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Advocate Aurora Health, located in the north‐central United States, is the result of a merger between two large health care organizations in April 2018. The health care system comprises 26 hospitals, offers more than 500 sites of care, and employs 75,000 team members. This article discusses the effects that coronavirus disease 2019 had on the perioperative services departments while directors and site leaders were still managing the complexities of the merger. Included are strategies used to address the challenges created by the pandemic, special considerations based on level‐of‐care capacity, the effect that the hold on elective surgeries had on staffing assignments, the reactivation process when elective surgery resumed, and the importance of keeping the perioperative team members informed and safe. It also illustrates how facing the challenges caused by the pandemic helped to solidify the merger of the two health care organizations.

The US Medical Licensing Examination (USMLE) Step 1 exam has proven a difficult stressor for medical students during their training, even with the advent of pass-fail scoring. The preparation period before the exam places students at high risk for burnout and depression, leading to impaired exam performance and other serious consequences including suicide. Many medical schools already provide academic support for students during USMLE Step 1 preparation, yet to date, there are no published programs specifically geared towards mental health support during this time.Students from the Larner College of Medicine at the University of Vermont developed the "Step-Siblings" program to partner pre-clinical level students preparing for Step 1 (Little Sibs) with clinical-level students (Big Sibs) in an effort to promote near-peer mentorship and support for those studying. Big Sibs were trained to offer emotional support and wellness advice, but specifically not to provide academic counselling. The pilot program was evaluated by student surveys.Our program successfully paired Little Sibs (This student-driven mentorship model is simple to implement, easily generalizable to other medical schools and other board exams, and bears the lasting benefit of combatting the stress and burnout so prevalent in medical education.The online version contains supplementary material available at 10.1007/s40670-022-01571-4.

PURPOSE Pembrolizumab, a programmed death 1 inhibitor, demonstrated promising single-agent activity in untreated patients with various cancer types. The phase II KEYNOTE-427 study evaluated efficacy and safety of single-agent pembrolizumab in treatment-naive patients with advanced clear cell renal cell carcinoma (ccRCC; cohort A) and advanced non-ccRCC (cohort B). Results of cohort A are reported. METHODS In this open-label, single-arm phase II study, patients with advanced ccRCC received pembrolizumab 200 mg every 3 weeks for ≤ 24 months. The primary end point was objective response rate by RECIST, version 1.1. RESULTS In the total population (N = 110), median time from enrollment to data cutoff was 35.9 (range, 29.5-40.3) months. Objective response rate was 36.4% with four (3.6%) complete responses and 36 (32.7%) partial responses; disease control rate was 58.2% (95% CI, 48.4 to 67.5). Most patients (68.2%) had a decrease in target lesions, including 30.9% with a reduction ≥ 60%. Median duration of response was 18.9 (range, 2.3-37.6+) months; 64.1% of responders had a response ≥ 12 months (Kaplan-Meier). Median progression-free survival was 7.1 months (95% CI, 5.6 to 11.0). Median overall survival was not reached; 12-month and 24-month overall survival rates were 88.2% and 70.8%, respectively. Durable responses were observed across all International Metastatic RCC Database Consortium categories. Grade 3-5 treatment-related adverse events were reported in 30.0% of patients, of which colitis and diarrhea were most frequent. CONCLUSION Single-agent pembrolizumab showed promising antitumor activity as a first-line treatment in patients with advanced ccRCC, with durable responses across International Metastatic RCC Database Consortium categories. Safety and tolerability profile of pembrolizumab monotherapy was comparable to what has been previously described in other tumor types.

