Search

The only supernovae (SNe) to have shown early gamma-ray or X-ray emission thus far are overenergetic, broad-lined Type Ic SNe (Hypernovae - HNe). Recently, SN 2008D shows several novel features: (i) weak XRF, (ii) an early, narrow optical peak, (iii) disappearance of the broad lines typical of SNIc HNe, (iv) development of He lines as in SNeIb. Detailed analysis shows that SN 2008D was not a normal SN: its explosion energy (KE ~ 6*10^{51} erg) and ejected mass (~7 Msun) are intermediate between normal SNeIbc and HNe. We derive that SN 2008D was originally a ~30Msun star. When it collapsed a black hole formed and a weak, mildly relativistic jet was produced, which caused the XRF. SN 2008D is probably among the weakest explosions that produce relativistic jets. Inner engine activity appears to be present whenever massive stars collapse to black holes., Comment: 22 pages, 7 figures. Accepted for publication in Science

Background The objective of this study was to evaluate the correlation between the 2001 Bethesda classification of endocervical glandular abnormalities and histological diagnosis. Study design A series of 155 women with endocervical glandular abnormalities on cervical smears were included: 91 with atypical glandular cells (AGC) not otherwise specified (NOS), 15 with AGC-favor neoplastic (FN); 35 with AGC associated with high-grade squamous intraepithelial lesion (HSIL) as combined diagnosis and 14 with adenocarcinoma in situ (AIS). Results Histological outcome of squamous neoplasias (CIN 2 or worse) and adenocarcinoma were significantly associated with AGC-FN and AIS, taking as reference AGC-NOS, and more associated with AIS than AGC-FN. Similar associations were observed for histological outcome of adenocarcinoma, but no association was observed for only squamous neoplasia. Histological outcome of CIN2 or worse was strongly associated with AGC when HSIL was also present, but no association was observed with only for adenocarcinoma histological outcome. Conclusions AGC-NOS, AGC-FN and AIS cytological diagnosis represent a progressively increasing association with neoplastic diagnosis, due to progressively increasing association with adenocarcinoma. Histological outcome of squamous neoplasia is frequent but does not differ with these cytological interpretations. The presence of HSIL associated with AGC represents greater probability of squamous neoplasia but not adenocarcinoma.

Resume Objectifs Le but de notre travail etait d’evaluer l’influence de la voie d’accouchement dans la presentation du siege a terme sur le score d’Apgar et les transferts en neonatologie dans une maternite francaise universitaire de niveau III. Materiel et methode Notre etude retrospective conduite sur une periode de dix ans (janvier 1996–decembre 2005) a permis d’inclure 568 presentations monofœtales du siege a terme. Les principaux criteres d’analyse ont ete les scores d’Apgar et les transferts en service de neonatologie. Resultats L’analyse des scores d’Apgar a 1,5 et 10 minutes et des transferts neonataux n’a pas mis en evidence de difference statistique. Conclusion L’absence de difference de pronostic neonatal permet de poursuivre les accouchements par le siege a terme, selon un protocole strict, dans notre service universitaire. La poursuite de cet enseignement obstetrical permet d’eviter des interventions chirurgicales non justifiees et d’ameliorer le pronostic maternofœtal, en cas de presentation inopinee du siege.

Objective: To analyse the correlation between cytomorphological criteria in smears with atypical glandular cells (AGC) or adenocarcinoma in situ (AIS) and human papillomavirus (HPV) reflex test results with different neoplastic histological diagnoses, particularly to distinguish between glandular and squamous neoplasia. Methods: A series of 155 women with glandular abnormalities in their conventional cervical smears was included: 106 with AGC, 35 with AGC associated with high-grade squamous intraepithelial lesion (HSIL) and 14 with AIS. Two reviewers evaluated 35 cytomorphological criteria and hybrid capture II (HCII) was performed in all cases. Colposcopy was carried out in all cases and biopsy in 126/155. For statistical purposes, predictive values and odds ratio (OR) were calculated, followed by chi-square automatic interaction detection. Results: Histology detected 56 cases of squamous and 17 of glandular intraepithelial or invasive neoplasia. Predictive values of the papillary groups and feathering criteria for glandular neoplasia were, respectively, 80.0% and 73.3%. Feathering was the criterion with the highest OR for distinguishing glandular from squamous neoplasia and also for distinguishing between glandular and non-neoplastic diagnosis. Rosettes and pseudostratified strips did not perform as well. Multivariant Classification and Regression Trees analysis identified feathering as the best criterion for distinguishing between glandular, squamous and non-neoplastic diagnoses regardless of HPV status. Conclusions: Feathering was the best criterion for predicting glandular neoplasia.

