controlled trial has investigated the effect of pre-operative education and training on post-operative respiratory complications, hospital length of stay, and health-related quality of life following upper abdominal surgery. The Lung Infection Prevention Post Surgery - Major Abdominal- with Pre-Operative Physiotherapy (LIPPSMAck POP) trial is a pragmatic, investigator-initiated, bi-national, multi-centre, patient- and assessor-blinded, parallel group, randomised controlled trial, powered for superiority. Four hundred and forty-one patients scheduled for elective open upper abdominal surgery at two Australian and one New Zealand hospital will be randomised using concealed allocation to receive either i) an information booklet or ii) an information booklet, plus one additional pre-operative physiotherapy education and training session. The primary outcome is respiratory complication incidence using standardised diagnostic criteria. Secondary outcomes include hospital length of stay and costs, pneumonia diagnosis, intensive care unit readmission and length of stay, days/h to mobilise >1 min and >10 min, and, at 6 weeks post-surgery, patient reported complications, health-related quality of life, and physical capacity. The LIPPSMAck POP trial is a multi-centre randomised controlled trial powered and designed to investigate whether a single pre-operative physiotherapy session prevents post-operative respiratory complications. This trial standardises post-operative assisted ambulation and

  19. Pre-operative chemotherapy for non-small cell lung carcinoma (United States)

    Woo, Tetsukan; Miyazawa, Naoki; Kaneko, Takeshi


    The roll by the cytotoxic chemotherapy and its efficacy in the treatment of non-small cell carcinoma (NSCLC) was not clearly identified until the 1980s when studies showed that cisplatin was beneficial in the treatment of NSCLC. The first randomized controlled trial (RCT) to evaluate the efficacy of post-operative (adjuvant) chemotherapy using the cisplatin regimen for resectable NSCLC was reported in 1988. Since then, an increasing number of RCTs have been carried out to evaluate post-operative chemotherapy. Pre-operative (neo-adjuvant) chemotherapy is a relatively new treatment strategy, as its name indicates. Compared with post-operative chemotherapy, fewer RCTs have been carried out to evaluate pre-operative chemotherapy. Given the inconsistency of the results from the RCTs, at least 12 meta-analyses have been published. Most of these meta-analyses reported overall survival (OS) benefit with hazard ratios (HRs) in the range of 0.81 to 0.89 in favor of pre-operative chemotherapy. An individual patient data meta-analysis by Burdett in 2014 indicates that the option of pre-operative chemotherapy + surgery is associated with better OS (HR 0.87, 95% CI, 0.78-0.96, P=0.007) and recurrence-free survival (RFS) (HR 0.85, 95% CI, 0.76-0.94, P=0.002) survival for operable NSCLC when compared with treatment with surgery alone. Although the current consensus recommends the use of post-operative chemotherapy, pre-operative chemotherapy has equivalent efficacy. Both strategies should be regarded as the first choice treatment options. Despite Burdett’s comment, indication of pre-operative chemotherapy for stage IA disease should be judged carefully. PMID:25806341

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

    Directory of Open Access Journals (Sweden)

    Anthony T Adenekan


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

  1. Does the Timing of Pre-Operative Medical Evaluation Influence Perioperative Total Hip Arthroplasty Outcomes? (United States)

    Lan, Roy H; Kamath, Atul F


    Medical evaluation pre-operatively is an important component of risk stratification and potential risk optimization. However, the effect of timing prior to surgical intervention is not well-understood. We hypothesized that total hip arthroplasty (THA) patients seen in pre-operative evaluation closer to the date of surgery would experience better perioperative outcomes. We retrospectively reviewed 167 elective THA patients to study the relationship between the number of days between pre-operative evaluation (range, 0-80 days) and surgical intervention. Patients' demographics, length of stay (LOS), ICU admission frequency, and rate of major complications were recorded. When pre-operative evaluation carried out 4 days or less before the procedure date, there was a significant reduction in LOS (3.91 vs. 4.49; p=0.03). When pre-operative evaluation carried out 11 days or less prior to the procedure date, there was a four-fold decrease in rate of intensive care admission (p=0.04). Furthermore, the major complication rate also significantly reduced (ppre-operative evaluation took place 30 days or less before the procedure date compared to more than 30 days prior, there were no significant changes in the outcomes. From this study, pre-operative medical evaluation closer to the procedure date was correlated with improved selected peri-operative outcomes. However, further study on larger patient groups must be done to confirm this finding. More study is needed to define the effect on rare events like infection, and to analyze the subsets of THA patients with modifiable risk factors that may be time-dependent and need further time to optimization.

  2. Subjectivity

    Directory of Open Access Journals (Sweden)

    Jesús Vega Encabo


    Full Text Available In this paper, I claim that subjectivity is a way of being that is constituted through a set of practices in which the self is subject to the dangers of fictionalizing and plotting her life and self-image. I examine some ways of becoming subject through narratives and through theatrical performance before others. Through these practices, a real and active subjectivity is revealed, capable of self-knowledge and self-transformation. 

  3. Effect of pre-operative sub-lingual misoprostol versus intravenous ...

    African Journals Online (AJOL)

    Background: Caesarean operation remains the most common abdominal surgery in women and has immense benefits to both mother and baby when employed. Haemorrhage, however, remains the greatest challenge associated with its outcome. Objective: To compare the effectiveness of pre-operative sub-lingual ...

  4. Current practices and medico-legal aspects of pre-operative consent ...

    African Journals Online (AJOL)

    Background: Written informed consent is a pre requisite for surgical intervention as it provides the forum for the patient to appreciate implications of the procedure and the doctor to explain details and effects of the surgery. Objectives: To evaluate the practice of obtaining informed consent pre-operatively by surgeons in ...

  5. The triple assessment in the pre-operative evaluation of patients ...

    African Journals Online (AJOL)

    Background: Triple assessment has been recommended in diagnosis of Breast cancer in Uganda. This review analyses its diagnostic value in patients presenting with clinically malignant breast lumps. Objective: To establish the validity and reliability of the triple assessment in the pre-operative evaluation of patients with ...

  6. Pre-Operative Vocal Cord Palsy in Goitre Patient | Omokanye | East ...

    African Journals Online (AJOL)

    Objectives: Determine the prevalence of vocal cord palsy and the relative prevalence of asymptomatic vocal cord palsy in pre-operative goitre patients using flexible fibreoptic laryngoscope (FFL) as a laryngeal visualisation technique. Design: Hospital-based, cross-sectional study conducted throughout 2011 on consecutive ...

  7. Pre-operative risk factors predict post-operative respiratory failure after liver transplantation.

    Directory of Open Access Journals (Sweden)

    Ching-Tzu Huang

    Full Text Available OBJECTIVE: Post-operative pulmonary complications significantly affect patient survival rates, but there is still no conclusive evidence regarding the effect of post-operative respiratory failure after liver transplantation on patient prognosis. This study aimed to predict the risk factors for post-operative respiratory failure (PRF after liver transplantation and the impact on short-term survival rates. DESIGN: The retrospective observational cohort study was conducted in a twelve-bed adult surgical intensive care unit in northern Taiwan. The medical records of 147 liver transplant patients were reviewed from September 2002 to July 2007. Sixty-two experienced post-operative respiratory failure while the remaining 85 patients did not. MEASUREMENTS AND MAIN RESULTS: Gender, age, etiology, disease history, pre-operative ventilator use, molecular adsorbent re-circulating system (MARS use, source of organ transplantation, model for end-stage liver disease score (MELD and Child-Turcotte-Pugh score calculated immediately before surgery were assessed for the two groups. The length of the intensive care unit stay, admission duration, and mortality within 30 days, 3 months, and 1 year were also evaluated. Using a logistic regression model, post-operative respiratory failure correlated with diabetes mellitus prior to liver transplantation, pre-operative impaired renal function, pre-operative ventilator use, pre-operative MARS use and deceased donor source of organ transplantation (p<0.05. Once liver transplant patients developed PRF, their length of ICU stay and admission duration were prolonged, significantly increasing their mortality and morbidity (p<0.001. CONCLUSIONS: The predictive pre-operative risk factors significantly influenced the occurrence of post-operative respiratory failure after liver transplantation.

  8. Pre-operative radiological measurement of femoral rotation for prosthetic positioning in total knee arthroplasty. (United States)

    Savin, Liliana; Botez, Paul; Mihailescu, Dan; Predescu, Vlad; Grierosu, Carmen


    This study outlines the benefits of the seated view radiograph of the knee in evaluation of the pre-operative individual distal femoral torsion (DFT) and for the follow-up of the post-operative rotational positioning of the femoral component in total knee arthroplasty. Study on 20 patients who underwent total knee arthroplasty and the correlation between the DFT measured before surgery with this radiology view, the intra-operative external rotation (ER) necessary for the parallel positioning of the femoral component with the transepicondylar axis (TEA) and the post-operative femoral rotational alignment of the prosthesis on the same view. In 90 % of cases the values of internal DFT were between -1(0) and -8(0), while the mean value of the internal rotation (IR) was -4.45(0). The mean value of the ER applied to the posterior bone resection was 4.25(0) (0(0)-7(0)), showing a statistically significant correlation between the pre-operative measurement and the intra-operative one of the posterior condylar angle (PCA) (r = 0.890, p = 0.000). Residual internal femoral malrotation has been identified in four cases, its mean value being 0.4(0). In three patients the pre-operative value of the PCA was higher than the intra-operative one and an internal malrotation of the post-operative femoral component was observed. The results are encouraging for the further use of this pre-operative view with the premises of increasing the accuracy of prosthetic positioning and reducing the mechanical complications.

  9. A nurse-led service for pre-operative pain management in hip fracture. (United States)

    Layzell, Mandy

    This article follows an In-depth piece published in last week's issue, which explored issues around pain management in older people following fractured neck of femur. It also discussed using femoral nerve block for pain relief in this group of patients. This Changing Practice article outlines the establishment of a nurse-led service to improve pre-operative pain management using femoral nerve block.





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

  11. Using pre-operative MRI to predict intraoperative hamstring graft size for anterior cruciate ligament reconstruction. (United States)

    Leiter, Jeff; Elkurbo, Mohamed; McRae, Sheila; Chiu, James; Froese, Warren; MacDonald, Peter


    Large variation in tendon size between individuals makes hamstring graft diameter for anterior cruciate ligament (ACL) reconstruction unpredictable. Inadequate graft diameter may necessitate an alternative source of tissue requiring pre-operative planning. The purpose of this study was to determine whether magnetic resonance image (MRI) measurements and clinical anthropometric data are predictive of hamstring tendon graft diameter. Data from 109 patients having ACL reconstruction with semitendinosus-gracilis (STGT) autograft were retrospectively evaluated. Cross-sectional area (CSA) of the gracilis tendon (GT) and semitendinosus tendon (ST) were determined from pre-operative MRI scans. Variables included pre-operative height, weight, body mass index (BMI), age and gender; and intra-operative graft diameter. Correlations between anthropometric variables, hamstring tendons CSA and intra-operative graft diameter were calculated. Multiple stepwise regression was performed to assess the predictive value of these variables to graft diameter. Sensitivity and specificity were calculated to evaluate the utility of MRI CSA measurements in accurately identifying inadequate graft diameter (<8 mm). All anthropometric variables were positively correlated with intraoperative graft diameter (p < 0.01). Semitendinosus-gracilis tendon CSA (p < 0.001) and STGT CSA and weight (p < 0.001) were significantly predictive models of graft diameter. Sensitivity and specificity were 79 and 74 %, respectively. The strongest indicators of a four-stranded STGT graft for primary ACL reconstruction were STGT CSA on MRI plus weight. Measurement of graft diameter can be performed pre-operatively via MRI to identify tendons that may be of inadequate size for ACL reconstruction. This can assist with surgical planning to determine the most appropriate graft choice. III.

  12. Pattern of Electrocardiographic Changes in Pre-operative check-up in Patients Undergoing ENT Surgery

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    Partha Pratim Das


    Full Text Available Background: The 12-lead ECG is the primary clinical tool for non-invasive assessment of cardiac electrical function. Before any surgery, ECG is commonly used in pre-operative check-up. Therefore pre-operative check-up of large number of people can be a valuable tool for accurate estimates of the prevalence of ECG abnormalities of general population. Objectives: To observe the extent of ECG changes in a group of population undergoing ENT surgery and to describe the prevalence of changes in relation to age and sex. Methods: 704 consecutive adult stable patients were included between age of 20 – 60 years without previously diagnosed case of any other systemic diseases who came to this hospital for elective surgical procedures and were investigated with new ECG for pre-operative check-up in private Hospital between January 201 to December 2010. Results: Total number of ECG recordings were 704; out of them 479 were male & 225 were female. Among 704 ECG recording 486(69.03% were normal. The number of old myocardial infarction (MI was in 36 cases (5.11%. Cardiac Ischaemia observed by ST depressions/T inversion was present in 15 cases (2.13%. Conclusion: The observation of the study is concludes that nearly 70% of all asymptomatic people (between 20 – 60 years possessing normal ECG but Ischaemic changes (like Q wave/ST depression & T inversion/ LBBB was present in about 8% cases. ECG changes of IHD (Ischaemic Heart Disease increases with age and male groups at higher risk of developing IHD. Key Words: ECG; Pre-operative Check-up; Myocardial Infarction (MI. DOI: BSMMU J 2011; 4(2:56-59



    Ashok Y.; Rahul K.; Nitin R.; Sunny L.


    ABSTRACT: This prospective study evaluate the influence of p re-operative no hair removal on surgical site infection in all abdominal and groin surgeries. As there are very few articles about pre - operative no hair removal and its effect at surgica l site in all types of wound. We are presenting thi s original article. Prospective review of 417 patients operated in Kris hna Hospital and Research Center, Karad. Between JAN-2010 to JAN-2011. The study contai...

  14. The value of pre-operative ultrasound mapping of the greater saphenous vein prior to 'closed' in situ bypass operations

    NARCIS (Netherlands)

    L.C. van Dijk (Lukas); C.H. Wittens; H. Pieterman; H. van Urk (Hero)


    textabstractObjective: The aim of this study was to test pre-operative ultrasound mapping for the detection of duplications and narrow vein segments of the greater saphenous vein (GSV) used as bypass for occlusive arterial disease surgery. Patients and methods: In 44 patients pre-operative

  15. Harm and benefits of short-term pre-operative radiotherapy in patients with resectable rectal carcinomas

    NARCIS (Netherlands)

    Bakx, R.; Emous, M.; Legemate, D. A.; Zoetmulder, F. A. N.; van Tienhoven, G.; Bemelman, W. A.; van Lanschot, J. J. B.


    AIM: To weigh the harms and benefits of short-term pre-operative radiotherapy in the treatment of resectable rectal cancer. METHODS: The benefits (reduction of local recurrence) and harm (increase of short-term complications) of short-term pre-operative radiotherapy are balanced using a model which

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

    Energy Technology Data Exchange (ETDEWEB)

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


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

  17. Pre-operative fasting: a nationwide survey of German anaesthesia departments. (United States)

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


    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.

  18. The impact of pre-operative serum creatinine on short-term outcomes after liver resection. (United States)

    Armstrong, Thomas; Welsh, Fenella Ks; Wells, John; Chandrakumaran, Kandiah; John, Timothy G; Rees, Myrddin


    The aim of the present study was to determine whether raised pre-operative serum creatinine increased the risk of renal failure after liver resection. Data were studied from 1535 consecutive liver resections. Outcomes in patients with pre-operative creatinine /=125 micromol/l (Group 2). The median age of the 1446 (94.3%) patients resected in Group 1 was 62 years compared with 67 years in the 88 (5.7%) patients in Group 2 (P kidney injury post-operatively (18.2% vs. 4.3%, P kidney injury had significantly higher blood loss. Although there was no difference in mortality, patients in Group 2 had higher post-operative morbidity (37.5%) than Group 1 (21.7%, P= 0.0006), with the incidence of cardiorespiratory complications being higher in Group 2 (25.9% vs. 8.9%, P= 0.0025). After liver resection, renal failure is rare but patients with an elevated creatinine pre-operatively are at an increased risk of both renal and non-renal complications.

  19. The effectiveness of pre-operative exercise physiotherapy rehabilitation on the outcomes of treatment following anterior cruciate ligament injury: a systematic review. (United States)

    Alshewaier, Shady; Yeowell, Gillian; Fatoye, Francis


    To evaluate the effectiveness of pre-operative exercise physiotherapy rehabilitation on the outcomes of treatment following anterior cruciate ligament injury. The following databases were searched: PubMed, Ovid, The Cochrane Library and Web of Science. Studies published between the inception of the databases and December 2015 were sought using appropriate keywords in various combinations. This search was supplemented with a manual search of the references of selected studies. Studies were assessed for methodological quality using the Physiotherapy Evidence Database scale. A total of 500 studies were identified, of which eight studies met the inclusion criteria and were included in the present review. The average Physiotherapy Evidence Database score for the studies included was 5.8, which reflects an overall moderate methodological quality. The eight studies investigated a total of 451 subjects of which 71% ( n=319) were males. The age of the participants in the eight studies ranged from 15 to 57 years. The duration of the intervention in the studies ranged from 3 to 24 weeks. This review found that pre-operative physiotherapy rehabilitation is effective for improving the outcomes of treatment following anterior cruciate ligament injury, including increasing knee-related function and improving muscle strength. However, whilst there was a significant improvement in quality of life from baseline following intervention, no significant difference in quality of life was found between the control and intervention groups. There is evidence to suggest that pre-operative physiotherapy rehabilitation is beneficial to patients with anterior cruciate ligament injury.


    Lepley, Lindsey K.; Palmieri-Smith, Riann M.


    PURPOSE Quadriceps activation failure is considered to contribute to the weakness that lingers following anterior cruciate ligament (ACL) reconstruction. Importantly, the impact of pre-operative quadriceps activation on post-operative quadriceps function is unknown. Understanding this relationship is clinically important; as the counteractive approach clinicians should employ pre-operatively to mitigate post-operative quadriceps weakness is unclear. Accordingly, the primary purpose of this study was to investigate the relationship between pre-operative quadriceps activation and post-operative quadriceps strength and activation. METHODS Fifty-four individuals post-ACL injury reported for testing on two occasions: prior-to-surgery and post-surgery once they returned to activity. Quadriceps activation was assessed using the burst superimposition technique and quantified using the central activation ratio. Quadriceps strength was assessed using isometric contractions that were performed at 90° of knee flexion. Multiple linear regressions were utilized to detect the relationships between pre-operative activation and strength and post-operative activation and strength. RESULTS Pre-operative activation was not associated with post-operative strength (R2=0.064, P=0.186). Pre-operative quadriceps activation and strength were associated with post-operative activation (R2=0.383, P≤0.001) and strength (R2=0.465, P≤0.001), respectively. CONCLUSIONS Individuals with better pre-operative quadriceps activation demonstrated greater post-operative activation. Similarly, individuals with better pre-operative strength demonstrated better post-operative strength. Pre-operative quadriceps activation was not a predictor of post-operative strength. From a clinical perspective, our work indicates that clinicians should utilize therapies targeting both quadriceps activation and strength prior to ACL-reconstruction in order to maximize these factors post-ACL reconstruction, as pre-operative

  1. Metabolic Function and the Prevalence of Lipodystrophy in a Population of HIV-Infected African Subjects Receiving Highly Active Antiretroviral Therapy (United States)

    Mutimura, Eugene; Stewart, Aimee; Rheeder, Paul; Crowther, Nigel John


    Objective This study measured the prevalence of lipodystrophy and the metabolic effects of highly active antiretroviral therapy (HAART) in HIV-infected African subjects. Methods Prevalence was measured in 571 Rwandans receiving HAART for ≥6 months. Metabolic variables were measured in 100 HIV-positive adults with lipodystrophy, 50 HIV-positive nonlipodystrophic adults, and 50 HIV-negative controls. Results A HAART regimen of stavudine, lamivudine, and nevirapine was used by 81.6% of subjects; none received protease inhibitors. Lipodystrophy was observed in 34% (48.5% in urban groups and 17.3% in rural groups) of subjects, with a prevalence of 69.6% in those receiving HAART for >72 weeks. Peripheral lipoatrophy combined with abdominal lipohypertrophy was observed in 72% of lipodystrophic subjects. HIV-positive adults with lipodystrophy had a significantly higher waist-to-hip ratio (WHR; 0.99 ± 0.05 vs. 0.84 ± 0.03: P lipodystrophy (3.60 [1.38]) than in HIV-positive nonlipodystrophic adults (3.19 [0.65]; P lipodystrophy, 16% of HIV-positive nonlipodystrophic adults, and 2% of controls, but insulin levels did not differ. Conclusions African subjects with lipodystrophy have increased WHR, glucose, and cholesterol levels. Glucose concentrations are also elevated in nonlipodystrophic HIV-positive subjects. Therefore, factors other than body fat redistribution contribute to the glucose intolerance. PMID:18077834

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

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    Puhl Wofhart


    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

  3. Blood glucose control in healthy subject and patients receiving intravenous glucose infusion or total parenteral nutrition using glucagon-like peptide 1

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    Nauck, Michael A; Walberg, Jörg; Vethacke, Arndt


    It was the aim of the study to examine whether the insulinotropic gut hormone GLP-1 is able to control or even normalise glycaemia in healthy subjects receiving intravenous glucose infusions and in severely ill patients hyperglycaemic during total parenteral nutrition....

  4. Pre-operative function, motivation and duration of symptoms predict sporting participation after total hip replacement. (United States)

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


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

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


    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.

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

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    Fukushima Kensuke


    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.

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

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    Chirojit Mukherjee


    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.

  8. Heat transfer experiments with a central receiver tube subjected to unsteady and non-uniform heat flux (United States)

    Fernández-Torrijos, María; Marugán-Cruz, Carolina; Sobrino, Celia; Santana, Domingo


    In this work, a molten salt test loop to study the heat transfer process in external molten salt receivers is described. The experimental installation is formed by a cylindrical molten salt tank, a pump, a flow meter, and an induction heater to generate the heat flux, which is applied in a small rectangular region of the tube surface. In central tower plants, the external receiver pipe is considered to be under unilateral concentrated solar radiation, because only one side of the pipe receives high heat flux. The main advantage of using an induction heater is the control of heating in different areas of the tube. In order to measure the effects of a non-homogenous and unsteady heat flux on the wall temperature distribution a series of experiments have been carried out. 4 K-type thermocouples have been welded at different axial and azimuthal positions of the pipe to obtain the wall temperature distribution. Different temperature measurements have been made varying the heat flux and water velocity to study their effects on the heat transfer process.

  9. Comparative gut microbiota and resistome profiling of intensive care patients receiving selective digestive tract decontamination and healthy subjects. (United States)

    Buelow, Elena; Bello González, Teresita D J; Fuentes, Susana; de Steenhuijsen Piters, Wouter A A; Lahti, Leo; Bayjanov, Jumamurat R; Majoor, Eline A M; Braat, Johanna C; van Mourik, Maaike S M; Oostdijk, Evelien A N; Willems, Rob J L; Bonten, Marc J M; van Passel, Mark W J; Smidt, Hauke; van Schaik, Willem


    The gut microbiota is a reservoir of opportunistic pathogens that can cause life-threatening infections in critically ill patients during their stay in an intensive care unit (ICU). To suppress gut colonization with opportunistic pathogens, a prophylactic antibiotic regimen, termed "selective decontamination of the digestive tract" (SDD), is used in some countries where it improves clinical outcome in ICU patients. Yet, the impact of ICU hospitalization and SDD on the gut microbiota remains largely unknown. Here, we characterize the composition of the gut microbiota and its antimicrobial resistance genes ("the resistome") of ICU patients during SDD and of healthy subjects. From ten patients that were acutely admitted to the ICU, 30 fecal samples were collected during ICU stay. Additionally, feces were collected from five of these patients after transfer to a medium-care ward and cessation of SDD. Feces from ten healthy subjects were collected twice, with a 1-year interval. Gut microbiota and resistome composition were determined using 16S rRNA gene phylogenetic profiling and nanolitre-scale quantitative PCRs. The microbiota of the ICU patients differed from the microbiota of healthy subjects and was characterized by lower microbial diversity, decreased levels of Escherichia coli and of anaerobic Gram-positive, butyrate-producing bacteria of the Clostridium clusters IV and XIVa, and an increased abundance of Bacteroidetes and enterococci. Four resistance genes (aac(6')-Ii, ermC, qacA, tetQ), providing resistance to aminoglycosides, macrolides, disinfectants, and tetracyclines, respectively, were significantly more abundant among ICU patients than in healthy subjects, while a chloramphenicol resistance gene (catA) and a tetracycline resistance gene (tetW) were more abundant in healthy subjects. The gut microbiota of SDD-treated ICU patients deviated strongly from the gut microbiota of healthy subjects. The negative effects on the resistome were limited to selection

  10. Improving operating room first start efficiency - value of both checklist and a pre-operative facilitator. (United States)

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


    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 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.

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

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    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)


    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.)

  12. Computer assisted surgery. Its usefulness in different levels of pre-operative deformities. (United States)

    Benavente, P; López Orosa, C; Oteo Maldonado, J A; Orois Codesal, A; García Lázaro, F J


    To compare the results obtained with computer assisted surgery with conventional techniques and evaluate the influence of navigation at different levels of preoperative deformity. A retrospective study was conducted on 100 cases with primary total knee arthroplasty performed with conventional or computer assisted surgery. A comparison was made of the post-operative mechanical axis of the lower limb between both groups and in terms of pre-operative deformity. Optimal alignment is most often obtained by using the navigation system (62%) than by a conventional technique (36%). Patients with deformities under 10° varus showed a mean post-operative alignment within the optimal range (0±3° deviation from the neutral mechanical axis), while those with more than 15° of varus show an alignment out of range, regardless of the technique used (p=.002). In those with a deformity of between 10 and 15° of pre-operative varus alignment, values were found closer to the neutral axis in the navigation group (178.7°) than in the conventional technique (175.5°), although these differences are not statistically significant (p=.127). Post-operative alignment obtained with navigation is better than with the conventional technique, with a smaller percentage of cases out of range, and greater accuracy in placing implants. A potential benefit was observed in navigation for cases with deformities of between 10 and 15° of varus. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  13. Pre-operative screening for excessive alcohol consumption among patients scheduled for elective surgery. (United States)

    Shourie, Swati; Conigrave, Katherine M; Proude, Elizabeth M; Ward, Jeanette E; Wutzke, Sonia E; Haber, Paul S


    Pre-operative intervention for excessive alcohol consumption among patients scheduled for elective surgery has been shown to reduce complications of surgery. However, successful intervention depends upon an effective and practical screening procedure. This study examines current screening practices for excessive alcohol consumption amongst patients scheduled for elective surgery in general hospitals. It also examines the appropriateness of potential sites and staff for pre-operative screening. Forms used routinely to assess alcohol consumption in the pre-admission clinics (PAC) of eight Sydney hospitals were examined. In addition, the appropriateness of six staff categories (surgeons, surgeons' secretaries, junior medical officer, anaesthetists, nurses and a research assistant) and of two sites (surgeons' office and PAC) in conducting additional screening was assessed at two hospitals. Outcomes included observed advantages and disadvantages of sites and personnel, and number of cases with excessive drinking identified. There was duplication in information collected routinely on alcohol use in the PACs in eight Sydney Hospitals. Questions on alcohol consumption in patient self-completion forms were not validated. The PAC provided for efficient screening but time to surgery was typically too short for successful intervention in many cases. A validated tool and efficient screening procedure is required to detect excessive drinking before elective surgery. Patients often present to the PAC too close to the time of surgery for any change in drinking to reverse alcohol's effects. The role of the referring general practitioner and of printed advice from the surgeon in preparing patients for surgery needs further investigation.

  14. The high prevalence of pathologic calcium crystals in pre-operative knees. (United States)

    Derfus, Beth A; Kurian, Jason B; Butler, Jeffrey J; Daft, Laureen J; Carrera, Guillermo F; Ryan, Lawrence M; Rosenthal, Ann K


    Calcium pyrophosphate dihydrate (CPPD) and basic calcium phosphate (BCP) crystals are important in the pathogenesis of osteoarthritis (OA) but are under recognized even in end stage disease. We determined the prevalence of these calcium crystals in synovial fluid (SF) of persons undergoing total knee arthroplasty for degenerative arthritis. SF samples were obtained from 53 knee joints undergoing total arthroplasty for a pre-operative diagnosis of OA. SF were analyzed via compensated light microscopy for CPPD crystals and a semiquantitative radiometric assay for BCP crystals. Fifty pre-operative radiographs were analyzed and graded according to the scale of Kellgren and Lawrence. Patients had an average age of 70 years at the time of surgery. CPPD and/or BCP crystals were identified in 60% of SF. Overall radiographic scores correlated with mean concentrations of BCP crystals. Higher mean radiographic scores correlated with the presence of calcium-containing crystals of either type in SF Radiographic chondrocalcinosis was identified in only 31% of those with SF CPPD. Pathologic calcium crystals were present in a majority of SF at the time of total knee arthroplasty. Intraoperative SF analysis could conveniently identify pathologic calcium crystals providing information that may be relevant to the future care of the patient's replaced joint and that of other joints. This information could also potentially aid in predicting the likelihood of the need for contralateral total knee arthroplasty.

  15. Pre-operative urodynamics in women with stress urinary incontinence increases physician confidence, but does not improve outcomes. (United States)

    Zimmern, Philippe; Litman, Heather; Nager, Charles; Sirls, Larry; Kraus, Stephen R; Kenton, Kimberly; Wilson, Tracey; Sutkin, Gary; Siddiqui, Nazema; Vasavada, Sandip; Norton, Peggy


    To determine if pre-operative urodynamic testing (UDS) affects physicians' diagnostic confidence and if physician confidence affects treatment outcomes at 1 year. The Value of Urodynamic Evaluation (ValUE) trial randomized 630 women with predominant stress urinary incontinence (SUI) to office evaluation (OE) or OE plus UDS prior to surgery. After OE, physicians completed a checklist of five clinical diagnoses: SUI, overactive bladder (OAB) wet and dry, voiding dysfunction (VD), and intrinsic sphincter deficiency (ISD), and reported their confidence in each. Responses ranged from 1 to 5 with; 1 = "not very confident (confident (95 + %)." After UDS, investigators again rated their confidence in these five clinical diagnoses. Logistic regression analysis correlated physician confidence in diagnosis with treatment success. Of 315 women who received OE plus UDS, 294 had complete data. Confidence improved after UDS in patients with baseline SUI (4.52-4.63, P confidence after UDS was not associated with higher odds of treatment success although mean changes in confidence were slightly higher for those who achieved treatment success. Physician diagnoses shifted more from not confident to confident for ISD and OAB-wet after UDS (McNemar's P-value women undergoing UDS for predominant SUI, UDS increased physicians' confidence in their clinical diagnoses; however, this did not correlate with treatment success. © 2013 Wiley Periodicals, Inc.

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

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    Joseph M. Blankush


    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.

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

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    Bates Tom


    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.

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

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    Tim Thomas Joseph


    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

  19. Effects of Pre-operative Psychological Status on Post-operative Recovery: A Prospective Study. (United States)

    Aspari, Ajay Raghunath; Lakshman, K


    Often in clinical practice, a spectrum of outcomes from surgery may be observed ranging from a quick and comfortable recovery to a recovery punctuated by persistent pain and decreased quality of life. While there has been a fast pace of advances made in the field of operative surgery, surgeons seldom pay attention to factors such as the psychological profile of a patient that can affect recovery from surgery. To study the effects of pre-operative psychological profile on post-operative recovery in terms of pain, return to work and quality of life. Consecutive patients undergoing laparoscopic surgeries at Sagar Hospitals, Jayanagar, were recruited. All patients were assessed for psychological status using the screening for illness behaviour questionnaire (SIBQ) and pain catastrophizing scale (PCS). Following surgery, they were followed up for a period of 3 months-on post-operative day 1, post-operative day 7, 1 month and 3 months from the date of surgery. Post-operative pain was measured using the visual analogue scale (Wong-Baker's), return to work was documented in days and quality of life was measured using the Short Form-36 version 2 (SF-36v2) Health Survey. The Pearson's correlation coefficients were used to compare variables with continuous data and Chi-square and Fisher's tests were used to test categorical data for significance. In a total of 98 patients recruited, 50 patients had a complete follow-up of 3 months. Significant correlations existed between the pre-operative markers and markers of recovery. The Chi-square test and Fisher's exact tests showed significant differences in the scores of pre-operative markers between the groups of patients who developed chronic pain and those who did not. Difference in scores with regard to quality of life was also noted. Psychological status does play a role in post-operative recovery. This result opens up scope for counselling patients towards a healthy and comfortable recovery from surgery.

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

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    E S Adarsh


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

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

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


    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 the post-operative outcome in CD. METHOD: This is a multicentre retrospective cohort study. The primary outcome was 30-day post-operative complications. Secondary outcomes were intra-abdominal septic complications, surgical site infection (SSI), re-operation, length of post-operative stay in a hospital.......021) compared to the non-optimized. Multivariate analyses showed that treatment with anti-TNF alpha agents OR 2.058 CI [1.043-4.4.064] and low haemoglobin OR 0.741 CI [0.572-0.0.961] increased the risk of overall post-operative complications. Co-morbidity increased the risk of SSI OR 2.567 CI [1...


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    Ana Cláudia Afonso Valladares


    Full Text Available Abstract: Every child, particularly those who will be submitted to surgery, needs to express themselves, create and 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 a public hospital in the city of Goiânia/GO in a two years’ period (1998-2000. The target population consisted of hospitalized children in the pre-operative process. It was concluded that great therapeutic benefit was achieved from the use of art therapy for this population as it helped the children to recover their mental balance, thus strengthening a healthier side of the child which had been deadened by the illness, hospitalization and treatment. Key words: art therapy; hospitalized child; mental health.


    Directory of Open Access Journals (Sweden)

    Ana Cláudia Afonso Valladares


    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.

  4. Accuracy of pre-operative hysteroscopic guided biopsy for predicting final pathology in uterine malignancies. (United States)

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


    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 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 malignancies.

  5. Pre-operative renal volume predicts peak creatinine after congenital heart surgery in neonates. (United States)

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


    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.

  6. [Interventional multidimodal hybrid unit: from pre-operative planning to immediate post-operative control]. (United States)

    Scolozzi, P; Schouman, T


    Computer assisted surgery has rapidly developed over the last decade, essentially due to the development of navigation and 3D virtual surgical planning and image fusion technologies. The recent introduction of intra-operative cone-beam CT scan (CBCT), which integrates flat panel technology, allows for high resolution bone imaging, the quality and accuracy of which is similar to the one obtained by conventional spiral CT scan. The combination of these two technologies in a "hybrid" operating unit enables the convergence of the pre-, intra- and post-operative steps in a linear computer-assisted processing chain, which optimises surgery accuracy, predictability and patient outcomes while potentially reducing costs, operating times and need for further surgical revision. The "hybrid" unit includes: 1) the operating room (65 m(2)) equipped with horizontal laminar-flow, a mobile monoplane ceiling suspended C-arm CBCT scan system with a flat panel detector, a wireless navigation system, and an interactive wall-mount touch screen 2) the control room (18 m(2)) separated from the operating room by an X-ray lead protective glass window, including two separate computer workstations for 3D image integration and processing 3) the scrub room (17 m(2)) with two separate stainless steel surgical wash-basins. The intra-operative protocol includes the following steps: 1) elaboration of the patient specific pre-operative computed planning and simulation based on pre-operatively and/or intra-operatively acquired patient images 2) intra-operative navigational guidance setting 3) surgical procedure 4) intra-operative 3D CT imaging 5) suture. Copyright © 2012. Published by Elsevier Masson SAS.

  7. Agreement between pre-operative and intra-operative bacteriological samples in 85 chronic peri-prosthetic infections. (United States)

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


    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.

  8. Serum retinol-binding protein 4 correlates with obesity, insulin resistance, and dyslipidemia in HIV-infected subjects receiving highly active antiretroviral therapy. (United States)

    Han, Sang Hoon; Chin, Bum Sik; Lee, Han Sung; Jeong, Su Jin; Choi, Hee Kyoung; Kim, Chang Oh; Choi, Jun Yong; Song, Young Goo; Lee, Hyun Chul; Kim, June Myung


    Highly active antiretroviral therapy (HAART) contributes to the development of metabolic complications including dyslipidemia, insulin resistance (IR), and lipodystrophy (LD). Recent studies reported that retinol-binding protein 4 (RBP4) is associated with IR, dyslipidemia, and obesity in non-HIV-infected populations. The aim of this study was to evaluate the associations between RBP4 and LD or metabolic abnormalities in HIV-infected subjects receiving HAART. We performed a cross-sectional study with 113 HIV-infected subjects receiving HAART for more than 6 months. Body composition and abdominal fat were measured by bioelectrical impedance analysis and ultrasonography, and fasting serum RBP4 was measured by enzyme-linked immunosorbent assay. Retinol-binding protein 4 levels in subjects with LD were similar to those without LD (P = .839). Retinol-binding protein 4 had significantly positive correlations with waist circumference (r = 0.298, P = .002), waist-to-hip ratio (r = 0.336, P = .001), body mass index (r = 0.310, P = .002), total body fat mass (r = 0.323, P = .001), total cholesterol (r = 0.188, P = .048), log (triglyceride) (r = 0.269, P = .004), and log (homeostasis model assessment of IR) (r = 0.207, P = .036), and negative correlations with quantitative insulin sensitivity check index (r = -0.209, P = .034) after adjustment for age and sex. In stepwise multivariate linear regression analysis, waist-to-hip ratio was the most significant independent predictor of increased RBP4 (standardized beta = .351, P = .001). These results suggest that serum RBP4 is associated with obesity, IR, and dyslipidemia in HIV-infected subjects receiving HAART.

  9. Pre-operative factors predicting good outcome in terms of health-related quality of life after ACL reconstruction. (United States)

    Månsson, O; Kartus, J; Sernert, N


    The life situation of many patients changes after an anterior cruciate ligament (ACL) rupture and subsequent reconstruction, and this may affect their health-related quality of life in many ways. It is well known that the overall clinical results after ACL reconstruction are considered good, but pre-operative predictive factors for a good post-operative clinical outcome after ACL reconstruction have not been studied in as much detail. The purpose of this study was to identify pre-operative factors that predict a good post-operative outcome as measured by the Short Form 36 (SF-36) and Knee Osteoarthritis Outcome Score (KOOS) 3-6 years after ACL reconstruction. Seventy-three patients scheduled for ACL reconstruction were clinically examined pre-operatively. The SF-36 and KOOS questionnaires were sent by mail to these patients 3-6 years after reconstruction. Predictive factors for health-related quality of life were investigated using a stepwise regression analysis. In conclusion, pre-operative factors, such as pivot shift, knee function, and range of motion, may predict a good post-operative outcome and explain up to 25% in terms of health-related quality of life after ACL reconstruction. Furthermore, it appears that the patients' pre-injury and pre-operative Tegner activity levels are important predictors of post-operative health-related quality of life. © 2012 John Wiley & Sons A/S.

  10. Pre-operative prediction of advanced prostatic cancer using clinical decision support systems: accuracy comparison between support vector machine and artificial neural network. (United States)

    Kim, Sang Youn; Moon, Sung Kyoung; Jung, Dae Chul; Hwang, Sung Il; Sung, Chang Kyu; Cho, Jeong Yeon; Kim, Seung Hyup; Lee, Jiwon; Lee, Hak Jong


    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 cancer. The performance of SVM is superior to ANN in the pre-operative prediction of advanced prostate cancer.

  11. Pre-operative Screening and Manual Drilling Strategies to Reduce the Risk of Thermal Injury During Minimally Invasive Cochlear Implantation Surgery. (United States)

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


    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.

  12. The efficacy of pre-operative oral medication of lornoxicam and diclofenac potassium on the success of inferior alveolar nerve block in patients with irreversible pulpitis: a double-blind, randomised controlled clinical trial. (United States)

    Prasanna, N; Subbarao, C V; Gutmann, J L


    To determine the effect of administration of pre-operative lornoxicam (LNX) or diclofenac potassium (DP) on the success of inferior alveolar nerve blocks (IANB) in patients with irreversible pulpitis in a double-blind randomised controlled trial. One hundred and fourteen patients with irreversible pulpitis of a mandibular posterior tooth participated. Patients indicated their pain scores on a Heft Parker visual analogue scale, after which they were randomly divided into three groups (n = 38). The subjects received identical capsules containing 8 mg LNX, 50 mg DP or cellulose powder (placebo, PLAC), 1 h before administration of IANB with 2% lidocaine containing 1 : 200 000 epinephrine. Lip numbness was assessed after 15 min, following which the teeth were tested with cold spray and their responses (negative or positive) were recorded. Access cavities were then prepared and success of IANB was defined as the absence of pain during access preparation and root canal instrumentation. The data were analysed using chi-squared tests. The percentages of teeth giving a negative response to cold test were 42.8% (PLAC), 78.5% (LNX) and 67.8% (DP), with no significant differences amongst the groups (P > 0.05). The success rates for the IANB in descending order were 71.4% (LNX), 53.5% (DP) and 28.5 (PLAC). A significant (P irreversible pulpitis, whilst the effect of pre-medication with DP was not significantly different from the PLAC.

  13. A pre-operative predictive score to evaluate the feasibility of complete cytoreductive surgery in patients with epithelial ovarian cancer. (United States)

    Chesnais, Marion; Lecuru, Fabrice; Mimouni, Myriam; Ngo, Charlotte; Fauconnier, Arnaud; Huchon, Cyrille


    Postoperative residual tumor is the major prognostic factor in ovarian cancer. The feasibility of complete cytoreductive surgery is assessed by laparoscopy. Our goal was to develop a predictive score prior to laparoscopy to evaluate the feasibility of complete cytoreductive surgery in patients with epithelial ovarian cancer. We developed a score to predict incomplete cytoreductive surgery by performing multiple logistic regressions after bootstrap procedures on data from a retrospective cohort of 247 patients with advanced ovarian cancer. This score was validated on a different population of 45 patients with ovarian cancer. Four criteria were independently associated with incomplete cytoreduction, confirmed by surgery: BMI ≥ 30 kg/m2 (adjusted odds ratio [aOR], 3.07; 95% confidence interval [95% CI], 1.0-9.6), CA125 > 100 IU/L (aOR, 3.99; 95% CI, 1.6-10.1), diaphragmatic and/or omental carcinomatosis by CT-Scan (aOR, 5.82; 95% CI, 2.6-13.1), and positive parenchymal metastases by PET/CT (aOR, 3.59; 95% CI, 1.0-12.8). The 100-point score was based on these criteria. The area-under-the-curve of the score was 0.79 (95% CI, 0.73-0.86). In the validation group, no patient ranked in the high-risk group of incomplete cytoreductive surgery had a complete upfront cytoreductive surgery (95% CI 0-16). Three of 29 patients for whom primary complete cytoreduction was not possible were classified in the group at low risk of incomplete cytoreductive surgery (12%; 95% CI 4-27). This pre-operative score may be useful for distinguishing which patients may have complete cytoreductive surgery from those who will receive neoadjuvant chemotherapy, while avoiding unnecessary laparoscopy.

  14. A pre-operative predictive score to evaluate the feasibility of complete cytoreductive surgery in patients with epithelial ovarian cancer.

    Directory of Open Access Journals (Sweden)

    Marion Chesnais

    Full Text Available Postoperative residual tumor is the major prognostic factor in ovarian cancer. The feasibility of complete cytoreductive surgery is assessed by laparoscopy. Our goal was to develop a predictive score prior to laparoscopy to evaluate the feasibility of complete cytoreductive surgery in patients with epithelial ovarian cancer.We developed a score to predict incomplete cytoreductive surgery by performing multiple logistic regressions after bootstrap procedures on data from a retrospective cohort of 247 patients with advanced ovarian cancer. This score was validated on a different population of 45 patients with ovarian cancer.Four criteria were independently associated with incomplete cytoreduction, confirmed by surgery: BMI ≥ 30 kg/m2 (adjusted odds ratio [aOR], 3.07; 95% confidence interval [95% CI], 1.0-9.6, CA125 > 100 IU/L (aOR, 3.99; 95% CI, 1.6-10.1, diaphragmatic and/or omental carcinomatosis by CT-Scan (aOR, 5.82; 95% CI, 2.6-13.1, and positive parenchymal metastases by PET/CT (aOR, 3.59; 95% CI, 1.0-12.8. The 100-point score was based on these criteria. The area-under-the-curve of the score was 0.79 (95% CI, 0.73-0.86. In the validation group, no patient ranked in the high-risk group of incomplete cytoreductive surgery had a complete upfront cytoreductive surgery (95% CI 0-16. Three of 29 patients for whom primary complete cytoreduction was not possible were classified in the group at low risk of incomplete cytoreductive surgery (12%; 95% CI 4-27.This pre-operative score may be useful for distinguishing which patients may have complete cytoreductive surgery from those who will receive neoadjuvant chemotherapy, while avoiding unnecessary laparoscopy.

  15. On enhancing planning and navigation of beating-heart mitral valve surgery using pre-operative cardiac models. (United States)

    Linte, Cristian A; Wierzbicki, Marcin; Moore, John; Guiraudon, Gérard; Jones, Douglas L; Peters, Terry M


    In an effort to reduce morbidity during minimally-invasive cardiac procedures, we have recently developed an interventional technique targeted towards off-pump cardiac interventions. To compensate for the absence of direct visualization, our system employs a virtual reality environment for image guidance, that integrates pre-operative information with real-time intra-operative imaging and surgical tool tracking. This work focuses on enhancing intracardiac visualization and navigation by overlaying pre-operative cardiac models onto the intra-operative virtual space, to display surgical targets within their specific anatomical context. Our method for integrating pre-operative data into the intra-operative environment is accurate within 5.0 mm. Thus, we feel that our virtually-augmented surgical space is accurate enough to improve spatial orientation and intracardiac navigation.

  16. Efficacy of pre-operative quadriceps strength training on knee-extensor strength before and shortly following total knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Rasmus Skov; Troelsen, Anders; Thorborg, Kristian


    -surgical treatment to be tried prior to surgical procedures. Patients with knee OA are characterized by decreased muscle strength, particularly in the knee-extensor muscles. Correspondingly, decreased knee-extensor strength is found to be associated with an increased risk of development, progression and severity...... of knee OA symptoms. Recent trials suggest a positive effect of pre-operative exercise on pre- and post-operative outcome; however, the most effective pre-operative knee-extensor strength exercise dosage is not known. The purpose of the present trial is to investigate the efficacy of three different...... exercise dosages of pre-operative, home-based, knee-extensor strength exercise on knee-extensor strength before and shortly after surgery in patients eligible for TKA due to end-stage knee OA. METHODS: In this randomized dose-response trial with a three-arm parallel design, 140 patients with end-stage knee...

  17. The role of CT and endoscopic ultrasound in pre-operative staging of pancreatic cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kala, Zdenek [Department of Surgery, Faculty Hospital Brno, Jihlavska 20, 639 00 Brno (Czech Republic)]. E-mail:; Valek, Vlastimil [Department of Radiology, Faculty Hospital Brno, Jihlavska 20, 639 00 Brno (Czech Republic)]. E-mail:; Hlavsa, Jan [Department of Surgery, Faculty Hospital Brno, Jihlavska 20, 639 00 Brno (Czech Republic)]. E-mail:; Hana, Kyselova [Department of Radiology, St. Annas Faculty Hospital, Pekarska 53, 656 91 Brno (Czech Republic); Vanova, Anna [Pedagogical Faculty of Masaryk University, Porici 9, 603 00 (Czech Republic)


    Purpose: The aim of our study was to compare the accuracy of computed tomography and endoscopic ultrasound (EUS) in pre-operative staging of pancreatic cancer. Methods: Comparative retrospective study of 86 patients with pancreatic cancer. CT was done in 55 patients, 41 patients were examined by EUS. Each patient underwent surgery and had proven pancreatic cancer by histology. CT and EUS results were correlated to per-operative and histological findings. The main attention was paid to the description of peri-pancreatic lymphadenopathy, para-aortic lymphadenopathy, peri-coeliac lymphadenopathy and tumor relationship to superior mesenteric vein, superior mesenteric artery, portal vein, inferior caval vein and common hepatic artery. A description rate was defined as number of pre-operative findings where the structures and relationships mentioned above were described. Results: The description rates of peri-pancreatic lymph nodes were 11 (20%) at CT and 36 (88.0%) at EUS. Para-aortic lymphadenopathy was described in 9 (16.0%) cases at CT and none at EUS. Peri-coeliac lymphadenopathy was mentioned only one time (2.0%) at CT contrary to 12 (29.0%) at EUS. Relationship of the tumor to the mesenteric vessels was well depicted in nine (16.0%) at CT versus nine (22.0%) at EUS. Portal vein relationship was well described in two (4.0%) at CT and seven (17%) cases at EUS. This description rate in vena cava inferior was one (2%) at CT and three (7.0%) at EUS, in hepatic artery it was one (2%) at CT and six (15%) at EUS. In the group of CT, resectability or non-resectability were well predicted in 33 (60%) patients and wrong predicted in 22 (40%) patients. In the group of EUS, resectability or non-resectability were well predicted in 34 (83%) patients and wrong predicted in 7 (17%) patients. Conclusion: According to our study, EUS is more accurate in prediction of local PC resectability than CT.