5069 Background: KEYNOTE-427 (NCT02853344), an open-label, single-arm, phase 2 study, showed clinical activity of first-line pembro monotherapy in patients (pts) with ccRCC (cohort A). Previous studies in RCC and immune-oncology suggest depth of response may correlate with long-term benefit. Association between depth of response and OS, along with updated efficacy and safety for cohort A of KEYNOTE-427, are presented. Methods: Pts with histologically confirmed ccRCC, measurable disease (RECIST v1.1), and no prior systemic therapy received pembro 200 mg IV Q3W for 2 y or until progressive disease, unacceptable toxicity, or withdrawal. End points: ORR (primary), DOR, and PFS (RECIST v1.1); OS, and safety. Association between depth of response (maximum reduction from baseline in the sum of target lesions) and OS was evaluated using Cox proportional hazards model with target lesion reduction group as time-varying covariate. Results: 110 pts enrolled; median time from enrollment to data cutoff was 23.1 (range, 16.7-27.5) mo. Overall, 38.2% of pts had favorable and 61.2% had intermediate/poor IMDC risk. ORR was 36.4% (95% CI, 27.4-46.1; 3 CRs, 37 PRs); median (range) DOR was not reached (2.3-23.5+ mo); 64.0% had a DOR ≥12 mo. Median PFS was 7.1 mo (95% CI, 5.6-11.0) and median OS was not reached; 18-mo PFS and OS rates were 26.6% and 80.0%, respectively. 69.1% had some reduction in target lesions. Pts with > 60% reduction in target lesions had a greater probability of survival than pts with a ≤60% reduction (Table). ORR observed in IMDC favorable and intermediate/poor risk was 31.0% and 39.7%, respectively; 18-mo OS rate was 95.2% for favorable and 70.5% for intermediate/poor IMDC risk. Treatment-related AEs (TRAEs) occurred in 81.8% of pts, primarily fatigue (29.1%) and pruritus (28.2%). Grade ≥3 TRAEs occurred in 29.1% of pts; 1 pt died of treatment-related pneumonitis. Conclusions: First-line pembro monotherapy was tolerable and showed promising antitumor activity in advanced ccRCC. In general, pts who had greater reductions in target lesions demonstrated a trend toward improved OS; pts with reduction of tumor burden ≥80% had comparable long term outcomes to those who achieved a RECIST 1.1 defined CR. Clinical trial information: NCT02853344 . [Table: see text]

We describe the relationship between the growth conditions of monogenic extensions of square-integrable functions f in terms of pointwise bounds or bounds on integral averages on the one hand, and the support of the Fourier transform or its annihilation by certain higher-dimensional analogues of the signum function on the other. We review known results involving a function’s monogenic extension and their classical Fourier transform. These results are extended to the Clifford-Fourier transform of Brackx, De Schepper and Sommen. The equivalence of the pointwise bounds and the bounds on the integral averages is observed as a consequence.

The National Ignition Facility (NIF) regularly operates at fluences above the onset of laser-induced optics damage. To do so, it is necessary to routinely recycle the NIF final optics, which involves removing an optic from a beamline, inspecting and repairing the laser-induced damage sites, and re-installing the optic. The inspection and repair takes place in our Optics Mitigation Facility (OMF), consisting of four identical processing stations for performing the repair protocols. Until recently, OMF has been a labor-intensive facility, requiring 10 skilled operators over two shifts to meet the throughput requirements. Here we report on the implementation of an automated control system—informed by machine learning— that significantly improves the throughput capability for recycling of NIF optics while reducing staffing requirements. Performance metrics for mid-2018 show that approximately 85% of all damage sites can be automatically inspected and repaired without any required operator input. Computer keystrokes have been reduced from about 6000 per optic to under 300.

Recent image guidance developments for preclinical synchrotron microbeam radiotherapy represent a necessary step for future clinical translation of the technique. Image quality can be further improved using x-ray phase contrast, which is readily available at synchrotron facilities. We here describe a methodology for phase contrast image guidance at the Imaging and Medical Beamline at the Australian Synchrotron. Differential phase contrast is measured alongside conventional attenuation and used to improve the image quality. Post-processing based on the inverse Riesz transform is employed on the measured data to obtain noticeably sharper images. The procedure is extremely well suited for applications such as image guidance which require both visual assessment and sample alignment based on semi automatic image registration. Moreover, our approach can be combined with all other differential phase contrast imaging techniques, in all cases where a quantitative evaluation of the refractive index is not required.

