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Purpose Differences in hysterectomy prevalence by rural or urban residence could distort comparisons of rural-urban cervical and uterine cancer incidence. Using data from a large population-based survey, we sought to understand whether hysterectomy prevalence varies by rural or urban residence and whether the relationship between hysterectomy prevalence and rurality varies by race or ethnicity. Methods Our analysis included 197,759 female respondents to the 2018 Behavioral Risk Factor Surveillance System, aged 20-79 years. We calculated population weighted proportions and 95% confidence intervals for hysterectomy prevalence, stratified by rural-urban residence and 5-year age groups. We also report estimates of hysterectomy prevalence by rural-urban residence for specific race and ethnic groups. Findings Hysterectomy prevalence increased with age and was more common among rural women than urban women. The largest absolute difference occurred among women aged 45-49 years; 28.6% of rural women (95% CI: 25.1-32.2) and 16.6% of urban women (95% CI: 15.3-17.8) reported a hysterectomy. For hysterectomy prevalence by race and ethnicity, rural estimates were higher than urban estimates for the following groups of women: non-Hispanic Asian, non-Hispanic other race, non-Hispanic Black, and non-Hispanic White. Among Hispanic women and non-Hispanic American Indian/Alaska Native women, rural-urban differences in hysterectomy prevalence were not statistically different at the 95% confidence level. Conclusions Our results suggest that variation in hysterectomy prevalence, if not adjusted in the analysis, could produce distorted comparisons in measures of the relationship between rurality and uterine and cervical cancer rates. The magnitude of this confounding bias may vary by race and ethnicity.

PURPOSE: Previous reports of gynecologic cancer rates have adjusted for hysterectomy prevalence with data from the Behavioral Risk Factor Surveillance System (BRFSS) or the National Health Interview Survey (NHIS). We sought to determine if BRFSS and NHIS produce similar estimates of hysterectomy prevalence. METHODS: Using data from BRFSS and NHIS, we calculated hysterectomy prevalence for women aged 20–79 years, stratified by 10-year age groups, survey year (2010, 2018), and race/ethnicity (Hispanic, non-Hispanic American Indian or Alaskan Native, non-Hispanic Asian, non-Hispanic Black, non-Hispanic White, non-Hispanic all other race groups). RESULTS: BRFSS and NHIS produced similar increasing trends in hysterectomy prevalence by age and directional differences by race and ethnicity. Fewer than 2% of women aged 20–29 years and more than 4 out of 10 women aged 70–79 years reported having had a hysterectomy. CONCLUSION: Our analyses suggest adjustment for hysterectomy prevalence with data from either survey would likely reduce distortion in cervical and uterine cancer rates. BRFSS, a survey which has a larger sample size than NHIS, may better support analyses of hysterectomy estimates for smaller subpopulations.

East Coast fever (ECF) in cattle is caused by the protozoan parasite Theileria parva, transmitted by Rhipicephalus appendiculatus ticks. In cattle ECF is often fatal, causing annual losses >$500 million across its range. The African buffalo (Syncerus caffer) is the natural host for T. parva but the transmission dynamics between wild hosts and livestock are poorly understood. This study aimed to determine the prevalence of T. parva in cattle, in a 30 km zone adjacent to the Serengeti National Park, Tanzania where livestock and buffalo co-exist, and to ascertain how livestock keepers controlled ECF and other vector-borne diseases of cattle.\ud \ud A randomised cross-sectional cattle survey and questionnaire of vector control practices were conducted. Blood samples were collected from 770 cattle from 48 herds and analysed by PCR to establish T. parva prevalence. Half body tick counts were recorded on every animal. Farmers were interviewed (n = 120; including the blood sampled herds) using a standardised questionnaire to obtain data on vector control practices. Local workshops were held to discuss findings and validate results.\ud \ud Overall prevalence of T. parva in cattle was 5.07% (CI: 3.70-7.00%), with significantly higher prevalence in older animals. Although all farmers reported seeing ticks on their cattle, tick counts were very low with 78% cattle having none. Questionnaire analysis indicated significant acaricide use with 79% and 41% of farmers reporting spraying or dipping with cypermethrin-based insecticides, respectively. Some farmers reported very frequent spraying, as often as every four days. However, doses per animal were often insufficient.\ud \ud These data indicate high levels of acaricide use, which may be responsible for the low observed tick burdens and low ECF prevalence. This vector control is farmer-led and aimed at both tick- and tsetse-borne diseases of livestock. The levels of acaricide use raise concerns regarding sustainability; resistance development is a risk, particularly in ticks. Integrating vaccination as part of this community-based disease control may alleviate acaricide dependence, but increased understanding of the Theileria strains circulating in wildlife-livestock interface areas is required to establish the potential benefits of vaccination.

Highlights • A bilioduodenal fistula may rarely occur after duodenal switch. This case report is original and interesting showing a successful conservative management of this rare complication. • A review of the literature on different types of Internal Biliodigestive Fistulae and their appropriate management are reported and briefly discussed. • We highlight the differential diagnosis and optional treatment in such a rare complication, and how we succeeded in its conservative management. • An accurate diagnosis and a team work between gastroenterologists and surgeons may be salvatory in this type of complication., Introduction Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is an advanced operation for morbid obesity. To our knowledge, no internal Biliodigestive Fistula has yet been reported as specific complication in the field of metabolic and bariatric Biliopancreatic diversion. Case presentation In this case report, we detail the case of a 57-year-old man who underwent a Single Anastomosis Duodeno-Ileal Switch (SADI-S) bariatric procedure for morbid obesity. Upon admission 3 weeks after the SADI-S procedure acute sepsis caused by a delayed choledoco-duodenal Fistula was diagnosed. A conservative management of this rare complication was successful. Discussion We highlight the differential diagnosis and optional treatment in such a rare complication, and how we succeeded in its conservative management, without any need for endoscopic nor surgical intervention. A review of the literature on different types of Internal Biliodigestive Fistulae and their appropriate management are reported and briefly discussed. Conclusion The aim of this case report is to highlight the existence of such a rare complication, and its successful multidisciplinary conservative medical management.

BackgroundThis paper explores the current role and place of diagnostic tests in the treatment of farm animal disease. With the growing focus on reduced reliance on antibiotic medicines in both animal and human patient care, attention is increasingly being focused on the practice, the technology and the function of diagnostic tests and how these can support responsible antimicrobial use. Emerging diagnostic technologies offer the possibility of more rapid testing for bacterial disease, while food chain actors and others are increasingly seeking to make diagnostic tests mandatory before the use of critically important antibiotics.MethodThis paper reports the findings of a recent large-scale on-line survey of UK farm animal veterinary surgeons (N=135) which investigated current veterinary diagnostic practice with particular attention to the relationship between diagnostic test use and antibiotic treatment.Results Results revealed a range of factors that influence veterinary diagnostic practice and demonstrate the continuing importance of clinical observation and animal/herd knowledge in the selection of antibiotic treatment. ConclusionThe findings identify a considerable ambivalence on the part of farm animal veterinarians regarding the current and future uses of rapid and point-of-care diagnostic tests as a means of improving clinical diagnosis and addressing inappropriate antibiotic medicine use.

