Postoperative Bowel Function and Related Factors in Enhanced Recovery Protocol with Patients Undergoing Hepatectomy

Patients’ bowel dysfunction is a major factor that weakens the results of surgical care as it can cause pain and weaken patients’ rehabilitation. Bowel dysfunction is a common postoperative problem, yet most incidents remain undocumented. The nursing profession has a significant role in enhancing the bowel function postoperatively. However, studies of postoperative bowel function after hepatectomy are scarce and somewhat incongruous. Enhanced recovery protocols are innovative models of care aiming for better outcomes of surgical care. Enhanced recovery protocols can improve gastrointestinal function after surgery, yet patients are also known to be satisfied with their care. The aim was to investigate if postoperative bowel function day varies between patients in terms of age, gender, ASA score, type of surgery, histology, patients’ experienced pain and experienced satisfaction three days after discharge and three months after operation in patients undergoing hepatectomy. The goal was to produce information for basis of scientific research, to give nurses in clinical setting more tools to work with hepatectomy patients undergoing enhanced recovery protocol and to produce information to nurse managers to use in process management of patients undergoing enhanced recovery protocol. The design of this study is descriptive. Data was collected retrospectively from hepatectomy patients (n = 134) undergoing enhanced recovery protocol within the first year of enhanced recovery protocol implementation. The data was based on registers and analyzed statistically. Mean age of patients was 62 years and mean day of discharge was 4. Main (n = 72) histology of the patients was colorectal liver metastases. Mean bowel function day was 3. Most of the patients were very satisfied or satisfied with the care three days after discharge (99%) and three months (90%) after operation. Most of the patients (72%) experienced moderate pain three days after discharge, but three months after operation 47% of the patients did not experience pain and 48% experienced moderate pain. There were no statistically significant differences in bowel function between different age groups, genders, ASA score groups or histologies. Neither were there statistically significant differences in postoperative bowel function in terms of experienced satisfaction or pain. There were statistically significant differences in postoperative bowel function between different types of surgery (p < 0.01). Nurses should take into consideration hepatectomy patients’ type of surgery and pay special attention in supporting major open hepatectomy patients’ postoperative bowel function. Nurses should educate patients undergoing major open hepatectomy about prolonged postoperative bowel function.

Quantum chaos in atom optics

I shall discuss the quantum and classical dynamics of a class of nonlinear Hamiltonian systems. The discussion will be restricted to systems with one degree of freedom. Such systems cannot exhibit chaos, unless the Hamiltonians are time dependent. Thus we shall consider systems with a potential function that has a higher than quadratic dependence on the position and, furthermore, we shall allow the potential function to be a periodic function of time. This is the simplest class of Hamiltonian system that can exhibit chaotic dynamics. I shall show how such systems can be realized in atom optics, where very cord atoms interact with optical dipole potentials of a far-off resonance laser. Such systems are ideal for quantum chaos studies as (i) the energy of the atom is small and action scales are of the order of Planck's constant, (ii) the systems are almost perfectly isolated from the decohering effects of the environment and (iii) optical methods enable exquisite time dependent control of the mechanical potentials seen by the atoms.

Physical performance limitations in adolescent and adult survivors of childhood cancer and their siblings.

PURPOSE: This study investigates physical performance limitations for sports and daily activities in recently diagnosed childhood cancer survivors and siblings. METHODS: The Swiss Childhood Cancer Survivor Study sent a questionnaire to all survivors (≥ 16 years) registered in the Swiss Childhood Cancer Registry, who survived >5 years and were diagnosed 1976-2003 aged <16 years. Siblings received similar questionnaires. We assessed two types of physical performance limitations: 1) limitations in sports; 2) limitations in daily activities (using SF-36 physical function score). We compared results between survivors diagnosed before and after 1990 and determined predictors for both types of limitations by multivariable logistic regression. RESULTS: The sample included 1038 survivors and 534 siblings. Overall, 96 survivors (9.5%) and 7 siblings (1.1%) reported a limitation in sports (Odds ratio 5.5, 95%CI 2.9-10.4, p<0.001), mainly caused by musculoskeletal and neurological problems. Findings were even more pronounced for children diagnosed more recently (OR 4.8, CI 2.4-9.6 and 8.3, CI 3.7-18.8 for those diagnosed <1990 and ≥ 1990, respectively; p=0.025). Mean physical function score for limitations in daily activities was 49.6 (CI 48.9-50.4) in survivors and 53.1 (CI 52.5-53.7) in siblings (p<0.001). Again, differences tended to be larger in children diagnosed more recently. Survivors of bone tumors, CNS tumors and retinoblastoma and children treated with radiotherapy were most strongly affected. CONCLUSION: Survivors of childhood cancer, even those diagnosed recently and treated with modern protocols, remain at high risk for physical performance limitations. Treatment and follow-up care should include tailored interventions to mitigate these late effects in high-risk patients.