  18. Utility of an intraoperative ultrasound in lateral approach mini-parathyroidectomy with discordant pre-operative imaging. (United States)

    Al-Lami, Ali; Riffat, Faruque; Alamgir, Furqan; Dwivedi, Raghav; Berman, Laurence; Fish, Brian; Jani, Piyush


    Objectives of this study were to assess the utility of intra-operative ultrasound to resolve discordant pre-operative imaging prior to a lateral approach mini-parathyroidectomy, by studying prospective case series in a head and neck endocrine unit. Patients with primary hyperparathyroidism due to a single adenoma with discordant pre-operative ultrasound and sestamibi were enrolled. They underwent a further intra-operative ultrasound by a head and neck radiologist with a view to proceed with a mini-parathyroidectomy. The main outcome measure was utility of intra-operative ultrasound compared to operative findings and pre-operative imaging. Secondary measures were complications of mini-parathyroidectomy, operative and ambulatory discharge time. Twenty-two patients underwent surgery with intra-operative ultrasound in the surgical position. The intra-operative ultrasound findings correlated with the operative findings in all cases (100 %). There were 16 inferior adenomas and 6 superior adenomas. Six inferior adenomas were in a retrosternal position, eight were obscured by benign thyroid lesions and a further two reported pre-operatively as superior. Three out of six superior adenomas were reported as inferior pre-operatively as the inferior thyroid artery was inadequately visualised, two were retro-carotid and one was retro-oesophageal. All patients were discharged within 23 h of surgery. There were no unsuccessful focused explorations. Histological analysis confirmed the adenomas. No morbidity (vocal cord palsy, haematoma, hungry bones) was noted. The results indicated that intra-operative ultrasound by a dedicated radiologist is a valuable tool in resolving discordance of pre-operative imaging. Appropriate patient positioning with neck extension and muscle relaxation allows placement of the probe in the obscure retro-carotid and retro-oesophageal locations and unmasks apparent "mediastinal" parathyroids facilitating focused dissection.

  19. Delta Inulin Adjuvant Enhances Plasmablast Generation, Expression of Activation-Induced Cytidine Deaminase and B-Cell Affinity Maturation in Human Subjects Receiving Seasonal Influenza Vaccine.

    Directory of Open Access Journals (Sweden)

    Lei Li

    Full Text Available There is a major need for new adjuvants to improve the efficacy of seasonal and pandemic influenza vaccines. Advax is a novel polysaccharide adjuvant based on delta inulin that has been shown to enhance the immunogenicity of influenza vaccine in animal models and human clinical trials. To better understand the mechanism for this enhancement, we sought to assess its effect on the plasmablast response in human subjects. This pilot study utilised cryopreserved 7 day post-vaccination (7dpv peripheral blood mononuclear cell samples obtained from a subset of 25 adult subjects from the FLU006-12 trial who had been immunized intramuscularly with a standard dose of 2012 trivalent inactivated influenza vaccine (TIV alone (n=9 subjects or combined with 5mg (n=8 or 10mg (n=8 of Advax adjuvant. Subjects receiving Advax adjuvant had increased 7dpv plasmablasts, which in turn exhibited a 2-3 fold higher rate of non-silent mutations in the B-cell receptor CDR3 region associated with higher expression of activation-induced cytidine deaminase (AID, the major enzyme controlling BCR affinity maturation. Together, these data suggest that Advax adjuvant enhances influenza immunity in immunized subjects via multiple mechanisms including increased plasmablast generation, AID expression and CDR3 mutagenesis resulting in enhanced BCR affinity maturation and increased production of high avidity antibody. How Advax adjuvant achieves these beneficial effects on plasmablasts remains the subject of ongoing investigation.Australia New Zealand Clinical Trials Register ACTRN12612000709842

  20. 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)


    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.)

  1. Using 3 Tesla magnetic resonance imaging in the pre-operative evaluation of tongue carcinoma. (United States)

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


    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 magnetic resonance imaging, direct measures of tumour thickness (mean ± standard deviation, 18.2 ± 7.3 mm) did not significantly differ from the reconstructed measures (mean ± standard deviation, 17.9 ± 7.2 mm; r = 0.879). Moreover, 3 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.

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

    Energy Technology Data Exchange (ETDEWEB)



    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.

  3. Validation of an assessment tool for pre-operative EVAR planning. (United States)

    Fatic, Nikola; Normahani, Pasha; Mars, Dejan; Standfield, Nigel J; Jaffer, Usman


    Current methods of teaching endovascular aortic aneurysm repair (EVAR) planning involve non-criteria-based observations that lack validity. The primary aim of this study was to validate an EVAR Planning Objective Structured Assessment of Skill (EpOSAS) tool for the assessment of pre-operative EVAR planning skills. Content analysis was performed in order to inform the formulation of EpOSAS domains. Thirty-five participants planned two cases of infra-renal abdominal aortic aneurysm for EVAR, using the OsiriX 7 platform. EVAR planning measurements, with accompanying screenshots, were uploaded onto an electronic data collection sheet. Performance was assessed by three blinded assessors using the EpOSAS tool. Construct and concurrent validity were evaluated. Inter-observer reliability for the three assessors for total EpOSAS scores was high (Cronbach's α 0.89). There were statistically significant differences in total EpOSAS scores between the different experience groups, demonstrating construct validity (Novice (5.3, IQR 5-5.3), Intermediate (15.3, IQR 14.8-16.8) and Experts (17.5, IQR 17-17.7), pplanning skills.

  4. Pre-operative predictors of weight loss at 1-year after Lap-Band surgery. (United States)

    Dixon, J B; Dixon, M E; O'Brien, P E


    The authors studied a range of preoperative factors for their predictive value of effectiveness of Lap-Band placement, using the percentage of excess weight loss at 1-year as the outcome measure (%EWL1). All factors were measured and recorded prior to surgery. Factors included: patient demographics, family, medical and weight history. Laboratory measures and the responses to the SF-36 Health Survey were also assessed. Factors were assessed for correlation with %EWL1. The group (N=440, F:M 383:57) had mean age 40.0+/-9.5 years, weight of 126+/-25 kg, and BMI 45.6+/-7.5 kg/m2 pre-operatively. At 1-year follow-up, the group had mean weight 97.6obesity. Important physical factors have been found to influence the rate of weight loss. Those with increased age, pain, physical disability and insulin resistance have a great deal to gain from weight loss. Although this study has identified factors that are associated with less weight loss, we have not found any factor that predicts an unacceptably low weight loss and thus provides a contraindication to Lap-Band placement. The findings of this study allow us to set more realistic goals for the rate of weight loss in specified sub-groups of our patients.

  5. Pre-operative embolisation of internal carotid artery branches and pial vessels in hypervascular brain tumours. (United States)

    Yoon, Y S; Ahn, J Y; Chang, J H; Cho, J H; Suh, S H; Lee, B H; Lee, K S


    Pre-operative embolisation is an effective method used to reduce intra-operative bleeding and operative difficulty in hypervascular brain tumour surgery. However, embolisation of the internal carotid artery (ICA) and pial tumour feeding branches has certain limitations. From March 2000 to November 2006, 8 patients underwent superselective embolisation for hypervascular brain tumour. Seven tumours were extra-axial (6 meningiomas, 1 solitary fibrous tumour) and 1 was intra-axial (metastatic hepatocellular carcinoma). In all patients, feeding vessels from ICA branches or pial arteries were successfully embolised using superselective microcatheterisation. A provocative test was applied in 4 patients who had tumours adjacent to the motor cortex. Angiographic devascularisation was slight to extensive. Mean devascularisation on post-embolisation MRI ranged from 40 to 80% (mean 63.8%). One patient (12.5%) suffered an embolisation-related complication (loss of choroidal brush), but was not clinically worse because of the pre-existing blindness. Superselective embolisation of ICA branches or pial vessels should be performed if several conditions are met, especially angiographic findings, pre-existing neurologic deficits, provocative test, and technical feasibility. If the ICA embolisation for hypervascular tumour is successfully achieved, the bleeding loss and operative risk can be reduced.

  6. Carotid Intima-Media Thickness in Indonesian Subjects with Cardiovascular Disease Risk Factors Who Were Not Receiving Lipid-Lowering Agents. (United States)

    Kaligis, Rinambaan W M; Adiarto, Suko; Nugroho, Johanes; Pradnyana, Bagus Ari; Lefi, Achmad; Rifqi, Sodiqur


    Carotid intima-media thickness (CIMT) is frequently utilized for detection of subclinical atherosclerosis. This study aims to investigate the association between the CIMT values and demographic characteristics, cardiovascular disease (CVD) risk factors, lipid biochemistry profiles, and high-sensitivity C-reactive protein (hs-CRP) levels among the Indonesian population. Subjects who had two or more CVD risk factors but were not receiving lipid-lowering therapy were recruited from six hospitals of Indonesia. Measurements of CIMT are obtained by ultrasonography of 12 sites within the common carotid artery. CVD risk factors, lipid and glucose profiles, and hs-CRP values were analyzed with respect to distribution of CIMT. The mean-max CIMT was 0.805 ± 0.190 mm (minimum, 0.268 mm; maximum, 1.652 mm) and the mean-mean CIMT was 0.614 ± 0.190 mm (minimum, 0.127 mm; maximum, 1.388 mm). Multivariate analyses confirmed an independent association between increasing CIMT and increasing age (regression coefficient = 0.004; p = 0.004). Our data show normative mean-mean CIMT data for Indonesian subjects with two or more CVD risk factors who are not receiving lipid-lowering therapy, which may guide CVD risk stratification of asymptomatic individuals in Indonesia.

  7. Females, younger patients and patients with high BMI have the highest pre-operative knee awareness measured using the Forgotten Joint Score. (United States)

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


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

  8. Weight loss approach during routine follow-up is effective for obstructive sleep apnea hypopnea syndrome subjects receiving nasal continuous positive airway pressure treatment. (United States)

    Fujii, Hiroko; Miyamoto, Masayuki; Miyamoto, Tomoyuki; Muto, Takashi


    The present study investigated the effectiveness of a weight loss program during routine medical follow-up with regularity on promoting weight reduction in obese obstructive sleep apnea hypopnea syndrome (OSAHS) subjects receiving continuous positive airway pressure treatment (CPAP). A total of 10 male obese OSAHS subjects treated with CPAP were enrolled in the present study that was an intervention study without a control and had a pre-post test study design. The age was 50.7 (7.8) (mean (SD)) years, and body mass index was 30.7 (2.5) kg/m(2). A 4-month weight loss program was developed, using a combined approach of diet and physical activity based on individual counseling with behavioral approach. At 4 months, weight was significantly decreased compared with the baseline value (88.4 (8.9) kg to 86.9 (8.8) kg, p=0.005), and the mean weight loss was a 1.7% decrease from the baseline. There was significantly higher percent weight loss in the group with a CPAP duration or = 30 months (2.7 (1.6) % vs. 0.6 (0.5) %, p=0.032). The present study shows that a weight loss program may be useful in reducing weight for male obese OSAHS subjects treated with CPAP.

  9. Pre-operative evaluation prior to soft tissue sarcoma excision - Why can't we get it right? (United States)

    Mesko, N W; Wilson, R J; Lawrenz, J M; Mathieu, J L; Ghiam, M K; Mathis, S L; Halpern, J L; Schwartz, H S; Holt, G E


    To define the association between an appropriate pre-operative workup (pre-operative advanced imaging studies, diagnostic biopsy) and incomplete soft tissue sarcoma (STS) excision. This was a retrospective review of 397 consecutive patient records (2000-2008), looking at primary site advanced imaging (MRI or CT) and diagnostic biopsy procedures completed prior to the initial attempt at definitive surgical excision. Downstream effects of an inadequate pre-operative workup were also evaluated, including time to referral to a sarcoma multi-disciplinary care team and perceived alteration of surgical care in order to obtain a complete excision of the altered sarcoma bed. Thirty-eight percent (149/397) of soft tissue sarcomas identified underwent an incomplete excision prior to referral. A significant difference in the incidence of pre-operative primary site advanced imaging (91% vs. 42%, p operative diagnostic biopsy (85% vs. 16%, p operative biopsy (p 5 cm (p operative workup prior to referral, leading to increased long-term morbidity following definitive re-excision. Education efforts to heighten awareness of suspicious soft tissue lesions remain vital. Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  10. Are routine pre-operative blood tests required in children undergoing primary cleft lip and/or palate repair? (United States)

    Eley, Karen A; Goodacre, T E


    Primary surgical repair of cleft lip and/or palate is performed before 9 months of age, often representing the first surgical intervention these children encounter. Obtaining pre-operative blood tests in young children often produces much anxiety for all involved. We reviewed the electronic data of 282 children over a five-year period undergoing primary cleft repairs to determine the value of pre-operative full blood count, and transfusion requirements. Of these, three children required post-operative blood transfusion. In two cases concurrent illness contributed to transfusion requirement. To determine if our findings were consistent with those at other Cleft Centres, the views of primary cleft surgeons in the UK and Ireland were obtained using a questionnaire. A 96% response rate was achieved. The majority of cleft surgeons stated they no longer request routine pre-operative blood tests. Few could recall any of their patients requiring transfusion, and in those that did there was an underlying medical condition contributing to transfusion requirement, and an equal number whom could not have been predicted pre-operatively. The benefit of obtaining routine full blood count and group and save in children undergoing cleft repair is small in comparison to the stress caused from obtaining these bloods, and has significant cost implications to the Health Service. Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Feasibility and effectiveness of pre-operative inspiratory muscle training in patients undergoing oesophagectomy: a pilot study

    NARCIS (Netherlands)

    Dettling, Daniela S.; van der Schaaf, Marike; Blom, Rachel L. G. M.; Nollet, Frans; Busch, Olivier R. C.; van Berge Henegouwen, Mark I.


    Patients undergoing oesophageal surgery have a high risk for post-operative complications including pulmonary infections. Recently, physical therapy has shifted from the post-operative to the pre-operative phase to diminish post-operative complications and to shorten hospital stay. The purpose of

  12. Pre-operative localisation of hyperfunctional parathyroid tissue with {sup 11}C-methionine PET

    Energy Technology Data Exchange (ETDEWEB)

    Otto, D.; Boerner, A.R.; Hofmann, M.; Brunkhorst, T.; Meyer, G.J.; Petrich, T.; Knapp, W.H. [Hannover University Medical School, Department of Nuclear Medicine, Hannover (Germany); Scheumann, G.F. [Hannover University Medical School, Department of Visceral and Transplant Surgery, Hannover (Germany)


    Previous studies have shown high sensitivity of positron emission tomography (PET) with {sup 11}C-methionine in the pre-operative localisation of parathyroid adenoma and hyperplasia. Nonetheless, in secondary and tertiary hyperparathyroidism (HPT) and in patients with recurrent disease, pre-operative localisation of adenomatous (PTA) or hyperplastic tissue is still a problem with all available methods. The aim of this study was to define the optimal imaging protocol and to compare the diagnostic value of {sup 11}C-methionine PET and {sup 99m}Tc-methoxyisobutylisonitrile (MIBI) single-photon emission computed tomography (SPECT): in particular, we wished to define the benefit of {sup 11}C-methionine in those patients with inconclusive or negative conventional imaging. Thirty highly pre-selected patients with HPT were enrolled. Sixteen patients had primary HPT, 12 patients had secondary HPT, and two patients had recurrences of parathyroid carcinomas. All patients had ultrasound of the neck, dual-phase scintigraphy with {sup 99m}Tc-MIBI and PET with {sup 11}C-methionine. SUV{sub parathyroid}/SUV{sub cervical} {sub soft} {sub tissue} (target-to-background) and SUV{sub parathyroid} {sub tissue}/SUV{sub thyroid} {sub tissue} (target-to-non-target) ratios were calculated. After surgery, histology of specimens was obtained in all patients but one. In 12 patients with secondary or tertiary HPT, 36 hyperplastic parathyroid glands were histologically verified. Twenty-five of 36 lesions (69%) were detected with {sup 11}C-methionine PET and 17 (47%) with {sup 99m}Tc-MIBI scintigraphy. PET studies were positive in 17/18 (94%) cases in which HPT was related to adenomas or carcinomas. {sup 99m}Tc-MIBI scintigraphy/SPECT yielded pathological lesions in 9/18 cases (50%). All eight atypical localisations of parathyroid glands were detected with PET but only six of the eight were detected with {sup 99m}Tc-MIBI scintigraphy/SPECT. In 10/11 patients with recurrent HPT and non

  13. Prevention of Biomaterial Infection by Pre-Operative Incubation with Human Cells. (United States)

    Pérez-Tanoira, Ramón; Aarnisalo, Antti A; Eklund, Kari K; Han, Xia; Soininen, Antti; Tiainen, Veli-Matti; Esteban, Jaime; Kinnari, Teemu J


    Cells of tissues and biofilm forming bacteria compete for the living space on the surface of an implant. We hypothesized the incubation of the implant (titanium, polydimethylsiloxane, and polystyrene surface) with human cells before implantation as a strategy to prevent bacterial adhesion and biofilm formation. After 24 hours of incubation with human osteogenic sarcoma SaOS-2 cells (1 × 10 5 cells/mL), the materials were incubated for 4.5 hours or two days with Staphylococcus aureus in serial 1:10 dilutions of 10 8 colony-forming units/mL. The bacterial adherence and biofilm biomass on materials pre-incubated with SaOS-2 cells were compared with our previous results on materials incubated only with bacteria or in simultaneous co-culture of SaOS-2 cells and S. aureus. Fluorescent microscopy and crystal violet stain were used. The number of viable SaOS-2 and bacterial cells present was tested using colorimetric methods (MTT, LDH) and drop plate method, respectively. The pre-treatment with human cells was associated with a reduction of bacterial colonization of the biomaterial at 4.5 hours and 48 hours compared with the non-pre-treated materials. The presence of bacteria decreased the number of viable human cells on all materials. ( Supplementary Fig. 1 ; see online supplementary materials at ). These results suggest that the pre-operative incubation of prostheses with host cells could prevent infection of biomaterials.

  14. Concordance between pre-operative and post-operative assessments of primary caries lesion depth: results from The Dental PBRN (United States)

    Nascimento, Marcelle M.; Bader, James D.; Qvist, Vibeke; Litaker, Mark S.; Williams, O. Dale; Rindal, Brad; Fellows, Jeffrey L.; Gilbert, Gregg H.; Gordan, Valeria V.


    Summary This study investigated the concordance between pre- and post-operative assessments of primary caries lesions depths by dentists from The Dental Practice-Based Research Network (DPBRN; A total of 229 DPBRN dentists collected data on 8,351 consecutive restorations inserted due to primary caries in 5,810 patients. Dentists estimated the pre-operative depth of caries lesions based on the diagnostic methods they typically used. The pre-operative depth was then compared to the post-operative depth, which dentists determined using actual clinical observation. Both estimated and observed depths were recorded as being in the outer ½ (E1) or inner ½ (E2) of enamel, or in the outer ⅓ (D1), middle ⅓ (D2) or inner ⅓ (D3) of dentin. Most restorations were placed to treat lesions that were pre-operatively assessed as extending to the D1 (53%) and D2 (25%) depths. Of the restored caries lesions, 10% were pre-operatively assessed as being limited to E2 depth and 3% to E1 depth. The majority of the restored enamel lesions were located on occlusal surfaces. Pre-operative estimates of caries lesion depth were more concordant with post-operative depths when the lesion was at an advanced stage: 88% concordance at the D3 depth; compared to 54% concordance at the E1 depth. DPBRN dentists can discriminate caries lesions at different depths, but the accuracy of their depth assessments was higher for dentin than for enamel lesions. In general, DPBRN dentists were more likely to underestimate than to overestimate depth of caries lesions, and the extent of underestimation was greater for enamel than for dentin lesions. PMID:20672722

  15. Greater pre-operative anxiety, pain and poorer function predict a worse outcome of a total knee arthroplasty. (United States)

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


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

  16. From pre-operative cardiac modeling to intra-operative virtual environments for surgical guidance: an in vivo study (United States)

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


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

  17. Nutritional status assessed by scored patient-generated subjective global assessment associated with length of hospital stay in adult patients receiving an appendectomy

    Directory of Open Access Journals (Sweden)

    Tzu-Hao Huang


    Full Text Available Background: Malnutrition has been associated with poor health outcomes in hospitalized patients. This study assessed the validity of the scored patient-generated subjective global assessment (PG-SGA in adult patients who had undergone an open appendectomy, and examined the association of this assessment tool with length of hospital stay. Methods: Nutritional status was determined by using the scored PG-SGA in adult patients (n = 86 who had undergone an open appendectomy within 24 hours of admission. Variables were compared between well-nourished and malnourished participants. Regression analysis was used to identify potential predictors for length of hospital stay. Receiver operator characteristic (ROC analysis was used to examine the validity of the PG-SGA score to predict the nutritional status. Results: On admission, 17% of the study subjects were malnourished and associated with a significantly older age (53.0 vs. 39.5, greater PG-SGA score (8 vs. 2, higher comorbidity (67% vs. 27%, and longer length of hospital stay (6.9 d vs. 4.1 d. The PG-SGA score and comorbidity were the determined risk factors for length of hospital stay after performing multiple regression analysis. Furthermore, the PG-SGA score had a significantly positive correlation with length of hospital stay (Spearman's rho = 0.378, p < 0.001. The area under the ROC curve indicating the PG-SGA score, compared with nutritional status, is 0.9751. Conclusions: The scored PG-SGA in adults receiving an appendectomy is significantly associated with length of hospital stay, and is an effective tool for assessing the nutritional status of patients with cancer and chronic illness, as well as of patients with acute surgical abdomen.

  18. Evaluation of the Patient-Generated Subjective Global Assessment (PG-SGA) as a predictor of febrile neutropenia in gynecologic cancer patients receiving combination chemotherapy: a pilot study. (United States)

    Phippen, Neil T; Lowery, William J; Barnett, J Cory; Hall, Lisa A; Landt, Cristy; Leath, Charles A


    Determine if pre-treatment Patient-Generated Subjective Global Assessment (PG-SGA) predicts febrile neutropenia (FN) in gynecologic cancer patients receiving primary combination chemotherapy. Following IRB approval, clinicopathologic variables, pre-treatment laboratory values and PG-SGA were recorded from eligible patients. Bone marrow toxicity (CTC 3.0) divided groups of patients: (1) No grade 3 or 4 neutropenia, (2) grade 3 or 4 neutropenia, (3) FN. Statistical analysis with Kruskal-Wallis one-way analysis of variance and a receiver operating characteristic (ROC) curve were performed. 58 patients met study inclusion: 25 in group 1, 28 in group 2, and 5 in group 3. Mean age was 61 and the majority, 42 (72%), had ovarian cancer. Median PG-SGA scores were: 6 (group 1) vs. 7 (group 2) vs. 14 (group 3) (p=0.019). Both median albumin: (1) 4.2 vs. (2) 4.0 vs. (3) 3.4 g/dl (p=0.041), and hemoglobin: (1) 12.1 vs. (2) 11.75 vs. (3) 10.6g/dl (p=0.05) differed between the groups. The overall AUC of the ROC curve for PG-SGA was 0.831 ± 0.064 (95% CI=0.706 to 0.956, p=0.015). Using the ROC, selecting a PG-SGA score of 7.5 to be predictive of febrile neutropenia yields a sensitivity of 100% and a specificity of 60%. When the cutoff value is set at 12.5, the specificity improves to 81% while decreasing sensitivity to 80%. PG-SGA scores were higher for patients experiencing FN and may be a reasonably predictive marker of FN in patients receiving multi-agent primary chemotherapy and likely benefactors of prophylactic GCSF. Published by Elsevier Inc.

  19. Rilpivirine versus efavirenz in HIV-1-infected subjects receiving emtricitabine/tenofovir DF: pooled 96-week data from ECHO and THRIVE Studies. (United States)

    Nelson, M R; Elion, R A; Cohen, C J; Mills, A; Hodder, S L; Segal-Maurer, S; Bloch, M; Garner, W; Guyer, B; Williams, S; Chuck, S; Vanveggel, S; Deckx, H; Stevens, M


    Week 96 efficacy and safety of the non-nucleoside reverse transcriptase inhibitor (NNRTI) rilpivirine (RPV) was compared to efavirenz (EFV) in subset of 1,096 subjects who received emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) in pooled data from 2 phase 3 studies. ECHO and THRIVE are double-blind, double-dummy, randomized, active-controlled, non-inferiority phase 3 studies of RPV versus EFV plus 2 NRTIs in antiretroviral-naïve adult subjects. The primary and secondary endpoints were the proportion of subjects with HIV-1 RNA <50 copies/ mL using an intent-to-treat, time to loss of virologic response (ITT-TLOVR) analysis at weeks 48 and 96, respectively. Safety, tolerability, immunologic response, adherence level, and other measures were also evaluated. At week 48, noninferior efficacy of RPV+FTC/TDF over EFV+FTC/TDF was established, and at week 96 RPV+FTC/TDF remained noninferior (77% overall response rate in both groups). Through week 96, rates of virologic failure were higher in the RPV+FTC/ TDF group, with low and similar rates of virologic failure and resistance mutations occurring during the second year of follow-up. Treatment with RPV+FTC/TDF was associated with a lower rate of discontinuation due to adverse events and grade 2-4 adverse events including dizziness, abnormal dreams/nightmares, rash, and lipid abnormalities. The pooled ECHO and THRIVE studies demonstrated noninferiority of RPV+FTC/TDF in achieving virologic response with safety and tolerability advantages over EFV+FTC/TDF through 96 weeks. Higher rates of virologic failure in the RPV+FTC/TDF group were balanced with higher rates of discontinuations due to adverse events in the EFV+FTC/TDF group.

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

    Directory of Open Access Journals (Sweden)

    Lucky Onotai


    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

  1. 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 NCT01732159.

  2. The effect of mannitol on renal function following cardio-pulmonary bypass in patients with normal pre-operative creatinine. (United States)

    Yallop, K G; Sheppard, S V; Smith, D C


    Mannitol is often added to the cardiopulmonary bypass pump prime to reduce the incidence of renal dysfunction, but studies so far have been inconclusive. Urinary excretion of microalbumin and retinol binding protein are more sensitive than routine biochemical tests of renal function after cardiac surgery. We performed a double-blind, randomised, controlled trial in cardiac surgical patients with pre-operative plasma creatinine Hartmann's solution. Blood and urine samples were taken on the day before surgery and daily for 5 days postoperatively for measurement of plasma urea and creatinine, urinary creatinine, retinol binding protein and microalbumin. We found no differences between the mannitol and control patients for any measured variable, and conclude that mannitol has little impact on renal function in patients with normal pre-operative plasma creatinine concentrations.

  3. Pre-operative liver biopsy in cirrhotic patients with early hepatocellular carcinoma represents a safe and accurate diagnostic tool for tumour grading assessment. (United States)

    Colecchia, Antonio; Scaioli, Eleonora; Montrone, Lucia; Vestito, Amanda; Di Biase, Anna Rita; Pieri, Martina; D'Errico-Grigioni, Antonia; Bacchi-Reggiani, Maria Letizia; Ravaioli, Matteo; Grazi, Gian Luca; Festi, Davide


    Knowledge of pre-operative tumour grade is crucial in the management of hepatocellular carcinoma (HCC) because it can influence recurrence and survival after surgery. The accuracy of pre-operative needle core biopsy (NCB) in tumour grading has been assessed in only a few studies with conflicting results. Our aim was to determine the long-term safety and the overall accuracy of NCB in assessing tumour grading in subjects who had undergone liver resection for a single HCC. Eighty-one cirrhotic patients with HCC who had undergone NCB before liver resection were selected. Only patients with a single HCC and with at least a five-year-follow-up were included. Tumour grading was scored according to a modified Edmondson-Steiner classification: well/moderately (low grade) vs poorly-differentiated (high grade). In the 81 patients with a solitary HCC (mean size 4.1 ± 2.3cm) tumour grade was correctly identified by NCB in 74 out of 81 (91.4%) HCCs. NCB overall sensitivity and specificity were 65% and 98.1%, respectively, with a PPV of 92% and an NPV of 91%. No major complications (in particular tumour seeding) were observed. The overall survival rates at 1, 3, and 5 years were 83%, 62%, and 44%, respectively; the recurrence rate after a 5-year-follow-up was 56.2% for low grade and 82.3% for high grade tumours (pNCB can be performed on early (<5 cm) HCC cirrhotic patients because it provides histologically useful information for HCC management with good accuracy and a low complication rate. Copyright © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

  4. The sensitivity of pre-operative axillary staging in breast cancer: comparison of invasive lobular and ductal carcinoma. (United States)

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


    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.

  5. 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


    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)....

  6. 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


    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.

  7. Dry eye, sleep quality, and mood status in glaucoma patients receiving prostaglandin monotherapy were comparable with those in non-glaucoma subjects.

    Directory of Open Access Journals (Sweden)

    Shugyoku Ra

    Full Text Available Prior studies suggested that glaucoma patients suffer worse dry eye and mood and sleep disorders than non-glaucoma subjects. Prostaglandin analogues are first-line therapy for glaucoma, inducing few instillation problems and sufficient pressure-reduction effects. This study compared dry eye, sleep quality, and mood status between glaucoma patients receiving prostaglandin monotherapy and non-glaucoma subjects.This cross-sectional study evaluated 1520 patients (579 males and 941 females for glaucoma status and dry eye-related symptoms (dryness, eye fatigue, photophobia, pain, blurring and signs (Schirmer test, tear break-up time, corneal staining scores. Of the total cohort, 93 patients were also evaluated by Pittsburgh sleep quality index (PSQI and hospital anxiety and depression score (HADS. Inclusion criteria were consecutive patients ≥ 51 years of age and best-corrected visual acuity ≥ 20/25. Glaucoma patients included those treated with prostaglandin or a fixed combination including prostaglandin. Exclusion criteria were history of ocular surgery within one month. Data were analyzed using the chi-square or Mann-Whitney U tests, at 5% significance.There were no significant differences in dry eye-related signs and symptoms between the control (n = 1431, mean age of 66.9 years and glaucoma groups (n = 89, 67.9 years. The psychiatric sub-analysis of the control (n = 61, 66.2 years and glaucoma groups (n = 32, 67.3 years revealed mean scores of 5.02 ± 3.10 and 5.16 ± 3.46 for PSQI (normal range ≤ 5, 9.47 ± 5.61 and 9.42 ± 7.36 for HADS (normal range ≤ 10, 4.84 ± 3.22 and 4.71 ± 3.45 for anxiety (normal range ≤ 5, and 4.63 ± 3.05 and 4.71 ± 4.40 for depression (normal range ≤ 5, respectively, without statistical significance.Our results were comparable between glaucoma patients on prostaglandin monotherapy and non-glaucoma subjects for dry eye-related clinical manifestations, sleep quality, and mood status.

  8. Population pharmacokinetics analysis of AMG 416, an allosteric activator of the calcium-sensing receptor, in subjects with secondary hyperparathyroidism receiving hemodialysis. (United States)

    Chen, Ping; Melhem, Murad; Xiao, Jim; Kuchimanchi, Mita; Perez Ruixo, Juan Jose


    This study characterizes the population pharmacokinetics of AMG 416, an allosteric activator of the calcium-sensing receptor, in subjects with secondary hyperparathyroidism receiving hemodialysis. AMG 416 doses ranging from 2.5 to 60 mg were administered intravenously as single or multiple thrice weekly (TIW) doses at the end of hemodialysis during rinseback. The influence of demographics, concomitant medications, and other disease-related biomarkers on pharmacokinetic parameters was explored. The predictability of the final model was evaluated using bootstrapping and visual predictive checks. A 3-compartment linear pharmacokinetic model that accounts for the hemodialysis clearance best described the data. Plasma clearance (interindividual variability) was 0.564 L/h (14.0%CV). The hemodialysis clearance was 22.2 L/h. The volume of distribution at steady-state was approximately 624 L (82%CV). The mean time to achieve 90% steady-state predialysis concentrations with 3- and 6-hour hemodialysis TIW was 46 and 32 days, respectively. No statistically significant (P AMG 416 exhibits linear and stationary pharmacokinetics within the range of doses evaluated. Within the range of covariate values investigated, pharmacokinetically driven adjustments of AMG 416 dosing on the basis of these covariates were not warranted. © 2015, The American College of Clinical Pharmacology.

  9. Subjective discomfort in children receiving 3 T MRI and experienced adults' perspective on children's tolerability of 7 T: a cross-sectional questionnaire survey. (United States)

    Chou, I-Jun; Tench, Christopher R; Gowland, Penny; Jaspan, Tim; Dineen, Rob A; Evangelou, Nikos; Abdel-Fahim, Rasha; Whitehouse, William P; Constantinescu, Cris S


    To explore the possible discomfort perceived by children participating in 7 T MRI research, and the age range in which children are most likely to tolerate it well. A cross-sectional survey using age-appropriate questionnaires containing six measures of subjective discomfort (general discomfort, dizziness, noisiness, claustrophobia and feeling of cold or warm). For children, 3 T clinical scanner in a tertiary referral teaching hospital; for adults, 3 and 7 T scanner in a university research building. Non-sedated children and young people under 18 years of age who underwent 3 T clinical MRI for brain or musculoskeletal scans and adult volunteers attending 7 T with or without 3 T for brain scans. 83% (89/107) of involved individuals returned questionnaires. The most common discomfort among 31 children receiving 3 T MRI was noisiness (39%), followed by cold (19%), general discomfort (16%), dizziness (13%) and claustrophobia (10%). The noise was reported more frequently in children younger than 12 years than those older (p=0.021). The most common discomfort for 58 adults receiving 7 T MRI was noisiness (43%). In adults, there was a higher frequency of general discomfort during 7 than 3 T scans (p=0.031). More than 85% of adult respondents thought children aged 12-17 years would tolerate 7 T scans well, but only 35% and 15% thought children aged 10-11 and 8-9 years, respectively, would. Noisiness was the most common discomfort across all ages in 3 and 7 T scanners. Although general discomfort was more common during 7 than 3 T scans in adults, most adults thought children aged 12 years or more would tolerate 7 T MRI well. Cautious enrolment of children in 7 T MRI study is warranted, but until there is more evidence of how well those aged 12 years or more tolerate 7 T MRI, we would caution against enrolling younger children. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

  10. Clinical Experiences with the FRONT Formula for Pre-Operative Airway Assessment and Documentation: a Multi-Centre Study. (United States)

    Mitre, Calin; Mitre, Ileana; Gyöngyösi, Zoltán; Fülesdi, Béla; Zdrehus, Claudiu; Breazu, Caius; Biro, Peter


    The prediction of difficult airway is one of the most important challenges before general anaesthesia. This study aimed to assess the clinical usefulness of the FRONT score, a recently developed scoring system to predict and document airway difficulties. This multi-centre, inter-observer, prospective and double-blinded study included 976 patients from two university centres. The pre-operative evaluation of the patients was performed by a pre-operative team of anaesthesiologists (team A) who evaluated and scored the expected difficulty of airway management. An intra-operative team of evaluators (team B) working independently of team A, performed the actual instrumentation of the airway and scored the actual findings. Both teams used the FRONT scoring system and worked independently of each other to ensure blinded assessments. The statistical analysis of the pre- and intra-operative FRONT scores was performed in an off-line blinded manner. Our results show a fair and promising association between pre-operative composite FRONT score and that observed at the induction phase (Spearman=0.43). Among the score components, the best correlation was observed for the F and R components (kappa=0.44 and 0.36, respectively), and the worse correlation was observed for the O and T components (kappa=0.25 and 0.24, respectively). The FRONT formula for the prediction and documentation of the airway status is a simple and effective method for assessing and defining airway management difficulties. Further prospective studies are required to assess the sensitivity and specificity of the system.

  11. Pre-operative and post-operative estimated glomerular filtration rate in Japanese patients with urological malignancies. (United States)

    Niwa, Naoya; Yoshida, Tadashi; Mizuno, Ryuichi; Kikuchi, Eiji; Miyajima, Akira; Hayashi, Matsuhiko; Oya, Mototsugu


    The suitable methods evaluating glomerular filtration rate (GFR) have not been established in patients undergoing radical nephrectomy (RN) or radical nephroureterectomy (RNU) due to urological malignancies in Japan as well as worldwide. We examined the relationship between creatinine clearance-based measured GFR (mGFR) versus estimated GFR (eGFR) calculated by 3 popular equations, 4-variable Modification of Diet in Renal Disease equation adjusted by Japanese correction coefficient (cmMDRD), 3-variable MDRD equation for Japanese population (eGFRcreat), and Chronic Kidney Disease-Epidemiology Collaboration equation adjusted by Japanese correction coefficient (cmCKD-EPI) in Japanese patients who had undergone RN or RNU due to renal cell carcinoma or upper tract urothelial carcinoma before and after surgery. Among the 3 equations examined, eGFRcreat was the closest to mGFR, although each eGFR was significantly higher than mGFR in the pre-operative period. In the post-operative period, cmMDRD and eGFRcreat, but not cmCKD-EPI, were comparable to mGFR. Each of eGFR was significantly correlated with mGFR in both the pre-operative and post-operative periods. Similar results were obtained by the subanalysis of the patients with pre-operative mGFR of < 60 mL/min/1.73 m2. Results of κ statistics also showed that eGFRcreat was most appropriate to estimate GFR both before and after heminephrectomy, when cut-off value of GFR of < 60 mL/min/1.73 m2 was used. Results of the present study suggest that eGFRcreat is likely to be the most appropriate equation for patients undergoing RN or RNU due to urological malignancies. However, more precise equations will be required for accurately estimating GFR.

  12. Pre-operative irreducible C1-C2 dislocations: intra-operative reduction and posterior fixation. The "always posterior strategy". (United States)

    Visocchi, Massimiliano; Pietrini, Domenico; Tufo, Tommaso; Fernandez, Eduardo; Di Rocco, Concezio


    According to Menezes' algorithm, pre-operative dynamic neuroradiological investigation in C1-C2 dislocations (C1C2D) instability is strongly advocated in order to exclude those patients not eligible for posterior fixation and fusion without previous anterior trans-oral decompression. Anterior irreducible compression due to C1C2D instability, it is said, needs trans-oral anterior decompression. We reviewed our experience in order to refute such a paradigm. The study involves 23 patients who were operated on for cranio-vertebral junction (CVJ) instability; all of them had C1C2D of varying degree on x-ray, computerised tomography (CT) and magnetic resonance (MR) imaging of the CVJ. Pre-operatively, irreducible C1C2D was demonstrated only in 3 patients, (2 with Down's Syndrome, one of them was harbouring os odontoideum, 1 Rheumatoid Arthritis), i.e. 13.04%; the remaining 19 (86.9%) had reducible C1-C2 dislocation. After an unsuccessful traction test conducted in the pre-operative phase under sedation, it was possible to completely reduce the C1C2D (with a combination of axial traction with light extension of the neck on the chest and a light flexion of the head on the neck by using a Mayfield head holder) and proceed to posterior fixation in all the patients under general anaesthesia using a precise "timing sequences fixation technique". Wiring (C0 and C3 were fixed first being stretched up to approximately 10 lbs, then C2 in order to pull up this vertebra last by forcing approximately 8 lbs) or screw fixation methods were used to achieve fusion along with post-operative external orthosis and neuroradiological assessment of the C1C2D. The instrumentation produced a lever and pulley effect which assisted reduction of the dislocation. At follow up (range 34-55 months-mean 45.33 months) the clinical picture was improved or stable in all patients. Pre-operative irreducibility of the C1C2D should not be an absolute indication for trans-oral decompression. An attempt to

  13. Reducing pre-operative length of stay for enterocutaneous fistula repair with a multi-disciplinary approach. (United States)

    Chamberlain, Mark; Dwyer, Rebecca


    Pre-operative assessment of complex surgical patients can be a lengthy process, albeit essential to minimise complication rates. In a tertiary referral unit specialising in the surgical repair of entercutaneous fistulas, a baseline audit revealed an average in-patient length of stay of 30.1 days, mainly caused by poor co-ordination between specialities. After the introduction of a weekly multi-disciplinary team meeting and the formalisation of a patient pathway, this admission length was reduced to 5.7 days (p<0.01), resulting in significant savings to the department.

  14. 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. (United States)

    Kurdi, Madhuri S; Muthukalai, Sindhu Priya


    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. 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. 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 Cognition was decreased with maximum sedation, successful parental separation and psychomotor impairment in the midazolam group (P children decreases pre-operative anxiety without impairing cognitive and psychomotor functions, the 0.75 mg/kg dose being most effective.

  15. 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


    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.

  16. Pre-operative embolization of hypervascular spinal metastasis using percutaneous direct intra-tumoural injection with Onyx under local anesthesia. (United States)

    Lim, Kai-Zheong; Goldschlager, Tony; Chandra, Ronil V


    Intra-operative blood loss remains a major cause of perioperative morbidity for patients with hypervascular spinal metastasis undergoing surgery. Pre-operative embolization is used to reduce intraoperative blood loss and operative time. This is commonly performed under general anesthesia via a trans-arterial approach, which carries a risk of spinal stroke. We propose an alternative technique for embolization of hypervascular metastases using the Onyx embolic agent via a percutaneous direct intra-tumoural injection under local anesthesia and sedation to reduce embolization risks and procedure time, as well as operative blood loss and operative time. A 74-year-old man presented with thoracic myelopathy with back and radicular pain on background of metastatic renal cell carcinoma. Magnetic resonance imaging (MRI) revealed a 3cm mass centered on the right lamina of T10 with extension into the spinal canal. The patient underwent a percutaneous imaging-guided direct intra-tumoural contrast parenchymogram, and Onyx embolization via a single needle. Initial needle placement and tumour assessment was completed in 30min; embolization time was 15min. Complete devascularization was achieved with no complications. Surgical resection was performed with lower than expected operative blood loss (150ml) and operative time (90min). His pre-operative symptoms improved, and he was discharged home the following day. At 6-month follow-up there was no recurrence of his symptoms. Further evaluation of direct percutaneous intra-tumoural Onyx embolization for hypervascular spinal tumours is warranted. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Impact of full-field digital mammography on pre-operative diagnosis and surgical treatment of mammographic microcalcification. (United States)

    Bundred, S M; Zhou, J; Whiteside, S; Morris, J; Wilson, M; Hurley, E; Bundred, N


    Accurate pre-operative diagnosis of impalpable breast lesions correlates closely with the number of surgical procedures required for treatment. Correct diagnosis of mammographic microcalcification (MM) as ductal carcinoma in situ (DCIS) or invasive breast cancer is important because lesions upgraded to malignant diagnosis at surgery require repeat surgical procedures in 44 % of cases. Despite correct pre-operative diagnosis of MM, 26 % require second therapeutic operations to achieve surgical clearance. Theoretically, improved conspicuity of malignant MM using digital mammography could improve diagnostic work-up and improve surgical outcomes for MM. To determine the impact of full-field digital mammography (FFDM) on the diagnostic accuracy and positive predictive value (PPV) of biopsy of MM and surgical management of MM, screening and symptomatic cases with MM (n = 1,479) were reviewed for women imaged between August 2007 and March 2010 using screen-film mammography (SFM) (n = 711), and using FFDM, imaged between April 2010 to March 2012 (n = 768). Demographic information including pre and postoperative diagnosis, and number and types of surgical procedures were recorded. Overall, 302 (128 invasive) and 251 (110 invasive) malignant lesions were diagnosed using SFM and FFDM, respectively. Reduction in PPV of biopsy was observed (SFM 42.5 %; FFDM 32.7 %, p cancers over two centimetres. This will increase concerns about treatment of lesions detected in the screening programme with widespread use of digital mammography.

  18. Pre-Operative Patient Education is Associated With Decreased Risk of Arthrofibrosis After Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Livbjerg, Anna Emilie; Frøkjær, Sara; Simonsen, Ole


    The purpose was to investigate risk factors for postoperative stiffness and long-term outcome following manipulation under anaesthesia (MUA). In one of the five Danish regions, all patients in a 4-year period who received MUA following total knee arthroplasty (N=36) were included in two case......-control studies. Data on potential risk factors were extracted from the Danish Knee arthroplasty Register and from a postal questionnaire including long-term outcome measures regarding pain, function and quality of life (Oxford Knee Score and EQ-5D). Previous knee surgery and a high preoperative Knee Society...... Function Score were significant risk factors, whereas attending a preoperative information meeting was associated with a significantly decreased risk of postoperative stiffness requiring MUA (P

  19. Effects of pre-operative submucosal dexamethasone injection on the postoperative swelling and trismus following surgical extraction of mandibular third molar. (United States)

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


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

  20. The value of MRI and CT in the pre-operative diagnosis of lumbar disc herniation

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    Hirabayashi, Shigeru; Kumano, Kiyoshi; Takahashi, Soichiro; Ishii, Jun (Kanto Rosai Hospital, Kawasaki, Kanagawa (Japan))


    A prospective analysis of computed tomography (CT) and magnetic resonance imaging (MRI) scans in 51 patients with lumbar disc herniation was made to determine the height of hernia for operation and, if impossible, the indications of myelography. Among the 51 patients, 40 (78%) received surgery based on these imaging modalities (Group A); and the remaining 11 (22%) underwent myelography for the confirmation of the height of hernia or detailed examination (Group B). Satisfactory or excellent surgical outcome was achieved in 95% in Group A and in 91% in Group B. Twenty seven patients had multiple disc herniation on CT and MRI; in 17 patients surgery was performed for one disc hernia that was radiologically found to compress the spinal nerve root; and in the other 10 hernia-related disc was not determined by either radiological or neurological manifestations. Satisfactory or excellent surgical outcome could, however, be achieved in 26 patients (96%). Myelography should be indicated when there is no neurological radicular sign in the lower extremities, and when there is no radiological evidence of the compressed spinal nerve root in spite of the presence of multiple disc herniation. The height of hernia may be determined when compression of the spinal nerve root is visualized on CT or MRI. (N.K.).

  1. Pre-operative thrombotic complications of neoadjuvant chemotherapy for breast cancer: Implications for immediate breast reconstruction

    Directory of Open Access Journals (Sweden)

    K. Richards


    Full Text Available Introduction: Thrombotic complications arising during the treatment of breast cancer can impact the breast reconstruction pathway. We set out to review the details of cases of thromboembolism occurring during neoadjuvant chemotherapy and peri-operatively to study the impact of the event and its management on subsequent breast reconstruction. Methods: We retrospectively reviewed the medical records of seven patients who had experienced a thrombotic event during their treatment of breast cancer between 2008 and 2012, who then proceeded to breast reconstruction. We recorded size and grade of tumour, neoadjuvant chemotherapeutic regimen, details of port insertion, planned reconstruction, thrombotic event and its management and the surgery performed and outcome. Results: All patients received chemotherapy via central venous access and went on to present with local symptomatic thrombosis. They were managed with anticoagulant regimens at the time of mastectomy and reconstruction, which were unique for each patient. The results revealed delays to surgery and modifications to planned reconstruction. Discussion: The majority of patients developing thrombotic complications go on to achieve successful reconstruction. There is significant variation in the anticoagulation management in this patient group. Identification of optimal anticoagulant regimes and the possibilities for prophylaxis may prove key in informing surgeons when planning the reconstructive process. Conclusion: An awareness of the effects of thrombotic events in this patient group is important in terms of developing an understanding of its impact on the performance of reconstruction, on the management of anticoagulation peri-operatively and on monitoring for post-operative complications.