Various methods have been described to aid pyloric drainage in patients undergoing esophagectomy with gastric reconstruction. These techniques are intended to prevent delayed gastric empting following esophagectomy that can be associated with early morbidity and long-term functional complaints. The current study aims to review the safety and efficacy of a pyloric stretch procedure performed at the time of esophagectomy. To achieve this, a retrospective review of 100 consecutive patients undergoing esophagectomy during the period 2011-2016 was performed. Until May 2013, no patients received intraoperative pyloric intervention. After May 2013, all patients (N = 50) underwent intraoperative pyloric stretch procedure that involved bidirectional mechanical dilatation of the pylorus. Postoperative outcomes including result of routine oral contrast swallow and early morbidity were evaluated. Intraoperative pyloric stretching was performed safely and without local complications in all patients. Delayed gastric emptying was observed significantly less frequently in patients who received intraoperative pyloric stretching (48% vs. 22%, P = 0.006). No significant differences were observed in postoperative outcomes. When considering all patients as a single cohort, the presence of delayed gastric emptying was associated with significantly higher rates of postoperative pneumonia (71% vs. 45%, P = 0.010), cardiac complications (57% vs. 25%, P = 0.001) as well as longer hospital say (12 vs. 15 days, P

Perioperative blood transfusion has been linked to poorer long-term survival in patients undergoing esophagectomy, presumably due to its potential immunomodulatory effects. This review aims to summarize existing evidence relating to the influence of blood transfusion on long-term survival following esophagectomy for esophageal cancer. A systematic literature search (up to February 2017) was conducted for studies reporting the effects of perioperative blood transfusion on survival following esophagectomy for esophageal cancer. Meta-analysis was used to summate survival outcomes. Twenty observational studies met the criteria for inclusion. Eighteen of these studies compared the outcomes of patients who received allogenic blood transfusion to patients who did not receive this intervention. Meta-analysis of outcomes revealed that allogenic blood transfusion significantly reduced long-term survival (HR = 1.49; 95% CI 1.26 to 1.76; P < 0.001). There appeared to be a dose-related response with patients who received ≥3 units of blood having lower long-term survival compared to patient who received between 0 and 2 units (HR = 1.59; 95% CI 1.31 to 1.93; P < 0.001). Two studies comparing patients who received allogenic versus autologous blood transfusion showed superior survival in the latter group. Factors associated with the requirement for perioperative blood transfusion included: intraoperative blood loss; preoperative hemoglobin; operative approach; operative time, and; presences of advanced disease. These findings indicate that perioperative blood transfusion is associated with significantly worse long-term survival in patients undergoing esophagectomy for esophageal cancer. Autologous donation of blood, meticulous intraoperative hemostasis, and avoidance of unnecessary transfusions may prevent additional deaths attributed to this intervention.

Resume Introduction Des nouvelles techniques sont proposees pour le traitement chirurgical de l’hypertrophie benigne de la prostate (HBP) : l’enucleation laser et l’adenomectomie par laparoscopie. Le but de cette etude retrospective etait la comparaison des resultats de la technique d’adenomectomie selon Millin realisee dans des conditions d’environnement medical contemporain aux resultats publies avec les nouvelles techniques d’enucleation laser ou d’adenomectomie par laparoscopie. Patients et methodes Deux cent quarante cas consecutifs d’adenomectomie realises selon la technique de Millin entre janvier 2004 et decembre 2008 ont ete analyses. Chaque patient etait evalue en preoperatoire par un score IPSS, un score de qualite de vie (SQV), un debit maximum (Qmax), un residu post-mictionnel (RPM), un volume prostatique total (VPT) mesure par echographie endo-rectale. La duree operatoire, le poids de la piece d’adenomectomie, le volume des pertes sanguines peroperatoires, le taux de transfusion sanguine, la duree de sondage, la duree de sejour, les complications postoperatoires immediates ont ete egalement rapportees selon la classification de Clavien. Chaque patient etait revu en consultation a 3 mois puis etait reconvoque en 2012. Lors de chacun des deux controles, un score IPSS, un SQV, une debitmetrie, un residu post-mictionnel etaient realises. Les resultats etaient compares a ceux de la litterature concernant l’adenomectomie realisee par voie ouverte ou par les nouvelles techniques chirurgicales. Resultats L’âge moyen etait de 69 ans, le volume prostatique total preoperatoire moyen 111 cc, le poids moyen de la piece d’adenomectomie 82 gr, les pertes sanguines peroperatoires moyennes 246 mL, le taux de transfusion 6 %, la duree moyenne de l’intervention 88 min, la duree moyenne de sondage 3,8 jours, et la duree moyenne de sejour (DMS) 5,6 jours. Les resultats fonctionnels a 3 mois mettaient en evidence une baisse du score IPSS de 25 a 5 points et du score de qualite de vie de 5 a 0,7 points, une augmentation du Qmax de 6,5 a 22 mL/sec, une baisse du RPM de 115 a 7,5 mL. Selon la classification classique ou de Clavien utilisee, le taux de complications precoces variait de 36 % a 49 %. Aucune complication de Clavien de Grade 4 ou 5 n’etait observee. Les resultats a long terme chez 137 (57 %) patients avec un âge moyen de 80 ans, revus avec un recul moyen de 5 ans, mettaient en evidence, un score IPSS variant de 2,5 a 6,6 points, un score de gene de 0 a 1,2, un Qmax de 13 a 23 mL/sec, un RPM de 0 a 25 mL. Conclusion Le manque d’exhaustivite des resultats et l’absence d’utilisation de la classification de Clavien rendait delicate la comparaison des resultats des differentes techniques. La motivation d’une equipe en faveur d’une technique representait un biais difficile a eviter, meme par la realisation d’une etude randomisee comparant deux techniques. L’adenomectomie selon Millin etait encore a ce jour la reference pour l’evaluation des nouvelles techniques chirurgicales dans le traitement des HBP de gros volume. Niveau de preuve 5.