Aim: To evaluate the presence of thermotolerant Campylobacter spp. in stray cats in southern Italy. Methods and Results: One hundred and thirteen animals were trapped in two different environments (urban area, harbour area) of the city of Naples. From each cat, rectal swabs were collected. The samples were processed in order to detect thermotolerant Campylobacter spp. by culture methods. The positive samples were then confirmed by multiplex polymerase chain reaction. Campylobacter jejuni was isolated from 19/113 (16·8%) stray cats, whereas Campylobacter coli was not isolated. The cat data (age, environment and sex) were analysed by two statistical analyses using the C. jejuni status (positive/negative) as a dependent variable. As regards statistical regression model results, age and environment were risk factors for C. jejuni positivity. In particular, cats older than 1 year had a significantly higher risk of being positive for C. jejuni than cats aged up to 1 year (OR = 10·440; P = 0·000). Moreover, cats living in the harbour area had a significantly higher risk to be a carrier of C. jejuni than cats living in urban area (OR = 17·911; P = 0·008). Conclusion: The findings of the present survey confirm stray cats as potential carriers of C. jejuni. Significance and Impact of the Study: This is the first study on the prevalence of C. jejuni in stray cats in Europe.

Resume Objectif Le but de ce travail etait de determiner les influences exercees sur les mineures lors d'une demande d'interruption volontaire de grossesse (IVG). Patientes et methodes Nous avons realise une etude descriptive retrospective de deux ans au sein du CHU de Nice. Du 1 er janvier 2003 au 31 decembre 2004, 204 patientes mineures ont ete incluses dans notre etude. Resultats Dans l'immense majorite des cas, les personnes de l'entourage (partenaire ou parents) qui sont informees de la demande d'IVG soutiennent la patiente dans son choix. Dans plus de 56 % des cas, les parents ne sont pas informes de la demande d'IVG. Discussion et conclusion Il semble que ce soit la necessite de se conformer au modele social existant qui motive la majorite des demandes d'IVG chez la mineure.

In the present work we study the phase transformations taking place by mechanical alloying in the Ni–Al system and with further consolidation by sintering at high pressures with the aim of maintaining nanometric grain size. Different phase transformations were observed during milling, a Ni(Al) saturated solid solution for Ni–25 at.%Al and the formation of the intermetallic compound for Ni–50 at.%Al. Amorphization and recrystallization was also observed after prolonged milling. These phases remain after sintering with nanometric grain size and very high values of hardness.

We present here the analysis of the early and late multiwavelength afterglow emission, as observed by Swift a small robotic telescope and very large telescope (VLT). We compare early observations with late afterglow observations obtained with Swift and the VLT and we observe an intense rebrightening in the optical band at about 1 day after the burst, which is not present in the X-ray band. The lack of detection in X-ray of such a strong rebrightening at lower energies may be described with a variable external density profile. In such a scenario, the combined X-ray and optical observations allow us to derive that the matter density located at ∼10 17 cm from the burst is approximately a factor of 10 higher than in the inner region. This is the first time in which a rebrightening has been observed in the optical afterglow of a gamma-ray burst that is clearly absent in the X-ray afterglow.