  2. 47 Systematic review and meta-analysis of analgesic efficacy and safety profile of single injection fascia iliaca compartment blocks in the acute pre-operative pain management of hip fractures. (United States)

    Fadhlillah, Fiqry; Chan, David


    It is hypothesised that a single injection fascia iliaca compartment block (FICB) administered in the pre-operative setting provides better analgesic control for traumatic hip fractures and is not associated with major adverse effects. Systemic analgesics, whilst effective, could lead to cardiovascular, respiratory and cognitive impairment. As a consequence, undertreatment of acute pain remains prevalent in adult patients with hip fractures, with a consistent decline seen in analgesic administration with age. Determine the analgesic efficacy and safety profile of single injection FICB performed in the pre-operative period for acute pain management in adult patients with traumatic hip fractures compared to other forms of analgesia. MEDLINE, EMBASE, Cochrane and CINAHL were independently searched to identify randomised controlled trials (RCTs) in English. Patients aged >18 years old who have suffered an isolated traumatic hip fracture (proximal femoral fracture) and received single injection FICB pre-operatively were included. No date restriction was applied and key journals and articles were scrutinised to include studies not identified by the primary search. Out of 3757 citations, eight RCTs were included in the final quantitative analysis, comprising of 645 participants. Acute pain was significantly reduced in FICB during positioning and movement, standardised mean difference (SMD)=-1.82 (95% CI:-2.26 to -1.38, padult patients with traumatic hip fractures. The benefit is more evident during positioning and mobilisation of the limb. FICB has a better safety profile and reduces dependency on systemic analgesia. © 2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  3. Evidence for biological effects of metformin in operable breast cancer: biomarker analysis in a pre-operative window of opportunity randomized trial. (United States)

    Hadad, Sirwan M; Coates, Philip; Jordan, Lee B; Dowling, Ryan J O; Chang, Martin C; Done, Susan J; Purdie, Colin A; Goodwin, Pamela J; Stambolic, Vuk; Moulder-Thompson, Stacy; Thompson, Alastair M


    Metformin has therapeutic potential against breast cancer, but the mechanisms of action in vivo remain uncertain. This study examined biomarker effects of metformin in primary breast cancer in a preoperative window of opportunity trial. Non-diabetic women with operable invasive breast cancer were randomized to receive open label pre-operative metformin (500 mg daily for 1 week then 1 g twice daily for a further week) or as controls, not receiving metformin. Patients in both arms had a core biopsy pre-randomisation and again at the time of surgery. Immunohistochemistry for phospho-AMPK (pAMPK), phospho-Akt (pAkt), insulin receptor, cleaved caspase-3, and Ki67 was performed on formalin-fixed paraffin-embedded cores, scored blinded to treatment and analysed by paired t test. In metformin-treated patients, significant up-regulation of pAMPK (paired t test, p = 0.04) and down-regulation of pAkt (paired t test, p = 0.043) were demonstrated compared to the control group. Insulin receptor and serum insulin remained similar following metformin treatment compared with a rise in insulin receptor and insulin in controls. Significant falls in Ki67 and cleaved caspase-3 (paired t test, p = 0.044) were seen in the metformin-treated patients but not in the control group. Changes were independent of body mass index. These biomarker data suggest mechanisms for metformin action in vivo in breast cancer patients via up-regulation of tumor pAMPK, down-regulation of pAkt, and suppression of insulin responses reflecting cytostatic rather than cytotoxic mechanisms.

  4. The blood-saving effect of tranexamic acid in minimally invasive total knee replacement: is an additional pre-operative injection effective? (United States)

    Lin, P-C; Hsu, C-H; Huang, C-C; Chen, W-S; Wang, J-W


    Tranexamic acid (TEA), an inhibitor of fibrinolysis, reduces blood loss after routine total knee replacement (TKR). However, controversy persists regarding the dosage and timing of administration of this drug during surgery. We performed a prospective randomised controlled study to examine the optimum blood-saving effect of TEA in minimally invasive TKR. We randomly assigned 151 patients who underwent unilateral minimally invasive TKR to three groups: 1) a placebo group (50 patients); 2) a one-dose TEA group (52 patients), who received one injection of TEA (10 mg/kg) intra-operatively on deflation of the tourniquet; and 3) a two-dose TEA group (49 patients), who received two injections of TEA (10 mg/kg) given pre-operatively and intra-operatively. Total blood loss was calculated from the maximum loss of haemoglobin. All patients were followed clinically for the presence of venous thromboembolism (VTE). The mean total blood loss was significantly higher in the placebo group than in the other two groups (1222 ml (845 to 2043) versus 1035 ml (397 to 1934) and 986 ml (542 to 1811), respectively (both p TEA groups (p = 0.148). The mean transfusion rate was higher in the placebo group than in the other two groups (22% versus 3.8% (p = 0.006) and 6.1% (p = 0.041), respectively) and there was no statistically significant difference in the mean transfusion rate between the one- and two-TEA groups (p = 0.672). Only one patient, in the two-dose group, had a radiologically confirmed deep venous thrombosis. Our prospective randomised controlled study showed that one intra-operative injection of TEA is effective for blood conservation after minimally invasive TKR.

  5. Analysis of the long term therapeutic effect of pre-operative installation of regional arterial infusion chemotherapy pump for advanced breast cancer

    Directory of Open Access Journals (Sweden)

    Jian-miao HE


    Full Text Available Objective To compare the long term therapeutic effects of the preoperative regional arterial infusion chemotherapy and the preoperative systemic venous chemotherapy in advanced breast cancer. Methods One hundred and eightysix patients with advanced breast cancer, admitted to the Department of General Surgery of PLA 309 Hospital from Jan. 2003 to Dec. 2008, were followed up for a long time. Of them 97 patients received preoperative regional arterial infusion chemotherapy (IAIC groups, and 89 patients received preoperative systemic vein chemotherapy (IVIC groups. The local recurrence rate, distant metastasis rate, overall survival rate (OS and disease free survival rate (DFS in the two groups were statistically analyzed, and the long term therapeutic effects of the two groups were compared. Results There were no statistically significant difference in distant metastasis rate (15.5% and14.6%, 1-year OS (99.0% and 96.6% and DFS (81.8% and 68.5%, and 3-year OS (88.7% and 79.8% between the two groups (P>0.05. While significant differences were found between the two groups (P<0.01 in post-operative local recurrence rate (7.2% and 18.0%, 3-year DFS (70.1% and 52.8%, and 5-year OS and DFS. Conclusion Compared with preoperative systemic venous chemotherapy, pre-operative regional arterial infusion chemotherapy can decrease the local recurrence rate, improve the 5-year total survival rate and disease free survival rate for advanced breast cancer. DOI: 10.11855/j.issn.0577-7402.2014.10.15

  6. Comparison of 3D reconstruction of mandible for pre-operative planning using commercial and open-source software (United States)

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


    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.

  7. Post-operative acute kidney injury in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension (United States)

    Moodley, Yoshan; Biccard, Bruce M.


    Hypertension is an independent predictor of acute kidney injury (AKI) in non-cardiac surgery patients. There are a few published studies which report AKI following non-suprainguinal vascular procedures, but these studies have not investigated predictors of AKI, including anti-hypertensive medications and other comorbidities, in the hypertensive population alone. We sought to identify independent predictors of post-operative AKI in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension. We performed univariate (chi-squared, or Fisher's exact testing) and multivariate (binary logistic regression) statistical analysis of prospectively collected data from 243 adult hypertensive patients who underwent non-suprainguinal vascular surgery (lower limb amputation or peripheral artery bypass surgery) at a tertiary hospital between 2008 and 2011 in an attempt to identify possible associations between comorbidity, acute pre-operative antihypertensive medication administration, and post-operative AKI (a post-operative increase in serum creatinine of ≥ 25 % above the pre-operative measurement) in these patients. The incidence of post-operative AKI in this study was 5.3 % (95 % Confidence Interval: 3.2-8.9 %). Acute pre-operative β-blocker administration was independently associated with post-operative AKI in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension (Odds Ratio: 3.24; 95 % Confidence Interval: 1.03-10.25). The acute pre-operative administration of β-blockers should be carefully considered in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension, in lieu of an increased risk of potentially poor post-operative renal outcomes. PMID:26966428

  8. Dynamic Changes of Post-Translationally Modified Forms of CXCL10 and Soluble DPP4 in HCV Subjects Receiving Interferon-Free Therapy.

    Directory of Open Access Journals (Sweden)

    Eric G Meissner

    Full Text Available Serum levels of the interferon (IFN-stimulated chemokine CXCL10 are increased during chronic HCV infection and associate with outcome of IFN-based therapy. Elevated levels of NH2-terminal truncated CXCL10 (3-77aa, produced by DPP4 cleavage, negatively associate with spontaneous clearance of acute HCV infection and sustained virological response (SVR with IFN-based therapy for chronic infection. The association of different CXCL10 forms and DPP4 with outcome during IFN-free HCV therapy has not been examined. Using novel Simoa assays, plasma was analyzed from HCV genotype-1 (GT1 subjects who relapsed (n = 11 or achieved SVR (n = 10 after sofosbuvir and ribavirin (SOF/RBV treatment, and from SOF/RBV relapsers who achieved SVR with a subsequent SOF/ledipasvir regimen (n = 9. While the NH2-truncated form of CXCL10 was elevated in HCV infection relative to healthy controls, pre-treatment plasma concentrations of CXCL10 forms failed to stratify subjects based on treatment outcome to IFN-free regimens. However, a trend (statistically non-significant towards elevated higher levels of total and long CXCL10 was observed pre-treatment in subjects who relapsed. All forms of CXCL10 decreased rapidly following treatment initiation and were again elevated in subjects who experienced HCV relapse, indicating that CXCL10 production may be associated with active viral replication. While soluble DPP4 (sDPP4 and NH2-truncated CXCL10 concentrations were highly correlated, on-treatment sDPP4 levels and activity declined more slowly than CXCL10, suggesting differential regulation. These data suggest post-translationally modified forms of CXCL10 will not support the prediction of treatment outcome in HCV GT1 subjects treated with SOF/RBV.

  9. Impact of pre-operative serum 25-hydroxyvitamin D on post-operative serum calcium in patients undergoing total thyroidectomy for benign goitre: retrospective study of 246 patients. (United States)

    Erlem, M; Klopp-Dutote, N; Biet-Hornstein, A; Strunski, V; Page, C


    To determine whether pre-operative serum 25-hydroxyvitamin D has an impact on post-operative parathyroid hormone and serum calcium levels in patients undergoing total thyroidectomy for benign goitre. This single-centre, retrospective study comprised 246 unselected surgical patients who had undergone total thyroidectomy for bilateral, benign, multinodular goitre. The correlation between pre-operative serum 25-hydroxyvitamin D and post-operative serum parathyroid hormone and serum calcium was studied to determine whether low pre-operative serum 25-hydroxyvitamin D was predictive of post-operative hypocalcaemia. Seventy-nine patients (32 per cent) had post-operative hypocalcaemia. Eighteen patients (7.32 per cent) experienced unintentional parathyroidectomy (1 parathyroid gland in 15 patients, 2 parathyroid glands in 3 patients). In univariate analysis, pre-operative serum 25-hydroxyvitamin D was not correlated with post-operative serum calcium (p = 0.69) or post-operative serum parathyroid hormone (p = 0.5804). Furthermore, in multivariate analysis, which took into account unintentional parathyroidectomy, no correlation was found (p = 0.33). Bilateral unintentional parathyroidectomy was statistically associated with post-operative hypocalcaemia (p = 0.032). Pre-operative serum 25-hydroxyvitamin D did not appear to have any impact on post-operative serum calcium in patients undergoing total thyroidectomy for benign goitre.

  10. Prediction of Long-term Post-operative Testosterone Replacement Requirement Based on the Pre-operative Tumor Volume and Testosterone Level in Pituitary Macroadenoma (United States)

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


    Non-functioning pituitary macroadenomas (NFPAs) are the most prevalent pituitary macroadenomas. One common symptom of NFPA is hypogonadism, which may require long-term hormone replacement. This study was designed to clarify the association between the pre-operative tumor volume, pre-operative testosterone level, intraoperative resection status and the need of long-term post-operative testosterone replacement. Between 2004 and 2012, 45 male patients with NFPAs were enrolled in this prospective study. All patients underwent transsphenoidal surgery. Hypogonadism was defined as total serum testosterone levels of operative magnetic resonance images. We prescribed testosterone to patients with defined hypogonadism or clinical symptoms of hypogonadism. Hormone replacement for longer than 1 year was considered as long-term therapy. The need for long-term post-operative testosterone replacement was significantly associated with larger pre-operative tumor volume (p = 0.0067), and lower pre-operative testosterone level (p = 0.0101). There was no significant difference between the gross total tumor resection and subtotal resection groups (p = 0.1059). The pre-operative tumor volume and testosterone level impact post-operative hypogonadism. By measuring the tumor volume and the testosterone level and by performing adequate tumor resection, surgeons will be able to predict post-operative hypogonadism and the need for long-term hormone replacement. PMID:26537232

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

    Bray, Lucy; Callery, Peter; Kirk, Sue


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

  12. Effect of a single dose of pre-operative pravastatin on C-reactive protein levels and neutrophil/lymphocyte ratio in patients undergoing mastectomy for breast cancer

    Directory of Open Access Journals (Sweden)

    J.A. Morantes Acevedo


    Full Text Available Introduction: In Mexico, breast cancer is the leading cause of death from malignant tumours in women over 25 years of age. Cancer patients present pro-inflammatory status which, added to the inflammatory response to surgery, worsens their prognosis, not only from a cardiovascular perspective but also by increasing the risk of tumour relapse and the onset of metastases. The objective of this study is to determine the role of pravastatin in the modulation of the systemic inflammatory response to surgical trauma by measuring C-reactive protein (CRP levels and the neutrophil/lymphocyte ratio (NLR in breast cancer patients undergoing radical mastectomy. Methods: Randomised, single-blind, prospective clinical trial in breast cancer patients undergoing mastectomy, divided into two groups of 15 patients each. One of the groups was administered a pre-operative dose of pravastatin 20 mg and the other was not and the pre- and post-surgical inflammatory biomarker levels were measured. The numerical variables are expressed as means and with standard deviation. The comparison between groups was performed with Student's T-test. Results: A total of 30 patients subject to radical mastectomy were enrolled in the study and divided into 2 groups. The mean age was 56.9 years in the control group and 53.4 years in the pravastatin group. It was found that the patients who received a 20 mg pre-op dose of pravastatin presented less CRP elevation, with a mean of 12.6 95% CI (8.34–16.9 vs 43.8 95% CI (34.3–53.37 in the control group, p 0.0000. Although the changes in the neutrophil/lymphocyte ratio were not statistically significant, p 0.2337, it was less elevated in the pravastatin group, with a mean of 3.57 95% CI (2.02–5.11 vs 7.17 95% CI (3–17.42 in the control group. Conclusions: The pre-surgical administration of a single dose of pravastatin 20 mg significantly reduced inflammatory biomarker elevation, especially C-reactive protein

  13. A double-blind, randomized, Phase III, multicenter study in 358 pediatric subjects receiving isotretinoin therapy demonstrates no effect on pediatric bone mineral density. (United States)

    Hoover, K B; Miller, C G; Galante, N C; Langman, C B


    This study compared the effects of pediatric acne treatment with two isotretinoin formulations on bone mineral density. We demonstrated no difference in the effect of the two formulations. No effect on pediatric bone mineral density was identified for either formulation. Isotretinoin (13-cis-retinoic acid) is a treatment for recalcitrant nodular acne with a purported effect on bone mineral density (BMD). The side effects of isotretinoin on vertebral bone were evaluated to assess the safety of a new FDA-approved isotretinoin formulation: Lidose-isotretinoin (Cip-Iso). This double-blind, randomized, phase III, active control, parallel-group, multicenter study compared the safety, efficacy, and non-inferiority of CIP-Iso to a marketed reference product, Accutane®, in severe recalcitrant nodular acne subjects. Three hundred fifty-eight pediatric male and female subjects aged between 12 and 17 years underwent 20 weeks of treatment with PA lumbar spine dual X-ray absorptiometry (DXA) measurements obtained for bone mineral density (BMD) and Z-scores, 5.5 months apart on visits 1 and 8. One hundred sixty-eight of 358 subjects had height adjusted Z-scores (HAZ) calculated. There was no difference in the least squares (LS) mean Z-score or HAZ of the two drugs at visit 1 or 8. The mean and LS mean Z-score and HAZ were greater than zero at visits 1 and 8 for both drugs. The change in the LS mean spine Z-score, but not HAZ, between visits, was statistically significant for both drugs. There was a mean increase in BMD (g/cm(2)) for both products between visits. There is no difference in the effect of two formulations of isotretinoin on spine bone density after 6 months of treatment. BMD increased and the small change in spine Z-score over treatment disappeared after height adjustment. Mean positive Z-scores and HAZ in the study were likely due to the exclusion of low and inclusion of high Z-score subjects.

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

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


    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.

  15. 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)


    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.)

  16. Absorbed doses received by infants subjected to panoramic dental and cephalic radiographs; Dosis absorbida recibida por infantes sometidos a radiografias dentales panoramicas y cefalicas

    Energy Technology Data Exchange (ETDEWEB)

    Carrizales, L.; Carreno, S. [Instituto Venezolano de Investigaciones Cientificas. Laboratorio Secundario de Calibracion Dosimetrica. Carretera Panamericana Km. 11. Apartado Postal 21827, Caracas (Venezuela)


    The IAEA Report No. 115 recommends that each country or region can establish levels of absorbed doses for each radiographic technique employed in diagnostic. assuming the extended and expensive of this purpose, we have been to begin in a first step with the dentistry area, in order to estimate the dose levels received at crystalline and thyroid level in infants that go to an important public institution in our country to realize panoramic and cephalic radiographs. This work will serve to justify and impel a quality assurance program in Venezuela on the dentistry area which includes aspects such as training for the medical lap referring the justification of the radiological practice, optimization of X-ray units to produce an adequate image quality that delivers to patient an absorbed dose as much lower as reasonably it can be reached without diagnostic detriment. (Author)

  17. Atlas and feature based 3D pathway visualization enhancement for skull base pre-operative fast planning from head CT (United States)

    Aghdasi, Nava; Li, Yangming; Berens, Angelique; Moe, Kris S.; Bly, Randall A.; Hannaford, Blake


    Minimally invasive neuroendoscopic surgery provides an alternative to open craniotomy for many skull base lesions. These techniques provides a great benefit to the patient through shorter ICU stays, decreased post-operative pain and quicker return to baseline function. However, density of critical neurovascular structures at the skull base makes planning for these procedures highly complex. Furthermore, additional surgical portals are often used to improve visualization and instrument access, which adds to the complexity of pre-operative planning. Surgical approach planning is currently limited and typically involves review of 2D axial, coronal, and sagittal CT and MRI images. In addition, skull base surgeons manually change the visualization effect to review all possible approaches to the target lesion and achieve an optimal surgical plan. This cumbersome process relies heavily on surgeon experience and it does not allow for 3D visualization. In this paper, we describe a rapid pre-operative planning system for skull base surgery using the following two novel concepts: importance-based highlight and mobile portal. With this innovation, critical areas in the 3D CT model are highlighted based on segmentation results. Mobile portals allow surgeons to review multiple potential entry portals in real-time with improved visualization of critical structures located inside the pathway. To achieve this we used the following methods: (1) novel bone-only atlases were manually generated, (2) orbits and the center of the skull serve as features to quickly pre-align the patient's scan with the atlas, (3) deformable registration technique was used for fine alignment, (4) surgical importance was assigned to each voxel according to a surgical dictionary, and (5) pre-defined transfer function was applied to the processed data to highlight important structures. The proposed idea was fully implemented as independent planning software and additional data are used for verification and

  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. Association of Elevated Pre-operative Hemoglobin A1c and Post-operative Complications in Non-diabetic Patients: A Systematic Review. (United States)

    Karimian, Negar; Niculiseanu, Petru; Amar-Zifkin, Alexandre; Carli, Francesco; Feldman, Liane S


    Pre-operative hyperglycemia is associated with post-operative adverse outcomes in diabetic and non-diabetic patients. Current pre-operative screening includes random plasma glucose, yet plasma glycated hemoglobin (HbA1c) is a better measure of long-term glycemic control. It is not clear whether pre-operative HbA1c can identify non-diabetic patients at risk of post-operative complications. The systematic review summarizes the evidence pertaining to the association of suboptimal pre-operative HbA1c on post-operative outcomes in adult surgical patients with no history of diabetes mellitus. A detailed search strategy was developed by a librarian to identify all the relevant studies to date from the major online databases. Six observational studies met all the eligibility criteria and were included in the review. Four studies reported a significant association between pre-operative HbA1c levels and post-operative complications in non-diabetic patients. Two studies reported increased post-operative infection rates, and two reported no difference. Of four studies assessing the length of stay, three did not observe any association with HbA1c level and only one study observed a significant impact. Only one study found higher mortality rates in patients with suboptimal HbA1c. Based on the limited available evidence, suboptimal pre-operative HbA1c levels in patients with no prior history of diabetes predict post-operative complications and represent a potentially modifiable risk factor.

  20. 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


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

  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


    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. Risk factors of pre-operational aortic rupture in acute and subacute Stanford type A aortic dissection patients. (United States)

    Li, Zhuo-Dong; Liu, Yang; Zhu, Jiang; Wang, Jun; Lu, Fang-Lin; Han, Lin; Xu, Zhi-Yun


    Aortic rupture is one of the main causes of early death in acute and subacute Stanford type A aortic dissection (ATAAD) patients. This study aimed to analyze potential risk factors for pre-operational aortic rupture in ATAAD patients. We retrospectively reviewed aortic dissection cases treated between May 2013 and May 2016 in Changhai Hospital, Shanghai. A total of 329 patients with ATAAD were included in the final analysis, and 31 patients died of aortic rupture before surgery. Clinical data on basic characteristics, clinical presentation, and biochemical measurements for all 329 patients were analyzed. The in-hospital aortic rupture rate was 9.4% (31/329), and the rupture accounted for 47% (31/66) of all in-hospital deaths of ATAAD patients. Patients who experienced rupture were significantly older (P0.7 ng/mL (OR: 9.28; 95% CI, 1.72-50.06; P=0.010), and D-dimer level ≥10 µg/mL (OR: 13.37; 95% CI, 2.18-81.97; P=0.005). Aortic rupture accounted for 47% of all in-hospital deaths among patient with ATAAD. Shock, pain requiring medication, a troponin level >0.7 ng/mL and a D-dimer level ≥10 µg/mL are independent risk factors for aortic rupture in these patients.

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

    Youngblood, Robert; Dezfuli, Homayoon; Siu, Nathan


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

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

    Energy Technology Data Exchange (ETDEWEB)

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


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

  5. Beneficial Effects of Pre-operative Exercise Therapy in Patients with an Abdominal Aortic Aneurysm: A Systematic Review. (United States)

    Pouwels, S; Willigendael, E M; van Sambeek, M R H M; Nienhuijs, S W; Cuypers, P W M; Teijink, J A W


    The impact of post-operative complications in abdominal aortic aneurysm (AAA) surgery is substantial, and increases with age and concomitant co-morbidities. This systematic review focuses on the possible effects of pre-operative exercise therapy (PET) in patients with AAA on post-operative complications,aerobic capacity, physical fitness, and recovery. A systematic search on PET prior to AAA surgery was conducted. The methodological quality of the included studies was rated using the Physiotherapy Evidence Database scale. The agreement between the reviewers was assessed with Cohen's kappa. Five studies were included, with a methodological quality ranging from moderate to good. Cohen's kappa was 0.79. Three studies focused on patients with an AAA (without indication for surgical repair) with physical fitness as the outcome measure. One study focused on PET in patients awaiting AAA surgery and one study focused on the effects of PET on post-operative complications, length of stay, and recovery. PET has beneficial effects on various physical fitness variables of patients with an AAA. Whether this leads to less complications or faster recovery remains unclear. In view of the large impact of post-operative complications, it is valuable to explore the possible benefits of a PET program in AAA surgery.

  6. Assessment of quality of life in patients receiving palliative care: comparison of measurement tools and single item on subjective well-being. (United States)

    Stiel, Stephanie; Psych, Dipl; Kues, Katharina; Krumm, Norbert; Radbruch, Lukas; Elsner, Frank


    Many quality-of-life assessment tools are not feasible in palliative care settings because of the severe impairment of the physical, cognitive, and psychological status of patients. This study investigated whether comprehensive instruments can be replaced by a single item concerning the well-being of patients. From April to December 2008 patients receiving palliative care in three different settings (palliative care unit, inpatient unit of the department of radiotherapy, inpatient hospice) were asked to answer the assessment tools Functional Assessment of Chronic Illness Treatment (FACIT-G), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30), Schedule for the Evaluation of the Individual Quality of Life (SEIQoL), and the Minimal Documentation System (MIDOS) including a single item on well-being. Correlations of sum and specific domain scores were used for correlational analysis. Datasets of 72 patients were collected. The MIDOS single item on well-being correlated significantly with the QoL indexes of the EORTC (Spearman rank correlation r = -0.563) and FACIT-G (0.527). SEIQoL had low to moderate correlations with the other assessment tools. Subscales on physical functioning from the FACIT-G (r = 0.583) and the EORTC-QLQ-C30 (r = 0.385) had the highest correlation with the single item on well-being. Well-being correlated higher with nonphysical subscales of the QoL instruments for patients in the palliative care unit than in the radiotherapy department. The single item is unable to completely replace comprehensive questionnaires, but it is useful to initiate communication on QoL and can be recommended as a substitute for physical-functional aspects of QoL assessment in the palliative care setting.

  7. Airflow in the Human Nasal Passage and Sinuses of Chronic Rhinosinusitis Subjects

    National Research Council Canada - National Science Library

    Kumar, Haribalan; Jain, Ravi; Douglas, Richard G; Tawhai, Merryn H


    .... Little is known about how sinus surgery affects sinonasal airflow. In this study nasal passage geometry was reconstructed from computed tomographic imaging from healthy normal, pre-operative, and post-operative subjects...

  8. Comparing pre-operative stereotactic radiosurgery (SRS) to post-operative whole brain radiation therapy (WBRT) for resectable brain metastases: a multi-institutional analysis. (United States)

    Patel, Kirtesh R; Burri, Stuart H; Boselli, Danielle; Symanowski, James T; Asher, Anthony L; Sumrall, Ashley; Fraser, Robert W; Press, Robert H; Zhong, Jim; Cassidy, Richard J; Olson, Jeffrey J; Curran, Walter J; Shu, Hui-Kuo G; Crocker, Ian R; Prabhu, Roshan S


    Pre-operative stereotactic radiosurgery (pre-SRS) has been shown as a viable treatment option for resectable brain metastases (BM). The aim of this study is to compare oncologic outcomes and toxicities for pre-SRS and post-operative WBRT (post-WBRT) for resectable BM. We reviewed records of consecutive patients who underwent resection of BM and either pre-SRS or post-WBRT between 2005 and 2013 at two institutions. Overall survival (OS) was calculated using the Kaplan-Meier method. Cumulative incidence was used for intracranial outcomes. Multivariate analysis (MVA) was performed using the Cox and Fine and Gray models, respectively. Overall, 102 patients underwent surgical resection of BM; 66 patients with 71 lesions received pre-SRS while 36 patients with 42 cavities received post-WBRT. Baseline characteristics were similar except for the pre-SRS cohort having more single lesions (65.2% vs. 38.9%, p = 0.001) and smaller median lesion volume (8.3 cc vs. 15.3 cc, p = 0.006). 1-year OS was similar between cohorts (58% vs. 56%, respectively) (p = 0.43). Intracranial outcomes were also similar (2-year outcomes, pre-SRS vs. post-WBRT): local recurrence: 24.5% vs. 25% (p = 0.81), distant brain failure (DBF): 53.2% vs. 45% (p = 0.66), and leptomeningeal disease (LMD) recurrence: 3.5% vs. 9.0% (p = 0.66). On MVA, radiation cohort was not independently associated with OS or any intracranial outcome. Crude rates of symptomatic radiation necrosis were 5.6 and 0%, respectively. OS and intracranial outcomes were similar for patients treated with pre-SRS or post-WBRT for resected BM. Pre-SRS is a viable alternative to post-WBRT for resected BM. Further confirmatory studies with neuro-cognitive outcomes comparing these two treatment paradigms are needed.

  9. A feasibility study exploring the role of pre-operative assessment when examining the mechanism of 'chemo-brain' in breast cancer patients. (United States)

    Jenkins, Valerie; Thwaites, Ryan; Cercignani, Mara; Sacre, Sandra; Harrison, Neil; Whiteley-Jones, Hefina; Mullen, Lisa; Chamberlain, Giselle; Davies, Kevin; Zammit, Charles; Matthews, Lucy; Harder, Helena


    Women receiving chemotherapy treatment for breast cancer may experience problems with their memory and attention (cognition), which is distressing and interferes with quality of life. It is unclear what causes or contributes to the problems they report: psychological distress, fatigue, coping style, or specific biological changes for example to pro inflammatory cytokines. Research shows however, that approximately a third of women with breast cancer perform poorly on tests of cognition before commencing chemotherapy. We aimed to examine the acceptability and relevance of pre-surgical assessments (bloods, brain imaging, cognitive tests and self-report questionnaires) when investigating the phenomenon of 'chemo-brain' and investigate whether inflammatory markers mediate chemotherapy-induced neuropsychological impairments in women treated for breast cancer. Women with early stage breast cancer completed neuropsychological and quality of life assessments at T1 (pre-surgery), T2 (post-surgery before chemotherapy) and T3 (6 months later). Blood cytokine levels were measured at the same time points and brain imaging was performed at T1 and T3. In total, 14/58 women participated (8 chemotherapy, 6 non-chemotherapy). Prior to the start of chemotherapy a decline in cognitive performance compared to baseline was observed in one participant. At T3 women who received chemotherapy reported poorer quality of life and greater fatigue. Increases in soluble tumour necrosis factor receptor II (sTNFRII), interleukin-6, interleukin-10 and vascular endothelial growth factor occurred post chemotherapy only. Levels of sTNFRII were inversely correlated with grey matter volume (GMV) of the right posterior insula in both groups. At T3, the chemotherapy group displayed a greater reduction in GMV in the subgenual and dorsal anterior cingulate, and the inferior temporal gyrus. Pre-operative recruitment to the study was challenging; however, the lack of significant changes in blood cytokine

  10. The impact of pre-operative comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery: a systematic review. (United States)

    Partridge, J S L; Harari, D; Martin, F C; Dhesi, J K


    Comprehensive geriatric assessment is an established clinical approach. It reduces mortality and improves the physical wellbeing of older people in the community or hospitalised for medical reasons. Pre-operative comprehensive geriatric assessment seems a plausible method for reducing adverse postoperative outcomes. The objectives of this systematic review and narrative synthesis are to describe how pre-operative comprehensive geriatric assessment has been used in surgical patients and to examine the impact of comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery. We searched MEDLINE, EMBASE and Web of Science from 1980 to 2013 (week 26). We included five studies: two randomised controlled trials and three before-and-after intervention quasi-experimental studies. Patient populations, interventions and outcome measures varied between studies. Both the randomised trials showed benefit on postoperative outcomes, including medical complications. Two of the before-and-after studies reported a positive impact on postoperative length of stay and other outcomes. The heterogeneity of study methods, populations, interventions and outcomes precluded meta-analysis. Based on this narrative synthesis, pre-operative comprehensive geriatric assessment is likely to have a positive impact on postoperative outcomes in older patients undergoing elective surgery, but further definitive research is required. Clinical services providing pre-operative comprehensive geriatric assessment for older surgical patients should be considered. © 2013 The Association of Anaesthetists of Great Britain and Ireland.

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

    NARCIS (Netherlands)

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


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

  12. Pre-operative functional mobility as an independent determinant of inpatient functional recovery after total knee arthroplasty during three periods that coincided with changes in clinical pathways

    NARCIS (Netherlands)

    Sluis, G. van der; Goldbohm, R.A.; Elings, J.E.; Nijhuis-Van der Sanden, M.W.G.; Akkermans, R.P.; Bimmel, R.; Hoogeboom, T.J.; Meeteren, N.L. van


    AIMS: To investigate whether pre-operative functional mobility is a determinant of delayed inpatient recovery of activities (IRoA) after total knee arthroplasty (TKA) in three periods that coincided with changes in the clinical pathway. PATIENTS AND METHODS: All patients (n = 682, 73% women, mean

  13. 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


    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.

  14. TNF-α concentrations in pre-operative synovial fluid for predicting early post-operative function and pain after fast-track total knee arthroplasty. (United States)

    Zietek, Pawel; Dziedziejko, Violetta; Safranow, Krzysztof; Zietek, Joanna; Stępień-Słodkowska, Marta; Bialecka, Monika; Zietek, Maciej; Kotrych, Daniel; Kamiński, Adam; Kowalska, Aleksandra


    Tumor necrosis factor-alpha (TNF-α) helps regulate neuroinflammation and anxiety and could conceivable predict early post-operative pain and function after fast-track total knee arthroplasty (TKA). In patients with severe osteoarthritic knees undergoing TKA, we assessed: the correlations between pre-operative concentrations of TNF-α in synovial fluid; pre- and six-week post-operative knee function and pain; pre- and post-operative anxiety; pre- and post-operative synovial fluid concentrations of cartilage oligomeric matrix protein (COMP); age and body mass index (BMI). Of 100 enrolled patients, 78 had evaluable TNF-α data, and 58 had evaluable COMP data. Pre-operative TNF-α concentrations were inversely correlated with post-operative pain scores during walking (rS=-0.26, P=0.03) and with change of pain at rest during six weeks after TKA (rs=-0.28, P=0.03) and were directly correlated with a higher post-operative Knee Society score (KSS) (rS=0.43, P<0.001) and with greater increases in this score during six weeks after TKA (rS=0.33, P=0.001). Mean TNF-α concentrations were higher in the 39 patients reporting any pre-operative pain at rest than in 36 patients reporting no pre-operative pain (P=0.015) and were the only independent predictor of pre-operative pain at rest (OR=13, P=0.02). Independent predictors of better post-operative knee function were higher log-transformed TNF-α concentrations (β=0.38, P=0.002) and male sex (β=0.28, P=0.02). High levels of pre-operative TNF-α concentrations could be used as an independent predictor of better knee function at six weeks of follow-up. In patients with lower pre-operative TNF-α concentrations, post-operative pain management may improve the early outcome of the operated joint. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. Assessment of pre-operational radiological conditions at the Linac Centre of the Lagos University Teaching Hospital, Nigeria. (United States)

    Aweda, M A


    The Lagos University Teaching Hospital, Nigeria has acquired a 6 - 15 MeV ELEKTA linear accelerator for clinical teletherapy. The 15 MeV is a sufficient energy to activate photonuclear interactions of the type (h(nu), n) and (h(nu), e), in some materials found within the locality, thereby enhancing the background radiation exposure levels in the environments. The objective of this study is to conduct a pre-operational assessment of the radiological conditions of the new LINAC Centre and its environments which is required for future uses in the assessment of the environmental impacts due to the applications of the facility. The results of this study are to provide a baseline data needed for such assessments and the impact of eventual LINAC accidents. Radiation exposure levels due to natural background radioactivity in the controlled and supervised areas and offices in the LINAC localities have been measured. The environmental radiation survey around the Centre was conducted according to the requirements prescribed by the ICRP, IAEA Basic Safety Standards etc. The specific radioactivity contents of 100 building, furna and flora material samples have been determined using a Gamma Well Scintillation Counter. The mean exposure rates all over the LINAC Centre varied from 2.0 muSvh(-1) to 3.3 muSvh(-1). In the controlled areas, the mean value was 2.4 muSvh(-1) and it was 2.7 muSvh in the supervised areas, while in the adjacent offices, it was 2.5 muSvh(-1). The means of the measured specific activities in the cement concrete, soil, plant and grass samples were 42.7299 Bqkg(-1), 39.9592 Bqkg(-1), 23.9010 Bqkg(-1) and 20.8940 Bqkg(-1) respectively. A database for the assessment of the environmental impacts of the clinical LINAC and the impacts of its eventual accidents has been generated for future periodic uses.

  16. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. (United States)

    Chin, K J; Adhikary, S; Sarwani, N; Forero, M


    Laparoscopic ventral hernia repair is an operation associated with significant postoperative pain, and regional anaesthetic techniques are of potential benefit. The erector spinae plane (ESP) block performed at the level of the T5 transverse process has recently been described for thoracic surgery, and we hypothesised that performing the ESP block at a lower vertebral level would provide effective abdominal analgesia. We performed pre-operative bilateral ESP blocks with 20-30 ml ropivacaine 0.5% at the level of the T7 transverse process in four patients undergoing laparoscopic ventral hernia repair. Median (range) 24-h opioid consumption was 18.7 mg (0.0-43.0 mg) oral morphine. The highest and lowest median (range) pain scores in the first 24 h were 3.5 (3.0-5.0) and 2.5 (0.0-3.0) on an 11-point numerical rating scale. We also performed the block in a fresh cadaver and assessed the extent of injectate spread using computerised tomography. There was radiographic evidence of spread extending cranially to the upper thoracic levels and caudally as far as the L2-L3 transverse processes. We conclude that the ESP block is a promising regional anaesthetic technique for laparoscopic ventral hernia repair and other abdominal surgery when performed at the level of the T7 transverse process. Its advantages are the ability to block both supra-umbilical and infra-umbilical dermatomes with a single-level injection and its relative simplicity. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

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

    LENUS (Irish Health Repository)

    Hayes, Brian D


    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.

  18. Pre-operative and intra-operative detection of axillary lymph node metastases in 108 patients with invasive lobular breast cancer undergoing mastectomy. (United States)

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


    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.

  19. The effect of pre-operative aspirin on bleeding, transfusion, myocardial infarction, and mortality in coronary artery bypass surgery: a systematic review of randomized and observational studies. (United States)

    Sun, Jack C J; Whitlock, Richard; Cheng, Ji; Eikelboom, John W; Thabane, Lehana; Crowther, Mark A; Teoh, Kevin H T


    To obtain estimates of the efficacy and safety of pre-operative aspirin in patients undergoing coronary artery bypass grafting (CABG). Eligible studies included randomized controlled trials (RCTs) and observational studies of patients undergoing CABG, comparing pre-operative aspirin with no aspirin/placebo, and reporting at least one of our primary outcomes. In eight RCTs (n = 805), pre-operative aspirin increased post-operative bleeding [Mean difference (MD), 104.9 mL; 95% confidence interval (CI), 19.2-190.6; P = 0.016] and reoperation [odds ratio (OR), 2.52; 95% CI, 1.18-5.38; P = 0.017), but not transfusion requirements (MD, 0.62 units; 95% CI, -0.06-1.30; P = 0.072). Subgroup analysis suggested that bleeding was increased with aspirin doses > or =325 mg/day, but not with lower doses. In 14 observational studies (n = 4485), pre-operative aspirin increased post-operative bleeding (MD, 113.6 mL; 95% CI, 45.2-182.0; P = 0.001) and transfusion requirements (MD, 0.34; 95% CI, 0.12-0.56 units; P = 0.002), but not reoperation (OR, 1.12; 95% CI, 0.69-1.83; P = 0.647). Neither analysis detected a significant effect on myocardial infarction or death. Pre-operative aspirin increases post-operative bleeding, but this may be avoided by the use of aspirin doses aspirin in the setting of contemporary cardiac surgical practice.

  20. 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)


    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

  1. Pre-operative prediction of cervical nodal metastasis in papillary thyroid cancer by 99mTc-MIBI SPECT/CT; a pilot study. (United States)

    Tangjaturonrasme, Napadon; Vasavid, Pataramon; Sombuntham, Premsuda; Keelawat, Somboon


    Papillary thyroid cancer has a high prevalence of cervical nodal metastasis. There is no "gold standard" imaging for pre-operative diagnosis. The aim of the present study was to assess the accuracy of pre-operative 99mTc-MBI SPECT/CT in diagnosis of cervical nodal metastasis in patients with papillary thyroid cancer Fifteen patients were performed 99Tc-MlBI SPECT/CT pre-operatively. Either positive pathological report of neck dissection or positive post-treatment I-131 whole body scan with SPECT/CT of neck was concluded for definite neck metastasis. The PPV, NPV, and accuracy of 99mTc-MIBI SPECT/CT were analyzed. The PPV NPV and accuracy were 80%, 88.89%, and 85.71%, respectively. 99mTc-MIBI SPECT/CT could localize the abnormal lymph nodes groups correctly in most cases when compared with pathological results. However the authors found one false positive case with caseating granulomatous lymphadenitis and one false negative case with positive post-treatment 1-131 whole body scan with SPECT/CT of neck on cervical nodes zone II and IV CONCLUSION: 99mTc-MIBI SPECT/CTseem promising for pre-operative staging of cervical nodal involvement in patients with papillary thyroid cancer without the need of using iodinated contrast that may complicate subsequence 1-131 treatment. However, false positive result in granulomatous inflammatory nodes should be aware of especially in endemic areas. 99mTc-MIBI SPECT/CT scan shows a good result when compared with previous study of CT or MRI imaging. The comparative study between different imaging modality and the extension of neck dissection according to MIBI result seems interesting.

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


    Zadnikar Rupnik, Daša


    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 ...

  3. Pre-operative functional mobility as an independent determinant of inpatient functional recovery after total knee arthroplasty during three periods that coincided with changes in clinical pathways. (United States)

    van der Sluis, G; Goldbohm, R A; Elings, J E; Nijhuis-van der Sanden, M W; Akkermans, R P; Bimmel, R; Hoogeboom, T J; van Meeteren, N L


    To investigate whether pre-operative functional mobility is a determinant of delayed inpatient recovery of activities (IRoA) after total knee arthroplasty (TKA) in three periods that coincided with changes in the clinical pathway. All patients (n = 682, 73% women, mean age 70 years, standard deviation 9) scheduled for TKA between 2009 and 2015 were pre-operatively screened for functional mobility by the Timed-up-and-Go test (TUG) and De Morton mobility index (DEMMI). The cut-off point for delayed IRoA was set on the day that 70% of the patients were recovered, according to the Modified Iowa Levels of Assistance Scale (mILAS) (a 5-item activity scale). In a multivariable logistic regression analysis, we added either the TUG or the DEMMI to a reference model including established determinants. Both the TUG (Odds Ratio (OR) 1.10 per second, 95% confidence intervals (CI) 1.06 to 1.15) and the DEMMI (OR 0.96 per point on the 100-point scale, 95% CI 0.95 to 0.98) were statistically significant determinants of delayed IRoA in a model that also included age, BMI, ASA score and ISAR score. These associations did not depend on the time period during which the TKA took place, as assessed by tests for interaction. Functional mobility, as assessed pre-operatively by the TUG and DEMMI, is an independent and stable determinant of delayed inpatient recovery of activities after TKA. Future research, focusing on improvement of pre-operative functional mobility through tailored physiotherapy intervention, should indicate whether such intervention enhances post-operative recovery among high-risk patients. Cite this article: Bone Joint J 2017;99-B:211-17. ©2017 The British Editorial Society of Bone & Joint Surgery.

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


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


    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 pat...

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

    Energy Technology Data Exchange (ETDEWEB)

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


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

  6. [Ischemia is not an independent predictive factor of chronic renal failure after partial nephrectomy in a solitary kidney in patients without pre-operative renal insufficiency]. (United States)

    Bahi, R; Pignot, G; Hammoudi, Y; Bensalah, K; Oger, E; Laguna, P; Barwari, K; Bessède, T; Rigaud, J; Roupret, M; Bernhard, J-C; Long, J-A; Zisman, A; Berger, J; Paparel, P; Lechevallier, E; Bertini, R; Salomon, L; Bex, A; Farfara, R; Ljungberg, B; Rodriguez, A R; Patard, J-J


    To assess the influence of vascular clamping and ischemia time on long-term post-operative renal function following partial nephrectomy (PN) for cancer in a solitary kidney. This is a retrospective study including 259 patients managed by PN between 1979 and 2010 in 13 centers. Clamping use, technique choice (pedicular or parenchymal clamping), ischemia time, and peri-operative data were collected. Pre-operative and last follow-up glomerular filtration rates were compared. A multivariate analysis using a Cox model was performed to assess the impact of ischemia on post-operative chronic renal failure risk. Mean tumor size was 4.0±2.3cm and mean pre-operative glomerular filtration rate was 60.8±18.9mL/min. One hundred and six patients were managed with warm ischemia (40.9%) and 53 patients with cold ischemia (20.5%). Thirty patients (11.6%) have had a chronic kidney disease. In multivariate analysis, neither vascular clamping (P=0.44) nor warm ischemia time (P=0.1) were associated with a pejorative evolution of renal function. Pre-operative glomerular filtration rate (Prenal failure. Renal function following PN in a solitary kidney seems to depend on non-reversible factors such as pre-operative glomerular filtration rate. Our findings minimize the role of vascular clamping and ischemia time, which were not significantly associated with chronic renal failure risk in our study. 5. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  7. 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.


    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

  8. 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.


    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 60...... to use of anti-TNF-alpha agents within 12 weeks before surgery (exposed) or not (unexposed). Outcomes were obtained from nationwide registries and a bacteraemia registry. Sub-analyses were performed for bacteraemia and for impact of pre-operative timing of anti-TNF-alpha agents. RESULTS: Among surgical...... procedures for CD, 214 were exposed and 2079 were not. We found no increased relative risks of death or abscess drainage 30 or 60 days after follow-up. Among exposed, 7.5% had a reoperation within 30 days vs. 8.6% among unexposed, adjusted odds ratio (OR) = 0.92, 95% confidence interval (CI): 0...

  9. 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


    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

  10. Books Received

    Indian Academy of Sciences (India)

    VG Bhide. Shekhar Phatak and Associates. 1998, Rs.80. Books Received. Biotechnological Methods of. Pollution Control. S A Abbasi and E Ramasami. Universities Press. 1999, Rs.1S0. The Penguin India Career Guide,. Vol 2, The Scien~es. Usha Albuquerque. Penguin Books. 1996, Rs.250. Fixed Points. Yu A Shashldn.

  11. Books Received

    Directory of Open Access Journals (Sweden)

    Murat Akser


    Full Text Available In 2014 we have received a variety of books onc inema and media from these publishers: Bloomsbury Academic, Cambridge Scholars Publishing, Continuum, Edinburgh University Press, Focal Press, Intellect, Paradigm, Peter Lang, Routledge, University of California Press, Wayne State University Press.

  12. Books Received

    Indian Academy of Sciences (India)

    Books Received. Challenge and Thrill of Pre-College. Mathematics. V Krishnamurthy et al. New Age International. 1996, Rs.220. Mathematics for Science. S M Uppal and H M Humphreys. New Age International. 1996, Rs.17S. Physics for Engineers. M R Srinivasan. New Age Publications. 1996. Statement about ownership ...

  13. The Agreement between the MMSE and IQCODE Tests in a Community-Based Sample of Subjects Aged 70 Years or Older Receiving In-Home Nursing: An Explorative Study

    Directory of Open Access Journals (Sweden)

    Øyvind Kirkevold


    Full Text Available Aim: It was the aim of this study to compare the Mini-Mental State Examination (MMSE with the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE and to explore the characteristics of subjects with possible dementia with only one of the two tools. Methods: We used a random sample of patients aged 70+ receiving social service or in-home nursing. The patients were tested with the MMSE, and the next of kin was interviewed using the following: the IQCODE, the Cornell Scale for Depression in Dementia (CSDD, the Neuropsychiatric Inventory (NPI, instrumental activities of daily living (IADL, personal ADL (PADL and the General Medical Health Rating (GMHR. Results: Subjects with dementia defined only according to the MMSE showed a pattern of scores on IADL, PADL, CSDD, NPI-10 and GMHR similar to the no-dementia group according to both the MMSE and the IQCODE. Those with dementia defined only according to the IQCODE showed a pattern of scores similar to the possible dementia group according to both the MMSE and the IQCODE.

