DIGESTIVE ENDOSCOPY, Issue 4 2006
Tsuyoshi Abe
Stent placement for the palliation of unresectable colon cancer is an alternative to surgical treatment that has recently become popular. A dedicated stent for colorectal cancer is not available in Japan. We report a patient with two colonic obstructions who underwent a successful palliative treatment using two stents. He was admitted to Toho University Ohashi Medical Center because of ileus. A colonoscopy revealed two advanced lesions with stenosis in the sigmoid and transverse colon. Because he had multiple liver metastases and severe Alzheimer dementia, we selected palliative stent placement for the treatment of both strictures. We placed a covered stent in the sigmoid colon stricture and subsequently attempted to place a second stent in the transverse colon stricture. However, the second stent could not be placed in the transverse colon because the modified delivery system could not pass through the first stent in the sigmoid colon. This probably led to a twisting of the stent in the sigmoid colon. We next used the 24 F introducer sheath that is included in Keller-Timmermans Introducer Sets. This strategy allowed the modified delivery system to be easily passed through the initial stent in the sigmoid colon and then advanced into the transverse colon stricture, enabling both stents to be positioned properly. [source]

REDUCING THE RISK OF PERISTOMAL INFECTION AFTER PEG PLACEMENT

DIGESTIVE ENDOSCOPY, Issue 4 2005
Iruru Maetani
Percutaneous endoscopic gastrostomy (PEG) was first described in 1980 as an effective means of enteral nutrition where oral intake is not possible. PEG placement is safe and has now replaced the nasogastric tube in patients who need long-term feeding. Although it is relatively safe with a very low associated mortality, minor complications, especially local and systemic infection, remain a problem. Of these, peristomal wound infections are the most common complication of PEG. In patients indicated for this procedure who are aged and/or frail, this complication may pose a critical problem. In the commonly used pull or push methods for PEG placement, the PEG tube is readily colonized by oropharyngeal bacteria. Infection of the PEG site is considered to be associated with contamination of the PEG catheter. There are important measures that should be taken to prevent peristomal infection. A number of rigorous studies have shown that prophylactic antibiotics are effective in reducing the risk of peristomal infection. As methicillin-resistant Staphylococcus aureus (MRSA) or other resistant organisms are emerging as a major pathogen in peristomal infection, however, currently recommended antibiotic prophylaxis regimens might be inappropriate. Alternative regimens and other approaches to prevent contamination of the PEG tube during the procedure are required. [source]

PHYLOGENETIC PLACEMENT OF AN UNUSUAL CORAL MUSHROOM CHALLENGES THE CLASSIC HYPOTHESIS OF STRICT COEVOLUTION IN THE APTEROSTIGMA PILOSUM GROUP ANT,FUNGUS MUTUALISM

EVOLUTION, Issue 8 2009
Bryn T. M. Dentinger
The ,50 million-year-old fungus-farming ant mutualism is a classic example of coevolution, involving ants that subsist on asexual, fungal biomass, in turn propagating the fungus clonally through nest-to-nest transmission. Most mutualistic ants cultivate two closely related groups of gilled mushrooms, whereas one small group of ants in the genus Apterostigma cultivates a distantly related lineage comprised of the G2 and G4 groups. The G2 and G4 fungi were previously shown to form a monophyletic group sister to the thread-like coral mushroom family Pterulaceae. Here, we identify an enigmatic coral mushroom that produces both fertile and sterile fruiting structures as the closest free-living relative of the G4 fungi, challenging the monophyly of the Apterostigma -cultivated fungi for the first time. Both nonparametric bootstrap and Bayesian posterior probability support the node leading to the G4 cultivars and a free-living Pterula mushroom. These data suggest three scenarios that contradict the hypothesis of strict coevolution: (1) multiple domestications, (2) escape from domestication, (3) selection of single cultivar lineages from an ancestral mixed-fungus garden. These results illustrate how incomplete phylogenies for coevolved symbionts impede our understanding of the patterns and processes of coevolution. [source]

NEW BASES FOR PERCUTANEOUS CAVAL FILTER PLACEMENT ON SITE IN GERIATRIC INSTITUTION IN PATIENTS AGED 75 AND OLDER

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2005
Alain F. Le Blanche MD
No abstract is available for this article. [source]

PHYLOGENETIC PLACEMENT OF BOTRYOCOCCUS BRAUNII (TREBOUXIOPHYCEAE) AND BOTRYOCOCCUS SUDETICUS ISOLATE UTEX 2629 (CHLOROPHYCEAE),