When new technology is deployed, it is critical to have the confidence that it will perform safely and as reliably as designed. For many years, DNV GL has helped companies that develop new technologies to implement a systematic, risk based Technology Qualification process (DNV RP-A203, 2013) [1]. The objective of this process is to ensure that all identified risks are properly addressed and the system performs the duties for which it was designed to. The field example described in this paper is based on Moho Nord's TLP located offshore Africa at 1,050 meters of water depth. Hutshinson, contracted by Hyundai Heavy Industries (HHI) and Total in 2013, supplied the complete scope of connectors for the project. The overall qualification process covered a solution to install a tension leg platform in deep water, which required the utilization of a tendon connector system. It consisted of a Tendon Top Connector (TTC), Tendon Bottom Connector (TBC) and Intermediate Tendon Coupling (ITC). The focus of this paper will be the TBC which connected the TLP tendons to the sea floor. Although Hutchinson has supplied this type of connection for many years, this was the first time it was used for TLP application. This paper provides an overview of Hutchinson's TBC, and the main steps covered by DNV GL's Technology Qualification process, as well as the results obtained. The understanding of the novel elements of this technology was obtained through a system to component assessment. The execution of the TBC Technology Qualification Plan carried out activities addressing the failure modes defined for the novel components. All qualification activities were documented, and the data generated collected to ensure its traceability and to determine the performance margin for each failure mode. The performance assessment was carried out to ultimately compare the available qualification evidence against the boundary conditions established in the technology qualification basis, confirming that the technology had met or exceeded all of the requirements. Once the TQ process was completed, the equipment was considered as fully qualified within the intended application.

Gastroparesis is a chronic gastric motility disorder in which the pathophysiology mimics a postvagotomy state. Pyloroplasty is beginning to emerge as a successful drainage procedure for refractory gastroparesis. Here we report our experience using pyloroplasty in the surgical management of diabetic and nondiabetic gastroparesis. A retrospective study was performed of 46 patients undergoing pyloroplasty for refractory gastroparesis from January 2010 through December 2013. Gastric emptying scintigraphy and the Gastroparesis Cardinal Symptom Index were assessed pre- and postoperatively. Laparoscopic pyloroplasty was performed in 42 patients, open pyloroplasty in three, and one patient was converted from laparoscopic to open pyloroplasty. Studies were repeated during the six to 12 month postoperative interval. The postoperative gastric emptying scintigraphy improved in 90 per cent of patients and normalized in 60 per cent. Postoperative T½ was significantly reduced (P = 0.001) as was four-hour retention (P0.001). The Gastroparesis Cardinal Symptom Index showed statistically significant reduction in symptom severity for all nine categories (P0.0005) as well as total symptom score (P0.005). No patients developed dumping syndrome. Pyloroplasty is a highly effective therapy for refractory gastroparesis, offering significant reduction in symptom severity, improvement in quality of life, and acceleration of gastric emptying.

This study examines an innovative application of the aerosol deliquescence and crystallization determination, for corrosion prevention and energy-saving strategies in free-cooled data centers. Aerosol deliquescence and crystallization were investigated by combining standardized aerosol sampling techniques (i.e. EN-14907) with the assessment of the electrical effects of aerosol, while varying relative humidity within a specially designed aerosol exposure chamber. Aerosol samples collected in the Po Valley (Northern Italy) were analysed; a clearly defined hysteresis cycle (deliquescence and crystallization at 60.5 +/- A 0.8 and 47.9 +/- A 0.7 % of RH, respectively) was found. Results were applied to a data center designed for the Italian National Oil and Gas Company, making it possible to identify a critical area for direct free cooling at this data center. As a result, aerosol hydration was avoided (thus preventing aerosol from damaging electrical components) and a large amount of energy saved (using free cooling instead of air-conditioning); the potential energy saving achieved in this way was 79 % (compared to the energy consumption of a traditional air-conditioning system): 215 GWh of energy was saved, and 78 fewer kt of equivalent CO2 was emitted per year. Moreover, in order to evaluate whether a real-time estimation of the aerosol hydration state within a data center could be performed, measured deliquescence and crystallization were compared through simulations performed using three different models: two thermodynamic models for deliquescence and a parametric model for crystallization. The results obtained tend to converge in terms of deliquescence, whereas in the case of crystallization, they failed to effectively simulate experimental aerosol behaviour.

