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Objective To characterize and identify risk factors for 30-day surgical site infections (SSIs) in patients with head and neck cancer who underwent microvascular reconstruction. Study Design Cross-sectional study with nested case-control design. Setting Nine American tertiary care centers. Subjects and Methods Hospitalized patients were included if they underwent head and neck cancer microvascular reconstruction from January 2003 to March 2016. Cases were defined as patients who developed 30-day SSI; controls were patients without SSI at 30 days. Postoperative antibiotic prophylaxis (POABP) regimens were categorized by Gram-negative (GN) spectrum: no GN coverage, enteric GN coverage, and enteric with antipseudomonal GN coverage. All POABP regimens retained activity against anaerobes and Gram-positive bacteria. Thirty-day prevalence of and risk factors for SSI were evaluated. Results A total of 1307 patients were included. Thirty-day SSI occurred in 189 (15%) patients; median time to SSI was 11.5 days (interquartile range, 7-17). Organisms were isolated in 59% of SSI; methicillin-resistant Staphylococcus aureus (6%) and Pseudomonas aeruginosa (9%) were uncommon. A total of 1003 (77%) patients had POABP data: no GN (17%), enteric GN (52%), and antipseudomonal GN (31%). Variables independently associated with 30-day SSI were as follows: female sex (adjusted odds ratio [aOR], 1.6; 95% CI, 1.1-2.2), no GN POABP (aOR, 2.2; 95% CI, 1.5-3.3), and surgical duration ≥11.8 hours (aOR, 1.9; 95% CI, 1.3-2.7). Longer POABP durations (≥6 days) or antipseudomonal POABP had no association with SSI. Conclusions POABP without GN coverage was significantly associated with SSI and should be avoided. Antipseudomonal POABP or longer prophylaxis durations (≥6 days) were not protective against SSI. Antimicrobial stewardship interventions should be made to limit unnecessary antibiotic exposures, prevent the emergence of resistant organisms, and improve patient outcomes.

There is a need for methods that can help predict and avoid fatigue failures of silicon nitride ceramic components. The fatigue threshold R-curve has been proposed as potential solution to this problem. In this study, the fatigue threshold R-curve for small, semielliptical surface cracks was calculated for a silicon nitride ceramic using the published bridging stress distribution developed from fatigue threshold tests on macroscopic crack specimens. To test the accuracy of the endurance strengths predicted using the fatigue threshold R-curve, fatigue tests were conducted using four-point bend beams of silicon nitride containing semielliptical surface cracks introduced by Knoop indentation. The effectiveness of the methodology was verified; indeed, 77% of the beams tested at stress levels above the predicted endurance strength failed within 107 cycles and 0% of the beams tested below the predicted endurance strength failed within 107 cycles. Furthermore, using the bridging stress distribution, which is thought to be a material property, the need for prohibitively difficult fatigue threshold experiments on small surface cracks is avoided. Accordingly, this methodology is potentially quite practical for use in the engineering design of ceramic mechanical components.

The role of microstructure in affecting the fatigue crack growth resistance of grain bridging silicon nitride ceramics doped with rare earth (RE = Y, La, Lu) oxide sintering additives was investigated. Three silicon nitride ceramics were prepared using MgO-RE2O3 and results were compared with a commercial Al2O3-Y2O3-doped material. Decreasing stress intensity range (ΔK) fatigue tests were conducted using compact-tension specimens to measure steady-state fatigue crack growth rates. Specimens doped with MgO-RE2O3 additives showed a significantly higher resistance to crack growth than those with Al2O3-Y2O3 additives and this difference was attributed to the much higher grain aspect ratio for the MgO-RE2O3-doped ceramics. When the crack growth data were normalized with respect to the total contribution of toughening by bridging determined from the monotonically loaded R-curves, the differences in fatigue resistance were greatly reduced with the data overlapping considerably. Finally, all of the MgO-RE2O3-doped silicon nitrides displayed similar steady-state fatigue crack growth behavior suggesting that they are relatively insensitive to the intergranular film.