Resume Objectif Evaluer les resultats de la sphincterotomie dans la dyssynergie vesico-sphincterienne d’origine neurologique. Patients et methode Etude retrospective portant sur 44 patients ayant eu une sphincterotomie entre janvier 2008 et septembre 2012. Tous les patients avaient une dyssynergie vesico-sphincterienne d’origine neurologique. L’âge moyen etait de 49,7 ans. Trente (70 %) patients etaient des traumatises medullaires et 34 (80 %) etaient porteurs de prothese d’incontinentation. La sphincterotomie etait realisee dans 55 % des cas en resection monopolaire (n = 24) et 43 % des cas au laser Revolix® (n = 19), apres retrait de la prothese uretrale. Resultats Le suivi moyen etait de 30 mois. La duree d’hospitalisation moyenne etait de cinq jours. Le residu post-mictionnel moyen preoperatoire etait de 149 mL et 176 mL en postoperatoire. Vingt-neuf pour cent (n = 13) ont beneficie d’une nouvelle sphincterotomie, avec un residu post-mictionnel moyen final a 116 mL. Le delai moyen avant nouvelle sphincterotomie etait de neuf mois. Enfin, 20 % (n = 9) ont finalement beneficie d’un autre traitement pour echec de la sphincterotomie. Conclusion Dans cette serie, nous avions observe que la sphincterotomie etait une technique bien toleree mais d’efficacite immediate modeste, avec un taux de succes initial de 57 %. Elle necessitait ainsi parfois un second temps et une surveillance au long cours afin de ne pas meconnaitre une nouvelle, avec un taux de succes meilleur (80 %).

The objective of the project was to ascertain whether urinary biomarkers of permethrin exposure are detected after wearing post-tailored, fabric-treated military uniforms under two different wear-time exposure scenarios. Study A occurred over 3.5 days and involved six participants wearing treated uniforms continuously for 30-32 h. Urine collection occurred at scheduled time points before, during, and after wearing the uniform. Study B, conducted over 19 days, included 11 participants wearing treated uniforms for 3 consecutive days, 8 h each day (with urine collection before, during, and after wear). Urinary biomarkers of permethrin (3-phenoxybenzoic acid (3PBA), cis- 2,2-(dichlorovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid (cDCCA), trans- 2,2-(dichlorovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid (tDCCA)) were detected during and after wear. Biomarker detection generally occurred over the 10- to 12-h period after putting on the uniform and subsided 24 h following uniform removal (in both Study A and B scenarios). Those wearing permethrin-treated uniforms under the longer wear-time scenario (Study A) excreted significantly higher cumulative mean levels compared with those in Study B (3.29 times higher for 3PBA and 2.23 times higher for the sum of c/tDCCA (P≤0.001)). Findings suggest that wearing permethrin-treated clothing does increase absorbed, internal dose levels of permethrin above population levels and is significantly related to wear-time duration.

Resume Objectif Etudier la faisabilite et rapporter les resultats initiaux de la nephrectomie laparoscopique avec extraction vaginale chez les patientes obeses ou en surpoids. Patientes et methodes Trois patientes ayant un IMC superieur a 28 kg/m 2 ont ete operees. L’âge etait de 51 ; 52 et 65 ans et l’IMC etait de 45,7 ; 57,3 et 28. Les trois patientes avaient un diabete non insulinodependant et une hypertension arterielle (HTA). Deux patientes etaient multipares et une nullipare. Les trois patientes ont subi une nephrectomie laparoscopique standard puis une extraction vaginale de la piece operatoire par une courte incision du cul-de-sac vaginal posterieur. L’alimentation etait normale des le lendemain de l’intervention. Il n’y avait pas de prescription de morphinique dans le service. Resultats Il n’y a pas eu de complication peroperatoire. Les durees d’intervention etaient de 288 ; 188 et 196 minutes. Les pertes sanguines etaient de 200 ; 120 et 100 mL. Les suites postoperatoires ont ete simples, avec une deambulation normale a j1. Les durees de sejour ont ete de deux, trois et cinq jours. Les patientes ont ete revues en consultation un mois plus tard sans evenement particulier avec une reprise normale de leur activite sexuelle. Conclusion La nephrectomie laparoscopique avec extraction vaginale etait une technique realisable chez les patientes obeses ou en surcharge ponderale. La morbidite parietale (infection, eventration) etait diminuee du fait de la petite taille des incisions abdominales.

Objectives To assess the impact of lymphovascular invasion (LVI) on upper urinary tract urothelial carcinomas (UTUCs) in a multicentre study on cancer-specific survival (CSS), recurrence-free survival and metastasis-free survival (MFS). To show the negative impact of LVI for patients with pN0/x disease and to stratify these patients into risk groups for metastatic relapse. Patients and Methods A multicentre retrospective study was performed on patients who underwent radical nephroureterectomy between 1995 and 2010. LVI status was evaluated as a prognostic factor for survival using univariate and multivariate Cox regression analysis. Results Overall, 551 patients were included and were divided into two groups: those without LVI (LVI−), n = 388 and those with LVI (LVI+), n = 163. LVI+ status was associated with high stage and grade UTUC and lymph node metastasis (P

Resume But La legislation francaise n’autorisant pas la desinfection de bas niveau pour les endoscopies des cavites steriles, evaluer l’impact economique et organisationnel et la securite bacteriologique du cystoscope flexible a gaine sterile a usage unique (CFGSUU) comparativement aux cystoscopes flexibles standards (CFS) dans deux CHU francais. Patients Etude prospective bi-centrique, ayant compare une periode d’utilisation du CFGSUU et une periode d’utilisation du CFS dans chaque CHU. Deux cent cinq patients ont ete inclus et repartis dans chaque groupe. Une analyse detaillee des durees de procedures et des couts a ete realisee dans les deux techniques ainsi qu’une analyse descriptive des taux d’infections urinaires. Un test d’etancheite des gaines apres leur utilisation etait realise. Resultats La duree d’installation du materiel etait superieure dans le groupe gaine : 16,2 minutes versus 10,9 dans le groupe standard. La duree moyenne de desinfection etait significativement moindre dans le groupe gaine : gain de temps de 53,8 minutes compare au groupe standard ; 99,01 % des gaines testees apres utilisation etaient etanches avec des taux d’infections urinaires similaires dans les deux groupes. Le cout moyen d’une cystoscopie a gaine etait inferieur au groupe standard, de facon significative a Lyon et non significative a Marseille. La difference de cout etait significative dans les deux centres en faisant varier les prix des gaines et l’activite des services. Conclusion Les CFGSUU permettaient une economie significative sur la duree de desinfection, les couts de consommables et les depenses de personnels, tout en assurant aux patients une securite bacteriologique comparable au CFS.