The rotator cuff and associated bony and soft tissue structures are complex, and rotator cuff tears present in a wide array of morphology and sizes. Shoulder arthroscopy has greatly expanded our knowledge about the pathoanatomy of cuff tears and associated lesions. Knowledge and recognition of common patterns of rotator cuff tears and associated lesions allow the shoulder surgeon to make rational decisions about the treatment of these lesions. Full-thickness, posterosuperior rotator cuff tears are classified and treated according to the geometric system, which allows tear pattern recognition to guide the repair pattern. Partial-thickness posterosuperior tears are classified by size and morphology according to Ellman. Both full- and partial-thickness subscapularis tears are common, and the typical pathoanatomical features exhibited by these tears should allow for increased recognition by surgeons. The capsuloligamentous tissue of the rotator interval commonly known as the comma should be used to guide the surgeon to retracted subscapularis tendon tears and should be preserved during repair. Preoperative findings may heighten the suspicion for occult or interstitial rotator cuff tears, and specific arthroscopic exam techniques allow for diagnosis of these lesions.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 35 - N° 7 - p. 720-724

Objective: To evaluate the presence of some criteria in cervical smears with atypical glandular cells and their correlation with histological patterns to identify pre-neoplastic and neoplastic lesions. Methods: Seventy-three women referred with an atypical glandular cell smear, who had undergone conization or hysterectomy, were included in this study. Referral Pap smears were reviewed using the set of 27 cyto-morphological criteria that was correlated with the histological diagnosis. Results: Histological results showed intraepithelial or invasive neoplasia in 35 (48%) cases and benign lesions in 38 (52%) cases. After logistic regression and decision tree analysis an increased nuclear/cytoplasmic ratio and the presence of dyskeratotic cells were strongly associated with intraepithelial or invasive neoplasia and the differential cyto-morphological criteria for glandular lesions were decreased cytoplasm, irregular nuclear membranes and the presence of nucleoli. Conclusion: The analysis of individual cyto-morphological criteria can better predict intraepithelial or invasive neoplasia and differentiate glandular from squamous lesions.

The value of video gaming in relation to endoscopic surgical skills is explored in this article. Subjects who had more experience and performed better on 3-dimensional games also performed better on an arthroscopic simulator during tasks requiring manipulation of tools. Although the correlation is established, no data are presented to support causation. Video gaming holds promise in assisting the trainee attempting to develop components of endoscopic skill. Further investigation is required to demonstrate that improvements in performance can be expected to result.

C3 and C4 plants are often reported to differ in functional traits and resource-use strategies, whereas nonnative plants may differ from native plants in functional traits, leading to different resource-use strategies that facilitate their invasion. In this study, we compared root functional traits of native and nonnative C3 and C4 grasses with the prediction that different resource acquisition strategies would be observed among these groups. We examined five root functional traits [mean diameter, specific root length, root tissue density, fine root percentage (diameter P P

Purpose: To assess a new method for biomechanical assessment of arthroscopic knots and to establish proficiency benchmarks using the Fundamentals of Arthroscopic Surgery Training (FAST) Program workstation and knot tester. Methods: The first study group included 20 faculty at an Arthroscopy Association of North America resident arthroscopy course (19.9 � 8.25 years in practice). The second group comprised 30 experienced surgeons attending an Arthroscopy Association of North America fall course (17.1 � 19.3 years in practice). The training group included 44 postgraduate year 4 or 5 orthopaedic residents in a randomized, prospective study of proficiency-based training, with 3 subgroups: group A, standard training (n ¼ 14); group B, workstation practice (n ¼ 14); and group C, proficiency-based progression using the knot tester (n ¼ 16). Each subject tied 5 arthroscopic knots backed up by 3 reversed hitches on alternating posts. Knots were tied under video control around a metal mandrel through a cannula within an opaque dome (FAST workstation). Each suture loop was stressed statically at 15 lb for 15 seconds. A calibrated sizer measured loop expansion. Knot failure was defined as 3 mm of loop expansion or greater. Results: In the faculty group, 24% of knots “failed” under load. Performance was inconsistent: 12 faculty had all knots pass, whereas 2 had all knots fail. In the second group of practicing surgeons, 21% of the knots failed under load. Overall, 56 of 250 knots (22%) tied by experienced surgeons failed. For the postgraduate year 4 or 5 residents, the aggregate knot failure rate was 26% for the 220 knots tied. Group C residents had an 11% knot failure rate (half the overall faculty rate, P ¼ .013). Conclusions: The FAST workstation and knot tester offer a simple and reproducible educational approach for enhancement of arthroscopic knot-tying skills. Our data suggest that there is significant room for improvement in the quality and consistency of these important arthroscopic skills, even for experienced arthroscopic surgeons. Level of Evidence: Level II, prospective comparative study.