INTRODUCTION This study examined whether the standard measure of cigar use in adolescents could be improved by the addition of a brand-specific example. METHODS In 2002, prevalence of tobacco use was assessed in six midwestern U.S. high schools using the Youth Risk Behavior Survey. The survey was readministered to the same schools in 2004, with the brand name "Black and Milds" added to the item measuring cigar use. Changes in local prevalence rates were compared with national rates. RESULTS Local rates of cigar and cigarette use in 2002 were consistent with national rates reported in 2003. In 2004, when the cigar item was modified to include a brand-specific example, the percentage of students reporting cigar use nearly doubled-from 12.9% to 20.7%. This difference was particularly notable among Black teens. During the same period, local rates of cigarette use remained constant, as did national rates of reported cigar and cigarette use. DISCUSSION Results suggest that the current national survey item may not adequately measure cigar use. Accordingly, prevalence of cigar use among adolescents may be greatly underestimated, especially among Black youth.

The joint commission recognizes effective communication among caregivers as an important factor for ensuring patient safety, especially at times when the patient's care is handed off from one caregiver or service to another. This case study reviews the course of treatment for one patient throughout the perioperative continuum, including the postoperative unit where a pre-arrest situation developed. A workshop using Bloom's Taxonomy of Educational Objectives enabled staff members to more clearly understand the patient's situation. It also allowed the participants to gain an increased understanding of significant data and has been strategic in preventing patient complications.

Arterial blood gas (ABG) analysis is a crucial skill for perioperative nurses, in particular the RN circulator. This article provides the physiological basis for assessing ABGs perioperatively and presents a systematic approach to blood gas analysis using the Romanski method. Blood gas sample data allow the reader to practice ABG interpretation. In addition, four case studies are presented that give the reader the opportunity to analyze ABGs within the context of surgical patient scenarios. The ability to accurately assess ABGs allows the perioperative nurse to assist surgical team members in restoring a patient's acid-base balance.

Approximate analytic expressions for the transmitted and diffracted fields from a non-uniform in-fiber Bragg grating are presented, in terms of Hermite and Kummer confluent hypergeometric functions. These novel approximate analytic solutions are derived for the case of a grating having both a weak linear variation of grating period with length (weak linear chirp) and a quadratic approximation to a Gaussian refractive index modulation variation. The solution is derived using the Beta-value first-order two-wave coupled differential equations and describes both on- and off-Bragg replay. The equations are shown to be useful, when compared to more exact numerical results, for a wide range of practical grating parameter values.

A study is presented of the application of commercially available FBGs (fibre Bragg gratings) to measure temperature gradients. The optical measurement system is based on an electronically tuned solid-state laser, S-TLD. FBG sensor calibration is carried out using a dual Peltier water-cooled system, with which linear temperature gradients are applied to the FBG, resulting in chirping along the grating. Spectral parameters are extracted from reflection intensity spectra using LabView software. A 'look-up table' approach is then used as a means of solving the inverse problem. Quantified worst-case errors associated with each estimated temperature value are presented, and in this way the accuracy of the temperature measurements are discussed. Based on our experimental results a novel proposal to use pre-chirped FBGs to optimize temperature gradient sensing is made.

•PATIENTS WITH BODY PIERCINGS present a challenge for today's perioperative nurses. The need to prepare these patients for surgery while promoting safety, preserving body image, and respecting cultural values has gone beyond the routine practice of jewelry removal. •BODY ART (ie, tattooing, piercing) has been practiced by men, women, and children from ancient times to the present. It was used then, as it is now, for many purposes, including personal expression, rite of passage, and fashion trends. •THE EXPANDING POPULARITY of body piercing increases the likelihood that patients will arrive for surgery with body jewelry in place. This article provides perioperative nurses with the proper tools to deliver culturally sensitive care to patients with body piercings. AORN J 79 (February 2004) 333–342.

