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To determine the benefits and safety of direct trocar insertion versus Veress needle technique in obese women undertaking diagnostic laparoscopy procedures. Randomized-controlled trial on 135 obese women undergoing diagnostic laparoscopy and dye test for infertility was conducted. Women were randomly assigned to either direct trocar access (n = 68) or Veress needle access (n = 67) before achieving pneumoperitoneum. The same surgeon executed the laparoscopic techniques with a single-puncture technique. The primary outcome measures included total length of the procedure and incidence of any complications, while the mean laparoscopic entry time, volume of CO2 required, and total of tries needed to attain successful entry were secondary outcomes. Intention-to-treat principle was applied to analysis. Women in both groups had similar socio-demographic and clinical characteristics and none were lost to follow-up. The overall length of the procedure was significantly lesser in the direct trocar group compared to the Veress needle group (9.9 ± 6.0 vs 16.7 ± 4.7 min; p 0.05). Direct trocar technique may be an effective alternative to Veress needle for pneumoperitoneum in obese women for diagnostic laparoscopy. It has a comparable rapid laparoscopic entry time but a significantly lower duration of the procedure and shorter exposure to anesthesia. Both methods are equally effective as there was no significant difference in the complications recorded. A greater sample trial may be essential for more corroborative substantiation. Clinical trial registration: PACTR201510000999192.

To determine how frequently the published operating room (OR) schedule of case start times correlated with the actual OR entry time for elective cases in the Fraser Health Authority (FHA) in British Columbia, Canada. Society guidelines recommend periods of fasting of two hours prior to the induction of general anesthesia, but patients frequently end up fasting much longer. This review aimed to determine when patients arrive in the OR—either earlier than their scheduled time or later. The premise of some is that patients often arrive earlier, and advising short fasting times on the basis of the OR slate time is unreliable. I wished to determine whether this fear is justified. The computerized OR management database was queried for slated time of entry and actual time of entry for elective surgical cases in 11 hospitals in the FHA. The difference in slated vs actual entry time of patients (in 30 min blocks) was reviewed to examine the proportion of patients entering the OR earlier than 90 min from their slated time. Additionally, anesthesiologists from the Royal Columbian/Eagle Ridge Hospitals were surveyed for their recall of case delays that were related to inappropriate consumption of fluids. One hundred and twenty-three thousand eight hundred and sixty-five cases from 11 hospitals over a 32-month period were analyzed. A very small proportion of cases (753 of 123,865 cases, 0.6%) entered the OR earlier than 90 min from their slated time. Relatively few cases were actually cancelled because of inappropriate fluid consumption in the recall of anesthesiologists in two institutions. In the FHA, the OR schedule is a reliable guide to providing instructions on timing of preoperative fluid consumption in appropriately selected elective surgical patients. Quality of care and patient satisfaction will safely be enhanced by limiting the period of fasting for elective surgical patients.

Change of direction (COD) testing has commonly reported a single total time to quantify performance despite that tests are made up of a number of different phases. No investigation into these phases has been completed, therefore the aim of this study was to examine the reliability between sessions and directions of the different phases of a 505 test. Twenty-one male youth athletes performed the 505 test in both directions on three occasions. Differences between directions and sessions were determined via a T-test and Two-way ANOVA respectively and a significance threshold was set at P ≤ 0.05. All strategy variables show acceptable relative and absolute reliability in both directions between sessions (ICC = 0.73–0.94; CV = 2.3–6.3%) apart from ground contact time (GCT) (ICC = 0.57–0.68; CV = 14.8–22.4%). Significant differences were identified between session one and three for entry time. Significant differences between directions for exit time on day two and for full approach, entry and GCT on day three. The non-dominant turning direction showed lower relative and absolute reliability between session for entry time (ICC = 0.73 vs 0.89; CV = 6.3 vs 3.7%) and GCT (ICC = 0.57 vs 0.68; CV = 14.8 vs 22.4%). Results indicate the phases of a 505 COD test have high relative and absolute reliability between sessions, although turning directions should be considered independently.

Background and objectives Attentional biases play an important role in the development and maintenance of obsessive-compulsive disorder (OCD). Previous studies using reaction time tasks in OCD have produced inconsistent results. This is the first study to measure attentional biases in patients with several subtypes of OCD using eye tracking. Methods Twenty-eight patients with OCD and 21 healthy controls were assessed using a free-viewing paradigm, incorporating contamination-related, checking-related, and neutral stimuli. Attentional patterns were measured using an eye tracker. A possible vigilance bias was assessed using entry time, and a possible maintenance bias was assessed using dwell time. Results Patients with checking-related symptoms of OCD showed a maintenance bias but no vigilance bias in regard to checking-related compared to neutral stimuli. No differences in attention were found in patients with contamination-related symptoms. Limitations Internal validity is restricted due to a high overlap between subgroups, the lack of negative (not OCD-related) control stimuli, and the absence of a clinical control group. Conclusions Patients with checking-related symptoms of OCD showed a maintenance bias to checking-related stimuli. Due to methodological limitations, the results should be considered preliminary and need to be replicated before firm conclusions can be drawn.