Purpose To determine the effectiveness of proficiency-based progression (PBP) training using simulation both compared with the same training without proficiency requirements and compared with a traditional resident course for learning to perform an arthroscopic Bankart repair (ABR). Methods In a prospective, randomized, blinded study, 44 postgraduate year 4 or 5 orthopaedic residents from 21 Accreditation Council for Graduate Medical Education–approved US orthopaedic residency programs were randomly assigned to 1 of 3 skills training protocols for learning to perform an ABR: group A, traditional (routine Arthroscopy Association of North America Resident Course) (control, n = 14); group B, simulator (modified curriculum adding a shoulder model simulator) (n = 14); or group C, PBP (PBP plus the simulator) (n = 16). At the completion of training, all subjects performed a 3 suture anchor ABR on a cadaveric shoulder, which was videotaped and scored in blinded fashion with the use of previously validated metrics. Results The PBP-trained group (group C) made 56% fewer objectively assessed errors than the traditionally trained group (group A) ( P = .011) and 41% fewer than group B ( P = .049) (both comparisons were statistically significant). The proficiency benchmark was achieved on the final repair by 68.7% of participants in group C compared with 36.7% in group B and 28.6% in group A. When compared with group A, group B participants were 1.4 times, group C participants were 5.5 times, and group C PBP participants (who met all intermediate proficiency benchmarks) were 7.5 times as likely to achieve the final proficiency benchmark. Conclusions A PBP training curriculum and protocol coupled with the use of a shoulder model simulator and previously validated metrics produces a superior arthroscopic Bankart skill set when compared with traditional and simulator-enhanced training methods. Clinical Relevance Surgical training combining PBP and a simulator is efficient and effective. Patient safety could be improved if surgical trainees participated in PBP training using a simulator before treating surgical patients.

A systematic study of black carbon (BC) vertical profiles measured at high-resolution over three Italian basin valleys (Terni Valley, Po Valley and Passiria Valley) is presented. BC vertical profiles are scarcely available in literature. The campaign lasted 45 days and resulted in 120 measured vertical profiles. Besides the BC mass concentration, measurements along the vertical profiles also included aerosol size distributions in the optical particle counter range, chemical analysis of filter samples and a full set of meteorological parameters. Using the collected experimental data, we performed calculations of aerosol optical properties along the vertical profiles. The results, validated with AERONET data, were used as inputs to a radiative transfer model (libRadtran). The latter allowed an estimation of vertical profiles of the aerosol direct radiative effect, the atmospheric absorption and the heating rate in the lower troposphere. The present measurements revealed some common behaviors over the studied basin valleys. Specifically, at the mixing height, marked concentration drops of both BC (range: from −48.4 ± 5.3 to −69.1 ± 5.5%) and aerosols (range: from −23.9 ± 4.3 to −46.5 ± 7.3%) were found. The measured percentage decrease of BC was higher than that of aerosols: therefore, the BC aerosol fraction decreased upwards. Correspondingly, both the absorption and scattering coefficients decreased strongly across the mixing layer (range: from −47.6 ± 2.5 to −71.3 ± 3.0% and from −23.5 ± 0.8 to −61.2 ± 3.1%, respectively) resulting in a single-scattering albedo increase along height (range: from +4.9 ± 2.2 to +7.4 ± 1.0%). This behavior influenced the vertical distribution of the aerosol direct radiative effect and of the heating rate. In this respect, the highest atmospheric absorption of radiation was predicted below the mixing height (~ 2–3 times larger than above it) resulting in a heating rate characterized by a vertical negative gradient (range: from −2.6 ± 0.2 to −8.3 ± 1.2 K day−1 km−1). In conclusion, the present results suggest that the BC below the mixing height has the potential to promote a negative feedback on the atmospheric stability over basin valleys, weakening the ground-based thermal inversions and increasing the dispersal conditions.