  14. Pre-operative neutrophil count and neutrophil-lymphocyte count ratio (NLCR) in predicting the histological grade of paediatric brain tumours: a preliminary study. (United States)

    Wilson, J R F; Saeed, F; Tyagi, A K; Goodden, J R; Sivakumar, G; Crimmins, D; Elliott, M; Picton, S; Chumas, P D


    The neutrophil-lymphocyte count ratio (NLCR) is an established prognostic marker for renal, lung and colorectal carcinomas and has been suggested to be predictive of histological grade and outcome in adult intracranial tumours. The purpose of this study was to determine whether a correlation of the pre-operative neutrophil count (NC) and NLCR with the final histological grade exists in paediatric intracranial tumours. A retrospective analysis was undertaken at a single centre. Patients less than 18 years old at the time of surgery who underwent tumour-related procedures from 2006 to 2015 were included. Patients with recurrent tumours, previous bone marrow transplant and metastases were excluded. Pre-operative full blood counts (FBC), collected before the diagnosis of intracranial pathology and before administration of steroids, were matched with histological diagnosis for each patient. Post-operative FBC was also recorded, together with survival data where applicable. A total of 116 patients (74 male, 42 female; mean age, 8 ± 0.9 years) with a diagnosis of primary intracranial tumours had pre-operative FBC that could be matched to final histological grade. Pre-operative NC and NLCR were higher with increasing grade of tumour: grade 1 (NC 4.29 109/l, NLCR 2.26), grade 2 (NC 4.59 109/l, NLCR 2.38), grade 3 (NC 5.67 109/l, NLCR 2.72) and grade 4 (NC 6.59 109/l, NLCR 3.31). Patients with WHO grade 1 and 2 tumours pooled together had a lower NC (4.37 95% CI ± 0.67 109/l) compared to WHO grade 3 and 4 patients (6.41 95% CI ± 0.99 109/l, p = 0.0013). The NLCR was lower in grade 1 and 2 tumours (2.29 ± 0.59) (compared to grade 3 and 4 tumours; 3.20 ± 0.76) but this did not reach significance (p = 0.069). The subgroup of patients with pilocytic astrocytoma had a significantly lower NC when compared to patients with high-grade tumours (p = 0.005). Medulloblastoma and supratentorial PNET subgroups had significantly higher NC compared to the low

  15. The effect of pre-operative topical anaesthetic cream on the ablative width and coagulative depth of ablative fractional resurfacing laser. (United States)

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


    Topical anaesthetic cream (TAC) is commonly used as a pre-treatment of ablative fractional resurfacing (AFR) laser. Most of anaesthetic cream contains distilled water as major component. Therefore, pre-operative TAC may interfere the photothermal reaction in the skin treated with fractional carbon-dioxide (FCO2) laser and fractional erbium-doped yttrium aluminium garnet (FEr:YAG) laser. The objective of the study was to compare the ablative width (AW) and coagulative depth (CD) of AFR laser with and without pre-treatment with TAC. Four Thai females who underwent abdominoplasty were included in the study. The excised skin of each subject was divided into four areas. TAC (eutectic mixture of local anaesthesia; EMLA) with 1-h occlusion was applied only on the first and second areas. The first and third areas were treated with FCO2 at 15 mj and 5% density. The second and fourth areas were treated with FEr:YAG at 28 J/cm2 and 5% density. Six biopsied specimens were obtained from each area. A total of 96 specimens (24 specimens from each area) were collected from four patients and examined randomly by two dermatopathologists. The ablative width and coagulative depth from each specimen were determined. In FCO2-treated specimens, the mean AW of the specimens that were pre-treated with TAC and control was 174.86 ± 24.57 and 188.52 ± 41.32 μm. The mean CD of the specimens that were pre-treated with TAC and control was 594.96 ± 111.72 and 520.03 ± 147.40 μm. There were no significant differences in AW and CD between both groups (p = 0.53 and p = 0.15). In FEr:YAG-treated specimens, the mean AW of the specimens that were pre-treated with TAC and control was 381.11 ± 48.02 and 423.65 ± 60.16 μm. The mean CD of the specimens that were pre-treated with TAC and control was 86.03 ± 29.44 and 71.59 ± 18.99 μm. There were no significant differences in AW and CD between both groups (p = 0.16 and p = 0.24). The pre

  16. Impact of same day vs day before pre-operative lymphoscintigraphy for sentinel lymph node biopsy for early breast cancer (local Australian experience). (United States)

    Huang, Yang Yang; Maurel, Amelie; Hamza, Saud; Jackson, Lee; Al-Ogaili, Zeyad


    To assess the impact of delayed vs immediate pre-operative lymphoscintigraphy (LSG) for sentinel lymph node biopsy in a single Australian tertiary breast cancer centre. Retrospective cohort study analysing patients with breast cancer or DCIS who underwent lumpectomy or mastectomy with pre-operative LSG and intra-operative sentinel lymph node biopsy from January 2015 to June 2016. A total of 182 LSG were performed. Group A patients had day before pre-operative LSG mapping (n = 79) and Group B had LSG mapping on the day of surgery (n = 103). The overall LSG localisation rate was 97.3% and no statistical difference was detected between the two groups. The overall sentinel lymph node biopsies (SLN) were identified in 99.6% of patients. The number of nodes excised was slightly higher in Group A (1.90 vs 1.72); however, this was not statistically significant. In addition, the number of nodes on histopathology and the incidence of second echelon nodal detection were also similar between the two groups without statistical significance. In conclusion, the 2-day LSG protocol had no impact on overall SLNB and LSG detection rates although slightly higher second tier nodes but this did not translate to any difference between the number of harvest nodes between the two groups. The 2-day LSG allows for greater flexibility in theatre planning and more efficient use of theatre time. We recommend a dose of 40 Mbq of Tc99 m pertechnetate-labelled colloid be given day prior to surgery within a 24-hour timeframe. © 2017 The Royal Australian and New Zealand College of Radiologists.

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

    Directory of Open Access Journals (Sweden)

    C.F. Carvalho


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

  18. The utility of MRI for pre-operative T and N staging of gastric carcinoma: a systematic review and meta-analysis. (United States)

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


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

  19. 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. (United States)

    Dos Santos Alves, V L; Stirbulov, R; Avanzi, O


    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. 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. 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. Post-surgical recovery, evaluated by 6MWT, was significantly better in patients who underwent a 4-month pre-operative physical rehabilitation protocol. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

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


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

  1. 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:; DeMartini, Wendy B.; Lee, Amie Y.; Partridge, Savannah C.; Peacock, Sue; Lehman, Constance D.


    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

  2. Correlation between pre-operative buccal bone thickness and soft tissue changes around immediately placed and restored implants in the maxillary anterior region: A 2-year prospective study. (United States)

    Arora, Himanshu; Ivanovski, Saso


    This study evaluated the correlation between pre-operative buccal cortical bone thickness and peri-implant tissue response following immediate placement and restoration of implants in the maxillary aesthetic zone. Eighteen patients (3 males, 15 females) with an age range of 19-57 years requiring the replacement of a single maxillary anterior tooth were included in this prospective study. Patients were selected on the basis of defined criteria: intact socket walls, absence of any acute infection in the sockets, absence of any gingival marginal pathology and attainment of a high primary stability (≥30 Ncm) at implant placement. Regardless of buccal bone thickness, all participating patients underwent the same treatment strategy that involved removal of the failed tooth, flapless surgery, immediate implant placement, grafting of the implant-socket gap and connection of a screw-retained provisional restoration. Buccal bone thickness was evaluated using pre-operative CBCT scans. Intra-oral photographs were taken before implant placement (baseline) and at 1- and 2-year follow-up to assess soft tissue changes around the implants. Aesthetic evaluation was carried out using the pink esthetic score (PES). All implants remained osseointegrated during the follow-up period of 2 years with mesial papilla, distal papilla, and mid-facial gingiva showing a mean recession of 0.06 ± 0.71 mm, 0.25 ± 0.78 mm, and 0.22 ± 0.83 mm, respectively. Pink esthetic score values improved from a median value of 9 (IQR 8.75-10.25) pre-operatively to 11 (IQR 9.75-12) at the end of 2 years. No significant correlation was found between buccal bone thickness (range 0.45-1.24 mm) and soft tissue or aesthetic changes. Within the limits of this study, no significant correlation could be found between pre-operative buccal bone width and the soft tissue and aesthetic outcome following immediate implant placement and restoration in the anterior maxilla. Therefore, favourable clinical and

  3. Pre-Operative Autologous Blood Donation Does Not Affect Pre-Incision Hematocrit in Adolescent Idiopathic Scoliosis Patients. A Retrospective Cohort of a Prospective Randomized Trial. (United States)

    Boniello, Anthony J; Verma, Kushagra; Peters, Austin; Lonner, Baron S; Errico, Thomas


    Pre-donation of autologous blood prior to spine fusion for adolescent idiopathic scoliosis (AIS) has been used in deformity surgery. The effect of pre-donation on pre-operative hematocrit (Hct) remains debated. Multiple factors may influence pre-operative Hct including intravascular volume status, patient factors, and timing of pre-operative blood donation. The purpose of this study was to determine if pre-donation significantly lowers pre-incision Hct in AIS patients. A retrospective cohort study of a Level-1 prospective randomized trial was conducted. 125 patients from the homogeneous population were included. AIS patients undergoing a posterior only spinal fusion for AIS were separated into two groups based on their pre-operative blood donation history. Demographic variables, pre-incision Hct, and transfusion rates were compared between the two groups using the Student's T-test. Pre-donation and non pre-donation groups had 28 and 97 patients, respectively. Pre-donation group was 75% female (21F, 7M) and non pre-donation group was 78% female (76F, 21M). There was no difference between pre-donation and non pre-donation groups in mean age (15.6 ± 2.2 vs 14.8 ± 2.2, p = 0.081), BMI (23.1 ± 4.2 vs 21.7 ± 5.3, p = 0.219), and pre-incision Hct (32.8 ± 3.4 vs 33.8 ± 3.1, p = 0.628). The overall transfusion rates were equivalent (32.1± 48.0% vs 25.8 ± 44.0%, p = 0.509), however, the rate of allogenic transfusion for the pre-donation group was significantly lower (3.6 ± 18.9% vs 25.8 ± 44.0%, p = 0.011). This study supports the use of pre-donation for AIS, without a significant drop in pre-incision Hct. Patients that donate are also much less likely to be exposed to allogenic blood. There may be a surgeon bias to recommend pre-donation in patients with a larger BMI and older age. Future studies are needed from a larger population of patients including those with non-AIS pathology. Level III.

  4. The effect of cochlear implantation on music perception by adults with usable pre-operative acoustic hearing. (United States)

    Looi, Valerie; McDermott, Hugh; McKay, Colette; Hickson, Louise


    This study investigated the change in music perception of adults undergoing cochlear implantation. Nine adults scheduled for a cochlear implant (CI) were assessed on a music test battery both prior to implantation (whilst using hearing aids; HAs), and three months after activation of their CIs. The results were compared with data from a group of longer-term CI users and a group of HA-only users. The tests comprised assessments of rhythm, pitch, instrument, and melody perception. Pre-to-post surgery comparisons showed no significant difference in the rhythm, melody, and instrument identification scores. Subjects' scores were significantly lower post-implant for ranking pitch intervals of one octave and a quarter octave (p=0.007, and pscores for these subjects. Analysis of the other tests' results provided insights into factors affecting music perception for adults with severe to profound hearing impairment.

  5. 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)


    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.)

  6. The influence of clinical risk factors on pre-operative B-type natriuretic peptide risk stratification of vascular surgical patients. (United States)

    Biccard, B M; Lurati Buse, G A; Burkhart, C; Cuthbertson, B H; Filipovic, M; Gibson, S C; Mahla, E; Leibowitz, D W; Rodseth, R N


    The role of the revised cardiac risk index in risk stratification has recently been challenged by studies reporting on the superior predictive ability of pre-operative B-type natriuretic peptides. We found that in 850 vascular surgical patients initially risk stratified using B-type natriuretic peptides, reclassification with the number of revised cardiac risk index risk factors worsened risk stratification (p  0, > 2, > 3 and > 4 risk factors, and p = 0.23 for > 1 risk factor). When evaluated with pre-operative B-type natriuretic peptides, none of the revised cardiac risk index risk factors were independent predictors of major adverse cardiac events in vascular patients. The only independent predictor was B-type natriuretic peptide stratification (OR 5.1, 95% CI 1.8-15 for the intermediate class, and OR 25, 95% CI 8.7-70 for the high-risk class). The clinical risk factors in the revised cardiac risk index cannot improve a risk stratification model based on B-type natriuretic peptides. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.

  7. 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


    Kurdi, Madhuri S.; Sindhu Priya Muthukalai


    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 randomise...

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

    Directory of Open Access Journals (Sweden)

    Attilio Cavezzi


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

  9. Minimally invasive fixation in tibial plateau fractures using an pre-operative and intra-operative real size 3D printing. (United States)

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


    The purpose of our study was to compare the outcome after minimally invasive reconstruction and internal fixation with and without the use of pre- and intra-operative real size 3D printing for patients with displaced tibial plateau fractures (TPFs). We prospectively followed up 40 consecutive adult patients with closed TPF who underwent surgical treatment of reconstruction of the tibial plateau with the use of minimally invasive fixation. Sixteen patients (group 1) were operated using a pre-operative and intra-operative real size 3D-model, while 24 patients (group 2) were operated without 3D-model printing, but using only pre-operative and intra-operative 3D Tc-scan images. The mean operating time was 148.2±15.9min for group 1 and 174.5±22.2min for group 2 (p=0.041). In addition, the mean intraoperative blood loss was less in group 1 (520mL) than in group 2 (546mL) (p=0.534). After discharge, all patients were followed up at 6 weeks, 12 weeks, 6 months, 1year and then every year post surgically and radiographic evaluation was carried out each time using clinical and radiological Rasmussen's score, with no significant differences between the two groups. Two patients (group 2) developed infection which resolved within 3 weeks after usage of antibiotics. Neither superficial nor deep infections were present in group 1. In all patients, no non-union occurred. No intraoperative, perioperative, or postoperative complications, such as loss of valgus correction, bone fractures, or metallic plate failures were detected at follow-up. In patients operated with the use of 3D-model printing, we found a significant reduction in surgical time. Moreover, the technique without a 3D-model increased the patient's and the surgeon's exposure to radiation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. 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)


    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.)

  11. Intra-operative vs pre-operative endoscopic sphincterotomy in patients with gallbladder and common bile duct stones: cost-utility and value-of-information analysis. (United States)

    Gurusamy, Kurinchi; Wilson, Edward; Burroughs, Andrew K; Davidson, Brian R


    Patients with gallbladder and common bile duct stones are generally treated by pre-operative endoscopic sphincterotomy (ES) followed by laparoscopic cholecystectomy (POES). Recently, a meta-analysis has shown that intra-operative ES during laparoscopic cholecystectomy (IOES) results in fewer complications than POES, with similar efficacy. The cost effectiveness of IOES versus POES is unknown. The objective of this study was to compare the cost effectiveness of IOES versus POES from the UK NHS perspective. A decision-tree model estimating and comparing costs to the UK NHS and QALYs gained following a policy of either IOES or POES was developed with a time horizon of 3 years. Uncertainty was investigated with probabilistic sensitivity analysis, and the expected value of perfect information (EVPI) and partial information (EVPPI) were also calculated. IOES was less costly than POES (approximately -£623 per patient [year 2008 values]) and resulted in similar quality of life (+0.008 QALYs per patient) as POES. Given a willingness-to-pay threshold of £20 000 per QALY gained, there was a 92.9% probability that IOES is cost effective compared with POES. Full implementation of IOES could save the NHS £2.8 million per annum. At a willingness to pay of £20 000 per QALY gained, the 10-year population EVPI was estimated at £0.6 million. IOES appears to be cost effective compared with POES.

  12. The prognostic value of pre-operative serum tetranectin, CA-125 and a combined index in women with primary ovarian cancer

    DEFF Research Database (Denmark)

    Høgdall, Claus K; Nørgaard-Pedersen, Bent; Mogensen, Ole


    OBJECTIVE: To study the prognostic value of pre-operative serum tetranectin (TN), CA125 levels and a mathematical formula (Index1) in primary ovarian cancer. MATERIALS AND METHODS: The study group consisted of sixty-six patients with varying FIGO stages I-IV. The end-point was death from ovarian....../l (relative hazard for FIGO stages = 3.3 and for TN = 2.6). CONCLUSION: TN was a strong prognostic variable in patients with advanced ovarian cancer. To the contrary, CA125 was a strong prognostic factor in patients with a localised ovarian cancer and of no prognostic value in patients with advanced cancer...... cancer. Evaluation was by univariate life-tables analyses and the multivariate Cox analysis. In the Cox analyses, the variables were tested respectively in actual values and as dichotomy variables with different cut-off levels: 6.7, 7.3 and 8.2 mg/l for TN, 35, 65, 100 and 165 U/ml for CA125. RESULTS...

  13. Electronic warfare receivers and receiving systems

    CERN Document Server

    Poisel, Richard A


    Receivers systems are considered the core of electronic warfare (EW) intercept systems. Without them, the fundamental purpose of such systems is null and void. This book considers the major elements that make up receiver systems and the receivers that go in them.This resource provides system design engineers with techniques for design and development of EW receivers for modern modulations (spread spectrum) in addition to receivers for older, common modulation formats. Each major module in these receivers is considered in detail. Design information is included as well as performance tradeoffs o

  14. Categorization of major and minor complications in the treatment of patients with resectable rectal cancer using short-term pre-operative radiotherapy and total mesorectal excision: a Delphi round

    NARCIS (Netherlands)

    Bakx, R.; Emous, M.; Legemate, D. A.; Machado, M.; Zoetmulder, F. A. N.; van Tets, W. F.; Bemelman, W. A.; Slors, J. F. M.; van Lanschot, J. J. B.


    BACKGROUND: To properly balance the benefit (reduction of local recurrence) of short-term pre-operative radiotherapy for resectable rectal cancer against its harm (complications), a consensus concerning the severity of complications is required. The aim of this study was to reach consensus regarding

  15. 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

    NARCIS (Netherlands)

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

    Objectives: 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

  16. A espirometria na avaliação pré e pós-transplante de medula óssea Pre-operative and post-operative spirometry in bone marrow transplant patients

    Directory of Open Access Journals (Sweden)

    Eliane Viana Mancuzo


    complications and looking for correlations with postoperative outcomes. METHODS:The spirometry findings in 120 male and female patients, all above the age of 12, were evaluated retrospectively and compared in terms of the following parameters: the type of bone marrow transplant; the underlying disease; cytomegalovirus serology; source of the transplanted cells; smoking; pulmonary infection; history of lung disease; duration of the hematological disease; chemotherapy employed; conditioning regimen; acute or chronic rejection of the transplant; and post-operative mortality. RESULTS: In the pre-operative spirometry, 16 patients (13.3% presented alterations: 6 (5% presented pure obstruction; 7 (5.8% presented pure restriction; and 3 (2.5% presented obstruction accompanied by a reduction in vital capacity. In the post-operative spirometry, 29 patients (24.2% presented alterations. The chance of presenting post-operative spirometry alterations was greater in patients presenting acute transplant rejection (p = 0.02, patients older than 30 (p = 0.02, female patients (p = 0.02 and patients receiving stem cells (p = 0.01. Having a history of lung disease was found to be associated with greater mortality, as was suffering from chronic transplant rejection. No relationship was found between pre-operative spirometry alterations and post-operative mortality. CONCLUSION: In bone marrow transplant patients, the alterations found through pre-operative spirometry were not predictive of post-operative pulmonary complications or mortality. Nor were such alterations determinant of whether or not a given patient was a good candidate for bone marrow transplant. Simple spirometry seems to be of little practical importance in the evaluation of such patients.

  17. [Arthroscopic Finding of Knee Joint in Relation to Age and Its Comparison with Pre-Operative Clinical Finding - a Retrospective Study]. (United States)

    Látal, P; Šimeček, K; Kloub, M


    PURPOSE OF THE STUDY In the retrospective study of two South Bohemian centres we present the comparison of pre-operative anamnestic clinical signs in relation to the arthroscopic intraoperative finding. The obtained data is used also to evaluate the arthroscopic finding in relation to age and sex. MATERIAL AND METHODS The arthroscopic findings of patients who underwent surgery in 2013-2014 period (1.1.2013-31.12.2014) at the Department of Trauma Surgery of České Budějovice Hospital, a.s. and in 2014 (1.1.-31.12.2014) at the Department of Orthopaedics and Traumatology of Písek Hospital, a.s. were evaluated. In total, 1 021 patients underwent surgery, with the mean age of 44 years. The patients were not selected. The group includes all the patients who underwent surgery, including those in whom repeat arthroscopy was performed, in the respective period of time, regardless of the mechanism of difficulties. A preoperative MRI scan was carried out in 470 patients. The referring physician was present during the examination. In all the patients undergoing surgery, the main clinical preoperative sign was examined based on the documentation, namely in the following order - hemarthros, locked knee, hydrops or merely a pain. In the arthroscopic finding, the medial meniscal lesion - anterior and posterior horn, and complete tear was assessed. The same was done for lateral meniscus. In anterior cruciate ligament - ACL - partial or complete tear was assessed. We identified the frequency of findings in relation to age and evaluated the correlations between the clinical signs and the arthroscopic finding. We calculated the sensitivity and specificity of hemarthros as a sign of ACL tear. The analysis was conducted based on the medical history in medical record documentation and the surgical protocol. The cartilage was not assessed. RESULTS Analysis of clinical and anamnestic signs in relation to arthroscopic findings 1. Negative arthroscopic findings (potential cartilage damage

  18. Relative utility of a visual analogue scale vs. a six-point Likert scale in the measurement of global subject outcome in patients with low back pain receiving physiotherapy. (United States)

    Harland, N J; Dawkin, M J; Martin, D


    Patients' subjective impression of change is an important construct to measure following physiotherapy, but little evidence exists about the best type of measure to use. To compare the construct validity and utility of two forms of a global subjective outcome scale (GSOS) in patients with back pain: Likert and visual analogue scale (VAS) GSOS. Two samples of patients attending physiotherapy for back pain completed a questionnaire battery at discharge from physiotherapy including either a Likert or VAS GSOS. One hundred and eighty-seven {79 males, mean age 52.1 [standard deviation (SD) 15.5] years} patients completed the Likert GSOS and a separate sample of 144 patients [62 males, mean age 55.7 (SD 15.9) years] completed the VAS GSOS upon discharge from physiotherapy. The two versions of the GSOS were compared using pre- and post-treatment changes in scores using a VAS (pain), Roland-Morris Disability Questionnaire (18-item version) and catastrophising subscale of the Coping Strategies Questionnaire 24. Both versions of the GSOS showed significant (PPhysiotherapy. Published by Elsevier Ltd. All rights reserved.

  19. Comparison of one stage laparoscopic cholecystectomy combined with intra-operative endoscopic sphincterotomy versus two-stage pre-operative endoscopic sphincterotomy followed by laparoscopic cholecystectomy for the management of pre-operatively diagnosed patients with common bile duct stones: a meta-analysis. (United States)

    Tan, Chester; Ocampo, Omar; Ong, Raymund; Tan, Kim Shi


    Laparoscopic cholecystectomy (LC) for symptomatic gallstone disease is one of the most common surgical procedures. Concomitant common bile duct (CBD) stones are detected with an incidence of 4-20% and the ideal management is still controversial. The frequent practice is to perform endoscopic sphincterotomy pre-operatively (POES) followed by LC, to allow subsequent laparoscopic or open exploration if POES fails. However, POES has shown different drawbacks such as need for two hospital admissions, need of two anesthesia inductions, higher rate of pancreatitis, and longer hospital stay. Hence, an intra-operative endoscopic sphincerotomy (IOES) has been proposed. To compare the 1 stage laparoscopic cholecystectomy (LC) combined with IOES versus 2-stage POES followed by LC for the management of pre-operatively known cholecystocholedocholithiasis. The search terms bile duct stones/calculi, ERCP, endoscopic sphincterotomy, laparoendoscopic rendezvous (LERV), and laparoscopic ductal clearance/choledochotomy/exploration were used. A comprehensive hand-based search of reference lists of published articles and review articles was performed to ensure inclusion of all possible studies and exclude duplicates. RCTs comparing 1 stage LC combined with IOES versus 2-stage POES followed by LC for the management of pre-operatively known cholecystocholedocholithiasis in adults. Three reviewers assessed trial quality and extracted the data. Data were entered in revman version 5.3. The trials were grouped according to the outcome measure assessed such as success rate of CBD stone clearance, incidence of pancreatitis, overall morbidity, and length of hospital stay. A total of 629 patients in 5 RCTs met the inclusion criteria. The success rate of CBD clearance (IOES = 93%, POES = 92%) was the same in both groups (OR 1.34; 95% CI 0.45-0.97; p = 0.60). Findings showed that IOES was associated with less pancreatitis (0.6%) than POES (4.4%) (OR 0.19; 95% CI 0.06-0.67; p = 0.01; I 2

  20. Right ventricular functional analysis utilizing first pass radionuclide angiography for pre-operative ventricular assist device planning: a multi-modality comparison. (United States)

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


    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.

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

    Energy Technology Data Exchange (ETDEWEB)

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


    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

  2. Solar heat receiver (United States)

    Hunt, Arlon J.; Hansen, Leif J.; Evans, David B.


    A receiver for converting solar energy to heat a gas to temperatures from C. The receiver is formed to minimize impingement of radiation on the walls and to provide maximum heating at and near the entry of the gas exit. Also, the receiver is formed to provide controlled movement of the gas to be heated to minimize wall temperatures. The receiver is designed for use with gas containing fine heat absorbing particles, such as carbon particles.

  3. A flexible WLAN receiver

    NARCIS (Netherlands)

    Schiphorst, Roelof; Hoeksema, F.W.; Slump, Cornelis H.


    Flexible radio receivers are also called Software Defined Radios (SDRs) [1], [2]. The focus of our SDR project [3] is on designing the front end, from antenna to demodulation in bits, of a °exible, multi-standard WLAN receiver. We try to combine an instance of a (G)FSK receiver (Bluetooth) with an

  4. 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. (United States)

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


    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.

  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. (United States)

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


    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. Low complexity MIMO receivers

    CERN Document Server

    Bai, Lin; Yu, Quan


    Multiple-input multiple-output (MIMO) systems can increase the spectral efficiency in wireless communications. However, the interference becomes the major drawback that leads to high computational complexity at both transmitter and receiver. In particular, the complexity of MIMO receivers can be prohibitively high. As an efficient mathematical tool to devise low complexity approaches that mitigate the interference in MIMO systems, lattice reduction (LR) has been widely studied and employed over the last decade. The co-authors of this book are world's leading experts on MIMO receivers, and here they share the key findings of their research over years. They detail a range of key techniques for receiver design as multiple transmitted and received signals are available. The authors first introduce the principle of signal detection and the LR in mathematical aspects. They then move on to discuss the use of LR in low complexity MIMO receiver design with respect to different aspects, including uncoded MIMO detection...

  7. Delphi Accounts Receivable Module - (United States)

    Department of Transportation — Delphi accounts receivable module contains the following data elements, but are not limited to customer information, cash receipts, line of accounting details, bill...

  8. Expanding subjectivities

    DEFF Research Database (Denmark)

    Lundgaard Andersen, Linda; Soldz, Stephen


    A major theme in recent psychoanalytic thinking concerns the use of therapist subjectivity, especially “countertransference,” in understanding patients. This thinking converges with and expands developments in qualitative research regarding the use of researcher subjectivity as a tool to understa...

  9. Is a pre-operative brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide measurement an independent predictor of adverse cardiovascular outcomes within 30 days of noncardiac surgery? A systematic review and meta-analysis of observational studies

    National Research Council Canada - National Science Library

    Karthikeyan, Ganesan; Moncur, Ross A; Levine, Oren; Heels-Ansdell, Diane; Chan, Matthew T V; Alonso-Coello, Pablo; Yusuf, Salim; Sessler, Daniel; Villar, Juan Carlos; Berwanger, Otavio; McQueen, Matthew; Mathew, Anna; Hill, Stephen; Gibson, Simon; Berry, Colin; Yeh, Huei-Ming; Devereaux, P J


    .... Pre-operative clinical cardiac risk indices have only modest predictive power. BNP predicts adverse cardiovascular outcomes in a variety of nonsurgical settings and may similarly predict these outcomes in the perioperative setting...

  10. Pre-operative dextrose infusion to diminish Post-operative stress and recovery in elective canine ovariohysterectomy - Evaluation of a novel approach

    Directory of Open Access Journals (Sweden)

    Laiju Philip


    Full Text Available The present study was conducted to evaluate the effect preoperative dextrose infusion in promoting post operative recovery. The bitches presented for panhysterectomy were divided into two groups consisting of six each. Physiological and Haematological Parameters were estimated before and after surgery. Cortisol concentration and glucose concentration were also estimated. Sedation score and pain score were recorded from immediately after surgery up to 3rd postoperative day. A significant reduction in stress in the immediate postoperative period was noted as indicated by lowered elevation of cortisol and glucose level, and early anaesthetic recovery in animals received dextrose infusion in the preoperative period. The positive benefits in terms of improved postoperative outcome and patient well being after elective surgery recommends preoperative dextrose infusion in dogs as a general protocol in future practice in animal surgery. [Vet. World 2010; 3(2.000: 88-89

  11. Pre-operative training induces changes in the histomorphometry and muscle function of the pelvic floor in patients with indication of radical prostatectomy. (United States)

    Ocampo-Trujillo, A; Carbonell-González, J; Martínez-Blanco, A; Díaz-Hung, A; Muñoz, C A; Ramírez-Vélez, R


    To evaluate the efficacy of preoperative pelvic floor muscle training (PFMT) on histomorphometry, muscle function, urinary continence and quality of life of patients undergoing radical prostatectomy (RP). A prospective intervention clinical study was designed in 16 patients with indication of RP who were randomized into two groups. The Control Group received routine pre-surgical education (hygienic-dietary measures). The intervention group received a training session with supervised PFMT, three times a day, for four weeks, 30 days before the PR. Muscle function of the external urethral sphincter, contraction pressure of the levator ani, urinary continence and quality of life related to health (HRQoL) were evaluated before and after the intervention. At the end of the intervention and day of the surgery, samples of residual muscle tissue were obtained from the external sphincter muscle of the urethra for histomorphometric analysis. After the intervention, those participants who carried out PFMT showed an increase in the cross-sectional area of the muscle fibers of the external urethral sphincter (1,313 ± 1,075 μm(2)vs. 1,056 ± 844 μm(2), P=.03) and higher pressure contraction of the levator ani (F=9.188; P=.010). After catheter removal, 62% of patients in the experimental group and 37% in the control group showed no incontinence. After removal of the catheter, 75% of the experimental group did not require any pad compared to 25% in the control group (p=NS). There were no significant differences between the two groups in any of the HRQoL domains studied. Pre-surgical PFMT in patients with RP indication induces changes in the histology and function of the pelvic floor muscles, without changes in urogenital function and HRQoL. These results provide new evidence regarding the benefit of PFMT in preventing RP associated complications. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  12. Solar energy receiver (United States)

    Schwartz, Jacob


    An improved long-life design for solar energy receivers provides for greatly reduced thermally induced stress and permits the utilization of less expensive heat exchanger materials while maintaining receiver efficiencies in excess of 85% without undue expenditure of energy to circulate the working fluid. In one embodiment, the flow index for the receiver is first set as close as practical to a value such that the Graetz number yields the optimal heat transfer coefficient per unit of pumping energy, in this case, 6. The convective index for the receiver is then set as closely as practical to two times the flow index so as to obtain optimal efficiency per unit mass of material.

  13. Receiver Gain Modulation Circuit (United States)

    Jones, Hollis; Racette, Paul; Walker, David; Gu, Dazhen


    A receiver gain modulation circuit (RGMC) was developed that modulates the power gain of the output of a radiometer receiver with a test signal. As the radiometer receiver switches between calibration noise references, the test signal is mixed with the calibrated noise and thus produces an ensemble set of measurements from which ensemble statistical analysis can be used to extract statistical information about the test signal. The RGMC is an enabling technology of the ensemble detector. As a key component for achieving ensemble detection and analysis, the RGMC has broad aeronautical and space applications. The RGMC can be used to test and develop new calibration algorithms, for example, to detect gain anomalies, and/or correct for slow drifts that affect climate-quality measurements over an accelerated time scale. A generalized approach to analyzing radiometer system designs yields a mathematical treatment of noise reference measurements in calibration algorithms. By treating the measurements from the different noise references as ensemble samples of the receiver state, i.e. receiver gain, a quantitative description of the non-stationary properties of the underlying receiver fluctuations can be derived. Excellent agreement has been obtained between model calculations and radiometric measurements. The mathematical formulation is equivalent to modulating the gain of a stable receiver with an externally generated signal and is the basis for ensemble detection and analysis (EDA). The concept of generating ensemble data sets using an ensemble detector is similar to the ensemble data sets generated as part of ensemble empirical mode decomposition (EEMD) with exception of a key distinguishing factor. EEMD adds noise to the signal under study whereas EDA mixes the signal with calibrated noise. It is mixing with calibrated noise that permits the measurement of temporal-functional variability of uncertainty in the underlying process. The RGMC permits the evaluation of EDA by

  14. Agreement among RTOG Sarcoma Radiation Oncologists in Contouring Suspicious Peritumoral Edema for Pre-operative Radiotherapy of Soft Tissue Sarcoma of the Extremity (United States)

    Bahig, Houda; Roberge, David; Bosch, Walter; Levin, William; Petersen, Ivy; Haddock, Michael; Freeman, Carolyn; DeLaney, Thomas F.; Abrams, Ross A.; Indelicato, Danny J.; Baldini, Elizabeth H.; Hitchcock, Ying; Kirsch, David G.; Kozak, Kevin R.; Wolfson, Aaron; Wang, Dian


    Purpose Peritumoral edema may potentially harbor sarcoma cells. The extent of suspicious edema (SE) included in the treatment volume is subject to clinical judgment, balancing the risk of missing tumor cells with excess toxicity. Our goal was to determine variability in SE delineation by sarcoma radiation oncologists (RO). Material and Method Twelve expert ROs were provided with T1 Gadolinium and T2-weighted MR images of 10 patients with high-grade extremity soft tissue sarcoma. Gross tumor volume, CTV3cm (3cm longitudinal and 1.5cm radial margin) and CTV2cm (2cm longitudinal and 1cm radial margin) were contoured by a single observer. Suspicious peritumoral edema, defined as abnormal signal on T2 images, was independently delineated by all 12 ROs. Contouring agreement was analyzed using the Simultaneous Truth and Performance Level Estimation (STAPLE) algorithm and kappa statistics. Results The mean volumes of GTV, CTV2cm and CTV3cm were respectively 130 cm3 (7–413 cm3), 280cm3 and 360cm3. The mean consensus volume computed using the STAPLE algorithm at 95% confidence interval was 188cm3 (24–565cm3) with a substantial overall agreement corrected for chance (mean kappa =0.71; range: 0.32–0.87). The minimum, maximum and mean volume of suspicious edema (excluding the GTV) were 4cm3, 182cm3 and 58 cm3 (representing a median of 29% of the GTV volume). The median volume of suspicious edema not included in the CTV2cm and in the CTV3cm was 5 cm3 and 0.3cm3 respectively. There were 3 large tumors with >30cm3 of suspicious edema not included in the CTV3cm volume. Conclusion Despite the fact that SE would empirically seem to be a more subjective volume, a substantial or near-perfect inter-observer agreement was observed in SE delineation in most cases with high-grade STS of the extremity. A median of 97% of the consensus SE is within the CTV2cm (99.8% within the CTV3cm). In a minority of cases, however, significant expansion of the CTVs is required to cover SE. PMID

  15. Assessment of the Pre-operative Nutritional Status of Patients who were Scheduled for Elective Surgery and Determination of Nutritional Support Requirements

    Directory of Open Access Journals (Sweden)

    Bahri Özer


    Full Text Available Aim: We aimed to evaluate the nutritional status with clinical, antropometric and laboratory methods in patients who were scheduled for elective surgery. Methods: Retrospective evaluation of 90 patients in a period of 4 years was performed. Patients with tumors (group 1 were compared with controls (group 2 in regard to nutritional status. Student t-test, Mann-Whitney U test and chi-square test were used for statistical analysis. Results: The mean age of patients in group 1 (3 males, 8 females and group 2 (35 males, 44 females was 62.8±11.0 and 47.7±16.2 years, respectively. The mean body mass index (BMI was 30.1±6.6. Triceps thickness and circumference of the upper mid-arm were 2.2±0.8 and 28.6±4.2 cm, respectively. All patients had a Subjective Global Assessment (SGA score A, but two patients were classified as having moderate nutritional risk according to Nutritional Risk Screening (NRS 2002. The mean length of hospital stay was 2.6±2.4 days. Complications were observed in four patients of group 2 and in two patients of group 1. Gender, SGA score, albumin, prealbumin, BMI, triceps thickness, circumference of the upper mid-arm and complication rates were statistically similar between the groups. There was a statistically significant difference in age, NRS 2002, gastrointestinal system findings, length of hospital stay, sedimentation and fasting blood glucose levels between the groups. Conclusion: Patients with nutritional risk can be detected using the NRS 2002. Nutritional support was necessary in 2% of all cases and in 18% of group 1 patients. However, advantages of antropometric measurements, biochemical tests, BMI and SGA could not be shown.


    Indian Academy of Sciences (India)

    Subject Index. Variation of surface electric field during geomagnetic disturbed period at Maitri, Antarctica. 1721. Geomorphology. A simple depression-filling method for raster and irregular elevation datasets. 1653. Decision Support System integrated with Geographic. Information System to target restoration actions in water-.

  17. New method for assessing hand disinfection shows that pre-operative alcohol/chlorhexidine rub is as effective as a traditional surgical scrub. (United States)

    Howard, J D; Jowett, C; Faoagali, J; McKenzie, B


    Several studies have shown that rubbing hands with an alcohol/chlorhexidine solution provides equivalent microbial decontamination to a conventional surgical scrub using aqueous chlorhexidine. However, the authors believe that these studies have methodological flaws that limit their applicability to the operating theatre environment. As such, a method was developed to compare products in an everyday operating theatre environment using working operating theatre personnel. To determine whether or not an alcohol/chlorhexidine rub is as efficacious as a traditional surgical scrub using a novel method. Bacterial counts at baseline were collected from 20 anaesthetists using the glove juice method. Subsequently, with sequential exchange of sterile gloves, one hand underwent a 3-min scrub using 4% aqueous chlorhexidine, and the other hand underwent a 60-s rub with a 70% isopropyl alcohol/0.5% chlorhexidine solution. The residual bacterial count was collected for each hand after 30 min using the glove juice method. These counts were converted to log10 values to compare the baseline counts of right and left hands, and efficacy between the treatment groups. Mean [± standard deviation (SD)] bacterial counts at baseline were (log10) 4.42 ± 0.81 for left hands and 4.64 ± 0.60 for right hands (P > 0.05). The mean (± SD) reduction from baseline was (log10) 1.45 ± 0.50 for 4% chlorhexidine and 2.01 ± 0.98 for alcohol/chlorhexidine (P > 0.05). An alcohol/chlorhexidine hand rub was found to be as efficacious as a traditional scrub after 30 min; this study differs from previous work as it was undertaken in a population of practising anaesthetists in their working environment. The McKenzie method allows baseline and study evaluations to be performed contemporaneously on the same individual. Each subject was his/her own control. This method offers a more clinically relevant way to compare disinfectant solutions than standard methods. Crown Copyright © 2014. Published by Elsevier

  18. Wideband CMOS receivers

    CERN Document Server

    Oliveira, Luis


    This book demonstrates how to design a wideband receiver operating in current mode, in which the noise and non-linearity are reduced, implemented in a low cost single chip, using standard CMOS technology.  The authors present a solution to remove the transimpedance amplifier (TIA) block and connect directly the mixer’s output to a passive second-order continuous-time Σ∆ analog to digital converter (ADC), which operates in current-mode. These techniques enable the reduction of area, power consumption, and cost in modern CMOS receivers.

  19. Biconical receiving antenna (United States)

    Grimes, Dale M.


    The modal solution to a biconical receiving antenna with arbitrary arm angles and lengths is presented in the form of sums over special functions; sums which are exact in the sense that no electromagnetic approximations are made. The antenna load is confined within a sphere of small radius centered at the apices of the cones. The analytical formulation is presented, along with solutions for ψ very small and very large, and certain selected numerical data. The general solution permits calculation of all detailed fields near and far, both receiving and transmitting current modes on the antenna arms and caps and the power and the momentum absorbed by the antenna from an incoming plane wave. It is shown that the receiving current modes are necessary for electromagnetic momentum to be conserved during power reception. Detailed calculation of comparative receiving and transmitting admittances confirms that they are identical, as predicted by the reciprocity theorem. The radiation patterns, however, for retransmission during reception and for transmission differ.

  20. Help Seeking and Receiving. (United States)

    Nadler, Arie

    Although social psychology has always had an interest in helping behavior, only recently has the full complexity of helping relations begun to be researched. Help seeking and receiving in the educational setting raise many issues regarding the use and effectiveness of the help itself. Central to all helping relations is the seeking/receiving…

  1. Pelvic joint fusion in patients with severe pelvic girdle pain - a prospective single-subject research design study. (United States)

    Kibsgård, Thomas J; Røise, Olav; Stuge, Britt


    The fusion of the pelvic joints in patients with severe pelvic girdle pain (PGP) is a controversial and insufficiently studied procedure. The aims of this study were to evaluate physical function and pain after sacroiliac joint (SIJ) fusion. A single-subject research design study with repeated measurements was conducted; pre-operatively and at 3, 6 and 12 months post-operatively. The outcome measures considered were the Oswestry disability index (ODI), visual analogue scale (VAS), and SF-36. Eight patients with severe PGP received open-accessed unilateral anterior SIJ fusion and fusion of the pubic symphysis. Seven patients reported positive results from the surgery. At 1 year post-operation, significant (p < 0.001) reductions in ODI (54 to 37) and VAS (82 to 57) were reported. The physical functioning, bodily pain, and social functioning scores in the SF-36 were also improved. Positive and significant changes in disability and pain at 1 year after SIJ fusion were observed. Despite these positive results, open accessed anterior fusion of the SIJ was associated with adverse events and complications such as infection and nerve damage.

  2. Pelvic joint fusion in patients with severe pelvic girdle pain – a prospective single-subject research design study (United States)


    Background The fusion of the pelvic joints in patients with severe pelvic girdle pain (PGP) is a controversial and insufficiently studied procedure. The aims of this study were to evaluate physical function and pain after sacroiliac joint (SIJ) fusion. Methods A single-subject research design study with repeated measurements was conducted; pre-operatively and at 3, 6 and 12 months post-operatively. The outcome measures considered were the Oswestry disability index (ODI), visual analogue scale (VAS), and SF-36. Eight patients with severe PGP received open-accessed unilateral anterior SIJ fusion and fusion of the pubic symphysis. Results Seven patients reported positive results from the surgery. At 1 year post-operation, significant (p < 0.001) reductions in ODI (54 to 37) and VAS (82 to 57) were reported. The physical functioning, bodily pain, and social functioning scores in the SF-36 were also improved. Conclusion Positive and significant changes in disability and pain at 1 year after SIJ fusion were observed. Despite these positive results, open accessed anterior fusion of the SIJ was associated with adverse events and complications such as infection and nerve damage. PMID:24629145

  3. Pressure difference receiving ears

    DEFF Research Database (Denmark)

    Michelsen, Axel; Larsen, Ole Næsbye


    waves behave in the air spaces leading to the interior surfaces of eardrums. A linear mathematical model with well-defined inputs is used for exploring how the directionality varies with the binaural directional cues and the amplitude and phase gain of the sound pathway to the inner surface...... of such pressure difference receiving ears have been hampered by lack of suitable experimental methods. In this review, we review the methods for collecting reliable data on the binaural directional cues at the eardrums, on how the eardrum vibrations depend on the direction of sound incidence, and on how sound...


    African Journals Online (AJOL)


    operative hospital stay in the povidone iodine group. INTRODUCTION. Benign prostatic hyperplasia (BPH) is histologically defined as non-malignant nodules arising in the region of the transition zone [1]. It is one of the most common disease ...

  5. Is the duration of pre-operative conservative treatment associated with the clinical outcome following surgical decompression for lumbar spinal stenosis? A study based on the Spine Tango Registry. (United States)

    Zweig, Thomas; Enke, Juliane; Mannion, Anne F; Sobottke, Rolf; Melloh, Markus; Freeman, Brian J C; Aghayev, Emin


    The incidence of lumbar spinal stenosis (LSS) continues to rise, with both conservative and surgical management representing options for its treatment. The timing of surgery for LSS varies from shortly after the onset of symptoms to several months or years after conservative treatment. The aim of this study was to investigate the association between the duration of pre-operative conservative treatment and the ultimate outcome following surgical interventions for LSS. The study was based on prospective multicentre registry data (Spine Tango). Cases of LSS with a documented duration of conservative treatment, undergoing spinal decompression with at least one post-operative patient assessment between 3 and 30 months, were included in the study. Cases of LSS with spondylolisthesis, additional spinal pathology or previous spinal surgery were excluded. Interrogation of the Spine Tango Registry listed 3478 patients meeting the prescribed inclusion criteria. This cohort was stratified into four groups: (1) no previous treatment (n = 497; 14.3%), (2) conservative treatment 12 months (n = 1258; 36.1%). Group 4 reference group in regression analysis. The inverse probability of treatment weighting (IPTW) was applied using the propensity score to balance the groups for their characteristics. Outcome measures included achievement of the minimum clinically important change (MCIC) score of 2 points for (a) back pain, (b) leg pain and (c) Core Outcome Measures Index (COMI), and (d) surgical complications, (e) general complications and (f) operation time >2 h. Patient group ("duration of conservative therapy") was not associated with achievement of the MCIC for post-operative relief of leg pain (p = 0.22), achievement of MCIC for the COMI score (p = 0.054), surgical complications (p = 0.11) or general complications (p = 0.14). Only MCIC for post-operative relief of back pain (p = 0.021) and operation time were significantly associated with patient group (p = 0

  6. Are sagittal spinopelvic radiographic parameters significantly associated with quality of life of adult spinal deformity patients? Multivariate linear regression analyses for pre-operative and short-term post-operative health-related quality of life. (United States)

    Takemoto, Mitsuru; Boissière, Louis; Vital, Jean-Marc; Pellisé, Ferran; Perez-Grueso, Francisco Javier Sanchez; Kleinstück, Frank; Acaroglu, Emre R; Alanay, Ahmet; Obeid, Ibrahim


    To evaluate the association in ASD patients between spinopelvic sagittal parameters and health-related quality of life (HRQL), adjusted for demographic and surgical variables. We constructed multiple linear regression models to investigate pre-operative (PreOp) and 6-month post-operative (PostOp) HRQL as assessed by the Oswestry Disability Index (ODI), with sagittal parameters as independent variables adjusted for potential confounders, such as age, sex, body mass index, past spine surgery, types of surgical treatment, and complications. A total of 204 patients (164 women, 40 men, mean age 53.1 years) were included in this study. In multivariate models for PreOp ODI, no significant association was observed between PreOp HRQL and sagittal parameters when adjusted for covariates. Interestingly, age, sex, American Society of Anesthesiologists score, and body mass index were still significantly associated with PreOp HRQL. In contrast to PreOp analysis, there was a significant association between PostOp worse HRQL (higher ODI) and positive T1 sagittal tilt (T1ST: the angle between a line drawn from the center of the femoral head axis to the midpoint of the T1 vertebral body and a vertical line). Sagittal vertical axis had a weaker association with HRQL than T1ST. PostOp ASD patients lose flexibility in the fused spinal segment, and might be predisposed to symptoms related to spinal sagittal malalignment due to limited compensatory ability to maintain a balanced standing posture. Interestingly, in patients with sagittal imbalance, low pelvic tilt (PT) of studies that used univariate analysis. Not only sagittal parameters, but also the pre-operative patient's general condition should be carefully reviewed when considering indication for ASD surgery. In contrast, although this is a short-term follow-up study, PostOp HRQL was significantly associated with sagittal parameters. When ASD surgery has been indicated, restoration of spinal sagittal alignment is certainly


    CERN Multimedia

    Denise Heagerty


    Unsolicited email, commonly known as SPAM, is a growing problem across the Internet at large. You are recommended to delete it. If the email looks suspicious, do not even open it (from Outlook you can delete email using the right button of your mouse to select the message and then selecting delete). Viruses are often hidden inside attachments, so do not open attachments in unsolicited email. SPAM and virus emails can be disguised to trick you into reading the email and/or performing an action. Here are examples of some techniques to help you recognise them: fake email addresses: emails can appear to be from people you know or even from yourself. Your own email address can appear in emails which you did not send, resulting in non-delivery messages or unexpected replies. Fake addresses may be used to send viruses. If the email looks suspicious then delete it and do not open the attachments. If you are unsure then check with the sender first. enticing subjects: the email subject uses words to make you curious...

  8. Angelopoulos receives Scarf Award (United States)

    Lee, Martin

    AGU's third annual F.L. Scarf Award has been awarded to Vassilis Angelopoulos for his Ph.D. thesis, “Transport Phenomena in the Earth's Plasma Sheet,” which he completed at the University of California, Los Angeles, under the supervision of Charles Kennel. As part of the award, Angelopoulos will give an invited talk on a related topic at the upcoming AGU Fall Meeting in San Francisco.The award was established to honor Fred L. Scarf, a pioneer and leader in solar-planetary research. The award is given by the Space Physics and Aeronomy (SPA) section for outstanding dissertation research that contributes directly to solar-planetary science. The major criterion for the award is the impact or potential impact of the research on the field of solar-planetary studies. The awardee receives $1000 and is invited to deliver a paper at one of the following year's AGU meetings.