Deep saline aquifers are potential reservoirs for commercial scale CO2 geologic sequestration (GS) due to their large storage capacity and wide availability. These reservoirs are regional in scale with no conventional stratigraphic or structural traps. The fate of supercritical CO2 injected in saline aquifers depends on hydrodynamics and phase trapping. This paper examines hydrodynamic trapping, and the question of whether basinward flow of groundwater can counteract updip CO2 movement after injection ends, and render the gas immobile. After injection pressure dissipates, the important flow mechanisms are viscous flow of groundwater (imposed by compaction and gravity) and buoyant flow of CO2 (imposed by the density contrast between injected CO2 and the formation fluid). Hydrodynamic trapping theory is reviewed and its application to GS is discussed. The same methods developed for oil and gas can be used to identify possible hydrodynamic traps for pools of CO2 post injection. Examples are given of deep basin aquifer dynamics and regional groundwater flow gradients as they relate to GS. In a dipping aquifer, groundwater flow and buoyant CO2 flow may be in the same direction (immature compacting basin) or the opposite direction (mature basin). The mature basin scenario is optimum for GS, as long-term updip CO2 movement will be reduced by saline aquifer flow. Analytic expressions are used to investigate trapping potential, and to estimate the rate of buoyant CO2 movement after injection ends in a mature basin example with groundwater flow down the dip. Key inputs such as hydraulic gradient, dip, and density contrast were varied to assess their relative influence. The results demonstrate that, post injection, it is possible for pooled CO2 to be hydrodynamically trapped under field conditions. CO2 could also be displaced downdip in aquifers with high hydraulic gradients (~ 0.02) and low dips (~ 0.25 degrees). In the more likely case of a low to average hydraulic gradient (~ 0.0004 to 0.003), and dip greater than ~ 0.25 degrees, buoyancy dominates, and the CO2 is generally displaced in the updip direction at rates of approximately one to one hundred feet per year. This can lead to significant displacement over the long time scales desired for GS. Therefore, in a mature basin, groundwater flow alone will usually be insufficient to counteract buoyancy, and phase trapping or hydrodynamic trapping will be needed to ultimately immobilize the CO2.

TPS9600 Background: The outcome of high risk stage IIIb and IIIc melanoma patients is poor, with a 5 year overall survival (OS) rate of < 50%. Adjuvant high dose IPI significantly improves 5 year progression free survival (PFS) and OS. In stage IV patients the combination of IPI and NIVO improves response rates (RR) and PFS compared to monotherapy, but at cost of higher toxicity. Neo-adjuvant treatment may be a favorable approach as immune checkpoint inhibition (ICI) is of greatest value at the moment of TCR triggering and therefore dependent on the amount of antigen present. The phase Ib OpACIN study comparing neo-adjuvant and adjuvant IPI and NIVO showed that neo-adjuvant treatment is feasible as all patients underwent surgery on time. The neo-adjuvant pathological RR was 80%, although 18/20 patients (90%) stopped early due to ≥1 grade 3 or 4 immune-related adverse events (irAEs). To date (median follow-up 45 wks), none of the 8 responders in the neo-adjuvant arm have relapsed. This raises the question whether the neo-adjuvant IPI and NIVO schedule can be adjusted to reduce toxicity but preserve efficacy. Methods: The aim of the multi-center phase 2 OpACIN-neo trial is to identify an optimal neo-adjuvant combination scheme of IPI and NIVO. 90 patients with resectable stage III melanoma will be randomized 1:1:1 between three combination schemes of IPI and NIVO. Patients in arm A will receive 2 courses standard regimen IPI 3mg/kg + NIVO 1mg/kg q3wks, in arm B IPI 1mg/kg + NIVO 3mg/kg q3wks, and in arm C 2 courses of IPI 3mg/kg q3wks directly followed (2-24hr) by 2 courses NIVO 3mg/kg q2wks. All patients will undergo surgery at week 6. The primary endpoints are rate of grade 3/4 irAEs, pathological RR, and radiologic RECIST 1.1. An interim analysis is planned after 13 patients have been accrued to each arm (according to the Simon 2-stage design). Major inclusion criteria are: ≥1 measurable lymph node metastases (according to RECIST 1.1) that can be biopsied, no history of in-transit metastases in the last 6 months, and naïve for ICI. Baseline biopsies and blood samples (week 0, 6, 12) will be taken for translational research. The first center started inclusion in December 2016, until now 2 patients have been enrolled. Clinical trial information: NCT02977052.