JOURNAL OF PHYCOLOGY, Issue 2 2004
Hoda H. Senousy
The phylogenetic placement of four isolates of Botryococcus braunii Kützing and of Botryococcus sudeticus Lemmermann isolate UTEX 2629 was investigated using sequences of the nuclear small subunit (18S) rRNA gene. The B. braunii isolates represent the A (two isolates), B, and L chemical races. One isolate of B. braunii (CCAP 807/1; A race) has a group I intron at Escherichia coli position 1046 and isolate UTEX 2629 has group I introns at E. coli positions 516 and 1512. The rRNA sequences were aligned with 53 previously reported rRNA sequences from members of the Chlorophyta, including one reported for B. braunii (Berkeley strain). Phylogenetic trees were constructed using distance, weighted maximum parsimony, and maximum likelihood, and their reliability was estimated using bootstrap analysis for distance and parsimony and Bayesian inference for likelihood. All methods showed, with high bootstrap or credibility support, that the four isolates of B. braunii form a monophyletic group whose closest relatives are in the genus Choricystis in the Trebouxiophyceae, whereas the previously reported B. braunii sequence is from a member of the Chlamydomonadales in the Chlorophyceae and isolate UTEX 2629 is a member of the Sphaeropleales in the Chlorophyceae. Polyphyly of these sequences was confirmed by Kishino-Hasegawa tests on artificial trees in which sequences were moved to a single lineage. [source]

A MODEL FOR THE BIOECONOMIC EVALUATION OF MARINE PROTECTED AREA SIZE AND PLACEMENT IN THE NORTH SEA

NATURAL RESOURCE MODELING, Issue 4 2002
ALASDAIR BEATTIE
ABSTRACT. The use of marine protected areas (MPAs) as a basic management tool to limit exploitation rates in marine fisheries has been widely suggested. Models are important in predicting the consequences of management decisions and the design of monitoring programs in terms of policy goals. However, few tools are available that consider both multiple fleets and ecosystem scale dynamics. We use a new applied game theory tool, Ecoseed, that operates within a temporally and spatially explicit biomass dynamics model, Ecopath with Ecosim, to evaluate the efficacy of marine protected areas in the North Sea in both ecological and economic terms. The Ecoseed model builds MPAs based on the change in values of predicted economic rents of fisheries and the existence value of biomass pools in the ecosystem. We consider the market values of four fisheries operating in the North Sea: a trawl fishery, a gill net fishery, a seine fishery, and an industrial (reduction) fishery. We apply existence values, scaled such that their aggregate is similar to the total fishery value, to six biomass pools of concern: juvenile cod, haddock, whiting, saithe, seals, and the collective pool ,Other predators' that include marine mammals. Four policy options were considered: to maximize the rent only; to maximize the existence values only; to maximize the sum of the rent and existence values; and, finally, to maximize the sum of the rent and the existence values, but excluding only the trawl fleet from the MPA. The Ecoseed model suggests that policy goals that do not include ecological considerations can negatively impact the rents obtained by the different fishing sectors. The existence values will also be negatively impacted unless the MPA is very large. The Ecoseed model also suggests that policy goals based solely on existence values will negatively impact most fisheries. Under policy options that included ecological considerations, maximum benefits were derived from an MPA that covered 25,40% of the North Sea, placed along the southern and eastern coasts. Finally, the Ecoseed model suggests that an exclusion of the trawl fishery only from the MPA can provide small-to-substantial positive impacts to most species and fleets; this relative impact depends on level of interaction between the trawl fleet and the other fleets target species (e.g., through bycatch). [source]

Automatic Light Source Placement for Maximum Visual Information Recovery

COMPUTER GRAPHICS FORUM, Issue 2 2007
P.-P. Vázquez
Abstract The automatic selection of good viewing parameters is a very complex problem. In most cases, the notion of good strongly depends on the concrete application. Moreover, when an intuitive definition of good view is available, it is often difficult to establish a measure that brings it to the practice. Commonly, two kinds of viewing parameters must be set: camera parameters (position and orientation) and lighting parameters (number of light sources, its position and eventually the orientation of the spot). The first parameters will determine how much of the geometry can be captured and the latter will influence on how much of it is revealed (i.e., illuminated) to the user. Unfortunately, ensuring that certain parts of a scene are lit does not make sure that the details will be communicated to the user, as the amount of illumination might be too small or too high. In this paper we define a metric to calculate the amount of information relative to an object that is effectively communicated to the user given a fixed camera position. This measure is based on an information-based concept, the Shannon entropy, and will be applied to the problem of automatic selection of light positions in order to adequately illuminate an object. In order to validate the results, we have carried out an experiment on users, this experiment helped us to explore other related measures. [source]

Novel Surgical Technique: Placement of a Deep Tip Stitch

DERMATOLOGIC SURGERY, Issue 12 2009
JOANNA L. CHAN MD
No abstract is available for this article. [source]

Novel Face-Lift Suspension Suture and Inserting Instrument: Use of Large Anchors Knotted into a Suture with Attached Needle and Inserting Device Allowing for Single Entry Point Placement of Suspension Suture.