Background and Importance.—Globally, almost one million new cases of stomach cancer were estimated to have occurred in 2012 (952,000 cases, 6.8% of the total), making it the fifth most common malignancy in the world, after lung, breast, colorectal, and prostate. Gastric cancer was the world's third leading cause of cancer mortality in 2012, responsible for 723,000 deaths, 8.8% of total cancer deaths.1 In 2017, 28,000 new cases and 10,960 deaths are estimated for gastric cancer in the United States.2 Estimated United States prevalence counts on January 1, 2014, for patients diagnosed within the previous 5-years was 48,271 (SEER Cancer Statistics Review-2014). Prognostic indices of survival & mortality in patients with gastric cancer are related to tumor stage including nodal involvement, direct tumor extension beyond the gastric wall, and wide-spread dissemination. Tumor histologic grade (degree of loss of cellular differentiation), and oncotype-specific ICD-O-3 phenotypes also provides important prognostic information. By more than 90%, the most common histologic type of stomach cancer is adenocarcinoma. The National Cancer Institute (NCI) ICD-O-3 SEER Site/Histology Validation List catalog (September 18, 2015) enumerates almost 200 subtypes for gastric cancer sites C160-C166, C168-C169. Based on the results of molecular evaluation of 295 primary gastric adenocarcinomas reported to The Cancer Genome Atlas (TCGA) project in 2014, a novel classification separating gastric cancers into four subtypes according to Epstein-Barr virus positive status, microsatellite instability, chromosomal instability, or genomic stability was proposed.3 Of interest, Helicobacter Pylori infection and its role in the development of gastric cancer is not mentioned. All cancer has a genetic basis. However, given the histologic and etiologic heterogeneity of gastric cancer, eventual comprehensive molecular characterization and genomic sequencing with identification of chromosomal aberrations, nucleotide substitutions mortality follow-up study is focused on short- and long-term comparative patient outcomes of stomach adenocarcinoma, ICD-O-3 8140-8147, and other selected gastric cancer oncotypes. Objective.—To update trends in incidence, prevalence, short- and long-term survival, and mortality of gastric cancer using the statistical database of SEER*Stat 8.3.4 for diagnosis years 1973-2014 employing multiple case selection variables. Methods.—A retrospective, population-based study using nationally representative data from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program to evaluate 157,258 cases for diagnosis years 1973-2014 comparing multiple variables of age, sex, race, stage, grade, cohort entry time-period, disease duration and histologic oncotype: Relative survival statistics were analyzed in two cohorts: 1973-1994 and 1995-2014. Survival statistics were derived from: SEER*Stat Database: Incidence – SEER 9 Regs Research Data, November 2016 Submission (1973-2014) Released April 2017. Results.—By more than 90%, the most common type of stomach cancer is adenocarcinoma. From 1975 to 2014, gastric cancer incidence has been steadily decreasing in the United States at the rate of −1.5% per year. In a total of 157,258 cases of invasive staged cancer of the stomach, mean age in males was 67.5 years, females 69.6 years, both male & female 67.4 years. Greater than 90% of cases occurred between ages 45-85+ years with the zenith in males at 70-74 years (15.1%) and 85+ years in females (17.9%). The overall annual US death rate per 100,000 per year for stomach cancer from 1975 to 2014 has decreased from 5.1 to 3.1, but excess mortality at 0-5 years remains exceedingly high. Mortality is a function of incidence and survival, and unfortunately, almost all of this decrease is due to the decrease in incidence of stomach cancer. Of the 157,258 invasive cases, 86.6% were clinically staged and 76.8% were histologically graded. Conclusions.—Given the histologic and etiologic heterogeneity of gastric cancer, major improvements in mortality and survival outcomes await the development of diagnostic markers for earlier diagnosis, and genomic sequencing and identification of chromosomal aberrations, nucleotide substitutions and epigenetic modifications that drive malignant transformation, for the development of targeted therapies for almost 200 gastric cancer subtypes.

