Is there good simulation basic training for end-to-side vascular microanastomoses?

BACKGROUND Microvascular anastomosis is the cornerstone of free tissue transfers. Irrespective of the microsurgical technique that one seeks to integrate or improve, the time commitment in the laboratory is significant. After extensive previous training on several animal models, we sought to identify an animal model that circumvents the following issues: ethical rules, cost, time-consuming and expensive anesthesia, and surgical preparation of tissues required to access vessels before performing the microsurgical training, not to mention that laboratories are closed on weekends. METHODS Between January 2012 and April 2012, a total of 91 earthworms were used for 150 microsurgical training exercises to simulate vascular end-to-side microanastomosis. The training sessions were divided into ten periods of 7 days. Each training session included 15 simulations of end-to-side vascular microanastomoses: larger than 1.5 mm (n=5), between 1.0 and 1.5 mm (n=5), and smaller than 1.0 mm (n=5). A linear model with the main variables being the number of weeks (as a numerical covariate) and the size of the animal (as a factor) was used to determine the trend in time of anastomosis over subsequent weeks as well as the differences between the different size groups. RESULTS The linear model shows a significant trend (p<0.001) in time of anastomosis in the course of the training, as well as significant differences (p<0.001) between the groups of animals of different sizes. For microanastomoses larger than 1.5 mm, the mean anastomosis time decreased from 19.3±1.0 to 11.1±0.4 min between the first and last week of training (decrease of 42.5%). For training with smaller diameters, the results showed a decrease in execution time of 43.2% (diameter between 1.0 and 1.5 mm) and 40.9% (diameter<1.0 mm) between the first and last periods. The study demonstrates an improvement in the dexterity and speed of nodes execution. CONCLUSION The earthworm appears to be a reliable experimental model for microsurgical training of end-to-side microanastomoses. Its numerous advantages are discussed here and we predict training on earthworms will significantly grow and develop in the near future. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Letter from the Navy Department to James O. Creighton,

One letter with instructions to give convoy to the vessel that would bring Tudor back to the United States.

Copy of Gov[erno]r Philips's additional instructions about settling some Palatine families in Nova Scotia: Copy Col. Dunbar's additional instruction about settling some Irish families in Nova Scotia : manuscript, [1730]

Copies of two documents, approved 20 Apr. 1730; instructions to Richard Philips state that a number of Protestant Irish and Palatine families have been granted land in Nova Scotia, to be surveyed by David Dunbar; and instructions to Dunbar to survey and lay out land for the families.

Papers relating to America. Presented to the House of commons, 1809.

Papers relating to the encounter between His Majesty's ship Leopard, and the American frigate Chesapeake.--Correspondence between Mr. Secretary Canning and Mr. Pinkney, from September 23, to November 28, 1808.--Instructions to the Honourable D. M. Erskine, by Mr. Secretary Canning; and the correspondence between the Honourable D. M. Erskine, and the Honourable Robert Smith.

Moderating drinking by correspondence : an evaluation of a new method of intervention

Recognizing the need to offer alternative methods of brief interventions, this study developed correspondence treatments for low-dependent problem drinkers and evaluated their impact. One hundred and twenty-one problem drinkers were recruited by media advertisements and were randomly allocated to a full cognitive behavioural treatment programme (CBT) or to a minimal intervention condition (MI) that gave information regarding alcohol misuse and instructions to record drinking. As predicted, CBT was more effective than MI in reducing alcohol consumption over the 4-month controlled trial period. CBT produced a 50% fall in consumption, bringing the average intake of subjects within recommended maximum levels. Treatment gains at 6 months were well maintained to 12 months. High levels of consumer satisfaction, a high representation of women and a substantial participation from isolated rural areas attested to the feasibility of the correspondence programme as an alternative treatment. However, some drinking occasions still involved high intake for a significant subgroup of subjects, and this issue will be addressed in future programmes. The results supported the use of correspondence delivery as a means of promoting early engagement and equity of access between city and country areas.

Mood, persistence, and success

Tested the hypothesis that level of performance and persistence in completing tasks is affected by mood. 44 female and 41 male college students received tape-recorded instructions to recall vividly happy or sad experiences or to imagine a neutral situation. Results for the primary dependent variables on which a mood difference was predicted were analyzed with a multivariate analysis of variance (MANOVA). After the induction happy Ss persisted longer at an anagrams task and solved more anagrams than sad Ss. Women were also faster at reaching solutions when happy than sad. Results support the hypothesis that positive moods promote persistence and ultimate success, but they raise questions about the role of self-efficacy and the sources of gender differences.

Basic finance made accessible in Excel 2007 : "the big 5, plus 2"

The basic principles and equations are developed for elementary finance, based on the concept of compound interest. The five quantities of interest in such problems are present value, future value, amount of periodic payment, number of periods and the rate of interest per period. We consider three distinct means of computing each of these five quantities in Excel 2007: (i) use of algebraic equations, (ii) by recursive schedule and the Goal Seek facility, and (iii) use of Excel's intrinsic financial functions. The paper is intended to be used as the basis for a lesson plan and contains many examples and solved problems. Comment is made regarding the relative difficulty of each approach, and a prominent theme is the systematic use of more than one method to increase student understanding and build confidence in the answer obtained. Full instructions to build each type of model are given and a complete set of examples and solutions may be downloaded (Examples.xlsx and Solutions.xlsx).