  9. Anchorage Receives Record Snowfall (United States)


    The forecast called for flurries, but the snow accumulated on the ground in Anchorage, Alaska, at the rate of 2 inches per hour (5 cm per hour) for much of Saturday, March 16, 2002. By the time the winter storm passed on Sunday afternoon, Anchorage had received 28.6 inches (72.6 cm) of snow, surpassing by far the previous record of 15.6 inches (39.6 cm) set on December 29, 1955. Flights were canceled and schools were closed as a result of the storm. This true-color image of Alaska was acquired by the Sea-viewing Wide Field-of-view Sensor (SeaWiFS), flying aboard the OrbView-2 satellite, on March 18. It appears another large, low-pressure system is heading toward the Anchorage region, which could bring substantially more snowfall. The low-pressure system can be identified by the characteristic spiral pattern of clouds located off Alaska's southwestern coast in this scene.

  10. CERN apprentice receives award

    CERN Multimedia


    Another CERN apprentice has received an award for the quality of his work. Stéphane Küng (centre), at the UIG ceremony last November, presided over by Geneva State Councillor Pierre-François Unger, Head of the Department of Economics and Health. Electronics technician Stéphane Küng was honoured in November by the Social Foundation of the Union Industrielle Genevoise (UIG) as one of Geneva’s eight best apprentices in the field of mechatronics. The 20-year-old Genevan obtained his Federal apprentice’s certificate (Certificat fédéral de capacité - CFC) in June 2007, achieving excellent marks in his written tests at the Centre d’Enseignement Professionnel Technique et Artisanal (CEPTA). Like more than 200 youngsters before him, Stéphane Küng spent part of his four-year sandwich course working at CERN, where he followed many practical training courses and gained valuable hands-on experience in various technical groups and labs. "It’ always very gr...

  11. The efficacy of pre-operative oral medication of paracetamol, ibuprofen, and aceclofenac on the success of maxillary infiltration anesthesia in patients with irreversible pulpitis: A double-blind, randomized controlled clinical trial (United States)

    Ramachandran, Anupama; Khan, Sulthan Ibrahim Raja; Mohanavelu, Deepalakshmi; kumar, Kumarappan Senthil


    Aim: To determine the effect of preoperative administration of paracetamol (PARA), ibuprofen (IBUP), or aceclofenac (ACEC) on the success of maxillary infiltration anesthesia in patients with irreversible pulpitis in a double-blinded randomized controlled trial. Materials and Methods: One hundred and twenty patients with irreversible pulpitis of a maxillary first molar participated. Patients indicated their pain scores on a Heft Parker visual analog scale, after which they were randomly divided into four groups (n = 30). The subjects received identical capsules containing 1000 mg PARA, 800 mg IBUP, 100 mg ACEC or cellulose powder (placebo, PLAC), 1 h before administration of maxillary infiltration anesthesia with 2% lidocaine containing 1:200,000 epinephrine. Access cavities were then prepared and success of anesthesia was defined as the absence of pain during access preparation and root canal instrumentation. The data were analyzed using chi-squared tests. Results: The success rates in descending order were 93.3% (IBUP), 90% (ACEC), 73.3% (PARA), and 26.5 % (PLAC). A significant (P irreversible pulpitis. PMID:23112474

  12. GNSS Software Receiver for UAVs

    DEFF Research Database (Denmark)

    Olesen, Daniel Madelung; Jakobsen, Jakob; von Benzon, Hans-Henrik


    This paper describes the current activities of GPS/GNSS Software receiver development at DTU Space. GNSS Software receivers have received a great deal of attention in the last two decades and numerous implementations have already been presented. DTU Space has just recently started development of ...... of our own GNSS software-receiver targeted for mini UAV applications, and we will in in this paper present our current progress and briefly discuss the benefits of Software Receivers in relation to our research interests....

  13. Prospective comparison of MR with diffusion-weighted imaging, endoscopic ultrasound, MDCT and positron emission tomography-CT in the pre-operative staging of oesophageal cancer: results from a pilot study. (United States)

    Giganti, Francesco; Ambrosi, Alessandro; Petrone, Maria C; Canevari, Carla; Chiari, Damiano; Salerno, Annalaura; Arcidiacono, Paolo G; Nicoletti, Roberto; Albarello, Luca; Mazza, Elena; Gallivanone, Francesca; Gianolli, Luigi; Orsenigo, Elena; Esposito, Antonio; Staudacher, Carlo; Del Maschio, Alessandro; De Cobelli, Francesco


    To compare the diagnostic performance of MR and diffusion-weighted imaging (DWI), multidetector CT, endoscopic ultrasonography (EUS) and 18 F-FDG (fluorine-18 fludeoxyglucose) positron emission tomography CT (PET-CT) in the pre-operative locoregional staging of oesophageal cancer. 18 patients with oesophageal or Siewert I tumour (9 directly treated with surgery and 9 addressed to chemo-/radiotherapy before) underwent 1.5-T MR and DWI, 64-channel multidetector CT, EUS and PET-CT before (n = 18) and also after neoadjuvant treatment (n = 9). All images were analysed and staged blindly by dedicated operators (seventh TNM edition). Two radiologists calculated independently the apparent diffusion coefficient from the first scan. Results were compared with histopathological findings. After the population had been divided according to local invasion (T1-T2 vs T3-T4) and nodal involvement (N0 vs N+), sensitivity, specificity, accuracy, positive- and negative-predictive values were calculated and compared. Quantitative measurements from DWI and PET-CT were also analysed. For T staging, EUS showed the best sensitivity (100%), whereas MR showed the highest specificity (92%) and accuracy (83%). For N staging, MR and EUS showed the highest sensitivity (100%), but none of the techniques showed adequate results for specificity. Overall, MR showed the highest accuracy (66%) for N stage, although this was not significantly different to the other modalities. The apparent diffusion coefficient was different between surgery-only and chemo-/radiotherapy groups (1.90 vs 1.30 × 10 -3  mm 2  s -1 , respectively; p = 0.005)-optimal cut off for local invasion: 1.33 × 10 -3  mm 2  s -1 (p = 0.05). Difference in standardized uptake value was also very close to conventional levels of statistical significance (8.81 vs 13.97 g cm -3 , respectively; p = 0.05)-optimal cut off: 7.97 g cm -3 (p = 0.44). In this pilot study, we have shown that MR with

  14. Pediatric central nervous system tumors in the first 3 years of life: pre-operative mean platelet volume, neutrophil/lymphocyte count ratio, and white blood cell count correlate with the presence of a central nervous system tumor. (United States)

    Tumturk, Abdulfettah; Ozdemir, Mehmet Akif; Per, Huseyin; Unal, Ekrem; Kucuk, Ahmet; Ulutabanca, Halil; Karakukcu, Musa; Canoz, Ozlem; Gumus, Hakan; Coskun, Abdulhakim; Kurtsoy, Ali


    The aim of this study is to describe the relationship of pre-operative complete blood count parameters [mean platelet volume (MPV), neutrophil/lymphocyte count ratio (NLCR), and white blood cell count (WBC)], with the clinical, radiological, and histopathological features and the management options for patients under 3 years of age with a newly diagnosed central nervous system tumors. Children with central nervous system (CNS) tumors in the first 3 years of life admitted in the Erciyes University Hospital between April 2004 and April 2014 were enrolled in this study. The CBC parameters were compared with those of an age- and sex-matched normal control group. In the study group, the means of MPV and WBC were 8.00 ± 1.24 fl, and 10,855 ± 3642/mm(3) respectively; the median (25-75%) of NLCR was 0.98 (0.66-1.46). For the control group, the means of MPV and WBC were 6.8 ± 0.73 fl and 8565 ± 2522/mm(3); the median (25-75%) of NLCR was 0.52 (0.36-0.70). The MPV, WBC, and NLCR were higher in the study group. The median overall survival (OS) of the patients was 60 months (range 0-81.6 months); and median event free survival (EFS) was 24 months (range 0-70.1 months). The formulation of MPV, NLCR, and WBC was found to be predictive for the diagnosis of CNS tumor in children with nonspecific symptoms. The univariate and multiple binary regression analyses showed a positive association of MPV, NLCR, and WBC and the risk of a diagnosis of CNS tumor. There was no relationship between MPV, WBC, NLCR, and histological subgroups. However, there were no associations between CBC parameters and OS or EFS of the patients. By causing suspicion, MPV, NLCR, and WBC may provide both an earlier radiological investigation decision and thereby an early diagnosis of CNS tumor in children with nonspecific symptoms in the first 3 years of life.

  15. Enhanced pre-operative axillary staging using intradermal microbubbles and contrast-enhanced ultrasound to detect and biopsy sentinel lymph nodes in breast cancer: a potential replacement for axillary surgery. (United States)

    Cox, Karina; Taylor-Phillips, Sian; Sharma, Nisha; Weeks, Jennifer; Mills, Philippa; Sever, Ali; Lim, Adrian; Haigh, Isobel; Hashem, Mohamed; de Silva, Tania; Satchithananda, Keshthra; Tang, Mengxing; Wallis, Matthew


    To compare the experience of four UK Centres in the use of intradermal microbubbles and contrast enhanced ultrasound (CEUS) to pre-operatively identify and biopsy sentinel lymph nodes (SLN) in patients with breast cancer. In all centres, breast cancer patients had a microbubble/CEUS SLN core biopsy prior to axillary surgery and patients in Centres 1 and 2 had a normal greyscale axillary ultrasound. Data were collected between 2010 and 2016; 1361 from Centre 1 (prospective, sequential), 376 from Centre 2 (retrospective, sequential), 121 from Centre 3 (retrospective, selected) and 48 from Centre 4 (prospective, selected). SLN were successfully core biopsied in 80% (Centre 1), 79.6% (Centre 2), 77.5% (Centre 3) and 88% (Centre 4). The sensitivities to identify all SLN metastases were 46.9% [95% confidence intervals (CI) (39.4-55.1)], 52.5% [95% CI (39.1-65.7)], 46.4% [95% CI (27.5-66.1)] and 45.5% [95% CI (16.7-76.6)], respectively. The specificities were 99.7% [95% CI (I98.9-100)], 98.1% [95% CI (94.5-99.6)], 100% [95% CI (93.2-100%)] and 96.3% [95% CI (81-99.9)], respectively.The negative predictive values were 87.0% [95% CI (84.3-89.3)], 84.5% [95% CI (78.4-89.5)], 86.9% [95% CI (82.4-90.3)] and 86.2% [95% CI (78.4-91.5)], respectively. At Centres 1 and 2, 12/730 (1.6%) and 7/181 (4%), respectively, of patients with a benign microbubble/CEUS SLN core biopsy had two or more lymph node (LN) macrometastases found at the end of primary surgical treatment. The identification and biopsy of SLN using CEUS is a reproducible technique. Advances in knowledge: In the era of axillary conservation, microbubble/CEUS SLN core biopsy has the potential to succeed surgical staging of the axilla.

  16. Communications receivers principles and design

    CERN Document Server

    Rohde, Ulrich L; Zahnd, Hans


    This thoroughly updated guide offers comprehensive explanations of the science behind today’s radio receivers along with practical guidance on designing, constructing, and maintaining real-world communications systems. You will explore system planning, antennas and antenna coupling, amplifiers and gain control, filters, mixers, demodulation, digital communication, and the latest software defined radio (SDR) technology. Written by a team of telecommunication experts, Communications Receivers: Principles and Design, Fourth Edition, features technical illustrations, schematic diagrams, and detailed examples. Coverage includes: • Basic radio considerations • Radio receiver characteristics • Receiver system planning • Receiver implementation considerations • RF and baseband techniques for Software-Defined Radios • Transceiver SDR considerations • Antennas and antenna coupling • Mixers • Frequency sources and control • Ancillary receiver circuits • Performance measurement

  17. Securities backed by healthcare receivables. (United States)

    Pallarito, K


    Prudential Securities has placed $40 million in medium-term, taxable notes believed to be the first AAA-rated securities backed by healthcare receivables. Standard & Poor's Corp. rated the three-year notes, which were issued by NPF III, an Ohio company created to buy receivables from cash-strapped providers, and are backed by the Medicare, Medicaid and insurance receivables of 21 hospitals and healthcare providers nationwide.

  18. Giving receivables an 'outside' chance. (United States)

    Slater, R M; Corti, R; Privitera, J


    Because of a greater number of patient visits and transactions, outpatient care typically involves more clerical and administrative work for less revenue than inpatient accounts. One hospital turned to outsourcing its outpatient receivables-contracting with an outside company to handle outpatient receivables. An outside company first can help an organization tackle an outpatient billing backlog and increase cash flow from outpatient accounts. Eventually, outsourcing can help an organization replace an outdated computer system and stem the tide of billing office employee attrition.

  19. Economic Galileo E5 Receiver

    Directory of Open Access Journals (Sweden)

    P. Kovar


    Full Text Available The Galileo system introduces an extremely wideband civil E5 signal for high precision navigation. The structure of the receiver for the E5 signal is complicated due to the signal complexity and the large bandwidth. It is possible to process the whole E5 signal or process separately E5a and E5b parts combining obtained results afterwards (we call here such method as piece-wise processing. The second procedure has three times worse standard deviation of the pseudorange then first one. The main goal of the paper is to present a design of an E5 receiver which we will call the economic E5 receiver (ecoE5. It is built from jointly controlled correlators for the processing of the E5a and E5b signals which are parts of the E5 signal. Control of these partial E5a and E5b correlators is realized by only one delay and one phase lock loops. The performance, i.e. the pseudorange noise and multipath errors, of the receiver equipped with the ecoE5, is only slightly worse (the standard deviation of the pseudorange noise is 10 - 20% larger than the performance of the optimal E5 receiver and it is much better than the performance of the receiver combining the piecewise (E5a and E5b measurements. The ecoE5 receiver hardware demands are about one quarter of the hardware demands of the classical E5 receiver.


    Directory of Open Access Journals (Sweden)

    A. K. Esman


    Full Text Available Recent research and development show promising use of high-performance solid-state receivers of the electromagnetic radiation. These receivers are based on the low-barrier Schottky diodes. The approach to the design of the receivers on the basis of delta-doped low-barrier Schottky diodes with beam leads without bias is especially actively developing because for uncooled receivers of the microwave radiation these diodes have virtually no competition. The purpose of this work is to improve the main parameters and characteristics that determine the practical relevance of the receivers of mid-infrared electromagnetic radiation at the operating room temperature by modifying the electrodes configuration of the diode and optimizing the distance between them. Proposed original design solution of the integrated receiver of mid-infrared radiation on the basis of the low-barrier Schottky diodes with beam leads allows to effectively adjust its main parameters and characteristics. Simulation of the electromagnetic characteristics of the proposed receiver by using the software package HFSS with the basic algorithm of a finite element method which implemented to calculate the behavior of electromagnetic fields on an arbitrary geometry with a predetermined material properties have shown that when the inner parts of the electrodes of the low-barrier Schottky diode is performed in the concentric elliptical convex-concave shape, it can be reduce the reflection losses to -57.75 dB and the standing wave ratio to 1.003 while increasing the directivity up to 23 at a wavelength of 6.09 μm. At this time, the rounded radii of the inner parts of the anode and cathode electrodes are equal 212 nm and 318 nm respectively and the gap setting between them is 106 nm. These parameters will improve the efficiency of the developed infrared optical-promising and electronic equipment for various purposes intended for work in the mid-infrared wavelength range. 

  1. Sensibility and Subjectivity: Levinas’ Traumatic Subject

    Directory of Open Access Journals (Sweden)

    Rashmika Pandya


    Full Text Available The importance of Levinas’ notions of sensibility and subjectivity are evident in the revision of phenomenological method by current phenomenologists such as Jean-Luc Marion and Michel Henry. The criticisms of key tenants of classical phenomenology, intentionality and reduction, are of a particular note. However, there are problems with Levinas’ characterization of subjectivity as essentially sensible. In “Totality and Infinity” and “Otherwise than Being”, Levinas criticizes and recasts a traditional notion of subjectivity, particularly the notion of the subject as the first and foremost rational subject. The subject in Levinas’ works is characterized more by its sensibility and affectedness than by its capacity to reason or affect its world. Levinas ties rationality to economy and suggests an alternative notion of reason that leads to his analysis of the ethical relation as the face-to-face encounter. The ‘origin’ of the social relation is located not in our capacity to know but rather in a sensibility that is diametrically opposed to the reason understood as economy. I argue that the opposition in Levinas’ thought between reason and sensibility is problematic and essentially leads to a self-conflicted subject. In fact, it would seem that violence characterizes the subject’s self-relation and, thus, is also inscribed at the base of the social relation. Rather than overcoming a problematic tendency to dualistic thought in philosophy Levinas merely reverses traditional hierarchies of reason/emotion, subject/object and self/other. 

  2. UWB communication receiver feedback loop (United States)

    Spiridon, Alex; Benzel, Dave; Dowla, Farid U.; Nekoogar, Faranak; Rosenbury, Erwin T.


    A novel technique and structure that maximizes the extraction of information from reference pulses for UWB-TR receivers is introduced. The scheme efficiently processes an incoming signal to suppress different types of UWB as well as non-UWB interference prior to signal detection. Such a method and system adds a feedback loop mechanism to enhance the signal-to-noise ratio of reference pulses in a conventional TR receiver. Moreover, sampling the second order statistical function such as, for example, the autocorrelation function (ACF) of the received signal and matching it to the ACF samples of the original pulses for each transmitted bit provides a more robust UWB communications method and system in the presence of channel distortions.


    Directory of Open Access Journals (Sweden)

    Ірина Олійник


    Full Text Available The article scrutinizes the notion of feedback applicable in classrooms where team teaching is provided. The experience of giving and receiving feedback has been a good practice in cooperation between a U.S. Peace Corps volunteer and a Ukrainian counterpart. Giving and receiving feedback is an effective means of classroom observation that provides better insight into the process of teaching a foreign language. The article discusses the stages of feedback and explicates the notion of sharing experience between two teachers working simultaneously in the same classroom. The guidelines for giving and receiving feedback have been provided as well as the most commonly used vocabulary items have been listed. It has been proved that mutual feedback leads to improving teaching methods and using various teaching styles and techniques.

  4. Transient simulation of molten salt central receiver (United States)

    Doupis, Dimitri; Wang, Chuan; Carcorze-Soto, Jorge; Chen, Yen-Ming; Maggi, Andrea; Losito, Matteo; Clark, Michael


    Alstom is developing concentrated solar power (CSP) utilizing 60/40wt% NaNO3-KNO3 molten salt as the working fluid in a tower receiver for the global renewable energy market. In the CSP power generation cycle, receivers undergo a daily cyclic operation due to the transient nature of solar energy. Development of robust and efficient start-up and shut-down procedures is critical to avoiding component failures due to mechanical fatigue resulting from thermal transients, thus maintaining the performance and availability of the CSP plant. The Molten Salt Central Receiver (MSCR) is subject to thermal transients during normal daily operation, a cycle that includes warmup, filling, operation, draining, and shutdown. This paper describes a study to leverage dynamic simulation and finite element analysis (FEA) in development of start-up, shutdown, and transient operation concepts for the MSCR. The results of the FEA also verify the robustness of the MSCR design to the thermal transients anticipated during the operation of the plant.

  5. Polarization mode dispersion effects on phase and polarization diversity receivers (United States)

    Pratt, Thomas G.; Ingram, Mary Ann


    The objective of this paper is to examine the combined effects of weak phase noise and polarization mode dispersion (PMD) on a coherent receiver employing phase and polarization diversity reception. The receiver is assumed to be subjected to the following: transmitter and receiver polarization misalignment relative to the principal states of the optical fiber, phase noise, polarization mode dispersion, and shot noise. The receiver outputs are investigated for ASK demodulation using square-law and envelope detection. The results show that for the assumed receiver configuration, square law detection provides an output which is independent of PMD, phase noise, and polarization misalignment. Envelope detection results in a receiver output which is dependent on all of these parameters. Furthermore, when phase noise and PMD are simultaneously present, the resulting probability of bit error is no greater than the probability of bit error under worst-case operating conditions when polarization mode dispersion and phase noise are absent.

  6. Partitioning of a DRM receiver

    NARCIS (Netherlands)

    Wolkotte, P.T.; Smit, Gerardus Johannes Maria; Smit, L.T.

    In this article we present the results of partitioning the OFDM baseband processing of a DRM receiver into smaller independent processes. Furthermore, we give a short introduction into the relevant parts of the DRM standard. Based on the number of multiplications and additions we can map individual

  7. Madhu Sudan Receives Nevanlinna Prize

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 7; Issue 12. Madhu Sudan Receives Nevanlinna Prize. Meena Mahajan Priti Shankar. Research News Volume 7 Issue 12 December 2002 pp 84-90. Fulltext. Click here to view fulltext PDF. Permanent link:

  8. Books Received Information and Announcements ...

    Indian Academy of Sciences (India)

    committee receives about 120-150 problems from which it prepares a short-list of about. 30 problems taking care to see that all the areas-algebra, combinatorics, geometry and number theory - are represented. The most important single criterion for a problem to be short-listed is that it should be new and not have been ...

  9. Receiver Operating Characteristic (ROC) Analysis (United States)

    Krupinski, Elizabeth A.


    Visual expertise covers a broad range of types of studies and methodologies. Many studies incorporate some measure(s) of observer performance or how well participants perform on a given task. Receiver Operating Characteristic (ROC) analysis is a method commonly used in signal detection tasks (i.e., those in which the observer must decide whether…

  10. Books Received Information and Announcements ...

    Indian Academy of Sciences (India)

    Books Received. Tradition, Science and Society. 5 Balachandra Roo. Navakarnataka. 1990, Rs.1S. A Textbook of Biology - Volume 2. P KG Nair, K P Achor, M J Hegde and 5 G Prabhu. Himalaya Publishing House. 1996, Rs.1S0. Indus Script - Its Nature and Structure. B V SUbbarayappa. New Era Publications. 1996 ...

  11. On the subject marker in Kinyarwanda | Zeller | Southern African ...

    African Journals Online (AJOL)

    This article examines the morphosyntactic representation of the subject agreement marker (SM) in null subject constructions in the Bantu language Kinyarwanda. Three prominent analyses are compared. The first analysis treats the SM in null subject constructions as a pronoun which receives the subject theta role in the ...

  12. Scintillation-Hardened GPS Receiver (United States)

    Stephens, Donald R.


    CommLargo, Inc., has developed a scintillation-hardened Global Positioning System (GPS) receiver that improves reliability for low-orbit missions and complies with NASA's Space Telecommunications Radio System (STRS) architecture standards. A software-defined radio (SDR) implementation allows a single hardware element to function as either a conventional radio or as a GPS receiver, providing backup and redundancy for platforms such as the International Space Station (ISS) and high-value remote sensing platforms. The innovation's flexible SDR implementation reduces cost, weight, and power requirements. Scintillation hardening improves mission reliability and variability. In Phase I, CommLargo refactored an open-source GPS software package with Kalman filter-based tracking loops to improve performance during scintillation and also demonstrated improved navigation during a geomagnetic storm. In Phase II, the company generated a new field-programmable gate array (FPGA)-based GPS waveform to demonstrate on NASA's Space Communication and Navigation (SCaN) test bed.

  13. Femtosecond Photon-Counting Receiver (United States)

    Krainak, Michael A.; Rambo, Timothy M.; Yang, Guangning; Lu, Wei; Numata, Kenji


    An optical correlation receiver is described that provides ultra-precise distance and/or time/pulse-width measurements even for weak (single photons) and short (femtosecond) optical signals. A new type of optical correlation receiver uses a fourth-order (intensity) interferometer to provide micron distance measurements even for weak (single photons) and short (femtosecond) optical signals. The optical correlator uses a low-noise-integrating detector that can resolve photon number. The correlation (range as a function of path delay) is calculated from the variance of the photon number of the difference of the optical signals on the two detectors. Our preliminary proof-of principle data (using a short-pulse diode laser transmitter) demonstrates tens of microns precision.

  14. Receiving Right/Wrong Feedback: Consequences for Learning


    Fazio, Lisa K.; Huelser, Barbie J.; Johnson, Aaron; Marsh, Elizabeth J.


    Prior work suggests that receiving feedback that one's response was correct or incorrect (right/wrong feedback) does not help learners, as compared to not receiving any feedback at all (Pashler, Cepeda, Wixted, & Rohrer, 2005). In three experiments, we examined the generality of this conclusion. Right/wrong feedback did not aid error correction, regardless of whether subjects learned facts embedded in prose (Exp. 1) or translations of foreign vocabulary (Exp. 2). While right/wrong feedback di...

  15. Digital-data receiver synchronization (United States)

    Smith, Stephen F.; Turner, Gary W.


    Digital-data receiver synchronization is provided with composite phase-frequency detectors, mutually cross-connected comparison feedback or both to provide robust reception of digital data signals. A single master clock can be used to provide frequency signals. Advantages can include fast lock-up time in moderately to severely noisy conditions, greater tolerance to noise and jitter when locked, and improved tolerance to clock asymmetries.

  16. Diversity of MMSE MIMO Receivers

    CERN Document Server

    Mehana, Ahmed Hesham


    In most MIMO systems, the family of waterfall error curves, calculated at different spectral efficiencies, are asymptotically parallel at high SNR. In other words, most MIMO systems exhibit a single diversity value for all {\\em fixed} rates. The MIMO MMSE receiver does not follow this pattern and exhibits a varying diversity in its family of error curves. This effect cannot be captured by DMT analysis, due to the fact that all fixed rates correspond to the same multiplexing gain, thus they cannot be differentiated within DMT analysis. This work analyzes this interesting behavior of the MMSE MIMO receiver and produces the MMSE MIMO diversity at each rate. The diversity of the quasi-static flat-fading MIMO channel consisting of any arbitrary number of transmit and receive antennas is fully characterized, showing that full spatial diversity is possible for all antenna configurations if and only if the rate is within a certain bound which is a function of the number of antennas. For other rate brackets, the avail...

  17. Joint Transmitter-Receiver Optimization in the Downlink CDMA Systems

    Directory of Open Access Journals (Sweden)

    Mohammad Saquib


    Full Text Available To maximize the downlink code-division multiple access (CDMA system capacity, we propose to minimize the total transmitted power of the system subject to users′ signal-to-interference ratio (SIR requirements via designing optimum transmitter sequences and utilizing linear optimum receivers (minimum mean square error (MMSE receiver. In our work on joint transmitter-receiver design for the downlink CDMA systems with multiple antennas and multipath channels, we develop several optimization algorithms by considering various system constraints and prove their convergence. We empirically observed that under the optimization algorithm with no constraint on the system, the optimum receiver structure matches the received transmitter sequences. A simulation study is performed to see how the different practical system constraints penalize the system with respect to the optimum algorithm with no constraint on the system.

  18. Absorption Efficiency of Receiving Antennas

    DEFF Research Database (Denmark)

    Andersen, Jørgen Bach; Frandsen, Aksel


    A receiving antenna with a matched load will always scatter some power. This paper sets an upper and a lower bound on the absorption efficiency (absorbed power over sum of absorbed and scattered powers), which lies between 0 and 100% depending on the directivities of the antenna and scatter...... patterns. It can approach 100% as closely as desired, although in practice this may not be an attractive solution. An example with a small endfire array of dipoles shows an efficiency of 93%. Several examples of small conical horn antennas are also given, and they all have absorption efficiencies less than...

  19. A subjective scheduler for subjective dedicated networks (United States)

    Suherman; Fakhrizal, Said Reza; Al-Akaidi, Marwan


    Multiple access technique is one of important techniques within medium access layer in TCP/IP protocol stack. Each network technology implements the selected access method. Priority can be implemented in those methods to differentiate services. Some internet networks are dedicated for specific purpose. Education browsing or tutorial video accesses are preferred in a library hotspot, while entertainment and sport contents could be subjects of limitation. Current solution may use IP address filter or access list. This paper proposes subjective properties of users or applications are used for priority determination in multiple access techniques. The NS-2 simulator is employed to evaluate the method. A video surveillance network using WiMAX is chosen as the object. Subjective priority is implemented on WiMAX scheduler based on traffic properties. Three different traffic sources from monitoring video: palace, park, and market are evaluated. The proposed subjective scheduler prioritizes palace monitoring video that results better quality, xx dB than the later monitoring spots.

  20. Visual perception of spatial subjects

    Energy Technology Data Exchange (ETDEWEB)

    Osterloh, K.R.S.; Ewert, U. [Federal Institute for Materials Research and Testing (BAM), Berlin (Germany)


    Principally, any imaging technology consists of two consecutive, though strictly separated processes: data acquisition and subsequent processing to generate an image that can be looked at, either on a monitor screen or printed on paper. Likewise, the physiological process of viewing can be separated into vision and perception, though these processes are much more overlapping. Understanding the appearance of a subject requires the entire sequence from receiving the information carried e.g. by photons up to an appropriate processing leading to the perception of the subject shown. As a consequence, the imagination of a subject is a result of both, technological and physiological processes. Whenever an evaluation of an image is critical, also the physiological part of the processing should be considered. However, an image has two dimensions in the first place and reality is spatial, it has three dimensions. This problem has been tackled on a philosophical level at least since Platon's famous discussion on the shadow image in a dark cave. The mere practical point is which structural details can be perceived and what may remain undetected depending on the mode of presentation. This problem cannot be resolved without considering each single step of visual perception. Physiologically, there are three 'tools' available to understanding the spatial structure of a subject: binocular viewing, following the course of perspective projection and motion to collect multiple aspects. Artificially, an object may be cut in various ways to display the interior or covering parts could be made transparent within a model. Samples will be shown how certain details of a subject can be emphasised or hidden depending on the way of presentation. It needs to be discussed what might help to perceive the true spatial structure of a subject with all relevant details and what could be misleading. (authors)

  1. Broadband direct RF digitization receivers

    CERN Document Server

    Jamin, Olivier


    This book discusses the trade-offs involved in designing direct RF digitization receivers for the radio frequency and digital signal processing domains.  A system-level framework is developed, quantifying the relevant impairments of the signal processing chain, through a comprehensive system-level analysis.  Special focus is given to noise analysis (thermal noise, quantization noise, saturation noise, signal-dependent noise), broadband non-linear distortion analysis, including the impact of the sampling strategy (low-pass, band-pass), analysis of time-interleaved ADC channel mismatches, sampling clock purity and digital channel selection. The system-level framework described is applied to the design of a cable multi-channel RF direct digitization receiver. An optimum RF signal conditioning, and some algorithms (automatic gain control loop, RF front-end amplitude equalization control loop) are used to relax the requirements of a 2.7GHz 11-bit ADC. A two-chip implementation is presented, using BiCMOS and 65nm...

  2. Long-term results of a randomized controlled trial analyzing the role of systematic pre-operative coronary angiography before elective carotid endarterectomy in patients with asymptomatic coronary artery disease. (United States)

    Illuminati, G; Schneider, F; Greco, C; Mangieri, E; Schiariti, M; Tanzilli, G; Barillà, F; Paravati, V; Pizzardi, G; Calio', F; Miraldi, F; Macrina, F; Totaro, M; Greco, E; Mazzesi, G; Tritapepe, L; Toscano, M; Vietri, F; Meyer, N; Ricco, J-B


    To evaluate the potential benefit of systematic preoperative coronary-artery angiography followed by selective coronary-artery revascularization on the incidence of myocardial infarction (MI) in patients undergoing carotid endarterectomy (CEA) without a previous history of coronary artery disease (CAD). We randomised 426 patients who were candidates for CEA, with no history of CAD, a normal electrocardiogram (ECG), and a normal cardiac ultrasound. In group A (n = 216) all patients underwent coronary angiography before CEA. In group B (n = 210) CEA was performed without coronary angiography. Patients were not blinded for relevant assessments during follow-up. Primary end-point was the occurrence of MI at 3.5 years. The secondary end-point was the overall survival rate. Median length of follow-up was 6.2 years. In group A, coronary angiography revealed significant coronary artery stenosis in 68 patients (31.5%). Among them, 66 underwent percutaneous Intervention (PCI) prior to CEA and 2 received combined CEA and coronary-artery bypass grafting (CABG). Postoperatively, no MI was observed in group A, whereas 6 MI occurred in group B, one of which was fatal (p = .01). During the study period, 3 MI occurred in group A (1.4%) and 33 were observed in group B (15.7%), 6 of which were fatal. The Cox model demonstrated a reduced risk of MI for patients in group A receiving coronary angiography (HR,.078; 95% CI, 0.024-0.256; p < .001). In addition, patients with diabetes and patients <70 years presented with an increased risk of MI. Survival analysis at 6 years by Kaplan-Meier estimates was 95.6 ± 3.2% in Group A and 89.7 ± 3.7% in group B (Log Rank = 6.54, p = .01). In asymptomatic coronary-artery patients, systematic coronary angiography prior to CEA followed by selective PCI or CABG significantly reduces the incidence of late MI and increases long-term survival. ( number, NCT02260453). Copyright © 2015 European Society for Vascular

  3. CERN physicist receives Einstein Medal

    CERN Multimedia


    On 29 June the CERN theorist Gabriele Veneziano was awarded the prestigious Albert Einstein Medal for significant contributions to the understanding of string theory. This award is given by the Albert Einstein Society in Bern to individuals whose scientific contributions relate to the work of Einstein. Former recipients include exceptional physicists such as Murray Gell-Mann last year, but also Stephen Hawking and Victor Weisskopf. Gabriele Veneziano, a member of the integrated CERN Theory Team since 1977, led the Theory Division from 1994 to 1997 and has already received many prestigious prizes for his outstanding work, including the Enrico Fermi Prize (see CERN Courier, November 2005), the Dannie Heineman Prize for mathematical physics of the American Physical Society in 2004 (see Bulletin No. 47/2003), and the I. Ya. Pomeranchuk Prize of the Institute of Theoretical and Experimental Physics (Moscow) in 1999.

  4. 18 CFR 367.1420 - Account 142, Customer accounts receivable. (United States)


    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Account 142, Customer accounts receivable. 367.1420 Section 367.1420 Conservation of Power and Water Resources FEDERAL ENERGY..., FEDERAL POWER ACT AND NATURAL GAS ACT UNIFORM SYSTEM OF ACCOUNTS FOR CENTRALIZED SERVICE COMPANIES SUBJECT...

  5. 18 CFR 367.1430 - Account 143, Other accounts receivable. (United States)


    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Account 143, Other accounts receivable. 367.1430 Section 367.1430 Conservation of Power and Water Resources FEDERAL ENERGY..., FEDERAL POWER ACT AND NATURAL GAS ACT UNIFORM SYSTEM OF ACCOUNTS FOR CENTRALIZED SERVICE COMPANIES SUBJECT...

  6. How does a combined pre-operative and post-operative rehabilitation program influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian Knee Ligament Registry (United States)

    Grindem, H.; Granan, LP.; Risberg, MA.; Engebretsen, L.; Snyder-Mackler, L.; Eitzen, I.


    Background Preoperative knee function is associated with successful postoperative outcome after ACL reconstruction (ACLR). However, there are few longer-term studies of patients who underwent progressive preoperative and postoperative rehabilitation compared to usual care Objectives To compare preoperative and 2 year postoperative patient-reported outcomes (PROs) in patients undergoing progressive preoperative and postoperative rehabilitation at a sports medicine clinic compared with usual care Methods We included patients aged 16–40 years undergoing primary unilateral ACLR. The preoperative and 2 year postoperative KOOS of 84 patients undergoing progressive pre- and postoperative rehabilitation at a sports medicine clinic (Norwegian Research Center for Active Rehabilitation [NAR] cohort) were compared with the scores of 2690 patients from the Norwegian Knee Ligament Registry (NKLR). The analyses were adjusted for sex, age, months from injury to surgery, and cartilage/meniscus injury at ACLR. Results The NAR cohort had significantly better preoperative KOOS in all subscales, with clinically relevant differences (>10 points) observed in KOOS Pain, ADL, Sports and Quality of Life. At 2 years, the NAR cohort still had significantly better KOOS with clinically relevant differences in KOOS Symptoms, Sports and Quality of Life. At 2 years, 85.7–94.0 % of the patients in the NAR cohort scored within the normative range of the different KOOS subscales, compared to 51.4–75.8 % of the patients in the NKLR cohort. Conclusion Patients in a prospective cohort who underwent progressive pre- and postoperative rehabilitation at a sports medicine clinic showed superior patient-reported outcomes both preoperatively and 2 year postoperatively compared to patients in the Norwegian Knee Ligament Registry who received usual care. PMID:25351782

  7. High bit rate BPSK receiver (United States)

    Osorio-Marti, J. A.; Sieiro, J. J.; Lopez-Villegas, J. M.


    This work presents a simple differentially BPSK receiver front-end using a novel schema without the need of an explicit carrier recovery system. The main principle of operation is the conversion of the incoming BPSK signal into an ASK signal having the same modulation pattern. Two versions of the system have been designed. One is intended to work at the 433.92 MHz ISM band and the other at 2 GHz frequency band. Accordingly, two prototypes of the system core, the BPSK to ASK converter circuit, have been implemented and tested. First a hybrid version for the low frequency operation and, second a multi chip module (MCM) for the 2 GHz frequency band. The system performance has been evaluated using Agilent Technologies Advanced Design System (ADS) platform. The ability to jointly perform system, circuit and EM simulations and co-simulations is the main advantage of this design tool. Obtained results indicate that modulation rates up to 20 Mbits/s for the hybrid version and up to 80 Mbits/s for the MCM version can be reached.

  8. Estimating Subjective Probabilities

    DEFF Research Database (Denmark)

    Andersen, Steffen; Fountain, John; Harrison, Glenn W.

    Subjective probabilities play a central role in many economic decisions, and act as an immediate confound of inferences about behavior, unless controlled for. Several procedures to recover subjective probabilities have been proposed, but in order to recover the correct latent probability one must...

  9. Estimating Subjective Probabilities

    DEFF Research Database (Denmark)

    Andersen, Steffen; Fountain, John; Harrison, Glenn W.


    Subjective probabilities play a central role in many economic decisions and act as an immediate confound of inferences about behavior, unless controlled for. Several procedures to recover subjective probabilities have been proposed, but in order to recover the correct latent probability one must ...

  10. Subjective meaning: an introduction

    NARCIS (Netherlands)

    van Wijnbergen-Huitink, Janneke; van Wijbergen-Huitink, Janneke; Meier, Cécile

    This introductory chapter traces some of the considerations on the basis of which relativistic approaches to subjective meaning became en vogue. In doing so, the chapter provides an overview of the relevant linguistic and philosophical issues when developing a treatment of subjectivity. In addition,

  11. Subjective safety in traffic.

    NARCIS (Netherlands)


    The term ‘subjective safety in traffic’ refers to people feeling unsafe in traffic or, more generally, to anxiety regarding being unsafe in traffic for oneself and/or others. Subjective safety in traffic can lead to road users limiting their mobility and social activities, which is one of the

  12. Subjective poverty line definitions

    NARCIS (Netherlands)

    J. Flik; B.M.S. van Praag (Bernard)


    textabstractIn this paper we will deal with definitions of subjective poverty lines. To measure a poverty threshold value in terms of household income, which separates the poor from the non-poor, we take into account the opinions of all people in society. Three subjective methods will be discussed

  13. Sexual dysfunction in testicular cancer patients subjected to post-chemotherapy retroperitoneal lymph node dissection: a focus beyond ejaculation disorders. (United States)

    Dimitropoulos, K; Karatzas, A; Papandreou, C; Daliani, D; Zachos, I; Pisters, L L; Tzortzis, V


    Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) represents an integral part of multidisciplinary treatment of advanced germ cell cancer; however, it is associated with a high complications rate. The present study aimed to describe sexual disorders in 53 patients with testicular cancer who underwent full bilateral, non-nerve-sparing PC-RPLND in our institution, focusing beyond ejaculatory dysfunction. The International Index for Erectile Function (IIEF) questionnaire was used as diagnostic tool of male sexual functioning pre-operatively and three months after RPLND, while post-operatively patients were asked to describe and evaluate changes in selected sexual parameters. Study findings demonstrate mixed pattern of changes in sexual functioning, with no difference in erectile functioning before and after operation. However, orgasmic function and intercourse and overall sexual satisfaction were found significantly impaired post-operatively. Sexual desire and frequency of attempted sexual intercourses were found significantly increased post-operatively, in comparison with pre-operative levels. With regard to patients' subjective perception on sexual functioning alterations after PC-RPLND, a significant number of patients reported higher levels of sexual desire, no difference in erectile function and worse orgasmic function and satisfaction post-operatively. Thus, patients subjected to PC-RPLND should be closely and routinely evaluated due to close relationship of sexual dissatisfaction with secondary psychological disorders. © 2015 Blackwell Verlag GmbH.

  14. Family Support and Subjective Well-Being

    DEFF Research Database (Denmark)

    Schnettler, Berta; Denegri, Marianela; Miranda, Horacio


    In order to distinguish typologies of university students based on family support received in the form of tangible and intangible resources, their level of satisfaction with life and food-related life as well as subjective happiness, a survey was applied to a non-probabilistic sample of 347 stude...

  15. Unifying Subjectivity and Objectivity

    Directory of Open Access Journals (Sweden)

    Murugesan Chandrasekaran


    Full Text Available The contribution of modern science to the progress of civilization is immeasurable. Even its tendency toward exclusive concentration on the objective world has had salutary effects of great value. Modern science has wiped away much that was merely superstitious or speculative. Its rejection of unfounded opinions and prejudices has helped the thinking mind question conventional beliefs, shed preferences and prejudices, and challenge established authority. But modern systems thinking inherited from natural science is the suppression of the subjective dimension of reality. Many complex systems are an attempt to define and represent all subjective experience in physical terms. The modern man has a bias towards objectivity. The powerful influence of sense impressions on his mind and thinking makes him ignore the subjective experience and consider only objective facts as a valid, legitimate and representation of reality. Observing objective factors that are physical is easier than observing subjective factors that are subtle. The mechanistic view of reality has led to the rejection of the role of the individual in social development as insignificant. The individuals determine the development of society. Their social power has its roots both in subjective factors and objective factors. Economy, politics, society, and culture are inseparable dimensions of a single integrated reality. Subject and object constitute an integrated whole. The mind sees them as separate and independent. Or it views one as completely subordinate to the other. Unbiased approach to the study of all human experiences may prove that subject and object are interdependent dimensions or elements of reality.

  16. Pharmacokinetic Evaluation of Oral Levofloxacin in Human Immunodeficiency Virus-Infected Subjects Receiving Concomitant Antiretroviral Therapy


    Villani, P.; Viale, P.; Signorini, L.; Cadeo, B.; Marchetti, F.; Villani, A.; Fiocchi, C; Regazzi, M B; Carosi, G


    The purpose of this study was to evaluate the pharmacokinetics (PK) profile of oral levofloxacin in human immunodeficiency virus-positive patients in steady-state treatment with nelfinavir (NFV) or with efavirenz (EFV) and to determine the effects of levofloxacin on the PK parameters of these two antiretroviral agents. For levofloxacin, plasma samples were obtained at steady state during a 24-h dosing interval. Plasma NFV and EFV concentrations were evaluated before and after 4 days of levofl...

  17. Cognitive performance and the thymus among HIV-infected subjects receiving HAART

    Directory of Open Access Journals (Sweden)

    Maria J Miguez-Burbano


    Full Text Available Maria J Miguez-Burbano1, John E Lewis2, Jose Moreno3, Joel Fishman41Robert Stempel School of Public Health & School of Medicine, Florida International University, Miami, FL, USA; 2Department of Psychiatry and Behavioral Sciences, 3Department of Medicine, 4Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USAObjective: To evaluate the impact of alcohol use, which is widespread in human immunodeficiency virus (HIV+ individuals, on highly active antiretroviral therapy (HAART-associated immune and cognitive improvements and the relationship between those two responses.Methods: In a case-control longitudinal study, thymic volume, cognition, and immune responses were evaluated at baseline and after 6 months therapy in HIV+ and HIV- controls. Cognitive performance was evaluated using the HIV Dementia Score (HDS and the California Verbal Learning Test (CVLT.Results: Prior to HAART, thymic volume varied considerably from 2.7 to 29.3 cm3 (11 ± 7.2 cm3. Thymic volume at baseline showed a significantly inverse correlation with the patient’s number of years of drinking (r2 = 0.207; p < 0.01, as well as HDS and the CVLT scores in both HIV-infected (r2 = 0.37, p = 0.03 and noninfected (r2 = 0.8, p = 0.01. HIV-infected individuals with a small thymic volume scored in the demented range, as compared with those with a larger thymus (7 ± 2.7 vs. 12 ± 2.3, p = 0.005. After HAART, light/moderate drinkers exhibited thymus size twice that of heavy drinkers (14.8 ± 10.4 vs. 6.9 ± 3.3 cm3.Conclusions: HAART-associated increases of thymus volume appear to be negatively affected by alcohol consumption and significantly related to their cognitive status. This result could have important clinical implications.Keywords: thymus, CNS, immune, alcohol


    Directory of Open Access Journals (Sweden)

    D.N. Bakhrakh


    Full Text Available The question about the subjects of law branches is concerning the number of most important and difficult in law science. Its right decision influences on the subject of law regulation, precise definition of addressees of law norms, the volume of their rights and duties, the limits of action of norms of Main part of the branch, its principles. Scientific investigations, dedicated to law subjects system, promote the development of recommendations for the legislative and law applying activity; they are needed for scientific work organization and student training, for preparing qualified lawyers.

  19. Importance of parathyroid SPECT and {sup 99m}Tc scintigraphy, and of clinical, laboratorial, ultrasonographic and cytologic correlation in the pre-operative localization of the parathyroid adenoma - pictorial assay;Importancia da complementacao com SPECT e {sup 99m}Tc na cintilografia das paratiroides e da correlacao clinica, laboratorial, ultrassonografica e citologica na localizacao pre-operatoria do adenoma de paratiroide: ensaio pictorico

    Energy Technology Data Exchange (ETDEWEB)

    Oliveira, Marco Antonio Conde de, E-mail: [Fleury Medicina e Saude, Sao Paulo, SP (Brazil). Servicos de Medicina Nuclear; Maeda, Sergio Setsuo; Dreyer, Patricia; Lobo, Alberto; Andrade, Victor Piana de; Hoff, Ana O.; Biscolla, Rosa Paula Mello; Smanio, Paola; Brandao, Cynthia M.A.; Vieira, Jose G. [Fleury Medicina e Saude, Sao Paulo, SP (Brazil)


    Objective: In patients with primary hyperparathyroidism, candidates for surgical intervention, the parathyroid pre-operative localization is of fundamental importance in planning the appropriate surgical approach. Materials and methods: 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. Results: in our experience, the complete protocol in parathyroid scintigraphy increases the accuracy of pre-operative parathyroid localization. Conclusion: the complete utilization of all available nuclear medicine methods (SPECT e {sup 99m}Tc) and image interpretation in a multidisciplinary context can improve the accuracy of parathyroid scintigraphy. (author)

  20. The Data Subject

    DEFF Research Database (Denmark)

    Blume, Peter


    This article considers whether it is fortunate that data protection rules, as a starting point, apply to all physical persons as data subjects, or whether it would be better to differentiate between kinds of persons on grounds of their ability to act as a data subject. In order to protect all...... persons, it is argued that a principle of care should be part of data protection law....

  1. Microwave receivers with electronic warfare applications

    CERN Document Server

    Tsui, James


    This book by the author of Digital Techniques for Wideband Receivers willbe like no other one on your book shelf as the definitive word on electronicwarfare (EW) receiver design and performance. Whether you are an EWscientist involved in the test and evaluation of EW receivers or a designerof RWR's and other EW-related receivers, Microwave Receivers withElectronic Warfare Applications is a handy reference through which you canperfect your technical art. Lucidly written, this book is a treatise on EWreceivers that is relevant to you if you are just looking for a top-levelinsight into EW receive

  2. Subject (of documents)

    DEFF Research Database (Denmark)

    Hjørland, Birger


    such as concepts, aboutness, topic, isness and ofness are also briefly presented. The conclusion is that the most fruitful way of defining “subject” (of a document) is the documents informative or epistemological potentials, that is, the documents potentials of informing users and advance the development......This article presents and discuss the concept “subject” or subject matter (of documents) as it has been examined in library and information science (LIS) for more than 100 years. Different theoretical positions are outlined and it is found that the most important distinction is between document......-oriented views versus request-oriented views. The document-oriented view conceive subject as something inherent in documents, whereas the request-oriented view (or the policy based view) understand subject as an attribution made to documents in order to facilitate certain uses of them. Related concepts...