Social hierarchy affects the access of animals to feed resources. On daily rotational pasture systems, supplementation time may influence feeding behavior. This trial was designed to test the effect of grain delivery time on the feeding behavior of heifers. Heifers divided into two groups according to breed (n = 15 Braford and n = 19 Jersey) were tested in a crossover design with two treatments: INITIAL—supplement at 8 am (entry time to a fresh paddock), and MIDDLE—supplement at 4 pm (middle time of paddock use). Animals entered a new paddock every morning, and grain supplement at 2 kg/animal/day was offered at the fence line (1 m/animal). Then, ingestive and other behaviors were registered by direct visual observation through scan sampling at 2-min intervals for 1 h after grain supply. Agonistic interactions were recorded continuously (instigator–victim) to build a social matrix whereby each heifer was defined as dominant, intermediate, or subordinate. Weekly pasture samples were collected according to the order that animals left the feeding area, using the hand-plucking technique, to determine crude protein and fiber content. Heifers spent more time grazing on the INITIAL treatment (p < 0.0001) but exhibited more behaviors on the MIDDLE treatment (p < 0.0001). Dominant heifers spent more time eating grain (p = 0.0008), whereas subordinate heifers spent more time grazing along the paddock (p = 0.0067), but not along the fence (p = 0.0008). The crude protein content of pasture samples was higher for the INITIAL treatment (p < 0.0001). Behavioral interaction occurred with respect to the order of leaving the feeding area, social rank, and crude protein consumed (p = 0.04). Subordinate heifers consistently grazed more and ate less grain supplement than dominant and intermediate heifers. However, when grain supplement was offered at the time animals entered the paddock, more grazing activity took place during supplement feeding, and subordinate heifers could select a high-protein diet. In the INITIAL treatment, this means that subordinate animals could benefit from the better pasture available, keeping a distance from dominant heifers, reducing agonistic interactions and likely improving their welfare.

Background We explored whether a previously successful initiative to improve first-case on-time starts succeeded because (i) preoperative steps started earlier (but the process did not necessarily improve) or (ii) the process was brought into better control. Methods We analysed 35 months of data comprising 28 882 first cases to calculate the difference of the time a patient entered the operating room (OR) vs the scheduled entry time. Median and inter-quartile range were used to evaluate changes in distribution parameters. A statistical process-control methodology was used to compare the differences in performance between the pre- and post-intervention phases. Results Post-intervention first cases entered the OR on average within 4 min [95% confidence interval (CI): 4–5 min] of the scheduled start time, as opposed to within 8 min (95% CI: 8–8 min) in the pre-intervention period. The median delay decreased from 5 min (95% CI: 5–5 min) to 2 min (95% CI: 2–2 min). The inter-quartile range of the difference between the scheduled start time and the first case in room time decreased from 13 min (95% CI: 13–13 min) to 10 min (95% CI: 9–10 min). Conclusions The reduction in inter-quartile range demonstrates that improvement in on-time starts resulted from the process being in better control. The start time of preoperative preparatory activities did not move earlier, which means that OR and preoperative staff do not need to arrive at work earlier. Improvements resulting from the process being in control were sustained.