SUMMARY Purpose To explore the use of disproportionality analysis of medication error data as a novel method to identify relationships that might not be obvious through traditional analyses. This approach can supplement descriptive data and target quality improvement efforts. Methods Data came from the Medication Error Quality Initiative (MEQI) individual event reporting system. Participants were North Carolina nursing homes who submitted incident reports to the Web-based MEQI data repository during the 2006 and 2007 reporting years. Data from 206 nursing homes were summarized descriptively and then disproportionality analysis was applied. Associations between medication type and possible causes at the state level were explored. A single nursing home was selected to illustrate how the method might inform quality improvement at the facility level. Disproportionality analysis of drug errors in this home was compared with benchmarking. Results Statewide, 59 drug-cause pairs met the disproportionality signal and 11 occurred in 10 or more reports. Among these, warfarin was co-reported with communication errors; esomeprazole, risperidone, and nitrofurantoin were disproportionately associated with transcription error; and oxycodone and morphine were disproportionately reported with name confusion. Facility-level analyses illustrate how descriptive frequencies and disproportionality analysis are complementary, but also identify different safety targets. Conclusions Exploratory analysis tools can help identify medication error types that occur at disproportionate rates. Candidate associations might be used to target patient safety work, although further evaluation is needed to determine the value of this information. Copyright # 2010 John Wiley & Sons, Ltd.

SUMMARY A modified isokinetic strengthening program for the knee flexors and extensors was evaluated in 32 patients with severe hemophilia. The program was effective in significantly strengthening the knee flexors and extensors; it did not increase the number of knee hemarthroses; and it could be done at home without special equipment. The greater increases in extensor and flexor strength among adolescents and adults were associated with less severe arthropathy, a l cm increase in thigh girth, and a greater number of days on which the exercises were done. RESUME Utilisation d'un programme modifie de musculation isokinetique chez des enfants presentant une hemophilie grave Un programme modifie de musculation isokinetique des flechisseurs et extenseurs de genou a ete analyse chez 32 sujets presentant une hemophilie grave. Le programme d'entrainement fut efficace en renforcant significativement les flechisseurs et extenseurs du genou, n'accrut pas le nombre des hemarthroses du genou et pu etre effectuea domicile sans equipment special. Dans les groupes d'âge adulte et adolescent, il y avait une association entre un accroissement plus important de la force des flechisseurs et extenseurs du genou, moins de douleurs articulaires, un accroissement d'un centimetre du tour de cuisse et un nombre accru de jours d'entrainement. ZUSAMMENFASSUNG Der Sinn eines modifizierten isokinetischen Trainingprogramms bei Patienten mit schwerer Hamophilie Bei 32 Patienten mit schwerer Hamophilie wurde ein modifiziertes isokinetisches Trainingprogramm fur Knieflexoren und -extensoren gepruft. Das Trainingprogramm bewirkte eine signifikante Kraftigung der Knieflexoren and -extensoren, es hatte keine erhohte Anzahl von Kniehamarthrosen zur Folge und es konnte zu Hause ohne eine spezielle Ausrustung durchgefuhrt werden. In den jugendlichen und erwachsenen Altersgruppen fand sich im Zusammenhang mit zunehmender Muskelkraft in den knieextensoren und -flexoren ein geringer Schweregrad der Arthropathie, eine Zunahme des Oberschenkelumfangs um l cm und eine Zunahme der Trainingstage. RESUMEN Utilizacion de un programa modificado de fortalecimiento isoquinetico en pacientes con hemofilia grave Se evaluo un programa modificado de fortalecimiento isoquinetico para los flexores y extensores de la rodilla en 32 pacientes con hemofilia grave. El programa de ejercicios fue efectivo para fortalecer los flexores y extensores de la rodilla, no aumento el numero de hemartrosis de rodilla y pudo ser realizado en casa sin ningun equipo especial. En asociacion con un mayor aumento en la fuerza de flexores y extensores, estaban los grupos de adolescentes y adultos, una artropatia menos grave, un aumento de l cm en el contorno del muslo y un aumento en el numero de dias de ejercicio.

The association of race and gender with different neurological levels of myelomeningocele was studied in 251 patients. Over-all, the white to black ratio was 3.6 and the male to female ratio was 0.86. However, the proportions of whites and females were significantly increased in thoracic-level patients (white to black ratio 13.6, male to female ratio 0.43), whereas the lumbar-level patients had sex and white to black ratios equivalent to the area population. This supports the concept that thoracic-level myelomeningocele has a different pathogenesis from lumbar-level.