  3. Trough Receiver Heat Loss Testing (Presentation)

    Energy Technology Data Exchange (ETDEWEB)

    Lewandowski, A.; Feik, C.; Hansen, R.; Phillips, S.; Bingham, C.; Netter, J.; Forristal, R.; Burkholder, F.; Meglan, B.; Wolfrum, E.


    This presentation describes the design, fabrication, and qualification of an experimental capability for thermal loss testing of full-size trough receiver elements; and the testing on a variety of receivers.

  4. Science of the subjective. (United States)

    Jahn, R G; Dunne, B J


    Over the greater portion of its long scholarly history, the particular form of human observation, reasoning, and technical deployment we properly term "science" has relied at least as much on subjective experience and inspiration as it has on objective experiments and theories. Only over the past few centuries has subjectivity been progressively excluded from the practice of science, leaving an essentially secular analytical paradigm. Quite recently, however, a compounding constellation of newly inexplicable physical evidence, coupled with a growing scholarly interest in the nature and capability of human consciousness, are beginning to suggest that this sterilization of science may have been excessive and could ultimately limit its epistemological reach and cultural relevance. In particular, an array of demonstrable consciousness-related anomalous physical phenomena, a persistent pattern of biological and medical anomalies, systematic studies of mind/brain relationships and the mechanics of human creativity, and a burgeoning catalogue of human factors effects within contemporary information processing technologies, all display empirical correlations with subjective aspects that greatly complicate, and in many cases preclude, their comprehension on strictly objective grounds. However, any disciplined re-admission of subjective elements into rigorous scientific methodology will hinge on the precision with which they can be defined, measured, and represented, and on the resilience of established scientific techniques to their inclusion. For example, any neo-subjective science, while retaining the logical rigor, empirical/theoretical dialogue, and cultural purpose of its rigidly objective predecessor, would have the following requirements: acknowledgment of a proactive role for human consciousness; more explicit and profound use of interdisciplinary metaphors; more generous interpretations of measurability, replicability, and resonance; a reduction of ontological

  5. The Subjectivity of Participation

    DEFF Research Database (Denmark)

    Nissen, Morten

    What is a 'we' – a collective – and how can we use such communal self-knowledge to help people? This book is about collectivity, participation, and subjectivity – and about the social theories that may help us understand these matters. It also seeks to learn from the innovative practices and ideas...... practices. Through this dialogue, it develops an original trans-disciplinary critical theory and practice of collective subjectivity for which the ongoing construction and overcoming of common sense, or ideology, is central. It also points to ways of relating discourse with agency, and fertilizing insights...... from interactionism and ideology theories in a cultural-historical framework....

  6. Airflow in the Human Nasal Passage and Sinuses of Chronic Rhinosinusitis Subjects.

    Directory of Open Access Journals (Sweden)

    Haribalan Kumar

    Full Text Available Endoscopic surgery is performed on patients with chronic inflammatory disease of the paranasal sinuses to improve sinus ventilation. Little is known about how sinus surgery affects sinonasal airflow. In this study nasal passage geometry was reconstructed from computed tomographic imaging from healthy normal, pre-operative, and post-operative subjects. Transient air flow through the nasal passage during calm breathing was simulated. Subject-specific differences in ventilation of the nasal passage were observed. Velocity magnitude at ostium was different between left and right airway. In FESS, airflow in post-surgical subjects, airflow at the maxillary sinus ostium was upto ten times higher during inspiration. In a Lothrop procedure, airflow at the frontal sinus ostium can be upto four times higher during inspiration. In both post-operative subjects, airflow at ostium was not quasi-steady. The subject-specific effect (of surgery on sinonasal interaction evaluated through airflow simulations may have important consequences for pre- and post-surgical assessment and surgical planning, and design for improvement of the delivery efficiency of nasal therapeutics.

  7. 21 CFR 1020.10 - Television receivers. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Television receivers. 1020.10 Section 1020.10 Food...) RADIOLOGICAL HEALTH PERFORMANCE STANDARDS FOR IONIZING RADIATION EMITTING PRODUCTS § 1020.10 Television receivers. (a) Applicability. The provisions of this section are applicable to television receivers...

  8. 49 CFR 393.88 - Television receivers. (United States)


    ... 49 Transportation 5 2010-10-01 2010-10-01 false Television receivers. 393.88 Section 393.88... NECESSARY FOR SAFE OPERATION Miscellaneous Parts and Accessories § 393.88 Television receivers. Any motor vehicle equipped with a television viewer, screen or other means of visually receiving a television...

  9. 47 CFR 32.1170 - Receivables. (United States)


    ... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES UNIFORM SYSTEM OF ACCOUNTS.... (f) Dividends received and receivable from affiliated companies accounted for on the equity method..., matured rents, and interest receivable under monthly settlements on short-term loans, advances, and open...

  10. Braille character discrimination in blindfolded human subjects. (United States)

    Kauffman, Thomas; Théoret, Hugo; Pascual-Leone, Alvaro


    Visual deprivation may lead to enhanced performance in other sensory modalities. Whether this is the case in the tactile modality is controversial and may depend upon specific training and experience. We compared the performance of sighted subjects on a Braille character discrimination task to that of normal individuals blindfolded for a period of five days. Some participants in each group (blindfolded and sighted) received intensive Braille training to offset the effects of experience. Blindfolded subjects performed better than sighted subjects in the Braille discrimination task, irrespective of tactile training. For the left index finger, which had not been used in the formal Braille classes, blindfolding had no effect on performance while subjects who underwent tactile training outperformed non-stimulated participants. These results suggest that visual deprivation speeds up Braille learning and may be associated with behaviorally relevant neuroplastic changes.

  11. Paying Hypertension Research Subjects (United States)

    Casarett, David; Karlawish, Jason; Asch, David A


    CONTEXT Cash payments are often used to compensate subjects who participate in research. However, ethicists have argued that these payments might constitute an undue inducement. OBJECTIVES To determine whether potential subjects agree with theoretical arguments that a payment could be an undue inducement. DESIGN/SETTING/PARTICIPANTS Survey of 350 prospective jurors. MAIN OUTCOME MEASURES Belief that a $500 payment for research participation would impair their own, and others' ability to think carefully about the risks and benefits of a clinical trial. RESULTS Two hundred sixty-one jurors (74.6%) believed that a $500 payment would impair subjects' ability to think carefully about the risks and benefits of research. Ninety-six of 120 (80%) expressed this concern about subjects with a low income ($50,000). In contrast, only 69 (19.7%) of jurors believed that a $500 payment would influence them. Jurors who believed that this payment would influence them reported lower incomes and less education. CONCLUSION Members of the general public share ethical concerns about the influence of payments for research, although they believe that these concerns are more applicable to others than to themselves.

  12. Subjects, Models, Languages, Transformations

    NARCIS (Netherlands)

    Rensink, Arend; Bézivin, J.; Heckel, R.


    Discussions about model-driven approaches tend to be hampered by terminological confusion. This is at least partially caused by a lack of formal precision in defining the basic concepts, including that of "model" and "thing being modelled" - which we call subject in this paper. We propose a minimal

  13. Subjective Duration and Psychophysics (United States)

    Eisler, Hannes


    Three models are proposed to describe the strategy applied by a subject when he is confronted with two successive time intervals and is required to deal with some relation between them, for example, by telling which was the longer by adjusting the second to match the first. (Author)

  14. Barron's SAT subject test

    CERN Document Server

    Jansen, MA, Robert


    Includes one diagnostic test and three complete tests, all questions answered and explained, self-assessment guides, and subject reviews. Also features test strategies, QR codes to short instructional videos, and a detailed appendix with equations, physical constants, and a basic math review.

  15. A zero-power radio receiver.

    Energy Technology Data Exchange (ETDEWEB)

    Brocato, Robert Wesley


    This report describes both a general methodology and some specific examples of passive radio receivers. A passive radio receiver uses no direct electrical power but makes sole use of the power available in the radio spectrum. These radio receivers are suitable as low data-rate receivers or passive alerting devices for standard, high power radio receivers. Some zero-power radio architectures exhibit significant improvements in range with the addition of very low power amplifiers or signal processing electronics. These ultra-low power radios are also discussed and compared to the purely zero-power approaches.

  16. Computer guided pre-operative planning and dental implant placement

    Directory of Open Access Journals (Sweden)

    Dušan Grošelj


    Full Text Available Background: Implants in dentistry are, besides fixed, removable and maxillofacial prosthodontics, one of the reliable possibility to make functional and aesthetic rehabilitation of the edentulism. Surgical and prosthodontic implant complications are often an inattentive consequence of wrong diagnosis, planning, and placement. In this article we present a technique using a highly advanced software program along with a rapid prototyping technology named stereolithography. A planning software for implant placement needs basically the high quality computed tomographic scan of one or both jaws for making accurate preoperative diagnostics and 3D preoperative plan. Later individual drill guide is designed and generated based on both the CT images and the preoperative planning. The patient specific drill guide transfers the virtual planning to the patient’s mouth at time of surgery.Conclusions: The advantages of computer guided implantology are the better prepared surgery with visualisation of critical anatomic structures, assessment of available bone and data about bone quality, increased confidence for the surgeon, deceased operative time, less frequent use of bone grafts, higher quality of collaboration between specialists and prosthetic lab and better communication with patients. Radiographic examination of the operation field for computer guided planning for implant placement is due to high costs justified as the most important information source on the areas to be implanted.


    African Journals Online (AJOL)


    Surgery today has become extremely complex to the extent that the oath we took "To do no harm" needs to be re-enforced in practically everything we do in the management of patients. It is therefore necessary and mandatory to document the process of informed consent which is a freely shared decision between the.

  18. Pre-operative diagnosis of thyroid cancer: Clinical, radiological and ...

    African Journals Online (AJOL)

    Aim. Ultrasonography and ne-needle aspiration biopsy (FNAB) are the mainstays of diagnosing thyroid cancer accurately and reducing the number of diagnostic lobectomies. No benchmark for diagnostic accuracy has been published in the South African context. is singleinstitution study addresses this decit. Methods. e ...

  19. Pre-operative Assessment for Arteriovenous Fistula Placement for Dialysis. (United States)

    Marques, Maria G; Ponce, Pedro


    Native AV fistulas are considered to be the best VA for most dialysis patients. A careful preoperative process of care is essential to maximize the proportion of fistulas that achieve adequacy for dialysis. An individualized and timely evaluation of patients starts early with the identification of risk factors, followed by a physical examination which should be complemented by ultrasound vascular mapping in most cases. Vascular mapping includes any technique that leads to information on patient's inflow and outflow anatomy (± hemodynamics) as they relate to arteriovenous access creation and may predict maturation. There is increasing evidence favoring the utilization of preoperative Doppler ultrasound which is recommended in all patients by NFK-KDOQI Guidelines. It allows noninvasive evaluation of both structural and functional aspects of vessels that play an important role in access maturation. Its major limitation is the relative inability to assess central vein patency. Although conventional venography is still the gold standard to evaluate central veins, it provides otherwise limited information and can incur serious adverse effects related to its invasive nature and contrast use. Alternatives to these two imaging techniques are rarely used, especially because of their higher costs and low availability. © 2016 Wiley Periodicals, Inc.

  20. Periorbital facial rejuvenation; applied anatomy and pre-operative assessment

    Directory of Open Access Journals (Sweden)

    Mohsen Bahmani Kashkouli


    Conclusion: Static and dynamic aging changes of the periorbital area should be assessed as an eyelid-eyebrow unit paying more attention to the anthropometric landmarks. Assessing the facial asymmetry, performing comprehensive and detailed ocular examination, and asking about patients' expectation are three key elements in this regard. Furthermore, taking standard facial pictures, obtaining special consent form, and finally getting feedback are also indispensable tools toward a better outcome.

  1. Investigating whether children's transition from pre-operational stage ...

    African Journals Online (AJOL)

    This implies that children.s cognitive development can be accelerated when they are exposed to more intellectually stimulating environment. It is recommended that early childhood teachers must expose children to various intellectually stimulating environments to help them accelerate their mental development.

  2. Abstract: Implementation of Pre-Operative Checklist: An Effort to ...

    African Journals Online (AJOL)

    Lesson Learned: Successful implementation was dependent on the involvement of a multidisciplinary team, and ongoing education regarding each component of the checklist. The checklist has helped to standardize perioperative care delivery, and improve overall interdisciplinary communication. Conclusion: Patient safety ...

  3. SRS Software Verification Pre Operational and Startup Test

    Energy Technology Data Exchange (ETDEWEB)

    HILL, L.F.


    This document defines testing for the software used to control the Sodium Removal System (SRS). The testing is conducted off-line from the. physical plant by using a simulator built-in to the software. This provides verification of proper software operation prior to performing the operational acceptance tests with the actual plant hardware.

  4. Pre-operative bladder irrigation with 1% Povidone iodine in ...

    African Journals Online (AJOL)

    Purpose: The aim of the study is to assess the effectiveness of using preoperative bladder irrigation with 1% povidone iodine in reducing post transvesical prostatectomy surgical site infections. Study design: This was a prospective randomized cohort study with blinding of patients and outcome adjudicator regarding group ...

  5. [Subjective cognition in schizophrenia]. (United States)

    Potvin, S; Aubin, G; Stip, E


    Given the extent, magnitude and functional significance of the neurocognitive deficits of schizophrenia, growing attention has been paid recently to patients' self-awareness of their own deficits. Thus far, the literature has shown either that patients fail to recognize their cognitive deficits or that the association between subjective and objective cognition is weak in schizophrenia. The reasons for this lack of consistency remain unexplained but may have to do, among others, with the influence of potential confounding clinical variables and the choice of the scale used to measure self-awareness of cognitive deficits. In the current study, we sought to examine the relationships between subjective and objective cognitive performance in schizophrenia, while controlling for the influence of sociodemographic and psychiatric variables. Eighty-two patients with a schizophrenia-spectrum disorder (DSM-IV criteria) were recruited. Patients' subjective cognitive complaints were evaluated with the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS), the most frequently used scale to measure self-awareness of cognitive deficits in schizophrenia. Neurocognition was evaluated with working memory, planning and visual learning tasks taken from Cambridge Neuropsychological Tests Automated Battery. The Stroop Color-Word test was also administered. Psychiatric symptoms were evaluated with the Positive and Negative Syndrome Scale and the Calgary Depression Scale for Schizophrenia. The relationships between subjective and objective cognition were evaluated with multivariate hierarchic linear regression analyses, taking into consideration potential confounders such as sociodemographic and psychiatric variables. Finally, a factor analysis of the SSTICS was performed. For the SSTICS total score, the regression analysis produced a model including two predictors, namely visual learning and Stoop interference performance, explaining a moderate portion of the variance

  6. Cirurgia de revascularização do miocárdio usando apenas tomografia computadorizada como angiograma pré-operatório Cirugía de revascularización del miocardio usando sólo tomografía computada como angiograma preoperatorio Coronary artery bypass using only computed tomography as pre-operative angiogram

    Directory of Open Access Journals (Sweden)

    Diego Felipe Gaia


    Full Text Available A cirurgia de revascularização do miocárdio (CRM é um procedimento bem estabelecido com indicações atuais precisas. O advento e a disseminação dessa técnica foram possíveis após a introdução do angiograma coronário. Embora muitos métodos de avaliação tenham evoluído nos últimos anos, nenhum conseguiu substituir o angiograma coronário invasivo como exame pré-operatório. A tomografia computadorizada (TC emergiu como uma alternativa ao angiograma coronário invasivo. O presente relato descreve dois casos de CRM realizadas usando-se apenas a TC como técnica de avaliação anatômica das artérias coronárias pré-operatória.La cirugía de revascularización del miocardio (CRM es un procedimiento bien establecido con indicaciones actuales precisas. El advenimiento y la divulgación de esta técnica fueron posibles después de la introducción del angiograma coronario. Aunque muchos métodos de evaluación hayan evolucionados en los últimos años, ninguno ha conseguido sustituir al angiograma coronario invasivo como examen preoperatorio. La tomografía computada (TC surgió como una alternativa al angiograma coronario invasivo. El presente informe describe dos casos de CRM realizadas usando sólo la TC como técnica de evaluación anatómica de las arterias coronarias preoperatoria.Coronary artery bypass graft (CABG is a well established procedure with current precise indications. The advent and spread of this technique was possible after the introduction of the coronary angiogram. Although many evaluation methods have been developed in the past years, to date, none have been able to replace the invasive coronary angiogram as a pre-operative exam. Computed tomography angiography (CTA has emerged as an alternative to invasive coronary angiogram. In this report we describe two CABG cases that were performed using only this technique as a pre-operative anatomic coronary arteries evaluation.

  7. Interaction, transference, and subjectivity

    DEFF Research Database (Denmark)

    Lundgaard Andersen, Linda


    Fieldwork is one of the important methods in educational, social, and organisational research. In fieldwork, the researcher takes residence for a shorter or longer period amongst the subjects and settings to be studied. The aim of this is to study the culture of people: how people seem to make...... sense of their lives and which moral, professional, and ethical values seem to guide their behaviour and attitudes. In fieldwork, the researcher has to balance participation and observation in her attempts at representation. Consequently, the researcher’s academic and life-historical subjectivity...... are important filters for fieldwork. In general, fieldwork can be understood as processes where field reports and field analysis are determined by how the researcher interacts with and experiences the field, the events and informants in it, and how she subsequently develops an ethnography. However, fieldwork...

  8. Writing and the 'Subject'

    DEFF Research Database (Denmark)

    Greve, Charlotte

    /reading subject) manifests itself in the material mark on the page. The study shows how this indexical reference to a ‘subject’ is manipulated and used as a mask through which a writer/painter can perform a certain ‘subject’. Through analyses of the various levels on which the ‘subject’ is represented...... in the early as well as the contemporary avant-garde, it becomes clear that the ‘subject’ is an unstable category that can be exposed to manipulation and play. Handwriting is performing as a signature (as an index), but is at the same time similar to the signature of a subject (an icon) and a verbal construct...

  9. Incorporating the Creative Subject

    DEFF Research Database (Denmark)

    Endrissat, Nada; Kärreman, Dan; Noppeney, Claus


    draw on a case study of a North American grocery chain that is known for employing art-school graduates and other creative talents in creative (store artist) and non-creative shop-floor positions. The study shows that the brand is partly built outside–in through association with employees who embody...... brand-relevant characteristics in their identities and lifestyles. In return, those employees receive identity opportunities to validate their desired sense of self as ‘creative subject’. We discuss the dual nature of identity-incentive branding as neo-normative control and outline its implications...

  10. Concentrated solar power generation using solar receivers (United States)

    Anderson, Bruce N.; Treece, William Dean; Brown, Dan; Bennhold, Florian; Hilgert, Christoph


    Inventive concentrated solar power systems using solar receivers, and related devices and methods, are generally described. Low pressure solar receivers are provided that function to convert solar radiation energy to thermal energy of a working fluid, e.g., a working fluid of a power generation or thermal storage system. In some embodiments, low pressure solar receivers are provided herein that are useful in conjunction with gas turbine based power generation systems.

  11. Subject Sensitive Invariantism: In Memoriam

    NARCIS (Netherlands)

    Blaauw, M.J.


    Subject sensitive invariantism is the view that whether a subject knows depends on what is at stake for that subject: the truth-value of a knowledge-attribution is sensitive to the subject's practical interests. I argue that subject sensitive invariantism cannot accept a very plausible principle for

  12. Compressive Sensing for Spread Spectrum Receivers

    DEFF Research Database (Denmark)

    Fyhn, Karsten; Jensen, Tobias Lindstrøm; Larsen, Torben


    to a decrease in the two design parameters. This paper investigates the use of Compressive Sensing (CS) in a general Code Division Multiple Access (CDMA) receiver. We show that when using spread spectrum codes in the signal domain, the CS measurement matrix may be simplified. This measurement scheme, named...... Compressive Spread Spectrum (CSS), allows for a simple, effective receiver design. Furthermore, we numerically evaluate the proposed receiver in terms of bit error rate under different signal to noise ratio conditions and compare it with other receiver structures. These numerical experiments show that though...

  13. Shipping/Receiving and Quality Control (United States)

    Federal Laboratory Consortium — Shipping receiving, quality control, large and precise inspection and CMM machines. Coordinate Measuring Machines, including "scanning" probes, optical comparators,...

  14. Hybrid Microoptical WDM Receiver for PON Communication

    Directory of Open Access Journals (Sweden)

    Vitezslav Jerabek


    Full Text Available The paper presents the design, simulation and construction results of the wavelength division multiplex (WDM optical hybrid receiver module for the passive optical network (PON. The optical WDM receiver was constructed using system of three micromodules in the new circle topology. The optical micromodule contains multimode fiber pigtail 50/125 µm, VHGT filter with collimation lens and two microwave optoelectronics receiver micromodules (OE receiver micromodules. OE receiver micromodules were designed by use small signal equivalent electrical circuit model and noise model, from which the mathematically solved the transmittance function, which was used for calculation and simulation of the optimal frequency characteristics and signal to noise ratio. For determine the limit frequency of OE receiver micromodule, the transcendent equation with transmittance function was numerically solved. OE receiver micromodule was composed of decollimation lenses and microwave optoelectronics receivers with bandwidth 2,5 GHz and alternatively in SMD technology with bandwidth 1,25 GHz, using the thin layer hybrid technology. WDM receiver use radiation 1490 nm for internet and 1550 nm for digital TV signals download information.

  15. Human factors evaluation of TSO-C129A GPS receivers (United States)


    This report documents an evaluation of the usability of TSO-C129a-certified Global Positioning System (GPS) receivers. Bench and flight tests were conducted on six GPS receivers. The evaluations covered 23 flight tasks. Both subjective and objective ...

  16. Variable velocity in solar external receivers (United States)

    Rodríguez-Sánchez, M. R.; Sánchez-González, A.; Acosta-Iborra, A.; Santana, D.


    One of the major problems in solar external receivers is tube overheating, which accelerates the risk of receiver failure. It can be solved implementing receivers with high number of panels. However, it exponentially increases the pressure drop in the receiver and the parasitic power consumption of the Solar Power Tower (SPT), reducing the global efficiency of the SPT. A new concept of solar external receiver, named variable velocity receiver, is able to adapt their configuration to the different flux density distributions. A set of valves allows splitting in several independent panels those panels in which the wall temperature is over the limit. It increases the velocity of the heat transfer fluid (HTF) and its cooling capacity. This receiver does not only reduce the wall temperature of the tubes, but also simplifies the control of the heliostat field and allows to employ more efficient aiming strategies. In this study, it has been shown that variable velocity receiver presents high advantages with respect to traditional receiver. Nevertheless, more than two divisions per panels are not recommendable, due to the increment of the pressure drop over 70 bars. In the design point (12 h of the Spring Equinox), the use of a variable number of panels between 18 and 36 (two divisions per panel), in a SPT similar to Gemasolar, improves the power capacity of the SPT in 5.7%, with a pressure drop increment of 10 bars. Off-design, when the flux distribution is high and not symmetric (e.g. 10-11 h), the power generated by the variable velocity receiver is 18% higher than the generated by the traditional receiver, at these hours the pressure drop increases almost 20 bars.

  17. The Subject's Matter

    DEFF Research Database (Denmark)

    in the significance of the body in our mental life. The sixteen specially commissioned essays in this book reflect the advances in these fields. The book is divided into three parts, each part covering a topic central to an explanation of bodily self-awareness: representation of the body; the sense of bodily......The body may be the object we know the best. It is the only object from which we constantly receive a flow of information through sight and touch; and it is the only object we can experience from the inside, through our proprioceptive, vestibular, and visceral senses. Yet there have been very few...... books that have attempted to consolidate our understanding of the body as it figures in our experience and self-awareness. This volume offers an interdisciplinary and comprehensive treatment of bodily self-awareness, the first book to do so since the landmark 1995 collection The Body and the Self...

  18. Directional Receiver for Biomimetic Sonar System (United States)

    Guarato, Francesco; Andrews, Heather; Windmill, James F.; Jackson, Joseph; Gachagan, Anthony

    An ultrasonic localization method for a sonar system equipped with an emitter and two directional receivers and inspired by bat echolocation uses knowledge of the beam pattern of the receivers to estimate target orientation. Rousettus leschenaultii's left ear constitutes the model for the design of the optimal receiver for this sonar system and 3D printing was used to fabricate receiver structures comprising of two truncated cones with an elliptical external perimeter and a parabolic flare rate in the upper part. Measurements show one receiver has a predominant lobe in the same region and with similar attenuation values as the bat ear model. The final sonar system is to be mounted on vehicular and aerial robots which require remote control for motion and sensors for estimation of each robot's location.

  19. High dynamic, low volume GPS receiver (United States)

    Hurd, W. J.


    A new GPS receiver concept and design are presented to meet the high dynamic and low volume requirements for range applications in missiles and drones. The receiver has the potential to satisfy all range requirements with one basic receiver, which has significant potential economic benefit over the alternate approach of using a family of receivers, each tailored for specific applications. The main new concept is to use approximate maximum likelihood estimates of pseudo range and range-rate, rather than tracking with carrier phase locked loops and code delay locked loops. Preliminary analysis indicates that receivers accelerating at 50 g or more can track with position errors due to acceleration of approximately 0.2 m/g, or 10 m at 50 g. Implementation is almost entirely digital to meet the low volume requirements.

  20. An SDR based AIS receiver for satellites

    DEFF Research Database (Denmark)

    Larsen, Jesper Abildgaard; Mortensen, Hans Peter; Nielsen, Jens Frederik Dalsgaard


    For a few years now, there has been a high interest in monitoring the global ship traffic from space. A few satellite, capable of listening for ship borne AIS transponders have already been launched, and soon the AAUSAT3, carrying two different types of AIS receivers will also be launched. One...... of the AIS receivers onboard AAUSAT3 is an SDR based AIS receiver. This paper serves to describe the background of the AIS system, and how the SDR based receiver has been integrated into the AAUSAT3 satellite. Amongst some of the benefits of using an SDR based receiver is, that due to its versatility, new...... detection algorithms are easily deployed, and it is easily adapted the new proposed AIS transmission channels....

  1. Praxis, subjectivity and sense

    Directory of Open Access Journals (Sweden)

    Alfredo Gómez-Muller


    Full Text Available A primordial aspect of the Sartrian critique of alienation concerns understanding the analytic ideology as the domination of materiality over the symbolic, in other words as the reification of the human, and therefore as anticulture. In the context of contemporary nihilism, the decoding of the mechanisms which consign praxis to the practico-inert requires a critique of the relations between the social sciences and philosophy, which in its turn implies a new theory of the relation between what Sartre calls the "notion" (the area of subjectivity and the "concept" (objectivity, From this perspective, the deconstruction of the established frontiers between the social sciences and philosophy, and between the conceptual and the narrative, is corelative to a redefinition of the relation between theory and practice.

  2. Fundamentals of GPS Receivers A Hardware Approach

    CERN Document Server

    Doberstein, Dan


    While much of the current literature on GPS receivers is aimed at those intimately familiar with their workings, this volume summarizes the basic principles using as little mathematics as possible, and details the necessary specifications and circuits for constructing a GPS receiver that is accurate to within 300 meters. Dedicated sections deal with the features of the GPS signal and its data stream, the details of the receiver (using a hybrid design as exemplar), and more advanced receivers and topics including time and frequency measurements. Later segments discuss the Zarlink GPS receiver chip set, as well as providing a thorough examination of the TurboRogue receiver, one of the most accurate yet made. Guiding the reader through the concepts and circuitry, from the antenna to the solution of user position, the book’s deployment of a hybrid receiver as a basis for discussion allows for extrapolation of the core ideas to more complex, and more accurate designs. Digital methods are used, but any analogue c...

  3. Decoding algorithm for vortex communications receiver (United States)

    Kupferman, Judy; Arnon, Shlomi


    Vortex light beams can provide a tremendous alphabet for encoding information. We derive a symbol decoding algorithm for a direct detection matrix detector vortex beam receiver using Laguerre Gauss (LG) modes, and develop a mathematical model of symbol error rate (SER) for this receiver. We compare SER as a function of signal to noise ratio (SNR) for our algorithm and for the Pearson correlation algorithm. To our knowledge, this is the first comprehensive treatment of a decoding algorithm of a matrix detector for an LG receiver.

  4. Exploiting Redundancy in an OFDM SDR Receiver

    Directory of Open Access Journals (Sweden)

    Tomas Palenik


    Full Text Available Common OFDM system contains redundancy necessary to mitigate interblock interference and allows computationally effective single-tap frequency domain equalization in receiver. Assuming the system implements an outer error correcting code and channel state information is available in the receiver, we show that it is possible to understand the cyclic prefix insertion as a weak inner ECC encoding and exploit the introduced redundancy to slightly improve error performance of such a system. In this paper, an easy way to implement modification to an existing SDR OFDM receiver is presented. This modification enables the utilization of prefix redundancy, while preserving full compatibility with existing OFDM-based communication standards.

  5. GPU Acceleration of DSP for Communication Receivers. (United States)

    Gunther, Jake; Gunther, Hyrum; Moon, Todd


    Graphics processing unit (GPU) implementations of signal processing algorithms can outperform CPU-based implementations. This paper describes the GPU implementation of several algorithms encountered in a wide range of high-data rate communication receivers including filters, multirate filters, numerically controlled oscillators, and multi-stage digital down converters. These structures are tested by processing the 20 MHz wide FM radio band (88-108 MHz). Two receiver structures are explored: a single channel receiver and a filter bank channelizer. Both run in real time on NVIDIA GeForce GTX 1080 graphics card.

  6. Global Positioning System receiver evaluation results

    Energy Technology Data Exchange (ETDEWEB)

    Byrne, R.H.


    A Sandia project currently uses an outdated Magnavox 6400 Global Positioning System (GPS) receiver as the core of its navigation system. The goal of this study was to analyze the performance of the current GPS receiver compared to newer, less expensive models and to make recommendations on how to improve the performance of the overall navigation system. This paper discusses the test methodology used to experimentally analyze the performance of different GPS receivers, the test results, and recommendations on how an upgrade should proceed. Appendices contain detailed information regarding the raw data, test hardware, and test software.

  7. International Energy: Subject Thesaurus

    Energy Technology Data Exchange (ETDEWEB)

    Raridon, M.H. (ed.)


    The International Energy Subject Thesaurus contains the standard vocabulary to indexing terms (descriptors) developed and structured to build and maintain energy information databases. Involved in this cooperative task are (1) the technical staff of the USDOE Office of Scientific and Technical Information (OSTI) in cooperation with the member countries of the Energy Technology Data Exchange (ETDE) and (2) the International Nuclear Information System (INIS) staff representing the more than ninety countries and organizations recording and indexing information for the international nuclear information community. ETDE member countries are also members of the International Nuclear Information System (INIS). Nuclear information indexed and recorded for INIS by these ETDE member countries is also included in the ETDE Energy Data Base, and indexing terminology is therefore cooperatively standardized for use in both information systems. This structured vocabulary reflects the scope of international energy research, development, and technological programs and encompasses terminology derived not only from the basic sciences but also from the areas of energy resources, conservation, safety, environmental impact, and regulation.

  8. Naming the Ethological Subject. (United States)

    Benson, Etienne S


    Argument In recent decades, through the work of Jane Goodall and other ethologists, the practice of giving personal names to nonhuman animals who are the subjects of scientific research has become associated with claims about animal personhood and scientific objectivity. While critics argue that such naming practices predispose the researcher toward anthropomorphism, supporters suggest that it sensitizes the researcher to individual differences and social relations. Both critics and supporters agree that naming tends to be associated with the recognition of individual animal rights. The history of the naming of research animals since the late nineteenth century shows, however, that the practice has served a variety of purposes, most of which have raised few ethical or epistemological concerns. Names have been used to identify research animals who play dual roles as pets, workers, or patients, to enhance their market value, and to facilitate their identification in the field. The multifaceted history of naming suggests both that the use of personal names by Goodall and others is less of a radical break with previous practices than it might first appear to be and that the use of personal names to recognize the individuality, sentience, or rights of nonhuman animals faces inherent limits and contradictions.

  9. A Subjective Rational Choice (United States)

    Vinogradov, G. P.


    The problem of constructing a choice model of an agent with endogenous purposes of evolution is under debate. It is demonstrated that its solution requires the development of well-known methods of decision-making while taking into account the relation of action mode motivation to an agent’s ambition to implement subjectively understood interests and the environment state. The latter is submitted for consideration as a purposeful state situation model that exists only in the mind of an agent. It is the situation that is a basis for getting an insight into the agent’s ideas on the possible selected action mode results. The agent’s ambition to build his confidence in the feasibility of the action mode and the possibility of achieving the desired state requires him to use the procedures of forming an idea model based on the measured values of environment state. This leads to the gaming approach for the choice problem and its solution can be obtained on a set of trade-off alternatives.

  10. Laboratory instruction and subjectivity

    Directory of Open Access Journals (Sweden)

    Elisabeth Barolli


    Full Text Available The specific aspects which determined the way some groups of students conducted their work in a university laboratory, made us understand the articulation of these groups´s dynamics, from elements that were beyond the reach of cognition. In more specific terms the conduction and the maintenance of the groups student´s dynamics were explicited based on a intergame between the non conscious strategies, shared anonymously, and the efforts of the individuals in working based on their most objective task. The results and issues we have reached so far, using a reference the work developed by W.R.Bion, with therapeutical groups, gave us the possibility for understanding the dynamics of the student´s experimental work through a new approach that approximates the fields of cognition and subjectivity. This approximation led us to a deeper reflection about the issues which may be involved in the teaching process, particularly in situations which the teacher deals with the class, organised in groups.

  11. Comunicação: uma necessidade percebida no período pré-operatório de pacientes cirúrgicos Comunicación: una necesidad percibida en lo periodo pre-operatorio de pacientes quirúgicos Communication: a percieved need in the pre-operative period for surgical patients

    Directory of Open Access Journals (Sweden)

    Waldine Viana da Silva


    Full Text Available O estudo teve como objetivo avaliar os sentimentos de pacientes no período pré-operatório. É um estudo descritivo com abordagem qualitativa. Foi realizado em uma unidade cirúrgica de um hospital público num município do Estado de São Paulo. A população constituiu-se de pacientes no período pré-operatório, na faixa etária de 10 a 80 anos. Observação não sistematizada e entrevista semi-estruturada foram utilizadas para coleta de dados. Os resultados evidenciaram a falta de comunicação efetiva devido às barreiras existentes, impedindo um relacionamento terapêutico adequado e, frente a isso, os pacientes permanecem ansiosos e deprimidos durante toda a internação por falta de orientação quanto à cirurgia e ausência de apoio por parte da equipe de Saúde.El estudio tuve como el objetivo evaluar los sentimientos de pacientes en el diario perioperatorio. Él es descriptivo com un abordaje cualitativo. Fue Ilevado a través de una unidad quirúrgica de un hospital público en el estado de São Paulo. La población consistió en pacientes en el diario perioperatorio, en la venda sería de 10 a los 80 años. Para la recolecta de datos fueron usados la observación y la entrevista semi-estructurada. Los resultados evidencian la carencia de la comunicación logran debido a las barreras existentes, inpedindo una ajustada relación terapéutica, afrontan a esto, los pacientes siguen ansiosos y pressionados durante toda la internacón debido a la falta de orientación cuanto a la chirugía y a la ausencia de la ayuda de parte del equipo de salud.The study had as objective to evaluate the patients' feelings in the pre-operative period. The study is descriptive with qualitative approach. It was accomplished in a surgical unit of a public hospital of São Paulo. The population was constituted of patients in the pre-operative period, in the age group from 10 to 80 years. Non-systematized observation and semi-structured glimpses were used

  12. List of Nuclear Materials Licensing Actions Received (United States)

    Nuclear Regulatory Commission — A catalog of all Materials Licensing Actions received for review. The catalog lists the name of the entity submitting the license application, their city and state,...

  13. Solar central receiver systems comparative economics (United States)

    Eicker, P. J.


    Several major conceptual design studies of solar central receiver systems and components were completed in the last year. The results of these studies were used to compare the projected cost of electric power generation using central receiver systems with that of more conventional power generation. The cost estimate for a molten salt central receiver system is given. Levelized busbar energy cost is shown as a function of annual capacity factor indicating the fraction of the cost due to each of the subsystems. The estimated levelized busbar energy cost for a central receiver (70 to 90 mills per kilowatt hour) is compared with the levelized busbar energy cost for a new coal fired Rankine cycle plant. Sensitivities to the initial cost of coal and the delta fuel escalation are shown.

  14. Metal Mesh Filters for Terahertz Receivers Project (United States)

    National Aeronautics and Space Administration — The technical objective of this SBIR program is to develop and demonstrate metal mesh filters for use in NASA's low noise receivers for terahertz astronomy and...

  15. Collector/Receiver Characterization (Fact Sheet)

    Energy Technology Data Exchange (ETDEWEB)


    Fact sheet describing NREL CSP Program capabilities for collector/receiver characterization: determining optical efficiency, measuring heat loss, developing and testing concentrators, concentrating the sun's power, and optically characterizing CSP plants.

  16. Changes in Received Pronunciation: Diachronic Case Studies

    National Research Council Canada - National Science Library

    Martin Hinton


    This paper sets out to investigate changes and individual irregularities in the Received Pronunciation of a number of individuals over time and to compare them with the changes noted in contemporary RP in the literature...

  17. High-Rate Receiver Design Project (United States)

    National Aeronautics and Space Administration — We propose an initial architectural and preliminary hardware design study for a high-rate receiver capable of decoding modulation suites specified by CCSDS 413.0-G-1...

  18. Digital Signal Processing Based Biotelemetry Receivers (United States)

    Singh, Avtar; Hines, John; Somps, Chris


    This is an attempt to develop a biotelemetry receiver using digital signal processing technology and techniques. The receiver developed in this work is based on recovering signals that have been encoded using either Pulse Position Modulation (PPM) or Pulse Code Modulation (PCM) technique. A prototype has been developed using state-of-the-art digital signal processing technology. A Printed Circuit Board (PCB) is being developed based on the technique and technology described here. This board is intended to be used in the UCSF Fetal Monitoring system developed at NASA. The board is capable of handling a variety of PPM and PCM signals encoding signals such as ECG, temperature, and pressure. A signal processing program has also been developed to analyze the received ECG signal to determine heart rate. This system provides a base for using digital signal processing in biotelemetry receivers and other similar applications.

  19. Optical Coherent Receiver Enables THz Wireless Bridge

    DEFF Research Database (Denmark)

    Yu, Xianbin; Liu, Kexin; Zhang, Hangkai


    We experimentally demonstrated a 45 Gbit/s 400 GHz photonic wireless communication system enabled by an optical coherent receiver, which has a high potential in fast recovery of high data rate connections, for example, in disaster....

  20. Metal Mesh Filters for Terahertz Receivers Project (United States)

    National Aeronautics and Space Administration — The best low-noise receiver solutions for frequencies above about 800 GHz rely on either a low-noise bolometric direct detector or a hot electron bolometric mixer....

  1. High dynamic GPS receiver validation demonstration (United States)

    Hurd, W. J.; Statman, J. I.; Vilnrotter, V. A.


    The Validation Demonstration establishes that the high dynamic Global Positioning System (GPS) receiver concept developed at JPL meets the dynamic tracking requirements for range instrumentation of missiles and drones. It was demonstrated that the receiver can track the pseudorange and pseudorange rate of vehicles with acceleration in excess of 100 g and jerk in excess of 100 g/s, dynamics ten times more severe than specified for conventional High Dynamic GPS receivers. These results and analytic extensions to a complete system configuration establish that all range instrumentation requirements can be met. The receiver can be implemented in the 100 cu in volume required by all missiles and drones, and is ideally suited for transdigitizer or translator applications.

  2. Rabies: What Care Will I Receive? (United States)

    ... Exposure at a Softball Tournament September 9, 2006: Horse Stabled in Tennessee Tested Positive for Rabies May ... the likelihood of rabies. You should receive a tetanus shot if you have not been immunized in ...

  3. Flexible receiver adapter formal design review

    Energy Technology Data Exchange (ETDEWEB)

    Krieg, S.A.


    This memo summarizes the results of the Formal (90%) Design Review process and meetings held to evaluate the design of the Flexible Receiver Adapters, support platforms, and associated equipment. The equipment is part of the Flexible Receiver System used to remove, transport, and store long length contaminated equipment and components from both the double and single-shell underground storage tanks at the 200 area tank farms.

  4. A handbook for solar central receiver design

    Energy Technology Data Exchange (ETDEWEB)

    Falcone, P.K.


    This Handbook describes central receiver technology for solar thermal power plants. It contains a description and assessment of the major components in a central receiver system configured for utility scale production of electricity using Rankine-cycle steam turbines. It also describes procedures to size and optimize a plant and discussed examples from recent system analyses. Information concerning site selection criteria, cost estimation, construction, and operation and maintenance is also included, which should enable readers to perform design analyses for specific applications.

  5. Accounts Receivables Management: Insight and Challenges

    Directory of Open Access Journals (Sweden)

    Charles Adusei


    Full Text Available This paper studied how Zoomlion Company Limited manages its accounts receivables. Based on multiple linear regression analysis, Kendall coefficient of concordance and One sample t-test, the result shows effective credit control systems by the company. However, poor monitoring and lack of effective follow up measures were the key challenges to debt management. The paper recommend stricter adherence to the credit policy and vigorously pursued effective recovery strategies and further prescribed best practices in accounts receivables management.

  6. Teachers' Assessment Experiences and Perceptions in the Practical-Aesthetic Subjects (United States)

    Oltedal, Elizabeth; Gamlem, Siv M.; Kleivenes, Ole M.; Ryslett, Kari; Vasset, Thorstein


    A challenge for the practical-aesthetic subjects is the perception that they are less important than theoretical knowledge subjects. These subjects are among the non-core subjects receiving highest grades in Norwegian lower secondary schools, but also represent the highest number of complaints about grading. This study investigates teachers'…

  7. System and method for acquisition management of subject position information (United States)

    Carrender, Curt


    A system and method for acquisition management of subject position information that utilizes radio frequency identification (RF ID) to store position information in position tags. Tag programmers receive position information from external positioning systems, such as the Global Positioning System (GPS), from manual inputs, such as keypads, or other tag programmers. The tag programmers program each position tag with the received position information. Both the tag programmers and the position tags can be portable or fixed. Implementations include portable tag programmers and fixed position tags for subject position guidance, and portable tag programmers for collection sample labeling. Other implementations include fixed tag programmers and portable position tags for subject route recordation. Position tags can contain other associated information such as destination address of an affixed subject for subject routing.

  8. System and method for acquisition management of subject position information

    Energy Technology Data Exchange (ETDEWEB)

    Carrender, Curt (Morgan Hill, CA)


    A system and method for acquisition management of subject position information that utilizes radio frequency identification (RF ID) to store position information in position tags. Tag programmers receive position information from external positioning systems, such as the Global Positioning System (GPS), from manual inputs, such as keypads, or other tag programmers. The tag programmers program each position tag with the received position information. Both the tag programmers and the position tags can be portable or fixed. Implementations include portable tag programmers and fixed position tags for subject position guidance, and portable tag programmers for collection sample labeling. Other implementations include fixed tag programmers and portable position tags for subject route recordation. Position tags can contain other associated information such as destination address of an affixed subject for subject routing.

  9. Towards a definition of SUBJECT in binding domains and subject ...

    African Journals Online (AJOL)

    Towards a definition of SUBJECT in binding domains and subject-oriented anaphors 27 and it holds little explanatory value. At best, EPP ensures that the highest argument will move to subject position. The final property I will discuss here is the fact that, in some languages (e.g. Icelandic and. Dutch), there is a subset of ...

  10. Renal effects of hyperinsulinaemia in subjects with two hypertensive parents

    DEFF Research Database (Denmark)

    Andersen, U B; Skøtt, P; Bruun, N E


    aged 18-35 years whose parents both had essential hypertension, and 22 age- and sex-matched subjects whose parents were both normotensive. Diabetes or morbid obesity in any subject or parent excluded the family. The 24-h blood pressure was measured. The subjects received an isocaloric diet with a fixed.......04). Compared with the controls, the subjects predisposed to hypertension had a higher 24-h diastolic blood pressure [78 (70, 82) mmHg, compared with 73 (68, 77) mmHg], but a similar insulin sensitivity index ¿10(7)x[313 (225, 427)] compared with 10(7)x[354 (218, 435)] l(2).min(-1).pmol(-1).kg(-1)¿. Thus...... the sodium-retaining effect of insulin was more pronounced in subjects with a strong genetic predisposition to essential hypertension than in subjects with normotensive parents. This effect may contribute to the development of hypertension in subjects with a genetic predisposition to hypertension....


    Directory of Open Access Journals (Sweden)

    IJBE Volume 1


    Full Text Available SUBJECT INDEX IJBE VOLUME 1EPA, 1Agrotourism, 148AHP, 148balance scorecard, 63batik tulis Rolla Junior, 23Broiler, 90business model canvas, 137business performance,32capital structure, 81cashew industry,158CHAID,106CLI,42coal transportation service,63company’s characteristics, 81competitive advantage, 12competitive strategy, 127consumer satisfaction, 51CSI, 42customer loyalty, 42customer satisfaction,42decision of visitors, 72development strategy, 23development,158entrepreneurship, 32Feasibility studies, 90FEM, 81gap analysis, 1Indonesia Stock Exchange, 177Indosat, 137investor,177Kawah Putih, 72kedai sop durian lodaya (KSDL,51klassen typology, 96leading sector, 96less cash society, 137liquidity ratio, 165location quotient, 96logistic regression, 115market, 177marketing development strategy, 148Marketing mix, 72mobile payment, 137modern and Traditional cage, 90multiple regression analyse,165multiple regression, 177net working capital, 165organic tofu product, 115Padang, 106paired comparison, 63partnership, 1, 32Pecking Order Theory, 81PLS, 81Portfolio, 96power, 32product quality, 51profitability ratio, 165Prol Tape Primadona, 127purchase decision, 115purchase intention, 51purchasing interest,115QSPM, 23, 127refilled drinking water, 106seed,1segmentation, 106SEM, 42, 51service quality, 51SMEs, 96specialty coffee, 12stock,177strategic diagnosis,137strategy, 158Sukorambi Botanic Garden, 148SWOT, 23, 127, 148, 158SWOT-AHP, 12tourists,72UD. Primadona, 127value chain, 12VRIO,12 AUTHOR INDEX IJBE VOLUME 1Adiningsih, Kartika Puspitasari,42Aknesia, Vharessa,12Amalia, Firda Rachma,90Andati, Trias, 177Anggraeni, Lukytawati,23Asriani,158Daryanto, Arief,12, 90Djamaludin, MD., 42Djohar, Setiadi,96Fachrodji, Achmad,72Fahmi, Idqan,1, 63, 127Fasyni, Awisal,106Hubeis, Musa,148Iskandar, Dodi,51Juanda, Bambang, 165Kirbrandoko, 12, 106, 115Lumbantoruan, Dewi Margareth,96Maulana, TB Nur Ahmad,81Muksin, 148Mukti Soleh, Cecep,63Najib, Mukhamad,106Noor, Tajudin,81

  12. Digital coherent receiver technique for onboard receiver of future optical data relay system (United States)

    Araki, Tomohiro


    A digital coherent receiver technique for an onboard receiver for use in a future space optical communication system is investigated. Digital coherent technologies comprising coherent detection and digital signal processing are confirmed to possibly increase the signal speed, improve the receiver sensitivity, and extend tolerance for the Doppler frequency shift. As a facet of expandability, the concept of a multichannel-rate receiver using a digital coherent technique is introduced. Experimental results using 2.5 Gbps DBPSK signal light demodulation are presented together with future issues involved in implementation. This study confirms that the digital coherent receiver has higher expandability than other detection techniques.