Background.—The values of SEER site recode variables are based on the primary site and histology data fields submitted to SEER by the registries. The site recode variables define the major cancer site/histology groups that are commonly used in the reporting of cancer incidence data and are added to the SEER databases as a convenience for researchers. These codes and definitions are periodically updated and changed by the National Cancer Institute as newer and more applicable information becomes available. Because this myeloma analysis includes cases diagnosed 2010+, the ICD-O-3 recode-updates with adjustment for WHO 2008 hematopoietic histologies that account for changes in the obsolete classification of hematopoietic histology codes, and the assignment of new names (ie, multiple myeloma-MM – to – plasma cell myeloma-PCM) is adhered to and used here. Plasma cell myeloma (PCM) is a bone-marrow based multifocal plasma cell malignancy (primary site C421). PCM is characterized by a single clone of plasma cells, believed to be derived from lymphoid B cells, and spans a clinical spectrum from asymptomatic to aggressive forms, plus disorders caused by the deposition of abnormal immunoglobulin chains in tissue. The current myeloma group ICD-O-3 histologic morphology types consists of:ICD-O-3 9731: Plasmacytoma, NOS, occurring in bone (osseous plasmacytoma malignancy data reportable to SEER only beginning since 1986);ICD-O-3 9732: Plasma cell myeloma – composed of three clinical variants: a) asymptomatic, b) Non-secretory myeloma, and c) Plasma cell leukemia (all coded to 9732);ICD-O-3 9734: Extramedullary plasmacytoma; anatomic sites other than bone. Objective.—Using the statistical database of SEER*Stat 8.3.4 (produced 4/14/2017 for diagnosis years 1973-2014), to assess, determine, compare, and summarize the occurrence, long-term survival and mortality indices of the three morphologic types of myeloma by age, sex, race and stage in two-cohort entry time-periods (1973-1994 and 1995-2014). All analyses are accomplished within the context of current SEER Site Recode ICD-O-3 (1/27/2003) definitions, terminologies and descriptions, and also in accordance with the rules of the consolidated Hematopoietic and Lymphoid Neoplasm Coding Manual data base (effective 1/1/2010 – release date January 2015). Methods.—Population data including 111,041 cases collected by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Frequency Database (18 SEER Registries Research Data + Hurricane Katrina Impacted Louisiana Cases, November 2016 Submission, 1973-2014 varying) for diagnosis years 1973-2014: Relative Survival Statistics were analyzed in two cohorts: 1973-1994 and 1995-2014. Survival statistics were derived from: SEER*Stat Database: Incidence – SEER 9 Regs Research Data, November 2016 Submission (1973-2014) Released April 2017. Results.—Tables 1-3 provide basic SEER comparative survival and mortality data of the three myeloma oncotypes by age, sex, stage and disease duration of patients in the 1973-2014 time-period. Epidemiologic, demographic, and case statistics data extracted from the most current NCI Cancer Statistics Review (CSR 2010-2014) are included. Conclusions.—Recent SEER age-adjusted incidence trends, 2011-2014, for all races has been downward, with an annual percentage change (APC) of -2.5% per year. Mean age in plasma cell myeloma (PCM) patients was about 1-year less in males (67.8 yrs) than in females (69.2 yrs). PCM is accompanied by a very high excess mortality and much reduced 5-year relative survival ratio especially in older age groups. Generally, first year excess death rates (EDRs) decreased with duration but increased with advancing entry age, and there was no sex difference. First year EDRs in blacks, all ages combined, was quite high but lower than EDRs in whites. Median survival, actual survival and 5-year relative survival ratios diminished precipitously to extremely low levels with increasing entry age attesting to the lethal character of this disease especially in older patients.

It is unknown how variations in surgical entry time in primary cesarean delivery (CD) may affect operative outcomes and maternal morbidity.Determine whether performing a primary CD in labor emergently ("stat") is associated with adverse maternal outcomes.Retrospective cohort study of patients who underwent primary CD at The Mount Sinai Hospital during the years of 2011-2016. Women with a singleton pregnancy and without a prior uterine scar attempting a trial of labor were included. An emergent CD was defined as a skin-to-uterine incision (I-U) time of ≤3 minutes. Subjects were dichotomized into those with an I-U time of ≤3 minutes or ≥5 minutes.1722 patients underwent primary CD and met eligibility criteria. 72 patients with an I-U time of 4 minutes were removed from the analysis. 196 patients (11.9%) had an I-U time ≤3 minutes and 1454 patients (88.1%) had an I-U time ≥5 minutes. There were no differences in any outcomes between groups. The likelihood of transfusion, hysterectomy, or admission to the intensive care unit (ICU) was 1.5% in the emergent group and 1.0% in the control group (p = .334). Postpartum length of stay was also similar between the groups (3.3 versus 3.2 days, p = .259). When 384 patients with I-U times10 minutes were excluded, surgical outcomes remained similar between groups. Among the subgroup of patients who reached the second stage of labor, surgical outcomes were also similar between groups.Emergent primary CD is not associated with increased maternal morbidity.