Resume Objectifs Determiner si l’ajout du score PCA3, et/ou de l’IRM prostatique permet d’ameliorer la selection des patients candidats a une premiere serie de biopsies de prostate. Methodes Une IRM prostatique multiparametrique (IRM MP) et un dosage de PCA3 ont ete realises avant biopsie chez les patients ayant une indication de premiere biopsie pour un toucher rectal anormal et/ou un PSA superieur a 4 ng/mL. Les sequences T2, dynamiques et de diffusion recherchaient une cible suspecte cotee sur un score de 4. Les patients ont ete inclus de facon prospective dans un seul centre. Les performances du PCA3 urinaire et de l’IRM ont ete evaluees par comparaison aux resultats des biopsies. Resultats Soixante-huit patients ont ete inclus, le PSA median etait de 5,2 ng/mL (3,2–28). La valeur predictive negative (VPN) des sores IRM 0, 1 et 2 etait respectivement de 80 %, 43 % et 69 %. La valeur predictive positive (VPP) des scores IRM de 3 et 4 etait de 50 % et 81 %. La valeur seuil discriminante pour le PCA3 etait de 21 (Se : 0,91 ; Sp : 0,50). Un seul patient avec des biopsies positives (0,5 mm de score de Gleason 3 + 3) avait a la fois une IRM negative et un PCA3 inferieur a 21. Conclusion L’association de l’IRM MP et du PCA3 permettait, dans cette etude, d’envisager une reduction du nombre de primo-biopsies inutiles sans ignorer la presence d’une eventuelle tumeur agressive.

Study Type – Prognosis (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Upper urinary tract urothelial carcinoma (UUT-UC) is a rare disease, usually treated by nephroureterectomy, occurring in a population with a median age of 70 years and with frequent tobacco use and other comorbidities. We know that the American Society of Anesthesiologists (ASA) score has prognostic value in urological oncology but this has not been assessed in UUT-UC. Using a multi-institutional French database, we have shown that the 5-year cancer-specific survival differed significantly between ASA 1, ASA 2 and ASA 3 patients (83.8%, 76.9% and 70.6%, respectively; P= 0.01). ASA status had a significant impact on cancer-specific survival in univariate and multivariate analyses, with a threefold higher risk of mortality at 5 years for ASA 3 compared with ASA 1 patients (P= 0.04). OBJECTIVE • To evaluate the impact of American Society of Anesthesiologists (ASA) scores on the survival of patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UUT-UC). PATIENTS AND METHODS • A retrospective multi-institutional cohort study of the French collaborative national database of UUT-UC treated by RNU in 20 centres from 1995 to 2010. • The influence of age, gender and ASA score on survival was assessed using a univariable and multivariable Cox regression analysis with pathological features used as covariables. RESULTS • Overall, 554 patients were included. The median follow-up was 26 months (10–48 months), and the median age was 69.5 years (61–76 years). In total, 114 (20.6%) patients were classified as ASA 1, 326 (58.8%) as ASA 2 and 114 (20.6%) as ASA 3. • The 5-year recurrence-free survival (P= 0.21) and metastasis-free survival (P= 0.22) were not significantly different between ASA 1 (52.8% and 76%), ASA 2 (51.9% and 75.3%) and ASA 3 patients (44.1% and 68.2%, respectively). • The 5-year cancer-specific survival differed significantly between ASA 1, ASA 2 and ASA 3 patients (83.8%, 76.9% and 70.6%, respectively; P= 0.01). • ASA status had a significant impact on cancer-specific survival in univariate and multivariate analyses, with a threefold higher risk of mortality at 5 years for ASA 3 compared with ASA 1 patients (P= 0.04). CONCLUSIONS • ASA classification correlates significantly with cancer-specific survival after RNU for UUT-UC. • It is a further pre-operative clinical variable that can be incorporated into future risk prediction tools for UUT-UC to improve their accuracy.

Ziel der vorliegenden Studie war, Ex-vivo-Funktionsparameter bei der Transfusion pathogeninaktivierter Thrombozytenkonzentrate (TK) im Vergleich zu konventionellen TK im perioperativen Setting zu untersuchen. Insgesamt 30 Patienten, bei denen postoperativ die Notwendigkeit zur Transfusion von 2 TK bestand, wurden in die Studie eingeschlossen. 15 Patienten erhielten konventionelle TK (konv. TK) und 15 Patienten erhielten pathogeninaktivierte TK (PI-TK). Alter, Volumen und Thrombozytengehalt der TK wurden erfasst. Vor (T0) und 30 min nach der Transfusion der TK (T1) wurden Blutproben fur Thrombozytenfunktionsdiagnostik (MEA) entnommen. Der Anstieg der Thrombozytenkonzentration (Inkrement) und das korrigierte Inkrement (CCI) wurden zum Zeitpunkt T1 errechnet. Weder an T0 noch an T1 wurden signifikante Gruppenunterschiede in den Ergebnissen der MEA oder in der konventionellen Gerinnungslaboranalyse beobachtet. Der Thrombozytengehalt pro TK war in den PI-TK signifikant hoher [3,3 (3,1/3,5)×1011 Thrombozyten pro PI-TK vs. 3 (2,9/3)×1011 Thrombozyten pro konv. TK, p

Obese patients with gastroesophageal reflux disease (GERD) refractory to medical therapy are a challenging patient population as obesity is a preoperative predictor of failure after antireflux surgery. We therefore sought to evaluate outcomes using one of two commercially available endoluminal therapies in this population. Consecutive obese patients (body mass index (BMI) > 30) with GERD (DeMeester >14.5) undergoing either Plicator (NDO) or Stretta (Curon) were identified in our single-institution prospective database. Outcomes assessed were: (1) failure rate (absolutely no symptomatic improvement after procedure and/or need for subsequent antireflux surgery), (2) postoperative vs. preoperative symptom (heartburn, chest pain, regurgitation, dysphagia, cough, hoarseness, and asthma) scores, and (3) proton-pump inhibitor (PPI) medication use. Twenty-two patients each underwent an endoluminal therapy (ten Plicator patients and 12 Stretta patients) with mean follow-up of 1.5 years. There were no treatment-associated complications. Mean BMI was not different between Plicator and Stretta groups (39.6 vs. 38.6, respectively, p = 0.33). The failure rate for the entire cohort was 28% (10% Plicator vs. 42% Stretta, p = 0.11). The proportion of patients reporting moderate/severe symptoms postop was significantly less than preop: chest pain 9% vs. 13% (p = 0.04), cough 22% vs. 36% preop (p = 0.025), voice changes 9% vs. 36% preop (p = 0.012), and dysphagia 9% vs. 32% preop (p = 0.04). The proportion of patients on PPI medications postop was also less than preop (45% vs. 81%, p = 0.1) Endoluminal treatment can provide a safe means of improving GERD symptoms for some obese patients, though many will continue to require medication therapy also. Further work aimed at understanding optimal candidates for endoluminal therapy in this patient population is warranted.

Electrocardiograms and radionuclide ventriculograms were obtained at rest and on exercise in 23 patients (20 men and 3 women, mean age 53.4 years) with exercise-dependent myocardial ischaemia after infarction, as well as in 22 persons (17 men and 5 women, mean age 43 years) without clinical, electrocardiographic and biochemical evidence of coronary heart disease. Among the ischaemia patients exercise-dependent loss of motility, as measured by regional ejection fraction and Fourier amplitude, occurred in 95% (50% of controls) in one sector, in 78% (4.5% of controls) in the two sectors with the highest contractility at rest, and in 74% (0% of controls) in three sectors. On exercise, phase shifts occurred in 87% (27% of controls). When combining the exercise-ECG, global ejection fraction as well as regional motility loss in one sector, in the two sectors with the highest contractility at rest and in three sectors, at least two of the five criteria of abnormality were present in 91.3% of the ischaemia patients, compared with at most one criterion in 90.9% of controls. The results indicate the greater diagnostic value of regional than global measures of ventricular function and emphasize the importance of radionuclide ventriculography as an addition to exercise electrocardiography in the pre-invasive diagnosis of coronary heart disease.