DERMATOLOGIC SURGERY, Issue 3 2006
Preliminary Report of 20 Cases with 6- to 12-Month Follow-Up
BACKGROUND Various suspension suture techniques exist to elevate the mid-face, jowls, and neck. OBJECTIVE To assess safety and efficacy of a new suspension suture and inserting instrument with both standard and minimal incision (no-skin-excision) face-lifts. METHODS A new type of multianchor suspension suture assembled from commercially available 2-0 absorbable monofilament material, with 5 to 9 equally spaced knots through which are secured 7 to 9 mm bits of 0 thickness similar suture material, and an attached straightened needle, was used to elevate and suspend facial tissues to temporal or mastoid fascia. The suspension sutures are placed in the deep subcutaneous tissues, just above the superficial musculo aponeurotic system (SMAS), by use of a novel, blunt instrument, which does not require a second, distal exit point. The suspension suture distal end floats free. The proximal needle end is sutured to fascia. The suture was used on 20 patients. Fourteen of them underwent pure, "no-skin-excision," suspension lifts. Six had suspension suture elevation of the mid-face in conjunction with relatively conservative open lifts. Nine- to 12-month results were evaluated. RESULTS With open face-lifts, 9- to 12-month results are excellent with significant persistence of the correction initially achieved. Resulting scars remained fine line. There were no complications. With pure suspension lifts, initial results were impressive. By 6 months, correction started to fade. By 12 months 100% of initial correction for jowls, and 80 to 100% for mid-face, appeared lost. Recovery time was 2 to 4 days. There were no significant complications. CONCLUSION Large multianchor, absorbable monofilament sutures can safely and effectively enhance results of conservative lifts, with remarkable elevation of the mid-face not achievable with simple SMAS flaps. These suspension sutures can easily and safely achieve impressive, though relatively short-term results, with a minimal incision, "no-skin-excision" technique. [source]

Antireflux stents for palliation of malignant esophagocardial stenosis

DISEASES OF THE ESOPHAGUS, Issue 2 2007
K. Schoppmeyer
SUMMARY., Placement of self-expanding metal stents (SEMS) for palliation of malignant stenoses at the gastroesophageal junction is often associated with stent migration and reflux symptoms. SEMS with an antireflux mechanism have been developed to overcome the latter problem. The aim of this study was to evaluate the safety and efficacy of antireflux Z-stents. Patients with advanced squamous cell or adenocarcinoma of the distal esophagus or cardia suffering from dysphagia received an antireflux Z-stent. Technical success, complications of the procedure, clinical symptoms before and after stent placement, reinterventions and survival were recorded. Follow-up was accomplished by patient interviews and a standardized questionnaire for primary care physicians. Eighteen consecutive patients received an antireflux Z-stent. Seventeen of 18 stents were placed technically successful in a single endoscopic procedure. Mean dysphagia score improved from 2.2 to 0.6. Four patients (22%) had permanent reflux symptoms, an additional nine (50%) were taking proton pump inhibitors on a regular basis. In 10 patients, a re-intervention was necessary mainly due to dislocation of the stent. To ensure adequate nutrition three and two patients received a percutaneous gastrostomy and a jejunostomy, respectively. Median survival from stent insertion was 54 days (range, 3,201). Although placement of an antireflux Z-stent is technically feasible, its application is hampered by frequent stent migration and insufficient prevention of gastroesophageal reflux. Further technical improvements of stents or alternative methods like brachytherapy are required for satisfactory palliation of malignant gastroesophageal stenosis. [source]

Echocardiographic Diagnosis of Air Embolism Associated with Central Venous Catheter Placement: Case Report and Review of the Literature