The high prevalence of opercular deformities present in fish from Mediterranean marine hatcheries is an important problem, which is causing considerable economic losses. The aetiology of this syndrome is not yet well understood. In this study a histological and ultrastructural description of gilthead sea bream (Sparus aurata) larvae affected with anomalies of the opercular complex was carried out.

Il libro esamina il sistema della pianificazione comunale come disciplinato dalla l.r. Campania n. 16 del 2004. In particolare, si sofferma sul piano urbanistico comunale illustrandone la funzione, la natura giuridica (indagandone le diversità rispetto al p.r.g.), le fasi del procedimento di formazione; viene esaminata, nei suoi riflessi giuridici e fiscali, la perequazione urbanistica, quale sistema di pianificazione il cui utilizzo da parte dei comuni campani è facoltativo. Costituiscono oggetto di analitica disamina i piani urbanistici attuativi ed il regolamento urbanistico edilizio comunale. Completa il lavoro l’esame della deliberazione di giunta regionale 11 maggio 2007, n. 834, emanata dall’amministrazione regionale con il dichiarato intento di semplificare ed accelerare la formazione di piani territoriali ed urbanistici, ma di fatto fonte di ulteriori complessità ed aggravamenti procedimentali.

Computers are routinely used for dose calculations in many radiotherapy applications. The determination of the absorbed dose at any point in patients undergoing radiation therapy is done with treatment planning systems (TPS) which include proper hardware and software. The purpose of the present work is to provide an additional procedure to analyse and evaluate the power of a TPS dose assessment. A thermoluminescence (TL) dosimetric technique was employed. Several dosimetry trials were carried out on homogeneous, inhomogeneous and anthropomorphic phantoms. The experimental procedure showed a reasonable degree of accuracy in testing some of the performances of the TPS under consideration. In particular, the procedure succeeded in detecting discrepancies from 3% to 5% between TPS calculated dose values and measured ones in the penumbra regions and in the proximity of media interfaces for some irradiation configurations.

The 1993 Center for Devices and Radiological Health (CDRH) and Conference of Radiation Control Program Directors, Inc. (CRCPD) study focused on exposure rates from high level fluoroscopic equipment. As a part of the Pennsylvania study, only eight facilities within our region were surveyed, with exposure rates varying from 6 to 398 roentgens per minute. With so great a range, a more detailed survey on all facilities possessing equipment capable of high level fluoroscopy and its associated data recording modes was undertaken. This study encompassed 108 units from 42 facilities within the 22 counties of the Western Pennsylvania region. It is possible that typical fluoroscopy may not be responsible for the highest patient exposures, but that the recording of the images, primarily in the cineradiographic mode, produces the highest patient exposure rates.

Gastroparesis (GP) is a symptomatic delay in gastric emptying in the absence of mechanical obstruction. Symptoms can be subjectively reported by the validated Gastroparesis Cardinal Symptom Index (GCSI).1

Since elbow arthroscopy first graduated from a purely diagnostic procedure, the management of cartilage and synovial lesions has remained the most frequent therapy. The most common indications for elbow arthroscopy in the athletic population are the removal of loose bodies and the debridement of periarticular osteophytes, and for these mechanical disorders the procedure has clearly shown its value. The success in treating pathologic conditions in the elbow is substantially dependent on the ability of the arthroscopist. The high degree of congruency of the articular surfaces and the relatively small capsular volume demand a thorough knowledge of arthroscopic elbow anatomy and the relationships of the articulating surfaces. Skills in portal placement, instrument triangulation, and safely maneuvering the arthroscope to obtain optimal views are essential. To the degree that these necessities are met, gratifying results can be achieved in the arthroscopic management of loose bodies, chondromalacia, osteochondritis dissecans, synovitis, synovial osteochondromatosis, and lateral synovial plicas.