The effect of saralasin, a competitive inhibitor of angiotensin II, was assessed in hypertensive patients with unilateral renal artery stenosis after furosemide application. A significant fall of systemic arterial blood pressure, an increase of renal venous renin activity, significantly on the stenosed side in patients without arteriosclerosis of the contralateral kidney, and an almost equal decrement of renal blood flow in both kidneys were observed. Conceivably saralasin exerts different sodium-dependent effects on peripheral angiotensin II and specific intrarenal vascular receptors.

We describe a new implementation of a single scatter simulation (SSS) algorithm for the prediction and correction of scatter in 3D PET. In this implementation, out of field of view (FoV) scatter and activity, side shields and oblique tilts are explicitly modelled. Comparison of SSS predictions with Monte Carlo simulations and experimental data from uniform, line and cold-bar phantoms showed that the code is accurate for uniform as well as asymmetric objects and can model different energy resolution crystals and low level discriminator (LLD) settings. Absolute quantitation studies show that for most applications, the code provides a better scatter estimate than the tail-fitting scatter correction method currently in use at our institution. Several parameters such as the density of scatter points, the number of scatter distribution sampling points and the axial extent of the FoV were optimized to minimize execution time, with particular emphasis on patient studies. Development and optimization were carried out in the case of GSO-based scanners, which enjoy relatively good energy resolution. SSS estimates for scanners with lower energy resolution may result in different agreement, especially because of a higher fraction of multiple scatter events. The algorithm was applied to a brain phantom as well as to clinical whole-body studies. It proved robust in the case of large patients, where the scatter fraction increases. The execution time, inclusive of interpolation, is typically under 5 min for a whole-body study (axial FoV: 81 cm) of a 100 kg patient.

By virtue of their education, training, and experience, college and university faculty are a rich national resource. Opportunities abound for faculty scholars to apply their knowledge and expertise to pressing community and public issues and problems. Yet, narrow definitions of scholarship embedded in higher education practice act as disincentives to such faculty work. After a brief discussion of the problem, this article reviews efforts made in the US to expand the definition of scholarship and proposes a conception of scholarship that works across disciplinary contexts and addresses 21st-century challenges.

Summary Aim: Improvement of the spatial resolution in positron emission tomography (PET) by incorporation of the image-forming characteristics of the scanner into the process of iterative image reconstruction. Methods: All measurements were performed at the whole-body PET system ECAT EXACT HR+ in 3D mode. The acquired 3D sinograms were sorted into 2D sinograms by means of the Fourier rebinning (FORE) algorithm, which allows the usage of 2D algorithms for image reconstruction. The scanner characteristics were described by a spatially variant line-spread function (LSF), which was determined from activated copper-64 line sources. This information was used to model the physical degradation processes in PET measurements during the course of 2D image reconstruction with the iterative OSEM algorithm. To assess the performance of the high-resolution OSEM algorithm, phantom measurements performed at a cylinder phantom, the hotspot Jaszczack phantom, and the 3D Hoffmann brain phantom as well as different patient examinations were analyzed. Results: Scanner characteristics could be described by a Gaussian-shaped LSF with a full-width at half-maximum increasing from 4.8 mm at the center to 5.5 mm at a radial distance of 10.5 cm. Incorporation of the LSF into the iteration formula resulted in a markedly improved resolution of 3.0 and 3.5 mm, respectively. The evaluation of phantom and patient studies showed that the high-resolution OSEM algorithm not only lead to a better contrast resolution in the reconstructed activity distributions but also to an improved accuracy in the quantification of activity concentrations in small structures without leading to an amplification of image noise or even the occurrence of image artifacts. Conclusion: The spatial and contrast resolution of PET scans can markedly be improved by the presented image restauration algorithm, which is of special interest for the examination of both patients with brain disorders and small animals.

Objectives & Background NICE guidance on anaphylaxis (Dec 2011) focuses on initial emergency management and onward referral. The guideline emphasises 5 main domains; documentation, tryptase sampling, observation, safe discharge and speciality follow up. Poor guidance compliance was highlighted during a departmental audit in 2012. An anaphylaxis care bundle was developed and implemented in response. We aimed to evaluate the impact of this bundle on departmental management of anaphylaxis. Methods A retrospective case note review of all adult patients diagnosed with anaphylactic shock, identified from electronic records between 8/7/15–13/12/15 (cycle 1) and 30/3/16–17/5/16 (cycle 2) was conducted. A departmental anaphylaxis care bundle was introduced on 14/12/15. The bundle included a diagnostic checklist, clinical pathway, patient information leaflet and covering fax letter for the newly arranged allergy clinic direct referral. Implementation was supported by posters, educational sessions and staff emails. Performance was evaluated against the 5 main domains of the NICE guidance with the required standard of 100% compliance. Results Cycles 1 and 2 identified 29 and 10 patients respectively. Performance improved across all 5 domains following the care bundle implementation. Documentation of time of onset improved from 17/29 to 10/10. Tryptase sampling at presentation and after 1–2 hours improved 4/29 and 2/29 respectively during cycle 1 to 9/10 and 9/10 during cycle 2. None of the patients in cycle 1 received advice regarding baseline tryptase compared to 9/10 in cycle 2. All 10 patients in cycle 2 were observed for at least 6 hours compared to 24/29 in cycle 1. In cycle 2 safe discharge was achieved in 9/10 patients compared to cycle 1 where 20/29 received epipens and 12/29 received information leaflets. Referral to specialist allergy services improved from 3/29 to 9/10. Conclusion Following the introduction of the departmental anaphylaxis care bundle, more adult patients presenting with anaphylaxis are being managed, discharged and followed up in accordance with NICE guidelines. The concise algorithm could be an invaluable resource in other busy and high pressure departments. The importance of education, awareness, reinforcement and accessibility was important in achieving the improvements seen. Due to the rotational nature of junior staff on-going education is needed to ensure sustainability of the improved performance.