We describe the principles of using orientation-independent differential interference contrast (OI-DIC) microscopy for mapping optical path length (OPL). Computation of the scalar two-dimensional OPL map is based on an experimentally received map of the OPL gradient vector field. Two methods of contrast enhancement for the OPL image, which reveal hardly visible structures and organelles, are presented. The results obtained can be used for reconstruction of a volume image. We have confirmed that a standard research grade light microscope equipped with the OI-DIC and 100 × / 1.3 NA objective lens, which was not specially selected for minimum wavefront and polarization aberrations, provides OPL noise level of ? 0.5 ?? nm and lateral resolution if ? 300 ?? nm at a wavelength of 546 nm. The new technology is the next step in the development of the DIC microscopy. It can replace standard DIC prisms on existing commercial microscope systems without modification. This will allow biological researchers that already have microscopy setups to expand the performance of their systems.

For paraxial wave-fields in two dimensions, it is known that the defocused OTF is given by a section through the ambiguity function. This is no longer true for high aperture fields. It is shown that there is a simple relationship, even for high aperture fields, between the two-dimensional (one transverse and one longitudinal) generalized OTF and the spectral correlation function. The connection with the Wigner distribution function is also discussed. The generalization to three-dimensional wavefields is also considered.

We retrospectively reviewed the use of biodegradable hemi-cerclage sutures in the treatment of 79 metacarpal fractures in 66 patients. The polyglycolic acid hemi-cerclages achieved sufficient fracture fixation to permit early motion exercises, but fractures were also immobilized for a mean of 3.7 (range, 1.5–6) weeks postoperatively, during which time physiotherapy was given. Adequate bony stability was achieved after a mean of 4.5 (range, 3.5–7) weeks and fracture redisplacement occurred in only one case.

The results of open carpal tunnel release using a short incision (2.5 cm) have been compared with those following a long incision (4.5 cm) in a prospective randomized study. Eighty patients were operated upon with a follow-up rate of 100%. The variables examined included grip strength, key and pulp pinch strength, sensory function and scar tenderness. Subjective variables such as tingling, numbness and night symptoms were specifically enquired into, and time for return to work was noted. The examinations took place pre-operatively, as well as one, two, three and six weeks post-operatively. Median time for return to work was 21 days for the short incision group and 18 days for the long incision group. The long incision resulted in a significant 10% loss of strength only at week three, otherwise no significant difference was found between the results of the two groups.

Forty-two patients (45 fingers) were retrospectively reviewed after operative release of flexion contractures of the proximal interphalangeal (PIP) joint. The release was accomplished through a palmar incision in 19 fingers, usually followed by skin coverage using a lateral transposition flap. A midlateral incision was used in 26 fingers. The 2 groups were comparably matched with respect to degree of contracture and demographic characteristics. Active range of motion (ROM) was measured before and after surgery. In the palmar incision group, preoperative median PIP joint ROM was 60 degrees to 90 degrees (extension/flexion) and 30 degrees to 90 degrees at the 3-year follow-up examination. In the midlateral incision group, preoperative median PIP joint ROM was 50 degrees to 90 degrees (extension/flexion) and 0 degrees to 90 degrees at the 1.5-year follow-up examination. The improvement in ROM was significantly better in the midlateral incision group than in the palmar incision group.