  13. Binomial congestion control at receivers for multicast (United States)

    Zhang, Bing; Liu, Zengji; Xu, Yayan; Li, Zhen; Zhang, Shi


    A single rate multicast congestion control for streaming media applications called Binomial congestion control At Receivers for Multicast (BARM) is proposed. Combining aspects of window-based and rate-based congestion control, the protocol shifts most of the congestion control mechanisms to multicast receivers. The main features of BARM are as follows. (1) The protocol adopts binomial algorithm (k=l=0.5, α=0.28, β=0.2 for our implementation) to adjust congestion window, which not only provides TCP-friendliness but decreases abrupt rate fluctuations, making it suitable for real time streaming media multicast applications. (2) The binomial algorithm is executed at the receivers instead of at the sender; to do this, a congestion window is maintained and updated separately by each receiver. Hence the protocol not only has a better scalability but reduces the burden of the sender significantly and is suitable to Client/Server model. (3) The congestion window is converted to the expected receiving rate which is then fed back to the sender if permitted. Compared to window feedback scheme, rate feedback scheme is simpler and increases the scalability. (4) The representative approach is used to suppress the feedback implosion. Simulations results indicate that BARM shows good fairness, TCP-friendliness, smoothness, scalability, and acceptable responsiveness.

  14. Chiral Receiving Antenna With Low Backscattering Levels

    CERN Document Server

    Karilainen, Antti O


    Receiving antennas absorb power from incident waves, but they also re-radiate some power into surrounding space. If a receiving antenna is to be used as a sensor which should not disturb the object under study, it should scatter as little power as possible in the receiving direction. We propose to use a chiral element composed of two orthogonal chiral particles as a low-scattering sensor.The element can transmit and receive circular polarization in all directions with the Huygens' pattern. We derive the vector effective length for the antenna using the small dipole approximation for the chiral particles. We observe that the element does not backscatter, regardless of the polarization, when the incidence direction is normal to the plane of the particles. Scattered fields, scattered axial ratio, and the scattering cross section are presented. We show that the zero-backscattering property holds also for the antenna element when it is capable to receive all the available power with conjugate loading. The approxim...

  15. Characteristics of patients who receive electroconvulsive therapy. (United States)

    Malla, A K


    Case records of all non-forensic psychiatric admissions (n = 5,729), over a three year period, to all the inpatient psychiatric facilities, within one geographic area were studied on a number of demographic, clinical, and treatment characteristics. Patients who had received E.C.T. were compared with those who did not receive tis treatment. The results showed that a high proportion (21%) had received E.C.T. In comparison with patients not receiving E.C.T., E.C.T. recipients were significantly older, more often female, had greater number of previous admissions, greater incidence of violent behaviour, and longer stays in hospital. E.C.T. patients did not differ from others on social class, education, and marital status, nor was E.C.T. prescribed more often to patients who had demonstrated suicidal behaviour, even if they had a diagnosis of depression. E.C.T. and non E.C.T. patients received an equal number of psychotropic drugs.


    Directory of Open Access Journals (Sweden)

    IJBE Volume 2


    Full Text Available SUBJECT INDEX IJBE VOLUME 2access credit, 93acquisition, 177AHP, 61, 82, 165arena simulation,43BMC, 69Bojonegoro, 69brand choice, 208brand image, 208brand positioning, 208bullwhip effect, 43burger buns, 1business synergy and financial reports, 177capital structure, 130cluster, 151coal reserves, 130coffee plantation, 93competitiveness, 82consumer behaviour, 33consumer complaint behavior, 101cooking spices, 1crackers, 1cross sectional analytical, 139crosstab, 101CSI, 12direct selling, 122discriminant analysis, 33economic value added, 130, 187employee motivation, 112employee performance, 112employees, 139EOQ, 23farmer decisions, 93farmer group, 52financial performance evaluation, 187financial performance, 52, 177financial ratio, 187financial report, 187fiva food, 23food crops, 151horticulture, 151imports, 151improved capital structure, 177IPA, 12leading sector, 151life insurance, 165LotteMart, 43main product, 61marketing mix, 33, 165matrix SWOT, 69MPE, 61multiple linear regression, 122muslim clothing, 197Ogun, 139Pangasius fillet, 82Pati, 93pearson correlation, 101perceived value, 208performance suppy chain, 23PLS, 208POQ, 23portfolio analyzing, 1product, 101PT SKP, 122pulp and papers, 187purchase decision, 165purchase intention, 33remuneration, 112re-purchasing decisions, 197sales performance, 122sawmill, 52SCOR, 23sekolah peternakan rakyat, 69SEM, 112SERVQUAL, 12Sido Makmur farmer groups, 93SI-PUHH Online, 12small and medium industries (IKM, 61socio-demographic, 139sport drink, 208stress, 139supply chain, 43SWOT, 82the mix marketing, 197Tobin’s Q, 130trade partnership, 52uleg chili sauce, 1 AUTHOR INDEX IJBE VOLUME 2Achsani, Noer Azam, 177Andati, Trias, 52, 177Andihka, Galih, 208Arkeman, Yandra, 43Baga, Lukman M, 69Cahyanugroho, Aldi, 112Daryanto, Arief, 12David, Ajibade, 139Djoni, 122Fahmi, Idqan, 1Fattah, Muhammad Unggul Abdul, 61Hakim, Dedi Budiman, 187Harianto, 93Hartoyo, 101Homisah, 1Hubeis, Musa, 112Hutagaol, M. Parulian, 93Jaya, Stevana

  17. The Communication Between Designer and Design Receiver

    DEFF Research Database (Denmark)

    Dai, Zheng; Dai, Yan


    When people think about a product,the first impression always mainly influences the result.Product is the medium of communication between designer and designer receiver.Because both of them have varied different experience and background,the information would be biased during the transferring...... process.The common symbols which can be recognized by both of designer and receiver are the key tools for communication.In some case,the same symbol in one product would be leads to different receiver impression.Generally,impression includes 3 aspects:aesthetics,function, and emotion.Designer needs...... to create an attractive and accurate impression in product from these 3 aspects.For facing the dilemma of communication,some experimental approaches can help designer deal with unique and diversity situations.Solving the detail problem in each step could keep the original meaning of designer....

  18. Windowed versus windowless solar energy cavity receivers

    Energy Technology Data Exchange (ETDEWEB)

    Jarvinen, P. O.


    A model for a windowed, high-temperature cavity receiver of the heated-air type is developed and used to evaluate the greenhouse effect as a method for obtaining high receiver operating efficiencies. The effects on receiver efficiency of varying the window cutoff wavelength, the amount of absorption in the window pass-band, the cavity operating temperature, and the number of windows are determined. Single windowed cavities are found to offer theoretical efficiencies comparable to windowless ones, while multiple windowed units are found to suffer from low operating efficiencies due to losses resulting from reflections at each window/air interface. A ''first order'' examination is made of the feasibility of air cooling the window to assure its survival. This appears possible if a proper combination of cooling technique and window material characteristics is selected.

  19. Patients' preferences for receiving laboratory test results. (United States)

    Sabahi, Azam; Ahmadian, Leila; Mirzaee, Moghadameh; Khajouei, Reza


    The laboratory, as a diagnostic department in the hospital, plays an important role in the treatment and prevention of diseases. Paying attention to patients' preferences for communication of test results may provide a better and more responsive system for delivering these results. This study aimed to identify patient preferences regarding receiving their laboratory test results electronically and to identify the reasons behind their choice. Descriptive-analytical study. This study was carried out in 2015 with 200 patients who had access to the internet and had been referred at least once previously to the hospital laboratory department to receive their test results. Data were collected through an expert-validated questionnaire, and its reliability was confirmed by test-retest (P = .8). Data were analyzed using χ2 and marginal independence SPSS and R software. Ninety-eight percent of participants preferred to be notified by short message service when their test results were ready. All participants preferred to receive their test results online, and 82.5% (n = 165) preferred to receive both normal and abnormal test results this way. The main reason for receiving results online was time savings, which was reported by 77% of participants, followed by lowering the chance of missing the results (31%). About 40% of participants thought e-mail notification was more secure than accessing the results through a hospital website. Findings showed that although patients wanted to benefit from online services for receiving their test results, they were concerned about confidentiality and security. Before using online technologies, security measures necessary to protect patient privacy and to gain the trust of patients should be defined.

  20. Building and Testing a Portable VLF Receiver (United States)

    McLaughlin, Robert; Krause, L.


    Unwanted emissions or signal noise is a major problem for VLF radio receivers. These can occur from man made sources such as power line hum, which can be prevalent for many harmonics after the fundamental 50 or 60 Hz AC source or from VLF radio transmissions such as LORAN, used for navigation and communications. Natural emissions can also be detrimental to the quality of recordings as some of the more interesting natural emissions such as whistlers or auroral chorus may be drowned out by the more common sferic emissions. VLF receivers must selectively filter out unwanted emissions and amplify the filtered signal to a record-able level without degrading the quality.

  1. Near-infrared receiver for advanced ophthalmology (United States)

    Myers, Richard A.; Farrell, Richard; Zhang, Yuhua; Roorda, Austin


    We will present research on the development of an optical receiver module with a wide frequency bandwidth and excellent response to near-infrared radiation. This module is being produced to promote new imaging modalities, allowing retinal specialist to utilize established diagnostic instruments, such as scanning laser ophthalmoscopes (SLO) in a unique or more effective manner. In particular, it can be applied towards more accurate visual threshold studies in both the healthy and diseased eye. With this goal in mind, measurements of the targeted receiver's performance with and without additional amplification are presented, as is a survey of available APD detectors.

  2. Avalanche Photodiode Arrays for Optical Communications Receivers (United States)

    Srinivasan, M.; Vilnrotter, V.


    An avalanche photodiode (APD) array for ground-based optical communications receivers is investigated for the reception of optical signals through the turbulent atmosphere. Kolmogorov phase screen simulations are used to generate realistic spatial distributions of the received optical field. It is shown that use of an APD array for pulse-position modulation detection can improve performance by up to 4 dB over single APD detection in the presence of turbulence, but that photon-counting detector arrays yield even greater gains.

  3. Signal Processing for Improved Wireless Receiver Performance

    DEFF Research Database (Denmark)

    Christensen, Lars P.B.


    This thesis is concerned with signal processing for improving the performance of wireless communication receivers for well-established cellular networks such as the GSM/EDGE and WCDMA/HSPA systems. The goal of doing so, is to improve the end-user experience and/or provide a higher system capacity...

  4. Management of Febrile Neutropenia in Patients receiving ...

    African Journals Online (AJOL)

    antifungal therapy for oral candidiassis. Eight (40%) patients received growth factors. The mean fever duration was 4.5 days (range 1–10 days). Two (10%) of the patients died. CONCLUSION: Febrile neutropenia in resource limited countries can be managed with good history and physical examination skills.

  5. A 24GHz Radar Receiver in CMOS

    NARCIS (Netherlands)

    Kwok, K.C.


    This thesis investigates the system design and circuit implementation of a 24GHz-band short-range radar receiver in CMOS technology. The propagation and penetration properties of EM wave offer the possibility of non-contact based remote sensing and through-the-wall imaging of distance stationary or

  6. immunisation fever amongst infants receiving Diphtheria

    African Journals Online (AJOL)



    Aug 6, 2013 ... Methods: A prospective study was conducted on a cohort of 710 in- fants who received ... immunisation, especially in infants and young children. Although generally benign and self-limiting, fever is ..... Although this method might minimise recall bias because of the short duration of memory re- call required ...

  7. Fresnel zone imaging of receiver functions (United States)

    Mullick, Nirjhar; Buske, Stefan


    The receiver function method is a widely applied and powerful technique to obtain structural information of the crust and mantle. In its standard implementation, the depths to interfaces are interpreted from the arrival time delay of waves converted at these interfaces relative to the direct P waves. In recent times, common methods from exploration seismics (e.g. Kirchhoff prestack depth migration) have been used to image the converters instead. However, these methods are in principle not designed for receiver function imaging because of the usually non-uniform and less dense source-receiver coverage, which may lead to results dominated by significant migration noise. In this study, we present a new imaging technique that works by restricting the migration operator to the Fresnel zone in the vicinity of the conversion point at the converter. Both a synthetic test and an application to a real data set show great improvements of image quality over standard Kirchhoff migration results particularly in the case of less favorable source receiver geometry.

  8. Receiving Assistance and Local Food System Participation

    Directory of Open Access Journals (Sweden)

    Rebecca L. Som Castellano


    Full Text Available A body of literature has noted that local food systems (LFSs may not involve active participation by individuals with lower incomes. This is, in part, a function of racial and class hegemony, as well as physical and financial accessibility of LFSs. LFS institutions, such as farmers’ markets, have been working to facilitate receipt of food assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP. Charitable assistance programs, such as food banks, have also been actively working to engage in LFSs, for example, by making local foods available. However, little research has explored the role that receiving public or charitable assistance can play in influencing LFS participation. In this article, I utilize quantitative and qualitative data collected from across the state of Ohio to examine the relationship between receiving assistance and LFS participation for women, who remain predominately responsible for food provisioning in the U.S., including among those who participate in LFSs. Quantitative results suggest that receiving assistance can increase participation in LFSs. Qualitative data provides more nuanced information about the importance of food assistance for women who want to participate in LFSs, and suggest that it is essential that food cooperatives and farmers’ markets are equipped to receive food assistance programs, such as SNAP, in order for women with lower incomes to participate in LFSs.

  9. Nicolas Receives 2004 Harry H. Hess Medal (United States)

    Allègre, Claude J.


    Adolphe Nicolas received the Hess Medal at the 2004 Fall Meeting Honors Ceremony on 15 December, in San Francisco, California. The medal is given for outstanding achievements in research in the constitution and evolution of Earth and other planets. Citation. Adolphe Nicolas is a pioneer in Earth sciences. He has almost created a new field that we can name: the textural geodynamics.

  10. Forestry professors and students receive national recognition


    Davis, Lynn


    Two Virginia Tech professors in the College of Natural Resources and the university's Society of American Foresters student chapter received awards for their accomplishments at the Society of American Foresters 2005 national convention held in Fort Worth, Texas, earlier this month.

  11. Two business professors receive Fulbright Scholar awards


    Ho, Sookhan


    Virginia Tech Pamplin College of Business professors Larry French and Mahmood A. Khan have received Fulbright Scholar Awards to teach and conduct research abroad next year. Both faculty members teach in the MBA program at the university's Northern Virginia Center in metro Washington, D.C.

  12. Compressed Sensing-Based Direct Conversion Receiver

    DEFF Research Database (Denmark)

    Pierzchlewski, Jacek; Arildsen, Thomas; Larsen, Torben


    Due to the continuously increasing computational power of modern data receivers it is possible to move more and more processing from the analog to the digital domain. This paper presents a compressed sensing approach to relaxing the analog filtering requirements prior to the ADCs in a direct...

  13. 7 CFR 29.42 - Receiving station. (United States)


    ... Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing... INSPECTION Regulations Definitions § 29.42 Receiving station. Points at which producer tobacco is offered for marketing (other than sale at auction on a designated market), including tobacco auction warehouses, packing...

  14. Anatomy of a digital coherent receiver

    DEFF Research Database (Denmark)

    Borkowski, Robert; Zibar, Darko; Tafur Monroy, Idelfonso


    Digital coherent receivers have gained significant attention in the last decade. The reason for this is that coherent detection, along with digital signal processing (DSP) allows for substantial increase of the channel capacity by employing advanced detection techniques. In this paper, we first r...

  15. Howard Feiertag receives hospitality industry award


    Ho, Sookhan


    Howard Feiertag, of Blacksburg, an instructor in hospitality and tourism management at Virginia Tech's Pamplin College of Business, received the inaugural Excellence in Sales and Marketing Strategy Award at the Hospitality Sales and Marketing Association/New York University Strategy Conference in New York recently.

  16. Subjective Narcosis Assessment Scale: measuring the subjective experience of nitrogen narcosis. (United States)

    van Wijk, Charles H; Meintjes, W A J


    The interaction of subjective experiences and objective measures of neuropsychological performance during hyperbaric exposure has received less attention in the literature, in part due to the shortage of available and appropriately standardized measures. This study aimed to describe the psychometric properties of a modified version of the Subjective High Assessment Scale when used in the hyperbaric context, by exploring internal reliability, factor structure, associations with psychological variables and simple cognitive delayed recall, and the effect of task focus on the recall of subjective experience. Seventy qualified divers completed dry hyperbaric chamber dives to 607.95 kPa, and completed ratings of their subjective experiences. Some also completed a delayed recall task and psychological measures prior to their dives. The scale displayed good internal consistency, with four meaningful factors emerging. It showed some significant but small associations with trait anxiety and transient mood states, and a small to moderate correlation with recall performance. There was no significant effect of task focus on self-report of subjective experiences. The modified scale, renamed the Subjective Narcosis Assessment Scale here, has useful psychometric properties, and promising potential for future use.

  17. Social effects of migration in receiving countries. (United States)

    Ohndorf, W


    This paper examines the impact of post-1945 migration into Western, Middle, and Northern Europe from Southern Europe, Turkey, and Northern Africa, and migration to the traditional immigration countries by Asian and Latin American immigrants, on the social structures of receiving countries. Between 1955 and 1974, 1) traditional migration to the US and Australia became less important for European countries while traditional receiving countries accepted many immigrants from developing countries; and 2) rapid economic revival in Western and Northern Europe caused a considerable labor shortage which was filled by migrant workers especially from Southern Europe, Turkey, and Northern Africa, who stayed only until they reached their economic goals. Since 1974, job vacancies have declined and unemployment has soared. This employment crisis caused some migrants 1) to return to their countries of origin, 2) to bring the rest of their families to the receiving country, or 3) to lengthen their stay considerably. The number of refugees has also significantly increased since the mid-970s, as has the number of illegal migrants. After the mid-1970s, Europe began to experience integration problems. The different aspects of the impact of migration on social structures include 1) improvement of the housing situation for foreigners, 2) teaching migrants the language of the receiving country, 3) solving the unemployment problem of unskilled migrants, 4) improvement of educational and vocational qualifications of 2nd generation migrants, 5) development of programs to help unemployed wives of migrants to learn the language and meet indigenous women, 6) encouraging migrants to maintain their cultural identity and assisting them with reintegration if they return to their original country, 7) coping with the problems of refugees, and 8) solving the problems of illegal migration. Almost all receiving countries now severely restrict further immigration. [Those policies should result in

  18. Human subjects research handbook: Protecting human research subjects. Second edition

    Energy Technology Data Exchange (ETDEWEB)



    This handbook serves as a guide to understanding and implementing the Federal regulations and US DOE Orders established to protect human research subjects. Material in this handbook is directed towards new and continuing institutional review board (IRB) members, researchers, institutional administrators, DOE officials, and others who may be involved or interested in human subjects research. It offers comprehensive overview of the various requirements, procedures, and issues relating to human subject research today.

  19. Recombinant Human Thrombopoietin Treatment Promotes Hematopoiesis Recovery in Patients with Severe Aplastic Anemia Receiving Immunosuppressive Therapy

    Directory of Open Access Journals (Sweden)

    Huaquan Wang


    Full Text Available Objective. To assess the effectiveness of recombinant human thrombopoietin (rhTPO in severe aplastic anemia (SAA patients receiving immunosuppressive therapy (IST. Methods. Eighty-eight SAA patients receiving IST from January 2007 to December 2012 were included in this retrospective analysis. Of these, 40 subjects received rhTPO treatment (15000 U, subcutaneously, three times a week. rhTPO treatment was discontinued when the platelet count returned to normal range. Hematologic response, bone marrow megakaryocyte recovery, and time to transfusion independence were compared. Results. Hematologic response was achieved in 42.5%, 62.5%, and 67.5% of patients receiving rhTPO and 22.9%, 41.6%, and 47.9% of patients not receiving rhTPO at 3, 6, and 9 months after treatment, respectively (P = 0.0665, P = 0.0579, and P = 0.0847, resp.. Subjects receiving rhTPO presented an elevated number of megakaryocytes at 3, 6, and 9 months when compared with those without treatment (P = 0.025, P = 0.021, and P = 0.011, resp.. The time to platelet and red blood cell transfusion independence was shorter in patients who received rhTPO than in those without rhTPO treatment. Overall survival rate presented no differences between the two groups. Conclusion. rhTPO could improve hematologic response and promote bone marrow recovery in SAA patients receiving IST.

  20. CERN Press Office receives award from Euroscience

    CERN Multimedia


    The CERN Communication group has received an award for its efforts in communicating the LHC first beam to the media and the public. James Gillies, head of the Communication group was presented the AlphaGalileo Research Public Relations Award on Wednesday, 14 October during the Euroscience Media Award Ceremony in Hannover. "It’s great to receive this recognition," said Gillies. "Of course, we had great material to work with: the LHC is a fantastic story and one that is going to get even better. Angels, Demons and black holes also had their roles to play, but behind the media interest there’s been a lot of hard work by my team. This is for them." The CERN Communication group also works with communication professionals in all the CERN Member States and major physics labs around the world through the European Particle Physics Communication Network, and the InterAction collaboration. "Without them," says Gillies, &am...

  1. Jian Receives 2009 F. L. Scarf Award (United States)


    Lan Jian has been awarded the AGU F. L. Scarf Award, given annually to recent Ph.D recipients for outstanding dissertation research that contributes directly to solar planetary sciences. Jian's thesis is entitled “Radial evolution of large-scale solar wind structures.” She was formally presented with the award at the Space Physics and Aeronomy section dinner during the 2009 AGU Fall Meeting, held 14-18 December in San Francisco, Calif. Lan Jian received her B.S. in geophysics from University of Science and Technology of China in 2003. She received her M.S. and Ph.D. degrees in geophysics and space physics, under the supervision of Christopher T. Russell, at University of California, Los Angeles in 2006 and 2008, respectively. Her research interests include various structures in the solar wind, their origin and evolution, and their effect on the space environment of planets.

  2. Grooms receives 2011 Donald L. Turcotte Award (United States)


    Ian Grooms has been awarded the AGU Donald L. Turcotte Award, given annually to recent Ph.D. recipients for outstanding dissertation research that contributes directly to the field of nonlinear geophysics. Grooms's thesis is entitled “Asymptotic and numerical methods for rapidly rotating buoyant flow.” He presented an invited talk and was formally presented with the award at the 2011 AGU Fall Meeting, held 5-9 December in San Francisco, Calif. Grooms received his B.S. in mathematics from the College of William and Mary, Williamsburg, Va., in 2005. He received a Ph.D. in applied mathematics in 2011 under the supervision of Keith Julien at the University of Colorado at Boulder. His research interests include asymptotic and numerical methods for multiscale problems in geophysical fluid dynamics.

  3. Perception of older adults receiving palliative care

    Directory of Open Access Journals (Sweden)

    Fernanda Laporti Seredynskyj


    Full Text Available The present study aimed at understanding the perception of older adults who are receiving palliative oncological care on self care in relation to different stages of the disease and how such perception affected their lives. This is a qualitative study using oral history conducted with 15 older adults receiving palliative chemotherapy treatment in a health institution. The following categories emerged: social network, perspectives for confronting life, changes and spirituality. It is necessary for nursing staff to understand this process so that the measures implemented take into account all of the implications of the disease and aim at improving quality of life.   doi: 10.5216/ree.v16i2.22795.

  4. Fused silica windows for solar receiver applications (United States)

    Hertel, Johannes; Uhlig, Ralf; Söhn, Matthias; Schenk, Christian; Helsch, Gundula; Bornhöft, Hansjörg


    A comprehensive study of optical and mechanical properties of quartz glass (fused silica) with regard to application in high temperature solar receivers is presented. The dependence of rupture strength on different surface conditions as well as high temperature is analyzed, focussing particularly on damage by devitrification and sandblasting. The influence of typical types of contamination in combination with thermal cycling on the optical properties of fused silica is determined. Cleaning methods are compared regarding effectiveness on contamination-induced degradation for samples with and without antireflective coating. The FEM-aided design of different types of receiver windows and their support structure is presented. A large-scale production process has been developed for producing fused silica dome shaped windows (pressurized window) up to a diameter of 816 mm. Prototypes were successfully pressure-tested in a test bench and certified according to the European Pressure Vessel Directive.

  5. Subjective memory complaints and personality traits in normal elderly subjects. (United States)

    Hänninen, T; Reinikainen, K J; Helkala, E L; Koivisto, K; Mykkänen, L; Laakso, M; Pyörälä, K; Riekkinen, P J


    To evaluate the relationship between objectively measured memory functions and subjective complaints of memory disturbance and whether subjective complaints are affected by some personality traits or affective states. Cross-sectional two-group comparison. The city of Kuopio in Eastern Finland, considered representative of the urban elderly population of Finland. Originally 403 subjects aged 67-78 years from the random sample and then two matched study groups initially including eighteen subjects but only ten in the final analysis. Screening and follow-up examinations of subjects with and without subjective memory complaints: (1) Memory functions: Benton's visual retention test and the paired-associated learning subtest of Wechsler Memory Scale. (2) Memory complaints: Memory Complaint Questionnaire. (3) Personality traits and affective state: Two subscales from Minnesota Multiphasic Personality Inventory and Geriatric Depression Scale. Complaints of memory loss did not correlate with the actual memory performance in the tests. However, those subjects who most emphatically complained of memory disturbance had greater tendencies toward somatic complaining, higher feelings of anxiety about their physical health, and more negative feelings of their own competence and capabilities than those who did not complain of memory deterioration associated with aging. The study suggests that subjective feelings of memory impairment are more closely associated with personality traits than with actual memory performance in normal elderly people.

  6. Subjectivity and professional vocational counselling


    Müller, Marina


    In this work, I shall deal with the psychodynamic approach to subjectivity in P.V.C. To this effect, I want to develop the concept of subject and subjectivity, its variation and historical-social construction and its approach in counselling, from a psychodynamic conceptual framework in P.V.C. with a short reference to the theoretical sources on which this approach is founded. Departamento de Psicología

  7. Hypersensitivity reactions in patients receiving hemodialysis. (United States)

    Butani, Lavjay; Calogiuri, Gianfranco


    To describe hypersensitivity reactions in patients receiving maintenance hemodialysis. PubMed search of articles published during the past 30 years with an emphasis on publications in the past decade. Case reports and review articles describing hypersensitivity reactions in the context of hemodialysis. Pharmacologic agents are the most common identifiable cause of hypersensitivity reactions in patients receiving hemodialysis. These include iron, erythropoietin, and heparin, which can cause anaphylactic or pseudoallergic reactions, and topical antibiotics and anesthetics, which lead to delayed-type hypersensitivity reactions. Many hypersensitivity reactions are triggered by complement activation and increased bradykinin resulting from contact system activation, especially in the context of angiotensin-converting enzyme inhibitor use. Several alternative pharmacologic preparations and dialyzer membranes are available, such that once an etiology for the reaction is established, recurrences can be prevented without affecting the quality of care provided to patients. Although hypersensitivity reactions are uncommon in patients receiving hemodialysis, they can be life-threatening. Moreover, considering the large prevalence of the end-stage renal disease population, the implications of such reactions are enormous. Most reactions are pseudoallergic and not mediated by immunoglobulin E. The multiplicity of potential exposures and the complexity of the environment to which patients on dialysis are exposed make it challenging to identify the precise cause of these reactions. Great diligence is needed to investigate hypersensitivity reactions to avoid recurrence in this high-risk population. Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  8. Radio Astronomy Software Defined Receiver Project

    Energy Technology Data Exchange (ETDEWEB)

    Vacaliuc, Bogdan [ORNL; Leech, Marcus [Shirleys Bay Radio Astronomy Consortium; Oxley, Paul [Retired; Flagg, Richard [Retired; Fields, David [ORNL


    The paper describes a Radio Astronomy Software Defined Receiver (RASDR) that is currently under development. RASDR is targeted for use by amateurs and small institutions where cost is a primary consideration. The receiver will operate from HF thru 2.8 GHz. Front-end components such as preamps, block down-converters and pre-select bandpass filters are outside the scope of this development and will be provided by the user. The receiver includes RF amplifiers and attenuators, synthesized LOs, quadrature down converters, dual 8 bit ADCs and a Signal Processor that provides firmware processing of the digital bit stream. RASDR will interface to a user s PC via a USB or higher speed Ethernet LAN connection. The PC will run software that provides processing of the bit stream, a graphical user interface, as well as data analysis and storage. Software should support MAC OS, Windows and Linux platforms and will focus on such radio astronomy applications as total power measurements, pulsar detection, and spectral line studies.

  9. Hepatic Dysfunction in Patients Receiving Intravenous Amiodarone. (United States)

    Hashmi, Ali; Keswani, Nicole R; Kim, Sharon; Graham, David Y


    Amiodarone is a commonly used antiarrhythmic drug. Hepatotoxicity following chronic oral administration occurs in 1% to 3% of patients. Hepatotoxicity following intravenous (IV) administration is infrequent but may be associated with dramatic increases in serum transaminases. We describe the incidence of liver toxicity among patients receiving IV amiodarone during a 5-year period. This was a single-center retrospective review of patients receiving IV amiodarone for any cause. The outcome measures were development of elevated serum transaminases and the relation of transaminitis to all-cause 30-day mortality. A total of 1510 patients received amiodarone intravenously between 2005 and 2011; 77 (5%) developed elevated liver enzymes. Enzyme elevation was divided into mild (100-300 IU/L), moderate (300-1000 IU/L), and severe (>1000 IU/L). The median alanine aminotransferase was 189 (37-10,006) IU/L and aspartate aminotransferase was 253 (84-12,005) IU/L. The 30-day mortality among those with transaminitis was 22%; however, no patient died of amiodarone-related liver disease. Amiodarone can cause severe elevation in liver enzymes. The incidence of severe transaminitis is low; deaths following IV amiodarone are rarely caused by drug-induced liver failure.

  10. Russian institute receives CMS Gold Award

    CERN Multimedia

    Patrice Loïez


    The Snezhinsk All-Russian Institute of Scientific Research for Technical Physics (VNIITF) of the Russian Federal Nuclear Centre (RFNC) is one of twelve CMS suppliers to receive awards for outstanding performance this year. The CMS Collaboration took the opportunity of the visit to CERN of the Director of VNIITF and his deputy to present the CMS Gold Award, which the institute has received for its exceptional performance in the assembly of steel plates for the CMS forward hadronic calorimeter. This calorimeter consists of two sets of 18 wedge-shaped modules arranged concentrically around the beam-pipe at each end of the CMS detector. Each module consists of steel absorber plates with quartz fibres inserted into them. The institute developed a special welding technique to assemble the absorber plates, enabling a high-quality detector to be produced at relatively low cost.RFNC-VNIITF Director Professor Georgy Rykovanov (right), is seen here receiving the Gold Award from Felicitas Pauss, Vice-Chairman of the CMS ...

  11. [Are domiciliary care patients receiving adequate thromboprophylaxis?]. (United States)

    Cátedra, B; Muñoz, F; Cabello, L


    The study aims to determine the percentage of patients treated at home with an indication of prophylaxis of thromboembolic disease (TED) according to the PRETEMED guidelines and whether they receive such prophylaxis. A cross-sectional descriptive study was conducted in Segovia Palace Health Centre (Madrid). to be included in the domiciliary care protocol. terminal patient, hospitalised or surgery in the last 3 months. The variables used include, age, sex, duration of domiciliary care, mobility, anticoagulant or antiplatelet treatment and reason, and associated and precipitating factors to calculate the risk of TED according to the PRETEMED guidelines, and if they receive such prophylaxis, by reviewing computerised medical records and meeting with the staff responsible. The study included a total of 187 patients, of whom 81% were women There was a significant differences in mean age by sex (men, 76.91 years, 95% CI; 72.59-81.24, and women, 86.72 years, 95% CI; 72.59-81.24, Pdomiciliary care have a low baseline risk of developing a TED episode in our study. There should be more emphasis placed on the prophylaxis of TED in acute medical episodes in which patients with slightly elevated risk may increase the likelihood of TED. Observational studies should be conducted to study the baseline risk and the subsequent development of TED in the population receiving home care. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  12. The Subject in Cognitive Psychotherapy

    Directory of Open Access Journals (Sweden)

    Isabel Caro-Gabalda


    Full Text Available This paper discusses the various subjects embedded in cognitive psychotherapy. The cognitive model developed by Beck, considered as a rationalist and modernist model, will exemplify these subjects. Cognitive therapy should be placed in the modernist historical context and related to a subject characterized as having rationality and the ability to observe and detect cognitions, emotions and behaviors. The paper develops this background introducing three main subject types. The first is the introspective and conscious subject, who is able to observe what is within oneself, has free access, and is conscious of one's cognitive world. The second is the cognitive miser that describes the subject who enters into therapy. The final subject identified, is the trained scientist who is able to develop a more objective knowledge, changing faulty schemas and cognitive distortions. This subject is the one most looked for in cognitive therapy. We could connect these subjects to some of the main elements of cognitive therapy such as the concept of ABC, assessment procedures, cognitive techniques or the relevance of schemas. Finally, the paper suggests some issues for study that could contribute to the theoretical and clinical evolution of cognitive psychotherapy.

  13. Efficacy of auditory training in elderly subjects

    Directory of Open Access Journals (Sweden)

    Aline Albuquerque Morais


    Full Text Available Auditory training (AT  has been used for auditory rehabilitation in elderly individuals and is an effective tool for optimizing speech processing in this population. However, it is necessary to distinguish training-related improvements from placebo and test-retest effects. Thus, we investigated the efficacy of short-term auditory training (acoustically controlled auditory training - ACAT in elderly subjects through behavioral measures and P300. Sixteen elderly individuals with APD received an initial evaluation (evaluation 1 - E1 consisting of behavioral and electrophysiological tests (P300 evoked by tone burst and speech sounds to evaluate their auditory processing. The individuals were divided into two groups. The Active Control Group [ACG (n=8] underwent placebo training. The Passive Control Group [PCG (n=8] did not receive any intervention. After 12 weeks, the subjects were  revaluated (evaluation 2 - E2. Then, all of the subjects underwent ACAT. Following another 12 weeks (8 training sessions, they underwent the final evaluation (evaluation 3 – E3. There was no significant difference between E1 and E2 in the behavioral test [F(9.6=0,.6 p=0.92, λ de Wilks=0.65] or P300 [F(8.7=2.11, p=0.17, λ de Wilks=0.29] (discarding the presence of placebo effects and test-retest. A significant improvement was observed between the pre- and post-ACAT conditions (E2 and E3 for all auditory skills according to the behavioral methods [F(4.27=0.18, p=0.94, λ de Wilks=0.97]. However, the same result was not observed for P300 in any condition. There was no significant difference between P300 stimuli. The ACAT improved the behavioral performance of the elderly for all auditory skills and was an effective method for hearing rehabilitation.

  14. Malnourished patients on hemodialysis improve after receiving a nutritional intervention. (United States)

    Calegari, Adaiane; Barros, Elvino Guardão; Veronese, Francisco Veríssimo; Thomé, Fernando Saldanha


    Malnutrition is multifactorial and may be modified by nutritional intervention. We aimed to assess the impact of an intervention on the nutritional status of malnourished hemodialysis patients and their acceptance of a non-industrialized nutritional supplement. 18 patients were studied, they were selected from a previous nutritional assessment where nutritional risk was defined as: subjective global assessment > 15 plus one criterion for malnutrition. The following variables were assessed: anthropometric parameters, subjective global assessment, dietary intake, six-minute walking test, quality of life (SF-36), and biochemical tests. Patients were randomized to either Control or Intervention Groups. The Intervention Group received a dietetic supplement during dialysis containing 355 kcal, prepared from simple ingredients. After three months, subjects from the Control Group and other patients also considered at nutritional risk underwent the same intervention. The study groups were compared after three months, and all patients were analyzed before and after the intervention. Fifteen men and three women, aged 56.4 ± 15.6 years-old, nine in each group, were studied. The Intervention Group showed an improvement in the subjective global assessment (p = 0.04). There were differences in role physical and bodily pain domains of SF-36, with improvement in the Intervention Group and worsening in the Control Group (p = 0.034 and p = 0.021). Comparisons before and after intervention for all patients showed improvement in the subjective global assessment (16.18 ± 4.27 versus 14.37 ± 4.20, p = 0.04), and in the six-minute walking test (496.60 ± 132.59 versus 547.80 ± 132.48 m; p = 0.036). The nutritional supplement was well tolerated by all patients, and it did not cause side effects. The nutritional intervention improved the subjective global assessment and quality of life of hemodialysis patients at short-term. A global intervention by a dietitian produced specific and

  15. The disease-subject as a subject of literature

    Directory of Open Access Journals (Sweden)

    Kottow Andrea R


    Full Text Available Abstract Based on the distinction between living body and lived body, we describe the disease-subject as representing the impact of disease on the existential life-project of the subject. Traditionally, an individual's subjectivity experiences disorders of the body and describes ensuing pain, discomfort and unpleasantness. The idea of a disease-subject goes further, representing the lived body suffering existential disruption and the possible limitations that disease most probably will impose. In this limit situation, the disease-subject will have to elaborate a new life-story, a new character or way-of-being-in-the-world, it will become a different subject. Health care professionals need to realize that patients are not mere observers of their body, for they are immersed in a reassesment of values, relationships, priorities, perhaps even life-plans. Becoming acquainted with literature's capacity to create characters, modify narratives and depict life-stories in crisis, might sharpen physicians' hermeneutic acumen and make them more receptive to the quandaries of disease-subjects facing major medical and existential decisions in the wake of disruptive disease.

  16. Atopic asthmatic subjects but not atopic subjects without ... (United States)

    BACKGROUND: Asthma is a known risk factor for acute ozone-associated respiratory disease. Ozone causes an immediate decrease in lung function and increased airway inflammation. The role of atopy and asthma in modulation of ozone-induced inflammation has not been determined. OBJECTIVE: We sought to determine whether atopic status modulates ozone response phenotypes in human subjects. METHODS: Fifty volunteers (25 healthy volunteers, 14 atopic nonasthmatic subjects, and 11 atopic asthmatic subjects not requiring maintenance therapy) underwent a 0.4-ppm ozone exposure protocol. Ozone response was determined based on changes in lung function and induced sputum composition, including airway inflammatory cell concentration, cell-surface markers, and cytokine and hyaluronic acid concentrations. RESULTS: All cohorts experienced similar decreases in lung function after ozone. Atopic and atopic asthmatic subjects had increased sputum neutrophil numbers and IL-8 levels after ozone exposure; values did not significantly change in healthy volunteers. After ozone exposure, atopic asthmatic subjects had significantly increased sputum IL-6 and IL-1beta levels and airway macrophage Toll-like receptor 4, Fc(epsilon)RI, and CD23 expression; values in healthy volunteers and atopic nonasthmatic subjects showed no significant change. Atopic asthmatic subjects had significantly decreased IL-10 levels at baseline compared with healthy volunteers; IL-10 levels did not significa

  17. The Object of the Subject

    DEFF Research Database (Denmark)

    Hansen, Brian Benjamin


    The article presents a theory of the subject, based on the work of Jacques Lacan, using the concepts of alienation, separation and liberation.......The article presents a theory of the subject, based on the work of Jacques Lacan, using the concepts of alienation, separation and liberation....

  18. Electromyographic and neuromuscular variables in unstable postpolio subjects, stable postpolio subjects, and control subjects. (United States)

    Rodriquez, A A; Agre, J C; Franke, T M


    To compare strength and endurance variables obtained in the quadriceps muscles of postpolio and control subjects over a 7-year interval with macro and single fiber electromyography (EMG) variables. A controlled inception cohort study. Neuromuscular research laboratory of a university hospital. A cohort of 23 postpolio and 14 control subjects. All postpolio subjects had a history, physical examination, and EMG consistent with previous poliomyelitis, and had greater than antigravity strength in the quadriceps muscle tested. Unstable postpolio subjects acknowledged new quadriceps weakness over the 7-year period of the study (n = 11), and stable postpolio subjects denied new weakness of the quadriceps over the same period (n = 12). All subjects had tests of neuromuscular function of the quadriceps muscles at the onset of this study and yearly over a 7-year period. EMG variables were determined on a separate day after the seventh year of neuromuscular measurements. Neuromuscular variables measured were isometric knee extension peak torque, isometric endurance (time to inability to maintain knee extensor contraction at 40% of maximal torque), tension time index (TTI) (product of isometric endurance time and 40% of maximal torque), and recovery of torque at 10 minutes after the endurance test. EMG variables were macro EMG and single fiber EMG (jitter, fiber density, and percent blocking). Unstable postpolio subjects did not lose strength more rapidly than stable postpolio subjects or control subjects. Unstable postpolio subjects were significantly weaker, had decreased TTI, larger macro EMG amplitude, greater jitter, blocking, and fiber density in comparison with stable postpolio subjects (all p postpolio group (p .05) with neuromuscular or EMG variables in control, stable, or unstable postpolio subjects.

  19. Performance Driven Six-Port Receiver and Its Advantages over Low-IF Receiver Architecture

    Directory of Open Access Journals (Sweden)

    Abul Hasan


    Full Text Available This paper provides an extensive analysis of the performance of a six-port based direct conversion receiver (SPR in terms of signal quality, dynamic range, noise figure, ports matching, isolation, bandwidth, and cost. Calibration technique using multimemory polynomials has been adopted in order to improve the signal quality of the six-port receiver. The performances of the calibrated receiver are then compared with the performances of a commercially available I-Q demodulator used as a low-IF receiver. The main advantages and disadvantages of the SPR compared to the low-IF receiver are highlighted. The major advantages of the SPR come in terms of its available input frequency bandwidth and the low power requirement. The SPR system requires no external bias supply but suffers in terms of the available conversion gain. A better port matching of the SPR can be guaranteed over a wide frequency bandwidth, which mixer based receiver systems lack. The main component limiting the performance of a SPR is the diode detector. A faster and a better diode detector will alleviate some of the problems highlighted in this paper. The SPR system is calibratable and its error-vector-magnitude performance can be made better than the I-Q demodulator used as a low-IF receiver.

  20. Concrete Aspects Regarding the Imputation of Current Tax Receivables in Insolvency Proceedings

    Directory of Open Access Journals (Sweden)

    Marioara Mirea


    Full Text Available This paper captures the practical aspects in terms of tax treatment of the receivables arising subsequent to the initiation of insolvency proceedings, during the observation period, in judicial reorganization or bankruptcy proceedings. These issues are treated from a fiscal perspective, as new periods. During the observation, reorganization or bankruptcy period, an insolvent company is subject to the Law on insolvency prevention and insolvency proceedings. On the other hand, the provisions of the Fiscal Procedure Code, as applied by the tax creditor, govern an individual procedure for the recovery of receivables while the Law on insolvency prevention and insolvency proceedings refers to a collective procedure for the recovery of receivables.

  1. Receivers Gather Data for Climate, Weather Prediction (United States)


    Signals from global positioning system (GPS) satellites are now being used for more than just location and navigation information. By looking at the radio waves from GPS satellites, a technology developed at NASA s Jet Propulsion Laboratory (JPL) not only precisely calculates its position, but can also use a technique known as radio occultation to help scientists study the Earth s atmosphere and gravity field to improve weather forecasts, monitor climate change, and enhance space weather research. The University Corporation for Atmospheric Research (UCAR), a nonprofit group of universities in Boulder, Colorado, compares radio occultation to the appearance of a pencil when viewed though a glass of water. The water molecules change the path of visible light waves so that the pencil appears bent, just like molecules in the air bend GPS radio signals as they pass through (or are occulted by) the atmosphere. Through measurements of the amount of bending in the signals, scientists can construct detailed images of the ionosphere (the energetic upper part of the atmosphere) and also gather information about atmospheric density, pressure, temperature, and moisture. Once collected, this data can be input into weather forecasting and climate models for weather prediction and climate studies. Traditionally, such information is obtained through the use of weather balloons. In 1998, JPL started developing a new class of GPS space science receivers, called Black Jack, that could take precise measurements of how GPS signals are distorted or delayed along their way to the receiver. By 2006, the first demonstration of a GPS radio occultation constellation was launched through a collaboration among Taiwan s National Science Council and National Space Organization, the U.S. National Science Foundation, NASA, the National Oceanic and Atmospheric Administration (NOAA), and other Federal entities. Called the Constellation Observing System for Meteorology, Ionosphere, and Climate (COSMIC

  2. Solomon Receives 2005 Harry H. Hess Medal (United States)

    Purdy, G. Michael; Solomon, Sean C.


    Sean C. Solomon received the Harry H. Hess Medal at the 2005 Fall Meeting Honors Ceremony, which was held on 7 December in San Francisco, Calif. The medal is given for outstanding achievements in research on the constitution and evolution of the Earth and other planets. It is a privilege to present Sean C. Solomon as the American Geophysical Union's Harry H. Hess Medal recipient. During more than 30 years of accomplished research he has established himself as one of the remarkable leadersin geophysical research today.

  3. Designing a heterostructure for the quantum receiver (United States)

    Kiselev, A. A.; Kim, K. W.; Yablonovitch, E.


    In this letter, we develop optimal parameters for a structure which is suitable for the realization of a coherent quantum receiver. Conditions including predefined photon wavelength, strain, small Zeeman splitting of the electron levels, and large Zeeman effect for quantum-confined light holes are satisfied simultaneously for the structure based on the InGaAsP solid solutions. We are able to achieve designs with wavelengths of 1.3 and 1.55 μm that are desirable for optoelectronic applications.

  4. Objectivity and Subjectivity: an Argument for Rethinking the ...

    African Journals Online (AJOL)

    I present, with critique, influential moments in the genesis of the received notions of objectivity and of subjectivity, and argue for the inadequacy of Nagel's problematization of these categories of contemporary thought. With the aim of suggesting a rethink of how philosophy questions are framed in our syllabus I argue two ...

  5. Ostomy patients’ perception of the health care received (United States)

    Nieves, Candela Bonill-de las; Díaz, Concepción Capilla; Celdrán-Mañas, Miriam; Morales-Asencio, José Miguel; Hernández-Zambrano, Sandra Milena; Hueso-Montoro, César


    ABSTRACT Aim: to describe ostomy patient’s perception about health care received, as well as their needs and suggestions for healthcare system improvement. Method: qualitative phenomenological study was conducted, involving individual and semi-structured interviews on the life experiences of 21 adults who had a digestive stoma. Participants were selected following a purposive sampling approach. The analysis was based on the constant comparison of the data, the progressive incorporation of subjects and triangulation among researchers and stoma therapy nurses. The software Atlas.ti was used. Results: perception of health care received is closely related to the information process, as well as training for caring the stoma from peristomal skin to diet. It is worthy to point out the work performed by stoma care nurses ensuring support during all stages of the process. Conclusion: findings contribute to address the main patients’ needs (better prepared nurses, shorter waiting lists, information about sexual relation, inclusion of family members all along the process) and recommendations for improving health care to facilitate their adaptation to a new status of having a digestive stoma. PMID:29236839

  6. Ostomy patients' perception of the health care received. (United States)

    Nieves, Candela Bonill-de Las; Díaz, Concepción Capilla; Celdrán-Mañas, Miriam; Morales-Asencio, José Miguel; Hernández-Zambrano, Sandra Milena; Hueso-Montoro, César


    to describe ostomy patient's perception about health care received, as well as their needs and suggestions for healthcare system improvement. qualitative phenomenological study was conducted, involving individual and semi-structured interviews on the life experiences of 21 adults who had a digestive stoma. Participants were selected following a purposive sampling approach. The analysis was based on the constant comparison of the data, the progressive incorporation of subjects and triangulation among researchers and stoma therapy nurses. The software Atlas.ti was used. perception of health care received is closely related to the information process, as well as training for caring the stoma from peristomal skin to diet. It is worthy to point out the work performed by stoma care nurses ensuring support during all stages of the process. findings contribute to address the main patients' needs (better prepared nurses, shorter waiting lists, information about sexual relation, inclusion of family members all along the process) and recommendations for improving health care to facilitate their adaptation to a new status of having a digestive stoma.

  7. Efficiency of the Receivable Rotation Ratio as a Measure of the Accounts Receivable Settlement Period

    Directory of Open Access Journals (Sweden)

    Aleksandra Szpulak


    Full Text Available Accounts receivable forecasting, due to a wide range of applications in a number of financial decisions, is an important area of a company’s financial forecasts. Estimation of accounts receivable involves finding solutions for two fundamental problems: forecasting the level of daily sales revenues and estimating the accounts receivable settlement period. This paper addresses the issue of constructing reliable models to be used in forecasting accounts receivable due on deliveries and services – the trend model and the simple regression model. The postulated models, together with a range of alternative methods suggested in the literature on the field, are tested to examine the quality of the resulting estimates of the A/R settlement period. The methods postulated in the paper prove to be functional – on the one hand, the results are reliable, on the other hand, the postulated models can be constructed using readily available data. (original abstract

  8. Cardiac Arrest in Pediatric Patients Receiving Azithromycin. (United States)

    Valdés, Santiago O; Kim, Jeffrey J; Niu, Mary C; de la Uz, Caridad M; Miyake, Christina Y; Moffett, Brady S


    To compare outcomes of pediatric patients treated with azithromycin compared with penicillin or cephalosporin. We hypothesized that azithromycin use would not be associated with increased cardiac mortality in the pediatric population. Retrospective cohort study from the Pediatric Health Information System database between 2008 and 2012. Patients Azithromycin was used in 5039 (6.1%); penicillin or cephalosporin was used in 77 943 (93.9%). Overall prevalence of antibiotic-associated CPR was 0.14%. Patients receiving a macrolide antibiotic had a lower prevalence of CPR compared with patients receiving a penicillin or cephalosporin (0.04% vs 0.14%, P = .04), and there was no difference in mortality. Multivariable analysis did not find an association between macrolide use and CPR. In contrast to recent adult studies, among children hospitalized for community-acquired pneumonia, azithromycin use was not associated with a greater prevalence of cardiac arrest compared with penicillin or cephalosporin use. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Parabolic Trough Receiver Heat Loss Testing (Poster)

    Energy Technology Data Exchange (ETDEWEB)

    Price, H.; Netter, J.; Bingham, C.; Kutscher, C.; Burkholder, F.; Brandemuehl, M.