Objectifs Le but de notre etude etait d’evaluer la capacite du test serique PHI a predire le resultat des biopsies prostatiques dans une large cohorte monocentrique. Methodes Entre 04/2010 et 05/2014, 594 patients adresses pour biopsies prostatiques du fait d’une suspicion de cancer prostatique (PSA eleve, TR anormal et/ou antecedent familial) ont ete inclus. Le PHI a ete determine a partir du dosage du PSA total, du PSA libre et du P2PSA (PHI = ([–2]proPSA/free PSA) × √(total PSA, Access Immunoassay Systems, Beckman Coulter ® ). Resultats Le PHI median etait significativement plus eleve chez les patients avec biopsies positives et Gleason ≥ 7. L’AUC etait respectivement de 0,79 et de 0,83. En analyse multivariee, le PHI etait predicteur independant du resultat des biopsies et son addition a un modele de base apportait un gain significatif. Au seuil de 25, 45 % des biopsies a posteriori inutiles auraient ete evitees tout en ayant ignore 4 % des cancers avec score de Gleason ≥ 7. Dans la meme population, le score PCA3 est apparu lui aussi comme un predicteur independant de la positivite des biopsies et l’association des deux marqueurs etait plus performante que chaque marqueur evalue individuellement ( Fig. 1 ). L’addition du PCA3 au PHI n’apportait par contre pas de gain supplementaire pour la prediction d’un cancer de Gleason ≥ 7 ( Fig. 2 ). Conclusion Le test serique PHI presente des performances diagnostiques elevees pour le diagnostic precoce du CaP. Son association au score urinaire PCA3 est utile pour predire la positivite des biopsies mais seul le PHI est utile pour predire un cancer de Gleason ≥ 7.

The crew station instrument panel of U.S. Army rotary-wing cockpits has changed from one of traditional displays (e.g., gauges and dials) to one using multifunction displays (MFDs). The newer design is referred to as a “glass cockpit.” Pilots generally approve of the introduction of glass cockpit designs, and there is significant evidence that commercial aircraft with glass cockpit designs have fewer accidents. However, a recent study of U.S. Army rotary-wing aircraft comparing accident rates between traditional and glass cockpit models of the same aircraft type found evidence for higher accident rates in the glass cockpit models. Since the design of future aircraft will almost certainly include glass cockpits, it is important to explain this finding. To identify characteristics of glass cockpit designs that might be contributing to the accident rate differences, pilots of both traditional and glass cockpit models of the OH-58 Kiowa and AH-64 Apache helicopters were surveyed regarding their attitudes toward traditional and glass cockpit designs in the areas of workload, safety, crew coordination, situational awareness, and training. The survey results suggest that the pilots of glass cockpit aircraft generally have more positive attitudes toward their cockpit than the pilots of traditional cockpit displays. Significantly, though, pilot ratings of some aspects of workload and training were more favorable for the traditional cockpit design than for the glass cockpit design, so further investigation on those areas offers the best chance of explaining the accident rate differences.

OBJECTIVE: The purpose of this study was to identify clinical signs and symptoms associated with detection of human papillomavirus (HPV) DNA in the female genital tract. STUDY DESIGN: A total of 516 university students (18 to 24 years old) enrolled in a cohort study that included the collection of genital specimens for HPV DNA testing every 4 months for up to 4 years. Reported symptoms and objective clinical findings of women with and without HPV DNA were compared by multivariate analysis. RESULTS: Acute and persisting HPV infections were not associated with discharge, itching, burning, soreness, or fissures. Clinical evidence of genital warts was statistically associated only with HPV types 6 and 11. Detection of any HPV DNA was associated with bacterial vaginosis (BV). Furthermore, a time lag analysis suggests that HPV infection usually precedes detection of BV. CONCLUSION: Most women who acquire genital HPV infection are asymptomatic; some, however, are at increased risk for BV.

Incidence data on human papillomavirus (HPV) infection are limited, and risk factors for transmission are largely unknown. The authors followed 603 female university students in Washington State at 4-month intervals between 1990 and 2000. At each visit, a sexual and health questionnaire was completed and cervical and vulvovaginal samples were collected to detect HPV DNA. At 24 months, the cumulative incidence of first-time infection was 32.3% (95% confidence interval: 28.0, 37.1). Incidences calculated from time of new-partner acquisition were comparable for enrolled virgins and nonvirgins. Smoking, oral contraceptive use, and report of a new male sex partner--in particular, one known for less than 8 months before sex occurred or one reporting other partners--were predictive of incident infection. Always using male condoms with a new partner was not protective. Infection in virgins was rare, but any type of nonpenetrative sexual contact was associated with an increased risk. Detection of oral HPV was rare and was not associated with oral-penile contact. The data show that the incidence of HPV associated with acquisition of a new sex partner is high and that nonpenetrative sexual contact is a plausible route of transmission in virgins.

Purpose Agriculture and associated services are central to the rural economy of the United Kingdom. Rural veterinary enterprises are important providers of services to livestock producers, but are now facing concerns over their future economic viability. The objectives of this chapter are to outline the changes occurring in the veterinary and agricultural sectors, and to explore the main issues affecting veterinary enterprises in a changing business environment. Methodology This is a conceptual chapter contextualised mainly within the United Kingdom. As such, the methodological approach comprises a critical review of current academic literatures, as well as government reports and relevant media articles. Findings The findings demonstrate that the commercial success of rural veterinary enterprises is critical to ensuring the future provision of high-quality animal health services to both farmers and government. The current issues facing farmers are likely to affect their willingness and resources to invest in veterinary services. Furthermore, farmers may have doubts as to vets’ ability to provide business-focussed services that add value. In addition, many public services are outsourced to private veterinary enterprises, and forthcoming policy changes are expected to lead to reduced income from public sources for both vets and their livestock farming clients. While wider issues affecting agriculture are beyond the control of private veterinary practitioners, veterinary enterprises will need to ensure that they can deal with such challenges and, where required, adapt their services accordingly. Research limitations The chapter is based on a review of extant literatures, and the scope of the research is therefore limited to existing knowledge about the farm animal veterinary business landscape. Originality/value The chapter summarises current knowledge of the challenges facing rural veterinary enterprises. While some of the issues described are specific to the veterinary sector, many are also relevant to other rural SMEs providing knowledge-intensive services to farmers. The chapter also describes areas requiring further empirical research.

A comparison of organizations in Mexico and the USA demonstrates that, for these two countries, different quality improvement approaches are related to actual quality and financial performance. For 345 firms multiple quality improvement variables are correlated with seven quality measures, four financial measures, and one operating performance measure. Results suggest that in both countries an increase in employee involvement leads to improved quality-a decrease in internal failure costs, the percentage of items defective, and costs of quality. In Mexico an increase in employee knowledge about quality improvement and customer focus also leads to improved quality (as measured above). In the USA, but not in Mexico, the quality improvement approach relates to financial performance. An increase in senior executive leadership and an increased emphasis upon both design and conformance in the USA leads to an improved return on assets and increased net profit. In each country similar distributions from respondent...