Model Diagnostics in the presence of measurement error

The problem of using information available from one variable X to make inferenceabout another Y is classical in many physical and social sciences. In statistics this isoften done via regression analysis where mean response is used to model the data. Onestipulates the model Y = µ(X) +ɛ. Here µ(X) is the mean response at the predictor variable value X = x, and ɛ = Y - µ(X) is the error. In classical regression analysis, both (X; Y ) are observable and one then proceeds to make inference about the mean response function µ(X). In practice there are numerous examples where X is not available, but a variable Z is observed which provides an estimate of X. As an example, consider the herbicidestudy of Rudemo, et al. [3] in which a nominal measured amount Z of herbicide was applied to a plant but the actual amount absorbed by the plant X is unobservable. As another example, from Wang [5], an epidemiologist studies the severity of a lung disease, Y , among the residents in a city in relation to the amount of certain air pollutants. The amount of the air pollutants Z can be measured at certain observation stations in the city, but the actual exposure of the residents to the pollutants, X, is unobservable and may vary randomly from the Z-values. In both cases X = Z+error: This is the so called Berkson measurement error model.In more classical measurement error model one observes an unbiased estimator W of X and stipulates the relation W = X + error: An example of this model occurs when assessing effect of nutrition X on a disease. Measuring nutrition intake precisely within 24 hours is almost impossible. There are many similar examples in agricultural or medical studies, see e.g., Carroll, Ruppert and Stefanski [1] and Fuller [2], , among others. In this talk we shall address the question of fitting a parametric model to the re-gression function µ(X) in the Berkson measurement error model: Y = µ(X) + ɛ; X = Z + η; where η and ɛ are random errors with E(ɛ) = 0, X and η are d-dimensional, and Z is the observable d-dimensional r.v.

MA17xexam00pdf

Exam questions and solutions in PDF

MA17xexam00

Exam questions and solutions in LaTex. Diagrams for the questions are all together in the support.zip file, as .eps files

The univalent polynomial of Suffridge as a summability kernel

A positive summability trigonometric kernel {K(n)(theta)}(infinity)(n=1) is generated through a sequence of univalent polynomials constructed by Suffridge. We prove that the convolution {K(n) * f} approximates every continuous 2 pi-periodic function f with the rate omega(f, 1/n), where omega(f, delta) denotes the modulus of continuity, and this provides a new proof of the classical Jackson`s theorem. Despite that it turns out that K(n)(theta) coincide with positive cosine polynomials generated by Fejer, our proof differs from others known in the literature.

Análise de séries temporais de coordenadas estimadas com GPS: uma proposta metodológica para detecção, remoção e recuperação de efeitos sazonais

GPS active networks are more and more used in geodetic surveying and scientific experiments, as water vapor monitoring in the atmosphere and lithosphere plate movement. Among the methods of GPS positioning, Precise Point Positioning (PPP) has provided very good results. A characteristic of PPP is related to the modeling and/or estimation of the errors involved in this method. The accuracy obtained for the coordinates can reach few millimeters. Seasonal effects can affect such accuracy if they are not consistent treated during the data processing. Coordinates time series analyses have been realized using Fourier or Harmonics spectral analyses, wavelets, least squares estimation among others. An approach is presented in this paper aiming to investigate the seasonal effects included in the stations coordinates time series. Experiments were carried out using data from stations Manaus (NAUS) and Fortaleza (BRFT) which belong to the Brazilian Continuous GPS Network (RBMC). The coordinates of these stations were estimated daily using PPP and were analyzed through wavelets for identification of the periods of the seasonal effects (annual and semi-annual) in each time series. These effects were removed by means of a filtering process applied in the series via the least squares adjustment (LSQ) of a periodic function. The results showed that the combination of these two mathematical tools, wavelets and LSQ, is an interesting and efficient technique for removal of seasonal effects in time series.

An extremal nonnegative sine polynomial

For any positive integer n, the sine polynomials that are nonnegative in [0, π] and which have the maximal derivative at the origin are determined in an explicit form. Associated cosine polynomials Kn (θ) are constructed in such a way that {Kn(θ)} is a summability kernel. Thus, for each Pi 1 ≤ P ≤ ∞ and for any 27π-periodic function f ∈ Lp [-π, π], the sequence of convolutions Kn * f is proved to converge to f in Lp[-ππ]. The pointwise and almost everywhere convergences are also consequences of our construction.