ECHOCARDIOGRAPHY, Issue 4 2006
Prasad Maddukuri M.D.
Transthoracic echocardiography (TTE) is a valuable tool in the evaluation of patients with suspected air embolism. This report describes the presentation and evaluation of a critically ill woman with spontaneous air embolism occurring during a central venous catheter replacement. Bedside TTE established the diagnosis of air embolism, allowing prompt initiation of appropriate therapy. This case report highlights this uncommon but potentially life-threatening complication of central line placement and the utility of echocardiography in its evaluation. [source]

Emergency Nurses' Utilization of Ultrasound Guidance for Placement of Peripheral Intravenous Lines in Difficult-access Patients

ACADEMIC EMERGENCY MEDICINE, Issue 12 2004
Larry Brannam MD
Objectives: Emergency nurses (ENs) typically place peripheral intravenous (IV) lines, but if repeated attempts fail, emergency physicians have to obtain peripheral or central access. The authors describe the patient population for which ultrasound (US)-guided peripheral IVs are used and evaluate the success rates for such lines by ENs. Methods: This was a prospective observational study of ENs in a Level I trauma center with a census of 75,000, performing US-guided IV line placement on difficult-to-stick patients (repeated blind IV placement failure or established history). ENs were trained on an inanimate model after a 45-minute lecture. Surveys were filled out after each US-guided IV attempt on a patient. ENs could decline to fill out surveys, which recorded the reason for use of US, type of patient, and success. Successful cannulation was confirmed by drawing blood and flushing fluids. Descriptive statistics were used to evaluated data. Results: A total of 321 surveys were collected in a five-month period no ENs declined to participate. There were 280 (87%) successful attempts. Twelve (29%) of the 41 failure patients required central lines, 9 (22%) received external jugular IVs, and 20 (49%) had peripheral IV access placed under US guidance by another nurse or physician. Twenty-eight percent (90) of all patients were obese, 18% (57) had sickle cell anemia, 10% (31) were renal dialysis patients, 12% (40) were IV drug abusers, and 19% (61) had unspecified chronic illness. The remainder had no reason for difficult access given. There were four arterial punctures. Conclusions: ENs had a high success rate and few complications with use of US guidance for vascular access in a variety of difficult-access patients. [source]

Heart Rate Response to Intravenous Catheter Placement

ACADEMIC EMERGENCY MEDICINE, Issue 9 2003
Joel M. Bartfield MD
Abstract Objective: To investigate the relationship between change in heart rate and pain and anxiety caused by intravenous catheter (IV) placement. Methods: An observational study was performed in a university-based tertiary care emergency department. Patients who required IV placement as part of their management were considered as possible subjects. Heart rates were recorded at the following times: baseline, tourniquet placement, and IV placement. Immediately after IV placement, subjects recorded pain and anxiety scores using 100-mm visual analog scales. Percentage change in heart rate (compared with baseline) was calculated at time of tourniquet placement (anxiety) and IV placement (pain). Simple linear regression analyses were performed comparing pain scores with percent change in heart rate at the time of IV and tourniquet placement. Significance was defined as p < 0.05. Results: Ninety subjects were enrolled. Subjects had a mean age of 48 years, and 54% were women. There was a normal distribution of heart rate changes, with greater than 80% of all subjects having a 10% or less change in heart rates. The results of the analysis of pain scores versus percentage change in heart rate at IV placement yielded a Pearson correlation coefficient of 0.13 (p = 0.2). The results of the analysis of anxiety scores versus percentage change in heart rate at tourniquet placement yielded a Pearson correlation coefficient of 0.014 (p = 0.9). Conclusions: Changes in heart rate do not correlate with pain and anxiety associated with IV placement. [source]

A direct main olfactory bulb projection to the ,vomeronasal' amygdala in female mice selectively responds to volatile pheromones from males

EUROPEAN JOURNAL OF NEUROSCIENCE, Issue 3 2009
Ningdong Kang
Abstract The main olfactory system, like the accessory olfactory system, responds to pheromones involved in social communication. Whereas pheromones detected by the accessory system are transmitted to the hypothalamus via the medial (,vomeronasal') amygdala, the pathway by which pheromones are detected and transmitted by the main system is not well understood. We examined in female mice whether a direct projection from mitral/tufted (M/T) cells in the main olfactory bulb (MOB) to the medial amygdala exists, and whether medial amygdala-projecting M/T cells are activated by volatile urinary odors from conspecifics or a predator (cat). Simultaneous anterograde tracing using Phaseolus vulgaris leucoagglutinin and Fluoro-Ruby placed in the MOB and accessory olfactory bulb (AOB), respectively, revealed that axons of MOB M/T cells projected to superficial laminae of layer Ia in anterior and posterodorsal subdivisions of the medial amygdala, whereas projection neurons from the AOB sent axons to non-overlapping, deeper layer Ia laminae of the same subdivisions. Placement of the retrograde tracer cholera toxin B into the medial amygdala labeled M/T cells that were concentrated in the ventral MOB. Urinary volatiles from male mice, but not from female conspecifics or cat, induced Fos in medial amygdala-projecting MOB M/T cells of female subjects, suggesting that information about male odors is transmitted directly from the MOB to the ,vomeronasal' amygdala. The presence of a direct MOB-to-medial amygdala pathway in mice and other mammals could enable volatile, opposite-sex pheromones to gain privileged access to diencephalic structures that control mate recognition and reproduction. [source]