Earlier investigations with BGO positron emission tomography (PET) scanners showed that the scatter correction technique based on multiple acquisitions with different energy windows are problematic to implement because of the poor energy resolution of BGO (22%), particularly for whole-body studies. The authors believe that these methods are likely to work better with NaI(Tl) because of the better energy resolution achievable with NaI(Tl) detectors (10%). Therefore, they investigate two different choices for the energy window, a low-energy window (LEW) on the Compton spectrum at 400-450 keV, and a high-energy window (HEW) within the photopeak (lower threshold above 511 keV). The results obtained for the authors' three-dimensional (3-D) (septa-less) whole-body scanners [axial field of view (FOV) of 12.8 cm and 25.6 cm] as well as for our 3-D brain scanner (axial FOV of 25.6 cm) show an accurate prediction of the scatter distribution for the estimation of trues method (ETM) using a HEW, leading to a significant reduction of the scatter contamination. The dual-energy window (DEW) technique using a LEW is shown to be intrinsically wrong; in particular, it fails for line source and bar phantom measurements. However, the method is able to produce good results for homogeneous activity distributions. Both methods are easy to implement, are fast, have a low noise propagation, and will be applicable to other PET scanners with good energy resolution and stability, such as hybrid NaI(Tl) PET/SPECT dual-head cameras and future PET cameras with GSO or LSO scintillators.

In order to evaluate the feasibility of the autologous transfusion in an alloimmunized sickle cell patient, changes in the hematologic and biochemical characteristics of erythrocytes stored for 42 days from two patients with sickle cell SC anemia were compared with control subjects' (Hb A) red blood cells. Erythrocytes were stored in Saline Adenosine Dextrose Mannitol at +4 degrees C. The cryopreservation storage was made and 51Cr red cell survival was measured in one patient. No significant difference in the hematologic and biochemical parameters of the SC red blood cells and the control subjects was observed during the storage at +4 degrees C. Red cell survivals determined in fresh cells, cells stored for 42 days at +4 degrees C and thawed cells from one patient demonstrate much shorter half-life values than those of normal red blood cells. Before application, our results need to be confirmed by the same protocol with another patient with sickle cell SC.

This paper discusses the findings from a survey of 599 managers in five countries in the Asia/South Pacific region. We sought to discover how similar the practices were, based on opinions, and the resulting performance, based on 14 measures, in the region. We also sought to derive a profile of practices which was associated with performance. Results indicate that practices may show more variety than performance relative to the regional scores. Regression analysis found only one measure of performance was significantly related to practice factors.

Dogs exhibit both neuroanatomical and cognitive changes as a function of age that parallel those seen in aging humans. This study describes in vivo changes in neuroanatomical and cerebrovascular characteristics of the canine brain as a function of age in a group of dogs ranging from 4 to 15 years old. Dynamic contrast-enhanced magnetic resonance imaging (MRI) was used to measure the kinetics of contrast agents in the brain. Measures of vascular volume and blood-brain barrier (BBB) permeability were derived from a pharmacokinetic analysis. Cortical atrophy and ventricular enlargement were characteristic features of the aged canine brain. Vascular volume did not vary as a function of age and BBB permeability exhibited a nonsignificant increasing trend with age. However, BBB dysfunction was detected in one middle-aged dog that in addition to having unusually large ventricles, demonstrated an early onset of diffuse senile plaques at postmortem. These findings indicate that BBB dysfunction detected by magnetic resonance imaging may be useful for predicting and potentially diagnosing early pathological conditions.

Zusammenfassung Ziel: In den letzten Jahren wurden verschiedene Algorithmen entwickelt, mit deren Hilfe an Volumen-PET-Systemen akquirierte 3D-Sino-gramme in 2D-Datensätze transformiert werden können. Damit eröffnet sich die Möglichkeit, die wesentlich höhere Sensitivität der 3D-Messung mit den Vorteilen der iterativen 2D-Rekonstruktion zu kombinieren. Ziel dieser Arbeit war es, die Wertigkeit dieses Ansatzes anhand von Phantommessungen und Patientenuntersuchungen zu evaluieren. Methoden: Alle Messungen wurden an einem Ganzkörper-PET-System der neuesten Generation (ECAT EXACT HR+) durchgeführt. Für die 2D-Messungen wurde ein Kollimator aus dünnen Wolframlamellen in das Gesichtsfeld eingebracht. Die akquirierten 3D-Daten wurden vor der Bildrekonstruktion mit dem von M. Defrise entwickelten “Fourier-Rebinning (FORE)”-Algorithmus in 2D-Sinogramme umsortiert. Zur Bildrekonstruktion wurde das Standardverfahren der gefilterten Rückprojektion (FBP) sowie ein optimiertes ML/EM-Verfahren mit Überrelaxation zur Konvergenzbeschleunigung eingesetzt. Die Ortsauflösung beider Verfahren sowie das Konvergenzverhalten und die Rauschentwicklung des ML/EM-Algorithmus wurde anhand von Phantommessungen untersucht. Darüber hinaus wurden Patientendaten sowohl im 2D-Modus als auch im 3D-Modus akquiriert und jeweils mit beiden Verfahren rekonstruiert. Ergebnisse: Bei gleicher Ortsauflösung wiesen die iterativ rekonstruierten Aufnahmen weniger und deutlich schwächer ausgeprägte Artefakte auf als die FBP-rekonstruierten Bilder, wodurch insbesondere die Detailerkennbarkeit verbessert wurde. Dies gilt sowohl für die im 2D-Modus als auch für die im 3D-Modus gemessenen Daten. Die beste Bildqualität ergab sich durch die iterative 2D-Rekonstruktion von 3D-Daten, die zuvor mit dem FORE-Algorithmus in 2D-Sinogramme transformiert wurden. Wie die Phantommessungen zeigten, reichen 50 Iterationsschritte aus, um mit dem optimierten ML/EM-Algorithmus einen Quantifizierungsfehler von weniger als 5% zu erreichen. Schlußfolgerung: Die vorgestellten Messungen belegen, daß die Qualität von 3D-PET-Aufnahmen durch die iterative Rekonstruktion verbessert werden kann. Durch die Verwendung des FORE-Algorithmus läßt sich dieses Konzept auch für die klinische Routine nutzen, da sich die Rechenzeit im Vergleich zur Rekonstruktion von reinen 2D-Daten nicht wesentlich verlängert.