Rates of elimination of fourteen substituted fluoren-9-ylmethyl benzenesulfonates have been measured in methanolic sodium methoxide and 90% aqueous ethanolic solutions of triethylamine, trimethylamine and 4-methyl morpholine. For the sodium methoxide, a linear Hammett plot with ρ = 0.74, consistent with reaction by an E2 mechanism, is observed. For the amine bases the Hammett plots are curved, suggesting a transition from an E2 mechanism for electron-withdrawing substituents to an irreversible E1cB mechanism with a smaller value of ρ for electron-donating substituents. The evidence for a change of mechanism is weakened by systematic and random deviations of substituents from correlations which span small changes in reactivity (less than ten-fold), by a surprisingly large value of ρ = 2 implied for the concerted (E2) reaction and by the possible influence of negative hyperconjugation. Nevertheless, it is consistent with independent evidence that the borderline between concerted and stepwise mechanisms is associated with chemically distinguishable reaction paths, even though pronounced carbanion character (and probably a small extent of bond-breaking to the leaving group) ensures a degree of similarity of structure and sensitivity to substituents of their transition states.

The significance of the similarity theorem for the fractional Fourier transform is discussed, and the properties of self-similar functions considered. The concept of the fractional Hankel transform is developed for use in the analysis of diffraction and imaging in symmetrical optical systems. The particular case of Fresnel diffraction from a circular aperture is discussed and the effects of the similarity theorem are described.

At present the best methods for rotation of discrete sampled images use a combination of (fast) Fourier interpolation followed by cubic interpolation onto a rotated grid. A method is presented which uses only Fourier interpolation. The new method has a similar computational complexity to the old, and is exactly reversible. The method uses the well-known decomposition of rotation into three pure shears. Each shear is performed using a 2D extension of the 1D Fourier shift theorem. This allows the fast Fourier transform (FFT) to be used. With appropriate data padding (such as zero padding) in both the real and Fourier domains, the procedure gives near perfect results and minimal loss of information in multiple rotation tests.

X-ray Talbot moire interferometers can now simultaneously generate two differential phase images of a specimen. The conventional approach to integrating differential phase is unstable and often leads to images with loss of visible detail. We propose a new reconstruction method based on the inverse Riesz transform. The Riesz approach is stable and the final image retains visibility of high resolution detail without directional bias. The outline Riesz theory is developed and an experimentally acquired X-ray differential phase data set is presented for qualitative visual appraisal. The inverse Riesz phase image is compared with two alternatives: the integrated (quantitative) phase and the modulus of the gradient of the phase. The inverse Riesz transform has the computational advantages of a unitary linear operator, and is implemented directly as a complex multiplication in the Fourier domain also known as the spiral phase transform.

Summary In an imaging system, it is known that the information capacity, rather than the resolution, is invariant. Thus super-resolution can be achieved by encoding/decoding additional information on to independent parameters of the imaging system. The concept of information capacity is extended to the full three-dimensional case.

To describe a severe phenotype of Meesmann's epithelial corneal dystrophy (MECD) and to determine the underlying molecular cause.We identified a 30-member family affected by MECD and examined 11 of the 14 affected individuals. Excised corneal tissue from one affected individual was examined histologically. We used PCR and direct sequencing to identify mutation of the coding regions of the KRT3 and KRT12 genes.Cases had an unusually severe phenotype with large numbers of intraepithelial cysts present from infancy and they developed subepithelial fibrosis in the second to third decade. In some individuals, the cornea became superficially vascularized, a change accompanied by the loss of clinically obvious epithelial cysts. Visual loss from amblyopia or corneal opacity was common and four individuals were visually impaired (≤6/24 bilaterally) and one was blind (6/60 bilaterally). In all affected family members, there was a heterozygous missense mutation c. 395TC (p. L132P) in exon 1 of the KRT12 gene, which codes for the helix-initiation motif of the K12 polypeptide. This sequence change was not found in unaffected family members or in 100 unaffected controls.The Leu132Pro missense mutation is within the helix-initiation motif of the keratin and is predicted to result in a significant structural change of the K12 protein. The clinical effects are markedly more severe than the phenotype usually associated with the Arg135Thr mutation within this motif, most frequently seen in European patients with MECD.