Objectives:Elucidate the incidence of cisplatin-induced ototoxicity in patients treated for head and neck cancer.Methods:This was an institutional review board approved retrospective study of patients treated with cisplatin for cancer at a tertiary referral hospital. The charts of patients of any age that had undergone cisplatin therapy from 1995 to the present were reviewed. We then narrowed this group down to those who had a diagnosis of cancer of the head and neck (hypopharyngeal, laryngeal, nasopharyngeal, oropharyngeal, scalp/face skin cancer, temporal, thyroid) and had pre- and posttreatment audiologic testing.Results:There were 1565 patients that had undergone therapy with cisplatin from 1995 to 2014. Of those, 203 patients had pre- and posttreament audiologic testing. Twenty patients had diagnosis of cancer involving the head and neck. The cochlear radiation doses were also collected from these patients. Preliminary results demonstrate that patients with head and neck cancer that were treated with...

The ability of cloze tests containing frequent, every n-th word deletions to measure comprehension of macropropositions has been challenged on both theoretical and empirical grounds, calling into question the validity of such tests for assessing comprehension of much of the discourse encountered by university-level students. To evaluate the comprehension of a writer’s reasoning, it is recommended that cloze tests position gaps so as to target recognition of cohesive devices and the ability to draw inferences from other sentences. To test the validity of such a design, a large sample of scores on discourse cloze tests administered in introductory college economics is compared to scores on true–false comprehension tests designed to target recognition of connective propositions. The two distributions of scores do not differ significantly in terms of mean value, dispersion or frequency distribution, suggesting that appropriately designed cloze tests can provide a valid assessment of the reader’s integration of theoretical text. In addition, the usefulness of readability formulas based on surface characteristics of text is challenged when readability is defined in terms of the difficulty of constructing a coherent representation of theoretical text.

Liesegang rings are laminated ring-like structures occasionally found in benign cysts and abscesses. They have been confused with parasites (especially eggs), algae, calcifications, and psammoma bodies. We examined Liesegang rings from fine-needle aspiration (FNA) biopsies of a benign cyst of the breast and a complex renal cyst. Liesegang rings were best observed with Papanicolaou, hematoxylin-eosin, Masson's trichrome, acid-fast (AFB), and Gram stains, which accentuate the concentrically laminated morphology. An amorphous electron-dense core and fibrillary lucent concentric rings were seen with transmission electron microscopy with no significant energy peaks by electron probe microanalysis or distinct diffraction patterns by X-ray diffraction. This investigation indicates that Liesegang rings are composed of organic substances most likely formed by periodic precipitation from a supersaturated solution within cystic fluid. Awareness of the Liesegang phenomenon within cystic lesions will decrease the possibility of erroneous misdiagnosis as another type of pathologic process. Diagn. Cytopathol. 1998;19:116–119. © 1998 Wiley-Liss, Inc.

We explored the potential impact of human papillomavirus (HPV) testing on women's intentions to be screened for cervical cancer in a cohort of Canadian women. Participants aged 25-65 years from an ongoing trial were sent a questionnaire to assess women's intentions to be screened for cervical cancer with HPV testing instead of Pap smears and to be screened every 4 years or after 25 years of age. We created scales for attitudes about HPV testing, perceived behavioral control, and direct and indirect subjective norms. Demographic data and scales that were significantly different (p < 0.1) between women who intended to be screened with HPV and those who did not intend were included in a stepwise logistic regression model. Of the 2,016 invitations emailed, 1,538 were received, and 981 completed surveys for a response rate of 63% (981/1,538). Eighty-four percent of women (826/981) responded that they intended to attend for HPV-based cervical cancer screening, which decreased to 54.2% when the screening interval was extended, and decreased further to 51.4% when screening start was delayed to age of 25. Predictors of intentions to undergo screening were attitudes (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.15, 1.30), indirect subjective norms (OR: 1.02; 95% CI: 1.01, 1.03) and perceived behavioral control (OR: 1.16; 95% CI: 1.10; 1.22). Intentions to be screened for cervical cancer with HPV testing decreased substantially when the screening interval was extended and screening started at age of 25. Use of primary HPV testing may optimize the screening paradigm, but programs should ensure robust planning and education to mitigate any negative impact on screening attendance rates.