    Parabolic trough receivers, or heat collection elements (HCEs), absorb sunlight focused by the mirrors and transfer that thermal energy to a fluid flowing within them. Thje absorbing tube of these receivers typically operates around 400 C (752 F). HCE manufacturers prevent thermal loss from the absorbing tube to the environment by using sputtered selective Cermet coatings on the absorber and by surrounding the absorber with a glass-enclosed evacuated annulus. This work quantifies the heat loss of the Solel UVAC2 and Schott PTR70 HCEs. At 400 C, the HCEs perform similarly, losing about 400 W/m of HCE length. To put this in perspective, the incident beam radiation on a 5 m mirror aperture is about 4500 W/m, with about 75% of that energy ({approx} 3400 W/m) reaching the absorber surface. Of the 3400 W/m on the absorber, about 3000 W/m is absorbed into the working fluid while 400 W/m is lost to the environment.

  10. Omnidirectional free-space optical receiver architecture (United States)

    Murshid, Syed H.; Lovell, Gregory L.; Finch, Michael F.


    Free Space Optical (FSO) communication is the fusion of wireless technology and optical fiber communications systems. It has the potential of providing fiber optic data rates without the physical restraints of optical fiber cables. This endeavor presents a novel receiver structure with potential for omnidirectional free space optical communications. Interesting approaches for accomplishing omnidirectional free space lasercomm such as direct detection and solar blind non-line of sight UV scattering have been reported over the last few years. However, these technologies have resulted in limited distances of the order of 10 to 100 meters and data rates often limited to less than 1 Mb/s. This endeavor reports the architecture of an omnidirectional receiver setup by integrating an off the shelf detector and a fiber bundle, where the fiber bundle couples omnidirectional photons within its field of view and delivers these photons to the detector. The coupling of light from all directions into a detector is regulated by the cone of the acceptance angle of the fiber. Multiple fibers with overlapping acceptance angles provide the necessary coverage that may be needed to extract the optical signal from the free space optical channel. Simulated results showing the normalized power pattern of the system is presented to demonstrate omnidirectional potential of the structure. Theoretical power level versus distance plot for an FSO System employing On-O Keying (OOK) is also presented.

  11. Is Piaget's epistemic subject dead? (United States)

    Lawson, Anton E.

    Niaz (1990) presents arguments in favor of the retention of Piaget's epistemic subject as a theoretical construct to guide research and practice in science education and psychology. The intent of this article is to point out the weaknesses of those arguments and to suggest that the weight of evidence argues against the existence of the logical thinker postulated by Piaget. Therefore, contrary to Niaz's conclusion that the acceptance of Piaget's epistemic subject will facilitate the development of cognitive theories with greater explanatory power, the conclusion is reached that Piaget's epistemic subject is dead and that continued acceptance of this aspect of Piagetian theory would be counterproductive.

  12. International energy: Subject thesaurus supplement

    Energy Technology Data Exchange (ETDEWEB)



    This is a supplement to International Energy: Subject Thesaurus (ETDE/PUB--2(Rev.1)), which replaced DOE/TIC-7000--the EDB Subject Thesaurus. This supplement is provided periodically to keep International Energy: Subject Thesaurus recipients up-to-date on valid vocabulary terms (descriptors) used in building and maintaining several international energy information databases. Each issue contains all new terms added since the publication of the Thesaurus. Each supplement is a cumulative listing of the new terms, so that each issue replaces the previous one.

  13. Subject Responses to Electrochromic Windows

    Energy Technology Data Exchange (ETDEWEB)

    Clear, Robert; Inkarojrit, Vorapat; Lee, Eleanor


    Forty-three subjects worked in a private office with switchable electrochromic windows, manually-operated Venetian blinds, and dimmable fluorescent lights. The electrochromic window had a visible transmittance range of approximately 3-60%. Analysis of subject responses and physical data collected during the work sessions showed that the electrochromic windows reduced the incidence of glare compared to working under a fixed transmittance (60%) condition. Subjects used the Venetian blinds less often and preferred the variable transmittance condition, but used slightly more electric lighting with it than they did when window transmittance was fixed.

  14. Holevo Capacity Achieving Joint Detection Receiver (United States)


    OPERATOR BY MULTIPLYING INVERSE OF ,.._/"’ 1390 EXTENDED MPE BASIS UNITARY MATRIX WITH SINGLE MODE MEASUREMENT UNITARY MATRIX U.S. Patent Dec. 31...US008620166B2 (12) United States Patent Guha (io) Patent No.: US 8,620,166 B2 (45) Date of Patent : Dec. 31,2013 (54) HOLEVO CAPACITY ACHIEVING JOINT...Subject to any disclaimer, the term of this patent is extended or adjusted under 35 U.S.C. 154(b) by 0 days. (21) Appl.No.: 13/307,439 (22) Filed: Nov

  15. Investigating Saudi Learners' Preferences for Giving and Receiving Macro and/or Micro Level Peer Feedback on Their Writing (United States)

    Alnasser, Suliman Mohammed; Alyousef, Hesham Suleiman


    Several studies have addressed the subject of the preferences of L2 student-writers for receiving teacher feedback (FB) on macro level features (feedback related to meaning) and micro level features (feedback related to surface level issues); however, none of these have investigated their preferences when it comes to giving and receiving peer…

  16. Eosinophils increase in animals that received biotherapic

    Directory of Open Access Journals (Sweden)

    Pedro Gilberto Silva Morais


    Full Text Available Dairy industry is an important Brazilian economic activity participating of income generation. European breeds cattle aren’t adapted to parasites found in the tropics, like the Rhipicephalus microplus tick. Parasites can acquire resistance to allopathic products, but not to homeopathic products. We evaluate the efficacy of an antiparasiticide biotherapic against the R. microplus tick. The biotherapic was prepared according to the homeopathic pharmacopoeia recommendations from vegetable (Abrotanum and animal products (Rhipicephalus microplus, Amblyomma cajenennense, Haematobia irritans, Musca domestica, Dermatobia hominis, all diluted and vigorous shaken (dynamized in water or alcohol at a ratio of 1:99, in the 12th Centesimal Hahnemann (CH12, with limestone as the carrier. This homeophatic product found in veterinary pharmacies of Ituiutaba’s region, Minas Gerais State, is registered at Ministério da Agricultura, Pecuária e Abastecimento (MAPA. Natural tick infestation was accessed in thirty Girolando (Gir x Holstein cows with 7 to 13 year-old, by monthly counting of tick female bigger than 6 mm, from October/2009 to July/2011. Cows were divided in three groups of 10 similar animals. The treated group (T1 received roughage, concentrate and biotherapic. The placebo group (T2 received roughage, concentrate and limestone and the control group (T3 received only roughage and concentrate. T1 and T2 groups were managed together and remained in the same paddock. T3 group was separed from T1 and T2 by a wire fence. From October 2009 to September 2010 blood cell counts and serum biochemical tests were performed monthly only in T1 and T2, but visual clinical observations were made in all animals. Any group was treated with acaricide when the count’s average reached 50 or more ticks. It was necessary 7 baths with acaricide in T1 and T2, while in T3 group (control group it was necessary 19 acaricide baths to control the cattle tick. We verified

  17. Politics of modern muslim subjectivities

    DEFF Research Database (Denmark)

    Jung, Dietrich; Petersen, Marie Juul; Sparre, Sara Lei

    Examining modern Muslim identity constructions, the authors introduce a novel analytical framework to Islamic Studies, drawing on theories of successive modernities, sociology of religion, and poststructuralist approaches to modern subjectivity, as well as the results of extensive fieldwork in th...

  18. Politics of modern muslim subjectivities

    DEFF Research Database (Denmark)

    Jung, Dietrich; Petersen, Marie Juul; Sparre, Sara Lei

    Examining modern Muslim identity constructions, the authors introduce a novel analytical framework to Islamic Studies, drawing on theories of successive modernities, sociology of religion, and poststructuralist approaches to modern subjectivity, as well as the results of extensive fieldwork...

  19. The Subjective Experience of Punishment

    National Research Council Canada - National Science Library

    Adam J. Kolber


    ... laws pay little attention to such differences. I make two central claims: First, a successful justification of punishment must take account of offenders' subjective experiences when assessing punishment severity...

  20. Pharmacokinetics of Nintedanib in Subjects With Hepatic Impairment. (United States)

    Marzin, Kristell; Kretschmar, Gunther; Luedtke, Doreen; Kraemer, Sandrine; Kuelzer, Raimund; Schlenker-Herceg, Rozsa; Schmid, Ulrike; Schnell, David; Dallinger, Claudia


    Nintedanib is an intracellular inhibitor of tyrosine kinases used in the treatment of non-small cell lung cancer and idiopathic pulmonary fibrosis (IPF). This phase 1 open-label study investigated the influence of mild and moderate hepatic impairment on the pharmacokinetics (PK), safety, and tolerability of nintedanib following oral administration of a single 100-mg dose. Subjects with hepatic impairment classified as Child-Pugh A (mild hepatic impairment) or Child-Pugh B (moderate hepatic impairment) were eligible. The control group comprised healthy matched subjects. Primary end points were Cmax and AUC0-∞ of nintedanib. Thirty-three subjects received nintedanib (8 in each of the Child-Pugh A and Child-Pugh B groups and 17 controls). The shape of the plasma concentration-time curve for nintedanib was similar between Child-Pugh A or B and healthy subjects. Nintedanib exposure was ∼2-fold higher in Child-Pugh A subjects and ∼8-fold higher in Child-Pugh B subjects than in healthy subjects. Adverse events were reported in 3 Child-Pugh B subjects (37.5%), no Child-Pugh A subjects, and 3 healthy subjects (17.6%). In conclusion, exposure to nintedanib was higher in Child-Pugh A and B subjects than in matched healthy subjects. A single dose of nintedanib 100 mg had an acceptable safety and tolerability profile in subjects with hepatic impairment. Results of this dedicated phase 1 study are in line with exploratory investigations into the PK of nintedanib in patients with advanced solid tumors or IPF and hepatic impairment. © 2017, The Authors. The Journal of Clinical Pharmacology Published by Wiley Periodicals, Inc. on behalf of American College of Clinical Pharmacology.

  1. The Severe Respiratory Insufficiency Questionnaire for Subjects With COPD With Long-Term Oxygen Therapy. (United States)

    Walterspacher, Stephan; July, Johanna; Kohlhäufl, Martin; Rzehak, Peter; Windisch, Wolfram


    Respiratory insufficiency in COPD may present as hypoxic and/or hypercapnic respiratory failure treated with long-term oxygen therapy (LTOT) and/or noninvasive ventilation (NIV) with LTOT. The Severe Respiratory Insufficiency Questionnaire (SRI) is a tool for the assessment of health-related quality of life (HRQOL) in subjects receiving NIV. However, it remains unclear whether the SRI is also capable of assessing and discriminating HRQOL in subjects receiving LTOT. Stable subjects with COPD receiving LTOT or NIV + LTOT (NIV) were prospectively recruited and completed the SRI, lung function tests, and blood gases. Confirmatory factor analysis for construct validity and internal consistency reliability were calculated. One hundred fifty-five subjects were included (113 LTOT, 42 NIV). The Cronbach α coefficient of the 7 subscales ranged between 0.69 and 0.89 (LTOT) and between 0.79 and 0.93 (NIV), respectively. In both groups, confirmatory factor analysis revealed a one-factor model for the SRI summary scale; in 5 subscales, one- or 2-factor models could be established. Group differences in the SRI subsets were all P <.05 (except for physical functioning) with higher scores in subjects receiving NIV. The SRI showed high reliability and validity in subjects with COPD receiving LTOT. Subjects receiving LTOT had lower SRI scores, indicating a poorer HRQOL compared with subjects with established NIV and LTOT. Copyright © 2016 by Daedalus Enterprises.

  2. Subjective Illness theory and coping

    Directory of Open Access Journals (Sweden)

    Gessmann H.-W.


    Full Text Available The article presents a view of a problem of subjective illness theory in context of coping behavior. The article compiles the results of the latest studies of coping; discloses the way subjective illness theory affects the illness coping and patient's health; presents the study of differences in coping behaviour of patients at risk of heart attack and oncology. The article is recommended for specialists, concerned with psychological reasons of pathogenic processes and coping strategies of patients.

  3. Receiver based PAPR reduction in OFDMA

    KAUST Repository

    Ali, Anum Z.


    High peak-to-average power ratio is one of the major drawbacks of orthogonal frequency division multiplexing (OFDM). Clipping is the simplest peak reduction scheme, however, it requires clipping mitigation at the receiver. Recently compressed sensing has been used for clipping mitigation (by exploiting the sparse nature of clipping signal). However, clipping estimation in multi-user scenario (i.e., OFDMA) is not straightforward as clipping distortions overlap in frequency domain and one cannot distinguish between distortions from different users. In this work, a collaborative clipping removal strategy is proposed based on joint estimation of the clipping distortions from all users. Further, an effective data aided channel estimation strategy for clipped OFDM is also outlined. Simulation results are presented to justify the effectiveness of the proposed schemes. © 2014 IEEE.

  4. Morel Receives 2005 Maurice Ewing Medal (United States)

    Schrag, Daniel P.; Morel, François M. M.


    François M. M. Morel received the Ewing Medal at the AGU Fall Meeting Honors Ceremony, which was held on 7 December 2005, in San Francisco, Calif. The medal is given for significant original contributions to the scientific understanding of the processes in the ocean; for the advancement of oceanographic engineering, technology, and instrumentation; and for outstanding service to marine sciences. François Morel has led the search to understand the role of metals in the ocean, starting with a focus on inorganic processes and aquatic chemistry, and leading to a blend of geochemistry, microbiology, biochemistry, and genetics. His influence comes from his research and from the way he has educated an entire community of scientists with his textbooks, with his teaching, and through his former students and postdocs who hold faculty positions at universities throughout the world.

  5. MRI in children receiving total parenteral nutrition

    Energy Technology Data Exchange (ETDEWEB)

    Quaghebeur, G. [Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG (United Kingdom)]|[Department of Paediatric Neuroradiology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH (United Kingdom); Taylor, W.J. [Department of Paediatric Neuroradiology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH (United Kingdom); Kingsley, D.P.E. [Department of Paediatric Neuroradiology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH (United Kingdom); Fell, J.M.E. [Department of Gastroenterology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH (United Kingdom); Reynolds, A.P. [Department of Chemical Pathology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH (United Kingdom); Milla, P.J. [Department of Gastroenterology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH (United Kingdom)


    Cranial MRI was obtained in 13 of a group of 57 children receiving long-term parenteral nutrition, who were being investigated for hypermanganasaemia. Increased signal intensity on T1-weighted images has been reported in adult patients on long-term parenteral nutrition and with encephalopathy following chronic manganese exposure in arc welding. It has been postulated that these changes are due to deposition of the paramagnetic trace element manganese. In excess manganese is hepato- and neurotoxic and we present the correlation of whole blood manganese levels with imaging findings. The age range of our patients was 6 months to 10 years, and the duration of therapy 3 months to 10 years. In 7 children we found characteristic increased signal intensity on T1-weighted images, with no abnormality on T2-weighted images. All patients had elevated whole blood manganese levels, suggesting that the basis for this abnormality is indeed deposition of manganese within the tissues. (orig.). With 3 figs.

  6. Humboldt SK pilot biodigester receives funding

    Energy Technology Data Exchange (ETDEWEB)



    The Canada-Saskatchewan Western Economic Partnership Agreement (WEPA) will provide funding for Canada's first pilot-scale biodigester to be built in Humboldt, Saskatchewan. The $208,138 pilot facility will use household garbage as well as agricultural waste such as manure and livestock operations, abattoirs and food processing to create heat or power and fertilizer. Support for this bio-energy facility, which could also reduce greenhouse gases, will come from the Prairie Agricultural Machinery Institute which has received $186,138 from Canada and Saskatchewan in the form of cost-shared federal-provincial funding. The pilot plant will test different combinations of waste material feedstocks and the characteristics of the resulting gas end products. The pilot facility will also provide design information for full-scale biodigester manufacturers in Canada. It is expected that 25 full-scale biodigesters will be constructed in Canada in the near future.

  7. Teleseismic receiver functions imaging of Siberia

    DEFF Research Database (Denmark)

    Soliman, Mohammad Youssof Ahmad; Thybo, Hans; Artemieva, Irina


    We map the lithosphere in Siberia by using the available broadband seismic data for calculation of Ps- and Sp-wave receiver functions (RF). RFs show converted waves from discontinuities in the vicinity of the seismic stations. The main objective is to image the Moho and upper mantle discontinuities......, including the lithosphere-asthenosphere boundary (LAB) beneath the study area. We construct the RF using the LQT method (Vinnik, 1977; Kind et al. 1995) in the version by Yuan et al. (1997). Rotation of ray coordinates uses the incidence angles predicted by the AK135 velocity model. This decomposes the wave...... by high-frequency S-RFs. Teleseismic converted Ps waves have higher frequency content (0.5–2 Hz) than Sp, which have an upper frequency of 0.1–0.2 Hz, and therefore Ps have about an order of magnitude better resolving power than Sp. The converted Sp-wave rarely resolve intracrustal structure, but can...

  8. The BINP receives its Golden Hadron award

    CERN Document Server


    On Thursday, 14 September, the LHC Project Leader, Lyn Evans, handed over a Golden Hadron award to Alexander Skrinsky of Russia's Budker Institute of Nuclear Physics (BINP). The prize is awarded in recognition of exceptional performances by suppliers and this year prizes were awarded to two firms, Cockerill-Sambre (Belgium) and Wah-Chang (United States), and to the Budker Institute, which was unable to receive the award at the same time as the two other recipients (see Bulletin No 34/2002, of 19 August 2002). The Russian institute has been rewarded for the particularly high-quality production of 360 dipole magnets and 185 quadrupole magnets for the LHC proton beam transfer lines.

  9. 18 CFR 367.1450 - Account 145, Notes receivable from associate companies. (United States)



  10. 47 CFR 25.131 - Filing requirements for receive-only earth stations. (United States)


    ... subject to restrictions as a result of international agreements or treaties. The Commission will maintain public information on the status of any such agreements. (h) Registration term: Registrations for receive... electronically through the International Bureau Filing System (IBFS) in accordance with the applicable provisions...

  11. Perturbation and Nonlinear Dynamic Analysis of Acoustic Phonatory Signal in Parkinsonian Patients Receiving Deep Brain Stimulation (United States)

    Lee, Victoria S.; Zhou, Xiao Ping; Rahn, Douglas A., III; Wang, Emily Q.; Jiang, Jack J.


    Nineteen PD patients who received deep brain stimulation (DBS), 10 non-surgical (control) PD patients, and 11 non-pathologic age- and gender-matched subjects performed sustained vowel phonations. The following acoustic measures were obtained on the sustained vowel phonations: correlation dimension (D[subscript 2]), percent jitter, percent shimmer,…

  12. Ototoxicity in children receiving cisplatin chemotherapy

    Directory of Open Access Journals (Sweden)

    Hee Jin Jang


    Full Text Available Purpose : Cisplatin is highly effective for the treatment of solid tumors in children. However, the clinical use of cisplatin is limited by its ototoxicity. The aim of this study was to evaluate the ototoxicity in children treated with cisplatin. Methods : We performed a single institution retrospective analysis of pediatric oncology patients who received cisplatin therapy between January 2001 and January 2008. Thirty-seven patients with sufficient medical and audiologic data were included in this study. Results : The median age at the time of diagnosis was 10.7 (range 3.8&#8211;16.7 years. There were 16 males and 21 females. The underlying diseases were osteosarcoma (15 cases, medulloblastoma (14 cases, germ cell tumors (7 cases, and hepatoblastoma (1 case. The median individual dose was 100 mg/m2/cycle (56-200. The median cumulative dose was 480 mg/m2 (200-1,490. Sixteen patients (43% received cranial radiotherapy. Of the 37 patients, 17 developed hearing loss, leading to an overall incidence of 46%. Logistic regression showed that age at treatment (P=0.04 and cumulative dose of cisplatin (P=0.005 were the significant risk factors in predicting hearing loss in children treated with cisplatin. In all the patients who had hearing loss, there was neither improvement nor aggravation during the follow-up (3&#8211;68 months. Conclusion : The cumulative dose of cisplatin (&gt;500 mg/m2 and younger age at treatment (&lt;12 years were 2 most important risk factors for ototoxicity in patients treated with cisplatin. Serial audiometric evaluations are needed in the patients with risk factors during and after cisplatin treatment.


    Directory of Open Access Journals (Sweden)

    Piotr Stachowski


    Full Text Available This paper presents the functioning of a closed pond as a small storage reservoir in the urban catchment area located in the Wilda district of Poznań. It presents the natural, hydro-geological and urban conditions and the factors conditioning the water level in the pond. Particular attention was focused upon on the pond as a rainwater receiver. The total catchment area and partial catchment area were determined. The inflow of water into the pond, with varying degrees of probability of occurrence, was calculated based on metrological data. The example of a pond in the John Paul II Park shows that this reservoir may be effectively used as rainwater receiver, without underestimating their other functions. They contribute to the increase of the underground water resources, increase the attractiveness of the recreational area and provide a natural value. However, the continuous urbanization, sealing the soil surface and the occurrence of extreme weather conditions necessitate a comprehensive look at the management of rainwater in urban areas. Calculations showed that the largest inflow of rain water occurs after a day’s rain with the probability p = 100%, and would amount to 3365 m3, and the water level in the pond would rise by only 0.25 m to a capacity of about 7000 m3. This represents 57% of the total capacity of the pond. If such an increase in the water level had occurred during the period of high water levels in the pond, it could not have damaging consequences of flooding. Only the occurrence of a day’s rain with the probability p = 10%, and capacity around 4700 m3, would completely fill the pond. Such a situation can be avoided by recultivation and desilting the bottom of the pond, where the slime collects with a capacity of 1300 m3.

  14. Ribcage compressibility in living subjects. (United States)

    Lee, M; Hill, S; Scullin, J


    The purpose of this study was to examine the responses of normal living subjects to the application of anteroposterior forces to the ribcage. Seventeen subjects aged between 25 and 37 years were tested during slow oscillatory loading while breath-holding at the end of a normal expiration. The mean stiffness coefficient was found to be 9.4 N mm(-1) (SD 2.9) and the mean gradient of the force-strain relation was 1888 N (SD 646). Comparison with previously published cadaver data indicates that the embalmed cadaver ribcage stiffness is in the order of three times stiffer than living subjects, while fresh cadavers showed comparable stiffness to living subjects. A number of studies have used models to predict and understand the behaviour of the thoracic spine. Validation of the behaviour of models which include the thoracic spine and ribcage depends on comparison of model response predictions with observed responses of human subjects. The present study provides data on the anteroposterior compressibility of the ribcage of living subjects which may be suitable for use in model validation studies. Copyright © 1994. Published by Elsevier Ltd.

  15. Preverbal subjects in null subject languages are not necessarily dislocated

    Directory of Open Access Journals (Sweden)

    João Costa


    Full Text Available In recent work on null subject languages it has been claimed that preverbal subjects are always (clitic-left dislocated. In this paper, we argue against this claim, on the grounds of empirical evidence from European Portuguese concerning agreement facts, asymmetries between preverbal subjects and clitic-left dislocated XPs with respect to minimality effects, the existence of languages with a mixed system (null expletive subjects and full referential ones, language acquisition data, the behavior of negative QPs and interpretation facts, and propose a non-uniform analysis of preverbal subjects and clitic-left dislocated XPs that derives their topic interpretation from a predication rule stated configurationally (section 2. Our account of the SVO and VSO orders displayed in European Portuguese relies on a specific formulation of the EPP parameter, on the locality constraint Attract Closest X and on the independently motivated claim that V-movement targets T in European Portuguese (section 3. Under our analysis, the computational system generates equally economical SVO and VSO derivations and discourse considerations, at the appropriate interface, rule out the unfelicitous ones.

  16. Full-wave receiver architecture for the homodyne motion sensor (United States)

    Haugen, Peter C; Dallum, Gregory E; Welsh, Patrick A; Romero, Carlos E


    A homodyne motion sensor or detector based on ultra-wideband radar utilizes the entire received waveform through implementation of a voltage boosting receiver. The receiver includes a receiver input and a receiver output. A first diode is connected to the receiver output. A first charge storage capacitor is connected from between the first diode and the receiver output to ground. A second charge storage capacitor is connected between the receiver input and the first diode. A second diode is connected from between the second charge storage capacitor and the first diode to ground. The dual diode receiver performs voltage boosting of a RF signal received at the receiver input, thereby enhancing receiver sensitivity.

  17. Acquisition of mutans streptococci and caries prevalence in pediatric sickle cell anemia patients receiving long-term antibiotic therapy. (United States)

    Fukuda, James T; Sonis, Andrew L; Platt, Orah S; Kurth, Susan


    The purpose of this study was to: (1) evaluate the prevalence of mutans streptococci (MS) and dental caries in sickle cell anemia (SCA) patients receiving long-term prophylactic penicillin therapy; and (2) determine changes in MS colonization and dental caries upon discontinuing the antibiotic. Sixty subjects with SCA and 60 age- and race-matched control subjects participated in this study. The SCA subjects were divided into 2 separate age groups: (1) group 1 subjects were under 6 years of age and received penicillin twice a day; and (2) group 2 subjects were 6 to 12 years old and received no daily prophylactic antibiotics, although up to age 6 they had received daily penicillin before it was discontinued. DMFS/dmfs scores for all subjects were obtained through a comprehensive dental examination including bitewing radiographs. Stimulated salivary samples to assess MS levels were obtained on all subjects. Data on medical, dental, fluoride, and dietary history were obtained on all patients through a written parental questionnaire. No group 1 patients had positive cultures for MS. In contrast, 70% of marched controls cultured positively for MS (Pinterproximal lesions compared to 47% of control subjects having these lesions (Pcaries prevalence or surfaces involved. These findings demonstrate that long-term penicillin prophylaxis in SCA patients likely prevents the acquisition of MS, resulting in significantly lower caries rates in these patients. This benefit occurs only during active administration of the drug, however, and only delays the acquisition of MS.

  18. Phase Noise Tolerant QPSK Receiver Using Phase Sensitive Wavelength Conversion

    DEFF Research Database (Denmark)

    Da Ros, Francesco; Xu, Jing; Lei, Lei


    A novel QPSK receiver based on a phase noise reduction pre-stage exploiting PSA in a HNLF and balanced detection is presented. Receiver sensitivity improvement over a conventional balanced receiver is demonstrated.......A novel QPSK receiver based on a phase noise reduction pre-stage exploiting PSA in a HNLF and balanced detection is presented. Receiver sensitivity improvement over a conventional balanced receiver is demonstrated....

  19. Comparative gut microbiota and resistome profiling of intensive care patients receiving selective digestive tract decontamination and healthy subjects

    NARCIS (Netherlands)

    Buelow, Elena; Bello González, Teresita D J; Fuentes, Susana; de Steenhuijsen Piters, Wouter A A; Lahti, Leo; Bayjanov, Jumamurat R; Majoor, Eline A M; Braat, Johanna C; van Mourik, Maaike S M; Oostdijk, Evelien A N; Willems, Rob J L; Bonten, Marc J M; van Passel, Mark W J; Smidt, Hauke; van Schaik, Willem


    BACKGROUND: The gut microbiota is a reservoir of opportunistic pathogens that can cause life-threatening infections in critically ill patients during their stay in an intensive care unit (ICU). To suppress gut colonization with opportunistic pathogens, a prophylactic antibiotic regimen, termed

  20. Pharmacokinetics of Loratadine in Pediatric Subjects. (United States)

    Lin, Chin-Chung; Radwanski, Elaine; Affrime, Melton; Cayen, Mitchell


    The pharmacokinetics of loratadine, a new nonsedating antihistamine, was studied in 14 pediatric volunteers between the ages of 8 to 12 years. In an open-label design, one volunteer (with body weight less than 30 kg) received 5 mg of loratadine syrup and 13 volunteers (with body weights greater than 30 kg) received 10 mg of loratadine syrup. Blood samples were collected up to 72 h after dosing. Plasma concentrations of loratadine and its metabolite, descarboethoxyloratadine, were determined by a specific and sensitive gas-liquid chromatographic method. Following a 10-mg dose as a syrup, plasma concentrations of loratadine and descarboethoxyloratadine could be determined up to 8 and 48 h, respectively. The maximum concentration (C(max)) of loratadine and descarboethoxyloratadine were approximately 4 ng ml(minus sign1) each. However, the AUC of the metabolite was about six times that of loratadine. The elimination phase half-life of descarboethoxyloratadine averaged about 13.8 hr. The pharmacokinetics of loratadine in pediatric subjects was similar to that in healthy adult volunteers.

  1. No differences in subjective knee function between surgical techniques of anterior cruciate ligament reconstruction at 2-year follow-up: a cohort study from the Swedish National Knee Ligament Register. (United States)

    Hamrin Senorski, Eric; Sundemo, David; Murawski, Christopher D; Alentorn-Geli, Eduard; Musahl, Volker; Fu, Freddie; Desai, Neel; Stålman, Anders; Samuelsson, Kristian


    The purpose of this study was to investigate how different techniques of single-bundle anterior cruciate ligament (ACL) reconstruction affect subjective knee function via the Knee injury and Osteoarthritis Outcome Score (KOOS) evaluation 2 years after surgery. It was hypothesized that the surgical techniques of single-bundle ACL reconstruction would result in equivalent results with respect to subjective knee function 2 years after surgery. This cohort study was based on data from the Swedish National Knee Ligament Register during the 10-year period of 1 January 2005 through 31 December 2014. Patients who underwent primary single-bundle ACL reconstruction with hamstrings tendon autograft were included. Details on surgical technique were collected using a web-based questionnaire comprised of essential AARSC items, including utilization of accessory medial portal drilling, anatomic tunnel placement, and visualization of insertion sites and landmarks. A repeated measures ANOVA and an additional linear mixed model analysis were used to investigate the effect of surgical technique on the KOOS4 from the pre-operative period to 2-year follow-up. A total of 13,636 patients who had undergone single-bundle ACL reconstruction comprised the study group for this analysis. A repeated measures ANOVA determined that mean subjective knee function differed between the pre-operative time period and at 2-year follow-up (p technique or gender. Additionally, the linear mixed model adjusted for age at reconstruction, gender, and concomitant injuries showed no difference between surgical techniques in KOOS4 improvement from baseline to 2-year follow-up. However, KOOS4 improved significantly in patients for all surgical techniques of single-bundle ACL reconstruction (p techniques of primary single-bundle ACL reconstruction did not demonstrate differences in the improvement in baseline subjective knee function as measured with the KOOS4 during the first 2 years after surgery. However

  2. Subjectivity and severe psychiatric disorders. (United States)

    Strauss, John


    To have a complete human science in the mental health field it is essential to give adequate attention to both the objective and the subjective data related to people with psychiatric disorders. The tendency in the past has been to ignore or discount one or the other of these data sources. Subjective data are particularly neglected, sometimes considered (only) part of the "art" of medicine since the usual methodologies of the physical sciences in themselves are not adequate to reflect the nature, elusiveness, and complexity of human subjective experience. The complete experience of hallucinated voices, for instance, often includes not only the voices themselves but also terrible anguish and terrifying inability to concentrate. But even such descriptors fall unnecessarily short of reflecting the data of the experience, thus leaving research, theory, and treatment with incomplete information. To represent adequately the subjective data it is essential to recognize that besides the usual discursive knowledge and methods of traditional physical science, a second kind of knowledge and method is required to reflect the depth of human experience. To accomplish this, we must employ approaches to narrative and the arts that are uniquely capable of capturing the nature of these experiences. Only by attending seriously in our research, training, theory, and practice to the unique nature of subjective data is it possible to have a true human science for our field.

  3. [Reproducibility of subjective refraction measurement]. (United States)

    Grein, H-J; Schmidt, O; Ritsche, A


    Reproducibility of subjective refraction measurement is limited by various factors. The main factors affecting reproducibility include the characteristics of the measurement method and of the subject and the examiner. This article presents the results of a study on this topic, focusing on the reproducibility of subjective refraction measurement in healthy eyes. The results of previous studies are not all presented in the same way by the respective authors and cannot be fully standardized without consulting the original scientific data. To the extent that they are comparable, the results of our study largely correspond largely with those of previous investigations: During repeated subjective refraction measurement, 95% of the deviation from the mean value was approximately ±0.2 D to ±0.65 D for the spherical equivalent and cylindrical power. The reproducibility of subjective refraction measurement in healthy eyes is limited, even under ideal conditions. Correct assessment of refraction results is only feasible after identifying individual variability. Several measurements are required. Refraction cannot be measured without a tolerance range. The English full-text version of this article is available at SpringerLink (under supplemental).

  4. subjective approach to subjective approach to human physiological

    African Journals Online (AJOL)


    This study was based on the subjective responses of the masons that are performing physical activity of blocklaying in the outdoor condition in outdoor condition in outdoor condition in Ogun State Nigeria. A total of 204 masons were investigated on the average of seventeen. Ogun State Nigeria. A total of 204 masons were ...

  5. Subject to Form: Research Interviews, Performative Subjectivity, Professional Development (United States)

    Sarigianides, Sophia Tatiana


    In this dissertation, I analyze teacher, literacy coach and researcher subjectivities in a five-year study of on-site professional development with middle-grade Language Arts teachers in a school designated by its district and state as severely underperforming. Interested in the role of research interviews as both research method and cultural…

  6. Subjective quality of life and emotional pain among subjects with ...

    African Journals Online (AJOL)

    Objective: Heart failure (HF) is a common pathology worldwide. Associated emotional pain is an important risk factor of increased morbidity and secondary psychopathology. Methods: Subjects in stable state of HF attending the cardiology clinic of Lagos University Teaching Hospital (LUTH) were recruited into the study.

  7. Social Interactions Receive Priority to Conscious Perception. (United States)

    Su, Junzhu; van Boxtel, Jeroen J A; Lu, Hongjing


    Humans are social animals, constantly engaged with other people. The importance of social thought and action is hard to overstate. However, is social information so important that it actually determines which stimuli are promoted to conscious experience and which stimuli are suppressed as invisible? To address this question, we used a binocular rivalry paradigm, in which the two eyes receive different action stimuli. In two experiments we measured the conscious percept of rival actions and found that actions engaged in social interactions are granted preferential access to visual awareness over non-interactive actions. Lastly, an attentional task that presumably engaged the mentalizing system enhanced the priority assigned to social interactions in reaching conscious perception. We also found a positive correlation between human identification of interactive activity and the promotion of socially-relevant information to visual awareness. The present findings suggest that the visual system amplifies socially-relevant sensory information and actively promotes it to consciousness, thereby facilitating inferences about social interactions.

  8. Neufeld Receives 2009 Donald L. Turcotte Award (United States)


    Jerome Neufeld has been awarded the Donald L. Turcotte Award, given annually to recent Ph.D. recipients for outstanding dissertation research that contributes directly to the field of nonlinear geophysics. Neufeld's thesis is entitled “Solidification in the fast lane: Flow-induced morphological instability in geological systems.” He was formally presented with the award at the Nonlinear Geophysics Focus Group reception during the 2009 AGU Fall Meeting, held 14-18 December in San Francisco, Calif. Jerome received his B.A.S. in engineering science from the University of Toronto in 2001, and a Ph.D. in geophysics from Yale University in 2008, under the supervision of J. S. Wettlaufer, on the impact of oceanic currents on the formation of sea ice. He is currently a fellow at the Institute of Theoretical Geophysics, University of Cambridge, working on the fluid dynamics of geophysical systems including carbon dioxide sequestration, the influence of flow on the crystal structure of mushy layers, and the evolution of icicles.

  9. CERN safety expert receives international award

    CERN Multimedia


    On 18 December 2004, the President of the Swiss Electro-technical Committee, Martin Reichle (left), presented the award to Helmut Schönbacher. Helmut Schönbacher, of the Safety Commission at CERN, has received, the "1906 Award" of the International Electrotechnical Commission (IEC) for his standardisation work on the influence of ionizing radiation on insulating materials. From 1986 until 2004, Schönbacher was leader of a working group on radiation composed of internationally recognised experts. It edited standards of the IEC 60544 series on the determination of the effects of ionizing radiation on electrical insulating materials. The working group also edited three IEC Technical Reports on the determination of long-term radiation ageing in polymers. This standardisation work and long-term experience from CERN on the radiation ageing of materials also contributed to research coordination programmes of the International Atomic Energy Agency (IAEA). From 1968 until 1988, Schönbacher was a member of the Rad...

  10. Crustal Structure beneath Mexico from Receiver Functions (United States)

    Espindola, V.; Quintanar, L.; Espindola, J.


    The Servicio Sismológico Nacional (SSN) is Mexico's official organism in charge of the observation of seismicity in the country. Operated by the Universidad Nacional Autonoma de Mexico, it counts with 32 broadband stations deployed throughout the country. The coverage includes most of the geologic provinces of the territory, which vary widely in their geologic characteristics. The availability of records from teleseisms at those stations makes feasible to obtain sound and homogeneous estimates of the structure of the crust in the Mexican territory through the analysis of receiver functions (RF). In this work we present the results of the analysis of RF obtained from events registered from 1998 to 2009 in the 32 stations of the SSN. The RF technique, which uses converted phases at major velocity discontinuities, is a well established technique to infer the velocity contrasts and thickness of the underlying crust. Using this method we were able to infer the depth of the Moho, a major intracrustal discontinuity and in some cases the depth to the base of the subducting plate. We present maps of crustal thickness in Mexico, which varies between about 29 km in the Yucatan peninsula to more than 40 km in central Mexico. Poisson's coefficient varies between 0.19 and 0.30. The position of the descending slab shows a large variation in the subduction angle (from about 6° in the SE margin of the Pacific coast to about 60° in the NW ) as has been found from other techniques.

  11. Infant position in neonates receiving mechanical ventilation. (United States)

    Rivas-Fernandez, May; Roqué I Figuls, Marta; Diez-Izquierdo, Ana; Escribano, Joaquin; Balaguer, Albert


    In patients of various ages undergoing mechanical ventilation (MV), it has been observed that positions other than the standard supine position, such as the prone position, may improve respiratory parameters. The benefits of these positions have not been clearly defined for critically ill newborns receiving MV.This is an update of a review first published in 2005 and last updated in 2013. Primary objectiveTo assess the effects of different positioning of newborn infants receiving MV (supine vs prone, lateral decubitus or quarter turn from prone) in improving short-term respiratory outcomes. Secondary objectiveTo assess the effects of different positioning of newborn infants receiving MV on mortality and neuromotor and developmental outcomes over the long term, and on other complications of prematurity. We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8), MEDLINE via PubMed (1966 to 22 August 2016), Embase (1980 to 22 August 2016) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 22 August 2016). We also searched clinical trials databases, conference proceedings and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. Randomised and quasi-randomised clinical trials comparing different positions in newborns receiving mechanical ventilation. Three unblinded review authors independently assessed trials for inclusion in the review and extracted study data. We used standard methodological procedures as expected by The Cochrane Collaboration and assessed the quality of the evidence using the GRADE approach. If the meta-analysis was not appropriate owing to substantial clinical heterogeneity between trials, we presented review findings in narrative format. We included in this review 19 trials involving 516 participants. Seven of the included studies (N = 222) had not been evaluated in the

  12. [Travel Preparations for Patients Receiving Peritoneal Dialysis]. (United States)

    Lu, Shu-Chi; Lin, Wen-Chuan


    People who receive peritoneal dialysis (PD) have more freedom than those who are on hemodialysis. However, some PD patients have difficulty adapting to their new environment and thus remain largely homebound. When they work or travel abord, who cannot rely wholly on others, these patients must handle certain life problems alone. It is essential for nursing staff to help PD patients to prepare for overcoming typical inconveniences, improving quality of life, and handling unfamiliar environments. The present study assists patients to arrange domestic and foreign tourism and to participate in various activities. The intervention teaches the pre-assessment of tourism, the assessment and selection of the sterile environment for exchange, the arrangements for dialysate, planning for handling complications, the travel matters attention, and other tourist information using group or individual instruction. It is expected that patients with peritoneal dialysis will be more willing to leave their houses and be better prepared to travel, which should lead to their having more fun and to their greater enjoyment of life.

  13. Patrick Janot receives the CNRS silver medal

    CERN Multimedia


    Patrick Janot during the award ceremony. (Photo Schwemling, Paris) On 25 November, Patrick Janot of the CERN Physics Department received the CNRS silver medal for IN2P3 (Institut national de physique nucléaire et de physique des particules). This prize, one of the most prestigious awarded by the French research centre, is given to scientists for the 'originality, quality and importance of their work, as recognised both nationally and internationally'. Patrick Janot joined the ALEPH collaboration, one of the four experiments at LEP, then under construction, in 1987. First a CERN Fellow, he went on to work for the CNRS at LAL in 1989. Together with his team, he developed innovative algorithms for the reconstruction of events. This work and others earned him the bronze CNRS medal in 1993, which is awarded to scientists for their first achievements. In 1997, he became a permanent physicist at CERN, where he continued to work for ALEPH. He was appointed LEP scientific co-ordinator for the last two years of the ac...

  14. CERN Web Pages Receive a Makeover

    CERN Multimedia


    Asudden allergic reaction to the colour turquoise? Never fear, from Monday 2 April you'll be able to click in the pink box at the top of the CERN users' welcome page to go to the all-new welcome page, which is simpler and better organized. CERN's new-look intranet is the first step in a complete Web-makeover being applied by the Web Public Education (WPE) group of ETT Division. The transition will be progressive, to allow users to familiarize themselves with the new pages. Until 17 April, CERN users will still get the familiar turquoise welcome page by default, with the new pages operating in parallel. From then on, the default will switch to the new pages, with the old ones being finally switched off on 25 May. Some 400 pages have received the makeover treatment. For more information about the changes to your Web, take a look at: Happy surfing!

  15. Psychoanalysis And Politics: Historicising Subjectivity (United States)

    Layton, Lynne


    In this paper, I compare three different views of the relation between subjectivity and modernity: one proposed by Elisabeth Young-Bruehl, a second by theorists of institutionalised individualisation, and a third by writers in the Foucaultian tradition of studies of the history of governmentalities. The theorists were chosen because they represent very different understandings of the relation between contemporary history and subjectivity. My purpose is to ground psychoanalytic theory about what humans need in history and so to question what it means to talk ahistorically about what humans need in order to thrive psychologically. Only in so doing can one assess the relation between psychoanalysis and progressive politics. I conclude that while psychoanalysis is a discourse of its time, it can also function as a counter-discourse and can help us understand the effects on subjectivity of a more than thirty year history in the West of repudiating dependency needs and denying interdependence. PMID:23678239

  16. Energy data base: subject thesaurus

    Energy Technology Data Exchange (ETDEWEB)

    Redford, J.S. (ed.)


    The technical staff of the DOE Technical Information Center, during its subject indexing activities, develops and structures a vocabulary that allows consistent machine storage and retrieval of information necessary to the accomplishment of the DOE mission. This thesaurus incorporates that structured vocabulary. The terminology of this thesaurus is used for the subject control of information announced in DOE Energy Research Abstracts, Energy Abstracts for Policy Analysis, and various update journals and bulletins in specialized areas. This terminology also facilitates subject searching of the DOE Energy Data Base on the DOE/RECON on-line retrieval system and on other commercial retrieval systems. The rapid expansion of the DOE's activities will result in a commitant thesaurus expansion as information relating to new activities is indexed. Only the terms used in the indexing of documents at the Technical Information Center to date are included. (JSR)

  17. [Lung cancer in the elderly subject]. (United States)

    Albrand, G; Biron, E; Boucot, I; Couderc, L J; Crestani, B; Dombret, M C; Guenard, H; Grivaux, M; Hervy, M P; Housset, B; Jougon, J; Orvoen-Frija, E; Piette, F; Pignon, T; Pinganaud, G; Puisieux, F; Quoix, E; Sauty, E; Vaylet, F; Wary, B; Weill-Engerer, S; Westeel, V; Wislez, M


    In France, the average age for the diagnosis of bronchial carcinoma is 64. It is 76 in the population of over 70. In fact, its incidence increases with age linked intrinsic risk of developing a cancer and with general ageing of the population. Diagnosis tools are the same for elderlies than for younger patients, and positive diagnosis mainly depends on fibreoptic bronchoscopy, complications of which being comparable to those observed in younger patients. The assessment of dissemination has been modified in recent years by the availability of PET scanning which is increasingly becoming the examination of choice for preventing unnecessary surgical intervention, a fortiori in elderly subjects. Cerebral imaging by tomodensitometry and nuclear magnetic resonance should systematically be obtained before proposing chirurgical treatment. An assessment of the general state of health of the elderly subject is an essential step before the therapeutic decision is made. This depends on the concept of geriatric evaluation: Geriatric Multidimensional Assessment, and the Comprehensive Geriatric Assessment which concerns overall competence of the elderly. This is a global approach that allows precise definition and ranking of the patient's problems and their impact on daily life and social environment. Certain geriatric variables (IADL, BADL, MMSE, IMC etc) may be predictive of survival rates after chemotherapy or the incidence of complications following thoracic surgery. The main therapeutic principles for the management of bronchial carcinoma are applicable to the elderly subject; long term survival without relapse after surgical resection is independent of age. Whether the oncological strategy is curative or palliative, the elderly patient with bronchial carcinoma should receive supportive treatments. They should be integrated into a palliative programme if such is the case. In fact, age alone is not a factor that should detract from optimal oncological management. The

  18. Diffuse exanthema in a patient receiving varenicline. (United States)

    Song, Wei; Miller, William A


    A diffuse exanthema in a patient receiving varenicline is reported. A 71-year-old white woman, who was initially admitted to the hospital for elective vascular bypass surgery, had a three-day history of a diffuse rash, severe itching, and moderate headache. Her symptoms started two days before her admission. She denied having a fever, chills, nausea, vomiting, diarrhea, and flulike symptoms. She also denied having had contact with anyone who was ill, tick or insect bites, exposure to cats, or any changes in her diet, habits, or personal hygiene. Her medical problems included peripheral vascular disease, chronic obstructive pulmonary disease (COPD), dyslipidemia, hypertension, and hypothyroidism. In addition to several medications she had been taking for over 2 years, she had been taking varenicline as an aid for smoking cessation for eight days. The patient had been smoking for 40 years. The bright-red rash covered 70% of her torso and four extremities. She had mild swelling in her cheeks, but not on the eyelids or lips. Both of her lungs were clear on auscultation, with distant breath sounds caused by her COPD. Varenicline was discontinued, and her symptoms had completely resolved by the eighth day following discontinuation of the medication. While it is possible that other medications caused her symptoms, she had been taking most of them for over 2 years and all of them for over 1 year. Also, continuation of these drugs did not prevent her symptoms from resolving, nor did it cause a recurrence of the skin reaction. A patient developed diffuse exanthema after being treated with varenicline.

  19. 47 CFR 15.117 - TV broadcast receivers. (United States)


    ... portion of a TV broadcast receiver, tuning aids of the same type and comparable capability and quality... 47 Telecommunication 1 2010-10-01 2010-10-01 false TV broadcast receivers. 15.117 Section 15.117... TV broadcast receivers. (a) All TV broadcast receivers shipped in interstate commerce or imported...

  20. Youth Homelessness and Individualised Subjectivity (United States)

    Farrugia, David


    This article aims to contribute to understandings of youth homelessness and subjectivity by analysing identity construction in terms of young people's negotiation of the structural and institutional environment of youth homelessness. I suggest that while existing literature on this topic concentrates mainly on micro-social encounters, the…