BACKGROUND: Activating mutations in serine-threonine protein kinase B-RAF (BRAF) are found in 50% of patients with advanced melanoma. Selective BRAF-inhibitor therapy improves survival, as compared with chemotherapy, but responses are often short-lived. In previous trials, MEK inhibition appeared to be promising in this population. METHODS: In this phase 3 open-label trial, we randomly assigned 322 patients who had metastatic melanoma with a V600E or V600K BRAF mutation to receive either trametinib, an oral selective MEK inhibitor, or chemotherapy in a 2:1 ratio. Patients received trametinib (2 mg orally) once daily or intravenous dacarbazine (1000 mg per square meter of body-surface area) or paclitaxel (175 mg per square meter) every 3 weeks. Patients in the chemotherapy group who had disease progression were permitted to cross over to receive trametinib. Progression-free survival was the primary end point, and overall survival was a secondary end point. RESULTS: Median progression-free survival was 4.8 months in the trametinib group and 1.5 months in the chemotherapy group (hazard ratio for disease progression or death in the trametinib group, 0.45; 95% confidence interval [CI], 0.33 to 0.63; P

For complete spherical concentration of light the maximum theoretically possible total energy density for a given power input can be, in principle, achieved by appropriate choice of polarization and angular amplitude variation. Illumination of a focusing system with a plane-polarized wave creates at the focus equal electric and magnetic energy densities. By appropriate choice of radial variation this energy density can be maximized. For hemispherical concentration the electric energy density can be seven sixteenths of the maximum possible for a given power input, and the total energy density can be seven eighths of the maximum possible. Focusing by optical systems satisfying the sine condition amongst others is also considered. For a system satisfying the sine condition, the total energy density can be 64/75 of the maximum possible.

Observations on white-light interference fringes show that the effects due to the introduction of a variable geometric phase, which is independent of the wavelength, differ significantly from those due to a change in the optical path difference.

“No Migration” Petitions must be submitted by operators of Class I hazardous disposal wells to apply for an exemption from the federal land ban restrictions on the disposal of hazardous waste. In many Class I disposal well operations, the injectate density can vary daily and usually has a different density than the native formation brine. The influence of the density contrast on the fluid potential must be included in a “No Migration” Petition modeling demonstration. After the model wells (s) is shut-in, the density contrast results in a net updip (lower density injectate) or downdip (higher density injectate) component of flow near the center of mass of the calculated plume (neglecting regional flow). In many cases, two model runs are required: one using the lowest anticipated injectate density and one using the highest anticipated injectate density for the entire modeled operational period. This was intended to provide adequate plume delineation over the injectate density range and implies that buoyancy effects on the plume position are not related to the average density. Three separate cases of a two-dimensional generic numerical model were used to examine buoyancy effects using constant and variable injectate density input values. Case 1 used a random selection of the daily variation about the mean density, and case 2 used correlated daily injectate densities over a five day period. The model calculated concentrations from cases 1 and 2 were compared to the results from a third case that used the mean density input value for the entire operational period. The calculated plume extent for all three cases is virtually identical for simulation times up to 10,000 years. The modeling results demonstrate that using a long-term average injectate density in “No Migration” Petition modeling rather than the range of extreme values may be justifiable by operators of Class I injection well facilities.

Renal cell carcinoma (RCC) accounts for approximately 3% of all cancers and is refractory to cytotoxic chemotherapy – immunotherapy has until recently been the standard of care for advanced disease. Randomised trials reported in the last 5 years have demonstrated that a number of agents including the monoclonal antibody, bevacizumab, and the kinase inhibitors – sorafenib sunitinib, temsirolimus and everolimus – are active in advanced RCC. Bevacizumab is directed against the vascular endothelial growth factor (VEGF), a key mediator of angiogenesis, whilst sorafenib and sunitinib inhibit a number of targets including the VEGF and platelet-derived growth factor (PDGFR) receptor tyrosine kinases. Temsirolimus and everolimus inhibit the intracellular mammalian target of rapamycin (mTOR) kinase. Sunitinib and temsirolimus have demonstrated efficacy in comparison with immunotherapy in the first-line setting in patients with favourable and poor prognosis advanced disease respectively. In the second-line setting, everolimus has shown benefit over placebo in patients who progress following treatment with a VEGF receptor tyrosine kinase inhibitor and sorafenib has demonstrated efficacy in comparison with placebo in patients with immunotherapy-refractory disease. We review here recent clinical trial data and discuss future developments in the systemic treatment of RCC including combination and sequential therapy, adjuvant therapy, the role of biomarkers and the prospects for the development of rational mechanism-directed therapy in this disease.