Background.—Incidence and prognosis of cancers of the endocrine glands vary greatly by stage and histologic type, and, thyroid cancer accounts for most (92%) of the cancers of the endocrine glands. It is the 8th most common of cancers and has been rising in incidence since 1975. It remains a formidable health threat in the United States in 2016 with estimated cases of 64,300 and 1980 deaths. Objective.—Provide 20-year comparative mortality analysis of thyroid cancer in a recent group of 145,457 staged cases (97.5%) of a total of 149,202 patients during the 1993-2013 entry time-period in six histologic subtypes by age, sex, race, stage and disease duration. Methods.—Population-based data from SEER registries,1 1973-2013, (SEER*Stat 8.3.2.) were analyzed. Results.—Tables 1-8 provide basic SEER epidemiologic, demographic, case-statistics, and comparative mortality follow-up data of 4 principal and 2 supplementary thyroid cancer oncotypes by age, sex, race, stage and disease duration of patients in the 1993-2013 time-period.Table 1.Thyroid Cancer Overview: Epidemiologic & Demographic Characteristics: SEER 1993-2013Table 2.Thyroid Cancer: Six Histologic Subtypes; Epidemiologic & Demographic Case Statistics, SEER 1993-2013Table 3.Papillary Adenocarcinoma, NOS, (ICD-O-3, 8260), 1993-2013, Age, StageTable 4.Follicular Adenocarcinoma, NOS, (ICD-O-3, 8330), 1993-2013, Age, StageTable 5.Papillary Carcinoma, Follicular Variant (ICD-O-3, 8340) Compared With Pap. & FollTable 6.Medullary, Papillary & Follicular Carcinoma 1993-13 Compared; All Stages CombinedTable 7.Thyroid Carcinoma, 1973-2013, Histology, All Ages, Race, Sex, Stage, Durations 0-5 & 5-10 YrsTable 8.Thyroid Carcinoma, 1973-2013, Histology, All Ages, Race, Sex, Stage, Durations 0-5 & 5-10 Yrs Conclusions.—Thyroid cancer when localized has a very good prognosis, with no significant excess mortality after diagnosis in papillary and papillary follicular variant cancers (PFV). Because nearly two thirds of thyroid cancers are localized, and excess death rate (EDR) is small in patients with regional cancer under age 50, overall excess mortality for all ages also virtually disappeared after 10 years in papillary and follicular cancer. Overall, the 5-year survival rate is greater than 90% for papillary and follicular carcinomas. Nevertheless, because of the marked predominance of papillary carcinoma, the continued increase in its relative frequency and annual projected deaths, thyroid carcinoma remains a significant health concern in the current era.

International audience; In phase II oncology trials, the use of new cytostatic drugs raises some questions regarding the endpoint. Time-to-event endpoints such as Progression-Free Survival have been recommended and led to new designs. In 2003, Case and Morgan proposed a design based on the comparison of the cumulative hazards at a clinically relevant timepoint. In 2013, Kwak proposed a design based on the one-sample log-rank test. If all the patients are followed from their entry time to the analysis date, the Kwak and Jung's design leads to a smaller sample size as compared to the Case-Morgan's design. However, the Case and Morgan's design requires less information since it only needs to follow every patient during a fixed interval of time. We propose a trade-off between these two approaches that corresponds to an adaptation of Kwak and Jung's design when the follow-up is expected to be restricted. Our proposal is based on the one-sample log-rank test as the Kwak and Jung's design but it uses the same follow-up information as the Case-Morgan's design. Simulation study shows that our proposal allows reducing the sample size as compared to the Case-Morgan's design (median difference of 23% [15%-33%]). Type I and type II error rates are close to their nominal rates planned in the protocol. A real phase II clinical trial in cervical cancer illustrated the interest of this new design. Thus, our proposal can be recommended as an alternative to the Kwak's design when patients' follow-up is restricted.

International audience; To type mathematical formula is a tedious task for all of us with the usual applications. Moreover, this task is very tiring for motor impairment. This paper describes the user centred methodology used to design the HandiMathKey virtual keyboard to type more easily the mathematical formula. Then we present a case study that compares the entry time between HandiMathKey and Word office for the mathematic formulas typing. This study shows that the HandiMathkey is easier to use and more efficient.

Objective: We explore how to optimally design systems for information input. Background: As computers are introduced into ever more devices with new methods of inputting information, there is a need for specialized systems that are optimally designed for their particular use. Method: The study demonstrates how to use a model of text entry times to build optimized keyboards for specific sets of text. The technique is demonstrated by using Fitts' law to model text entry times. Alphabet letters are assigned to keys in a way that minimizes predicted entry time for the specified set of text. The predicted entry times are validated by an experiment in which two keyboards are optimized for different sets of text. Results: Text entry is faster for the keyboard optimized for that text compared with the keyboard optimized for the other text. Learning to use the keyboards is fairly quick, with significant learning being observed after only one half-hour session. Conclusion: There is a need and an ability to design specialized keyboards for some situations. The study demonstrates that optimization of keyboards can decrease text entry times. Application: This research shows how to design optimized keyboards for many different situations. The approach should be useful for aviation, medical, industrial, and other specialized situations in which normal keyboard designs cannot be used.

The piriformis fossa is the ideal portal of entry for antegrade interlocking nailing. Localizing this portal can be difficult and its eccentricity leads to complications. This prospective comparative study was designed to compare an innovative way to obtain the ideal portal from inside the medullary canal in cases of plate failure and compare it to the classic antegrade portal. It included 41 cases (19 antegrade and 22 retrograde). The retrograde portal was significantly better in terms of entry time, radiation time, blood-loss, and wound length. The proper portal was rapidly and easily achieved in all retrograde cases without complications; while four in antegrade cases had complications. Minimum follow-up was 2 years. Level of evidence III.