Incidence of Deep Venous Thrombosis Associated with Femoral Venous Catheterization

ACADEMIC EMERGENCY MEDICINE, Issue 5 2000
Nabeela Z. Mian MD
ABSTRACT Objective: To determine in adult medical patients the incidence of deep venous thrombosis (DVT) resulting from femora] venous catheterization (FVC). Methods: A prospective, observational study was performed at a 420-bed community teaching hospital. Hep-arin-coated 7-Fr 20-cm femoral venous catheters were inserted unilaterally into a femoral vein. Each contra-lateral leg served as a control site. Age, gender, number of FVC days. DVT risk factors, administration of DVT prophylaxis, and DVT formation and site were tabulated for each patient. Venous duplex sonography was performed bilaterally on each patient within 7 days of femoral venous catheter removal. Results: Catheters were placed in 29 men and 13 women. Femoral DVT was identified by venous duplex sonography in 11 (26.2%) of the FVC legs and none (0%) in the control legs. Posterior tibial and popliteal DVT was identified in both the FVC and control legs of 1 patient. DVT formation at the site of FVC insertion was highly significant (p = 0.005). There were no statistically significant associations with age (p = 0.42), gender (p = 0.73), number of DVT risk factors (p = 0.17), number of FVC days (p = 0.89), or DVT prophylaxis (p , 099). Conclusion: Placement of femoral catheters for central venous access is associated with a significant incidence of femoral DVT as detected by venous duplex sonography criteria at the site of femoral venous catheter placement. Physicians must be aware of this risk when choosing this vascular access route for adult medical patients. Further studies to assess the relative risk for DVT and its clinical sequelae when using the femoral vs other central venous catheter routes are indicated. Key words: deep venous thrombosis; femoral vein; catheterization; pulmonary embolism. [source]

The response of manured forage maize to starter phosphorus fertilizer on chalkland soils in southern England

GRASS & FORAGE SCIENCE, Issue 2 2000
Withers
The impact of various starter phosphorus (P) fertilizers on the growth, nutrient uptake and dry-matter (DM) yield of forage maize (Zea mais) continuously cropped on the same area and receiving annual, pre-sowing, broadcast dressings of liquid and semi-solid dairy manures was investigated in two replicated plot experiments and in whole-field comparisons in the UK. In Experiment 1 on a shallow calcareous soil (27 mg l,1 Olsen-extractable P) in 1996, placement of starter P fertilizer (17 or 32 kg ha,1) did not benefit crop growth or significantly (P > 0·05) increase DM yield at harvest. However, in Experiment 2 on a deeper non-calcareous soil (41 mg l,1 Olsen-extractable P) in 1997, placement of starter P fertilizer (19 or 41 kg P ha,1), either applied alone or in combination with starter N fertilizer (10 or 25 kg N ha,1), significantly increased early crop growth (P < 0·01) and DM yield at harvest by 1·3 t ha,1 (P < 0·05) compared with a control without starter N or P fertilizer. Placement of starter N fertilizer alone did not benefit early crop growth, but gave similar yields as P, or N and P, fertilizer treatments at harvest. Large treatment differences in N and P uptake by mid-August had disappeared by harvest. In field comparisons over the 4-year period 1994,97, the addition of starter P fertilizer increased field cumulative surplus P by over 70%, but without significantly (P > 0·05) increasing DM yield, or nutrient (N and P) uptake, compared with fields that did not receive starter P fertilizer. The results emphasized the extremely low efficiency with which starter P fertilizers are utilized by forage maize and the need to budget manure and fertilizer P inputs more precisely in order to avoid excessive soil P accumulation and the consequent increased risk of P transfer to water causing eutrophication. [source]