Multi-station forging machines with automatic work transfer between stations permit very high production rates to be reached, but considerable time and effort by skilled personnel must be spent in workplanning and their setting up and timing. The paper presents an integrated approach to the computer-assisted design of the tooling systems and identification of appropriate setting conditions and timing for multi-station presses to be used in cold, warm and hot forging. The approach is based on (i) the classification of possible configurations of punch- and die-side tool subassemblies, (ii) the automatic retrieval of the tool-holder assembly configuration for the specific station of the press, (iii) the assembly rules and automatic scaling and fitting of individual tool components and (iv) the animation -with check for interference- of die, punches, slugs, grippers and ejectors according to the kinematic model of the press.

Purpose: To establish the metrics (operational definitions) necessary to characterize a reference arthroscopic Bankart procedure, and to seek consensus from experienced shoulder arthroscopists on the appropriateness of the steps, as well as errors identified. Methods: Three experienced arthroscopic shoulder surgeons and an experimental psychologist (comprising the Metrics Group) deconstructed an arthroscopic Bankart procedure. Fourteen full-length videos were analyzed to identify the essential steps and potential errors. Sentinel (i.e., more serious) errors were defined as either (1) potentially jeopardizing the procedure outcome or (2) creating iatrogenic damage to the shoulder. The metrics were stress tested for clarity and the ability to be scored in binary fashion during a video review as either occurring or not occurring. The metrics were subjected to analysis by a panel of 27 experienced arthroscopic shoulder surgeons to obtain face and content validity using a modified Delphi Panel methodology (consensus opinion of experienced surgeons rendered by cyclical deliberations). Results: Forty-five steps and 13 phases characterizing an arthroscopic Bankart procedure were identified. Seventy-seven procedural errors were specified, with 20 designated as sentinel errors. The modified Delphi Panel deliberation created the following changes: 2 metrics were deleted, 1 was added, and 5 were modified. Consensus on the resulting Bankart metrics was obtained and face and content validity verified. Conclusions: This study confirms that a core group of experienced arthroscopic surgeons is able to perform task deconstruction of an arthroscopic Bankart repair and create unambiguous step and error definitions (metrics) that accurately characterize the essential components of the procedure. Analysis and revision by a larger panel of experienced arthroscopists were able to validate the Bankart metrics. Clinical Relevance: The ability to perform task deconstruction and validate the resulting metrics will play a key role in improving surgical skills training and assessing trainee progression toward proficiency.

In this study the single-dose and steady-state pharmacokinetics of unchanged triflusal and its metabolite 2-hydroxy-4-trifluoromethylbenzoic acid (HTB) were studied in 12 elderly subjects treated with a single oral administration of 300 mg triflusal and repeated oral administrations of 300 mg triflusal b.i.d. for 13 days. After a single administration, unchanged triflusal is promptly absorbed (t(max) 0.75 h, C(max) 3.83mgr;g/mL) and rapidly depleted from the systemic circulation. Its concentration was measurable only up to 1 to 4 h after administration. The apparent terminal half-life was 0.85 h. HTB proves to be quickly generated from triflusal (t(max) 2.00 h, C(max) 39.88mgr;g/mL) and slowly eliminated from the body (t = 54.6 h). With the dose regimen proposed, unchanged triflusal does not accumulate in the body. Conversely, HTB plasma concentration builds up progressively toward steady-state levels of approximately 102mgr;g/mL after 4 to 5 d of treatment. No substantial change in peak time, elimination rate constant and half-life evaluated after single-dose treatment was observed on multiple-dose regimen for unchanged triflusal and its metabolite HTB. Therefore, our findings do not indicate a time-dependent pharmacokinetics for triflusal. There were no changes in blood pressure, heart rate or laboratory safety date, i.e., biochemical or hematological profiles.