Zusammenfassung Ziel: Mit kleineren Detektorelementen läßt sich bei PET-Scannern eine bessere räumliche Auflösung erzielen. Allerdings verschlechtert sich damit die Zählstatistik in den rekonstruierten Bildern. Daher wurde in dieser Studie der Einfluß verschiedener Aufnahmeparameter auf das Signal-zu-Rausch-Verhältnis (SNR) mit dem Ziel untersucht, die Qualität der PET-Aufnahmen zu optimieren. Methode: Die Messungen wurden an einem modernen Ganzkörper-PET-System (ECAT Exact HR+, Sie- mens/CTI) mit den vom Hersteller empfohlenen Einstellungen im 2D- und 3D-Modus durchgeführt. Zur Simulation von Patientenmessungen im Thoraxbereich wurde das EEC-Ganzkörperphantom mit verschiedenen Einsätzen verwendet. Bei den Messungen im Emissions- und Transmissionsmodus wurden die Ereigniszahlen sowie die untere Schwelle des Energiediskriminators variiert. Mit Hilfe einer einfachen Modellfunktion wurde der Einfluß der Ereigniszahlen im Emissions- und Transmissionsdatensatz auf das SNR parametrisiert. Ergebnisse: Bei den in der PET üblicherweise verwendeten Zählraten beeinflußt die Emissionsmessung das SNR im rekonstruierten Bild stärker als die Transmissionsmessung. Mit steigender unterer Energieschwelle verbessert sich bei gleicher Anzahl an Gesamtereignissen das SNR. Unter Verwendung der abgeleiteten Modellfunktion konnte die optimale Aufteilung der Gesamtmeßzeit (Emission und Transmission) abgeschätzt werden. Sowohl für den 2D- als auch für den 3D-Modus ergab sich ein optimaler Anteil der Emissionsmeßzeit an der Gesamtmeßzeit von etwa 75%. Schlußfolgerung: Der vorgestellte phänomenologische Ansatz bietet die Möglichkeit, das SNR und damit die Qualität von PET-Aufnahmen für den jeweiligen Scanner und die jeweilige Fragestellung auf einfache Weise zu optimieren.

The performance parameters of the whole-body PET scanner ECAT EXACT HR/sup +/ (CTI/Siemens, Knoxville, TN) were determined following the standard proposed by the International Electrotechnical Commission (IEC). The tests were expanded by some measurements concerning the accuracy of the correction algorithms and the geometric fidelity of the reconstructed images. The scanner consists of 32 rings, each with 576 BGO detectors (4.05/spl times/4.39/spl times/30 mm/sup 3/), covering an axial field-of-view of 15.5 cm and a patient port of 56.2 cm. The transaxial FWHM determined by a Gaussian fit in the 2D (3D) mode is 4.5 (4.3) mm at the center. It increases to 8.9 (8.3) mm radially and to 5.8 (5.2) mm tangentially at a radial distance of r=20 cm. The average axial resolution varies between 4.9 (4.1) mm FWHM at the center and 8.8 (8.1) mm at r=20 cm. The system sensitivity for unscattered true events is 5.85 (26.4) cps/Bq/ml (measured with a 20 cm cylinder). The 50% dead-time losses were reached for a true event count rate (including scatter) of 286 (500) kcps at an activity concentration of 74 (25) kBq/ml. The system scatter fraction is 0.24 (0.35). With the exception of the 3D attenuation correction algorithm, all correction algorithms work reliably. The results reveal that the ECAT EXACT HR/sup +/ has a good and nearly isotropic spatial resolution. Due to the small detector elements, however, it has a low slice sensitivity which is a limiting factor for image quality.

Improving quality and productivity simultaneously is vital to organizational competitiveness. Although continuous improvement is accepted as the objective for world class competition, it is not clear as to which interventions achieve the best performance, which variables intervene by enhancing or restricting the achievement of high quality and productivity, or which measures are appropriate for evaluating differences. Develops a quality evaluation tool and total factor productivity measures for health care clinics. Uses data envelopment analysis (DEA) to discriminate between high and low slack groups. Finds that hypothesized relationships and interactions between quality, productivity, and slack generally have statistically insignificant differences, exceptions being that health care consumers were able to identify characteristics of high and low quality care as well as health care professionals and that health care quality can increase with no decline in productivity when there is high‐slack. In general, high‐slack clinics could increase quality or productivity, but not both.

Prognostic impact of lymphadenectomy during radical nephroureterectomy (RNU) for urothelial carcinoma of the upper urinary tract (UTUC) is controversial. Our aim was to assess the impact of lymph node status (LNS) on survival in patients treated by RNU.In our multi-institutional, retrospective database, 714 patients with non-metastatic UTUC had undergone RNU between 1995 and 2010. LNS was tested as prognostic factor for survivals through univariate and multivariable Cox regression analysis.Median age was 70 years [interquartile range (IQR), 60-75] with median follow-up of 27 months (IQR, 10-50). Overall, lymphadenectomy was performed in 254 patients (35.5 %). Among these patients, 204 (80 %) had negative lymph nodes (pN0) and 50 (20 %) had positive lymph nodes (pN1/2). The 5-year cancer-specific survival (CSS) was 81 % [95 % confidence interval (CI), 73-88 %] for pN0 patients, 85 % (95 % CI, 80-90 %) for pNx patients and 47 % (95 % CI, 24-69 %) for pN1/2 patients (p 0.001). Metastasis-free survival (MFS) and overall survival (OS) rates were significantly lower in pN1/2 patients than in pN0 and pNx patients (p 0.05). On multivariable analysis, LNS did not appear as an independent prognostic factor for CSS, OS or MFS (p 0.05). In case of lymph node involvement, extra-nodal extension was marginally associated with worse CSS (log rank p = 0.07). The retrospective design was the main limitation.LNS is helpful for survival stratification in patients treated with RNU for UTUC. However, LNS did not appear as an independent predictor of survival in this retrospective series and needs to be investigated in a large multicentre, prospective evaluation.

Using the professional portfolio as a structure, faculty and administrators can work together to assign and assess faculty work in ways that meet the needs of faculty members, their unit, the students, the institution, and society.

Arrhythmogenic substrate diagnosis has been achieved by electrophysiological studies and best localized by successful radiofrequency ablation. Pre-invasive localization procedures have been based on surface ECGs and more recently on biomagnetism, but in addition to these electric and magnetic signals a mechanical signal may be utilized: the initial site of contraction may be detected by phase analysis during radionuclide ventriculography. Generation of three-dimensional data set of phases is achieved by incorporating the new emission tomography technique. The performance of this modified phase analysis has been investigated for the detection of the normal contraction pattern during sinus rhythm, the arrhythmogenic substrate of the WPW syndrome and ventricular tachycardia, and further, to define the limitations of the method in experimental studies on pigs. In 30 out of 44 patients with normal sinus rhythm and no ventricular lesion, a characteristic phase pattern was found. Physiologically, the initial site of contraction appeared to be paraseptal and in the anterior wall of the right ventricle close to the apex. In 13 patients with WPW syndrome and in seven with ventricular tachycardia, the phase data were compared to the electrophysiological study. In 14 of 20 there was a complete match, in 3 of 20 a mechanical focus was found in the area adjacent to the electric focus. From experimental pig studies with simulated stimulation, a spatial precision of at least 20 mm was found at a pre-excitation of 20 ms.(ABSTRACT TRUNCATED AT 250 WORDS)

A constellation of terms is necessary to describe the work of faculty, because faculty do different things and view what they do from different perspectives.

Changes in faculty roles and rewards are under way across the nation. How institutions approach change depends on their missions and campus cultures.