The case against preoperative biliary drainage with pancreatic resection

HPB, Issue 6 2006
Rurik C. Johnson
The majority of patients with periampullary malignancies currently undergo biliary drainage before pancreaticoduodenectomy. Placement of an endoprosthesis reliably ameliorates jaundice and pruritus. However, preoperative biliary drainage leads to bile colonization and increases the risk of postoperative wound infection after pancreatic resection. Preoperative biliary drainage does not appear to lower postoperative morbidity or mortality following pancreatic resection and does not lower but probably increases costs associated with pancreatic resection. Preoperative biliary drainage is frequently used with little clinical benefit and its utilization should be limited to specific clinical indications, i.e. patients receiving neoadjuvant therapy, patients waiting several weeks or more for surgical evaluation and resection, patients with cholangitis. [source]

Centerline Placement and Alignment of Anisotropic Nanotubes in High Aspect Ratio Cylindrical Droplets of Nanometer Diameter

ADVANCED MATERIALS, Issue 1 2009
Richa Sharma
High aspect ratio cylindrical droplets of carbon-nanotube solutions present interesting hydrodynamic flow patterns during evaporation, where particles are aligned and positioned. The flow inside droplets with diameters <1000,nm positions all the nanotubes along the droplet centerline with 95% precision, while droplets with diameters >3µm align the nanotubes along the droplet edges during evaporation. [source]

Robust flat waves with a uniform feed using a randomized local search

INTERNATIONAL JOURNAL OF NUMERICAL MODELLING: ELECTRONIC NETWORKS, DEVICES AND FIELDS, Issue 4 2008
Brian Keller
Abstract Placement of radar emitters in non-uniformly spaced radar arrays typically involves optimizing the placement of a fixed number of emitter elements across the array. This paper explores optimizing for a flat wave under uniform feed where the number of emitter elements is not fixed. A randomized local search algorithm is used to generate an emitter design, and a greedy search is used to find the optimal solution in that neighborhood. This technique results in a near-field wave with less than 1 dB of amplitude ripple and less than 8 degrees of phase ripple across a width of 50,. The designs chosen are robust in the sense that solutions with neighboring pixels on are also of high quality. Furthermore, the proposed algorithm can also find array designs that generate flat waves that are not parallel to the emitter array. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Development of a Clinical Practice Guideline for Testing Nasogastric Tube Placement

JOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 1 2009
Sue Peter
PURPOSE.,A Perth metropolitan hospital group standardized changes to nasogastric tube placement, including removal of the "whoosh test" and litmus paper, and introduction of pH testing. DESIGN AND METHODS.,,Two audits were conducted: bedside data collection at a pediatric hospital and a point-prevalence audit across seven hospitals. RESULTS.,,Aspirate was obtained for 97% of all tests and pH was , 5.5 for 84%, validating the practice changes. However, patients on continuous feeds and/or receiving acid-inhibiting medications had multiple pH testing fails. PRACTICE IMPLICATIONS.,Nasogastric tube placement continues to present a challenge for those high-risk patients on continuous feeds and/or receiving acid-inhibiting medications. [source]

Art and the Power of Placement edited by newhouse, victoria

JOURNAL OF AESTHETICS AND ART CRITICISM, Issue 4 2006
LARRY SHINER
No abstract is available for this article. [source]

Predictors of Nursing Home Placement in African Americans with Dementia

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2004
Joseph E. Gaugler PhD
The objective of the present study was to identify predictors of institutionalization in African Americans who suffer from dementia. Data were derived from the Medicare Alzheimer's Disease Demonstration Evaluation (MADDE), which collected information on Alzheimer's patients and their family caregivers over a 3-year period. The baseline MADDE sample included 667 older African Americans suffering from dementia recruited from eight catchment areas in the United States. A Cox proportional hazards model was used to create a predictive model of institutionalization. Subsequent analyses found that care recipient age, sex, Medicaid eligibility, and cognitive impairment; site; and caregiving burden were significant predictors of time to placement. The results, among the first to examine predictors of nursing home placement of cognitively impaired African Americans, emphasize the clinical implications and complex interplay of race, dementia, and caregiving context in the institutionalization process. [source]