The stocker cattle grazing enterprise in the southestern USA has been hindered by unacceptable performance of animals grazing bermudagrasses [Cynadon dactylon (L.) Pen.] and other warm-season perennial grasses, particularly during the latter stages of the grazing season. The objective of this study was to determine the effect of a self-limiting protein supplement on performance of yearling and weanling cattle (Bos taurus × B. indicus) grazing bermudagrass pastures. The 2-yr study was conducted in 1990 and 1991 and included 180 yearling cattle and 80 weanling calves that were randomly allocated to replicate groups of the following two treatments: (i) bermudagrass pasture alone (BGPAS); and (ii) bermudagrass pasture supplemented with a 28% crude protein condensed molasses block (PMB) [...]

SUMMARY A new cryo-jet freezing apparatus is described that is easy to use and gives good results using a propane-butene mixture (3: 1). Our use of the freezer in the study of mouse spinal cord explant cultures is discussed. At the tissue surface, the quality of tissue preservation from freezing, followed by freeze substitution, rivals that of conventional electron microscopic methods. Certain intracellular structures are better visualized using our methods. There is no evidence of the tissue being distorted by the cryogen jet when the freezer is operated correctly. A new freeze substitution device is also discussed.

(...) A 4-yr study compared overall and seasonal performance of stocker steers grazed on «Brazos», «Grazer», Coastal, and «Tifton-44» bermudagrass cultivars. Established paddocks were grazed continuously for an average of 154 d (24 April-25 September) each year (1982-1985). Annual fertilization rates were 306-26-174 lb/acre of N-P-K. Average stocking rate was 4.4 steers/acre. (...)

Attempts to compare the magnitude of corporations and countries are frequently biased by the use of inconsistent measures. While Gross National Product reflects the output obtained from a nation's land, labor and capital resources, corporate sales reflect not only the firm's output but also that of its suppliers. A more realistic picture can be obtained by comparing corporate value added to national output. While available information permits only an approximation of the former, it appears that the average company is responsible for less than 50 percent of the value of the product it sells. The basic conclusion that some firms are in this sense comparable to Nation-States remains valid. However, the rank of the largest companies relative to countries is reduced substantially.

A significant anemia develops in Buffalo rats bearing the Morris hepatoma 7777. By indiceal measurements the red blood cells (RBCs) appear to be microcytic and hypochromic. Ferrokinetic studies demonstrate a decreased uptake of iron in the bone marrow and an increased incorporation of iron in the spleens of the tumor-bearing animals. RBC survival studies indicate the presence of a hemolytic component which appears to contribute to the anemia. The RBCs from tumor-bearing animals (T-RBC) have a greatly increased fragility in sodium chloride solutions. Inspection of these T-RBCs by electron microscopy demonstrates significant echinocytosis when they are compared to normal cells. Electrophoretic separation of the hemoglobin from T-RBCs shows a pattern different from normal cells and consistent with the pattern described for hemoglobin from spleen and bone marrow. The findings are consistent with bone marrow inadequacy and an increased splenic erythropoiesis which is insufficient to maintain normal hematological values. The hypothesis is presented that the RBCs synthesized under these circumstances appear in the circulation with an "immature" hemoglobin pattern and are hemolyzed more readily. This process then contributes to the hemolytic component and development of the anemia.

SUMMARY The effect of treatment with either gypsum or sodium chloride on the saturated hydraulic conductivity (Ks) of repacked soil columns and modulus of rupture (MOR) was studied on surface samples of two red-brown earth soils from SE wheat belt in Australia. When the exchangeable sodium percentage (ESP) of the two soils was increased to >80, KS was substantially reduced and MOR increased relative to the untreated soil; the values of the parameters were nearly equal for these pairs of high ESP soils. However, after treatment with gypsum the Raywood soil had a Ks twice, and a MOR less than half, the corresponding values for the Glenloth soil. Micromorphological and scanning electron microscope (SEM) observations suggest that the increase in Ks following gypsum treatment is associated with an increase in visible macropores and reduced clay dispersion; Na treatment increased dispersion at the soil surface, with the clay particles forming an impermeable surface seal and illuviation argillans.

The following reaction variables were studied and reported on: Temperature, stirring rate, nature of the organic solvent and concentration of the reactants Amine solubility is important in determining polymer yield. Der Einflus folgender Reaktionsvariabler wurde untersucht: Temperatur, Ruhrgeschwindigkeit, Art des organischen Losungsmittels und Konzentration der Reaktanten. Die Ausbeute an Polymeren wird wesentlich durch die Loslichkeit der Aminkomponente mitbestimmt.