Perioperative staff nurses at Aurora Health Care, Milwaukee, Wisconsin, questioned variations in the use of mechanical venous thromboembolism prophylaxis and sought to improve the consistency of prophylaxis care and ensure use of evidence-based practices. A work group consisting of perioperative clinical nurse specialists, a nurse clinician, and a staff nurse performed a systematic literature review to determine best practices for the implementation of mechanical venous thromboembolism prevention in the perioperative period. Key practices identified included optimal application times for initiating mechanical prophylaxis before the surgical procedure and the use of unilateral mechanical prophylaxis for some orthopedic procedures. We found no published consensus regarding a cumulative benefit from combining sequential compression devices and graduated compression stockings and no clinical evidence to support the use of alternative configurations for specialty procedural tables to prevent venous thromboembolism. We disseminated the best practices that we identified within our hospital and to the greater nursing community through posters and presentations.

We present a method for measuring the optical transfer function (OTF) of a camera lens using a tartan test pattern containing sinusoidal functions with multiple frequencies and orientations. The method is designed to optimize measurement accuracy for an adjustable set of sparse spatial frequencies and be reliable and fast in a wide range of measurement conditions. We describe the pattern design and the algorithm for estimating the OTF accurately from a captured image. Simulations show the tartan method is significantly more accurate than the International Organization for Standardization 12233 standard slanted-edge method. Experimental results from the tartan method were reproducible to 0.01 root mean square and in reasonable agreement with the slanted-edge method.

We present a novel method for accurately measuring the optical transfer function (OTF) of a camera lens by digitally imaging a tartan test pattern containing sinusoidal functions with multiple frequencies and orientations. The tartan pattern can be tuned to optimize the measurement accuracy for an adjustable set of sparse spatial frequencies. The measurement method is designed to be accurate, reliable, and fast in a wide range of measurement conditions, including uncontrolled lighting. We describe the design of the tartan pattern and the algorithm for estimating the OTF accurately from a captured digital image. Simulation results show that the tartan method has significantly better accuracy for measuring the modulus of the OTF (the modulation transfer function, or MTF) than the ISO 12233 standard slanted-edge method, especially at high spatial frequencies. With 1% simulated imaging noise, the root mean square (RMS) error of the tartan method is on average 5 times smaller than the RMS error of the slanted-edge method. Experiments with a printed tartan chart show good agreement (0.05 RMS) with MTFs measured using the slanted-edge method and that, like the slanted-edge method, our method is tolerant to wide variations in illumination conditions.

This review discusses miscellaneous diseases with rheumatic manifestations, and out of necessity many rarities are delineated, eg, the Charcot-type joints accompanying congenital sensory neuropathy with anhidrosis or the little-known arthritides that can result from severe acne. Of more general interest is a recent study showing that rheumatic disorders may underlie many neurologic admissions. In cardiology, the main point of interest is a possible resurgence of acute rheumatic fever, occurring first in the United States. Physicians should be alert to this possibility, particularly with the importance of prophylactic antibiotics. Finger clubbing and hypertrophic osteoarthropathy remain unexplained manifestations of pulmonary disease provoking an "International Workshop" devoted to their study. Platelet-derived growth factors may be the favorite candidate. Metabolic disorders with rheumatic complaints include the storage diseases. Some advances in imaging and assessment have been made, and the benefits of liver transplantation are the subject of another report. Other small-print causes of rheumatic complaints include drug abuse, whose protean manifestations include many resembling vasculitic or granulomatous disease.