Effect of Establishing Guidelines on Appropriate Urinary Catheter Placement

ACADEMIC EMERGENCY MEDICINE, Issue 3 2010
Mohamad G. Fakih MD
Abstract Objectives:, Avoiding placement of unnecessary urinary catheters (UCs) in the emergency department (ED) affects UC utilization during hospitalization. The authors sought to evaluate the effect of establishing institutional guidelines for appropriate UC placement coupled with emergency physician (EP) education on UC utilization. Methods:, Urinary catheter utilization was measured before and after the establishment of guidelines and EP education. Data collected included the presence of a UC on ED arrival, placement of a UC in the ED, documentation of a physician order for UC placement, reasons for placement, and compliance with the guidelines. Chi-square analyses were used to study the association between pre- and postintervention time periods and catheter use. Results:, A total of 377 (15%) patients had UCs; only 151 (47%) UCs initially placed in the ED had a physician order documented. UC placement was appropriately indicated in 75.5% of patients with a documented physician order, but in only 52% of cases without a documented physician order (p < 0.001). The physician intervention was associated with an overall reduction in UC utilization from 16.4% to 13% (p = 0.018). Physicians ordered 40% fewer UCs postintervention compared to preintervention. Preintervention, a physician order for UC placement was found indicated in 72.6% patients, compared to 82.2% patients with UC placed postintervention (p = 0.21). Conclusions:, Establishing guidelines for UC placement and physician education in the ED were associated with a marked reduction in utilization. However, addressing appropriate UC utilization may require evaluating other factors such as nursing influence on utilization. ACADEMIC EMERGENCY MEDICINE 2010; 17:337,340 © 2010 by the Society for Academic Emergency Medicine [source]

Critical Role of Inferior Vena Caval Filter Placement After Pulmonary Embolectomy

JOURNAL OF CARDIAC SURGERY, Issue 3 2005
Peter Rosenberger M.D.
Postoperative placement of an inferior vena caval filter (IVCF) may prevent recurrent PE. We present a patient who underwent pulmonary embolectomy in whom postoperative placement of an IVCF was postponed due to hemodynamic instability and severe hemorrhage. Recurrent PE was recognized 12 hours after the initial surgery, and required reoperative pulmonary embolectomy. This report documents that recurrent PE can occur early after pulmonary embolectomy even in the presence of coagulopathy. Therefore, concurrent IVCF placement should be considered during or immediately after pulmonary embolectomy to prevent recurrent pulmonary embolism. [source]

Left Ventricular Endocardial Lead Placement Using a Modified Transseptal Approach

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2004
Ph.D., SEN JI M.D.
Coronary sinus cannulation and placement of left ventricular (LV) leads can be difficult. Occasionally alternative approaches are required. We report the first case of a modified transseptal LV endocardial lead placement via the left axillary vein for cardiac resynchronization. (J Cardiovasc Electrophysiol, Vol. 15, pp. 234-236, February 2004) [source]

Development of a test to evaluate residents' knowledge of medical procedures,,

JOURNAL OF HOSPITAL MEDICINE, Issue 7 2009
Shilpa Grover MD
Abstract BACKGROUND AND AIM: Knowledge of core medical procedures is required by the American Board of Internal Medicine (ABIM) for certification. Efforts to improve the training of residents in these procedures have been limited by the absence of a validated tool for the assessment of knowledge. In this study we aimed to develop a standardized test of procedural knowledge in 3 medical procedures associated with potentially serious complications. METHODS: Placement of an arterial line, central venous catheter, and thoracentesis were selected for test development. Learning objectives and multiple-choice questions were constructed for each topic. Content evidence was evaluated by critical care subspecialists. Item test characteristics were evaluated by administering the test to students, residents and specialty clinicians. Reliability of the 32-item instrument was established through its administration to 192 medical residents in 4 hospitals. RESULTS: Reliability of the instrument as measured by Cronbach's , was 0.79 and its test-retest reliability was 0.82. Median score was 53% on a test comprising elements deemed important by critical care subspecialists. Increasing number of procedures attempted, higher self-reported confidence, and increasing seniority were predictors of overall test scores. Procedural confidence correlated significantly with increasing seniority and experience. Residents performed few procedures. CONCLUSIONS: We have successfully developed a standardized instrument to assess residents' cognitive competency for 3 common procedures. Residents' overall knowledge about procedures is poor. Experiential learning is the dominant source for knowledge improvement, but these experiences are increasingly rare. Journal of Hospital Medicine 2009;4:430,432. © 2009 Society of Hospital Medicine. [source]

Percutaneous Mitral Valve Repair for Mitral Regurgitation

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2003
PETER C. BLOCK M.D.
Mitral regurgitation (MR) associated with, ischemic, and degenerative (prolapse) disease, contributes to left ventricular (LV) dysfunction due to remodeling, and LV dilation, resulting in worsening of MR. Mitral valve (MV) surgical repair has provided improvement in survival, LV function and symptoms, especially when performed early. Surgical repair is complex, due to diverse etiologies and has significant complications. The Society for Thoracic Surgery database shows that operative mortality for a 1st repair is 2% and for re-do repair is 4 times that. Cardiopulmonary bypass and cardiac arrest are required. The attendant morbidity prolongs hospitalization and recovery. Alfieri simplified mitral repair using an edge-to-edge technique which subsequently has been shown to be effective for multiple etiologies of MR. The MV leaflers are typically brought together by a central suture producing a double orifice MV without stenosis. Umana reported that MR decreased from grade 3.6 +/,0.5 to0.8 +/,0.4 (P < 0.0001)and LV ejection fraction increased from 33 +/,13% to 45 +/,11%(P = 0.0156). In 121 patients, Maisano reported freedom from re-operation of 95 +/,4.8% with up to 6 year follow-up. Oz developed a MV "grasper" that is directly placed via a left ventriculotomy and coapts both leaflets which are then fastened by a graduated spiral screw. An in-vitro model using explanted human valves showed significant reduction in MR and in canine studies, animals followed by serial echo had persistent MV coaptation. At 12 weeks the device was endothelialized. These promising results have paved the way for a percutaneous or minimally invasive off pump mitral repair. Evalve has developed catheter-based technology, which, by apposing the edges of a regurgitant MV, results in edge-to-edge repair. Release of the device is done after echo and fluoroscopic evaluation under normal loading conditions. If the desired effect is not produced the device can be repositioned or retrieved. Animal studies show excellent healing, with incorporation of the device into the leaflets at 6,10 weeks with persistent coaptation. Another percutaneous approach has been to utilize the proximity of the coronary sinus (CS) to the mitral annulus (MA). Placement of a self-compressing device in the CS along the region of the posterior MA has, in canine models, reduced MR and addresses the issues of MA dilation and its contribution to MR. Ongoing studies are underway for both techniques. (J Interven Cardiol 2003;16:93,96) [source]

Is Carotid Artery Stent Placement a Viable Option for Carotid Artery Stenosis in Patients Aged 80 years or Greater?

JOURNAL OF NEUROIMAGING, Issue 2 2010
Ramachandra P. Tummala MD
No abstract is available for this article. [source]

Use of a collagen-platelet rich plasma scaffold to stimulate healing of a central defect in the canine ACL

JOURNAL OF ORTHOPAEDIC RESEARCH, Issue 4 2006
Martha M. Murray
Abstract The anterior cruciate ligament (ACL) of the knee fails to heal after primary repair. Here we hypothesize that a beneficial biologic repair response can be induced by placing a collagen-platelet rich plasma (collagen-PRP) material into a central ACL defect. A collagen-PRP scaffold was used to treat a central ACL defect in vivo. In the first experiment, the histologic response in treated and untreated defects was evaluated at 3 (n,=,5) and 6 weeks (n,=,5). In the second experiment, biomechanical testing of the treated ligaments (n,=,8) was performed at 6 weeks and compared with the results of biomechanical testing of untreated defects at the same time-point (n,=,6). The percentage filling of the defects in the treated ACLs was significantly higher at both the 3- and 6-week time-points when compared with the untreated contralateral control defects (50,±,21% vs. 2,±,2% at 3 weeks, and 43,±,11% vs. 23,±,11 at 6 weeks; all values mean,±,SEM. Biomechanically, the treated ACL defects had a 40% increase in strength at 6 weeks, which was significantly higher than the 14% increase in strength previously reported for untreated defects (p,<,0.02). Placement of a collagen-PRP bridging scaffold in a central ACL defect can stimulate healing of the ACL histologically and biomechanically. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 24:820,830, 2006 [source]

On the theory of optimal sensor placement

AICHE JOURNAL, Issue 5 2002
Donald J. Chmielewski
On the Theory of Optimal Sensor Placement An optimal sensor placement is defined as a sensor configuration that achieves the minimum capital cost while observing prespecified performance criteria. Previous formulations of this problem have resulted in the definition of a mixed-integer nonlinear program (MINLP) with dimensions dependent on the value of the integer decision variables. The main contribution of this work is an equivalent reformulation of the design problem such that the dimension of the NLP is independent of all decision variables. Additionally, the traditional sensor-placement problem, based on static process conditions, is extended to linear dynamic processes. The final contribution is the exact conversion of the general NLP into a convex program through the use of linear matrix inequalities. The aggregation of these results show that the sensor-placement problem can be solved globally and eficiently using standard interior-point and branch-and-bound search algorithms. [source]