Follow the lighthouse route in Nova Scotia, Canada

Within half an hour of leaving Halifax Airport I managed to get myself lost. I noticed an exit sign for St Margaret’s Bay and, despite written instructions to the contrary, it sounded like the right way to go. But I was on the Lighthouse Route and on my way back to Halifax...

A multimodal physiotherapy programme plus deep water running for improving cancer-related fatigue and quality of life in breast cancer survivors

The aim of the study was to assess the feasibility and effectiveness of aquatic‐based exercise in the form of deep water running ( DWR ) as part of a multimodal physiotherapy programme ( MMPP ) for breast cancer survivors. A controlled clinical trial was conducted in 42 primary breast cancer survivors recruited from community‐based P rimary C are C entres. Patients in the experimental group received a MMPP incorporating DWR , 3 times a week, for an 8‐week period. The control group received a leaflet containing instructions to continue with normal activities. Statistically significant improvements and intergroup effect size were found for the experimental group for P iper F atigue S cale‐ R evised total score ( d = 0.7, P = 0.001), as well as behavioural/severity ( d = 0.6, P = 0.05), affective/meaning ( d = 1.0, P = 0.001) and sensory ( d = 0.3, P = 0.03) domains. Statistically significant differences between the experimental and control groups were also found for general health ( d = 0.5, P < 0.05) and quality of life ( d = 1.3, P < 0.05). All participants attended over 80% of sessions, with no major adverse events reported. The results of this study suggest MMPP incorporating DWR decreases cancer‐related fatigue and improves general health and quality of life in breast cancer survivors. Further, the high level of adherence and lack of adverse events indicate such a programme is safe and feasible.

Familienerinnerungen. Ein Fragment 1790-1913

History of the family of Isak Mirabeau (born 1840); his maternal grandfather Isak Henle was the first Jew to receive civic rights in Hall (Wuerttemberg); his paternal grandfather came from Olnhausen (Wuerttemberg); he was a hops and wool merchant; he became wealthy as a supplier for the French army, and entered the banking business; notes on Jewish history in 19th century Wuerttemberg; contains also instructions to his son for the case of his death (does not have to say kaddish).

The visual preferences for forest regeneration and field afforestation - four case studies in Finland

The overall aim of this dissertation was to study the public's preferences for forest regeneration fellings and field afforestations, as well as to find out the relations of these preferences to landscape management instructions, to ecological healthiness, and to the contemporary theories for predicting landscape preferences. This dissertation includes four case studies in Finland, each based on the visualization of management options and surveys. Guidelines for improving the visual quality of forest regeneration and field afforestation are given based on the case studies. The results show that forest regeneration can be connected to positive images and memories when the regeneration area is small and some time has passed since the felling. Preferences may not depend only on the management alternative itself but also on the viewing distance, viewing point, and the scene in which the management options are implemented. The current Finnish forest landscape management guidelines as well as the ecological healthiness of the studied options are to a large extent compatible with the public's preferences. However, there are some discrepancies. For example, the landscape management instructions as well as ecological hypotheses suggest that the retention trees need to be left in groups, whereas people usually prefer individually located retention trees to those trees in groups. Information and psycho-evolutionary theories provide some possible explanations for people's preferences for forest regeneration and field afforestation, but the results cannot be consistently explained by these theories. The preferences of the different stakeholder groups were very similar. However, the preference ratings of the groups that make their living from forest - forest owners and forest professionals - slightly differed from those of the others. These results provide support for the assumptions that preferences are largely consistent at least within one nation, but that knowledge and a reference group may also influence preferences.

An SIMD machine for low-level vision

This paper presents an SIMD machine which has been tuned to execute low-level vision algorithms employing the relaxation labeling paradigm. Novel features of the design include: 1. (1) a communication scheme capable of window accessing under a single instruction. 2. (2) flexible I/O instructions to load overlapped data segments; and 3. (3) data-conditional instructions which can be nested to an arbitrary degree. A time analysis of the stereo correspondence problem, as implemented on a simulated version of the machine using the probabilistic relaxation technique, shows a speed up of almost N2 for an N × N array of PEs.

Toward Effective Scalar Hardware for Highly Vectorizable Applications

The performance of a program will ultimately be limited by its serial (scalar) portion, as pointed out by Amdahl′s Law. Reported studies thus far of instruction-level parallelism have mixed data-parallel program portions with scalar program portions, often leading to contradictory and controversial results. We report an instruction-level behavioral characterization of scalar code containing minimal data-parallelism, extracted from highly vectorized programs of the PERFECT benchmark suite running on a Cray Y-MP system. We classify scalar basic blocks according to their instruction mix, characterize the data dependencies seen in each class, and, as a first step, measure the maximum intrablock instruction-level parallelism available. We observe skewed rather than balanced instruction distributions in scalar code and in individual basic block classes of scalar code; nonuniform distribution of parallelism across instruction classes; and, as expected, limited available intrablock parallelism. We identify frequently occurring data-dependence patterns and discuss new instructions to reduce latency. Toward effective scalar hardware, we study latency-pipelining trade-offs and restricted multiple instruction issue mechanisms.

Compiler Assisted Leakage Energy Optimization for Clustered VLIW Architectures

Miniaturization of devices and the ensuing decrease in the threshold voltage has led to a substantial increase in the leakage component of the total processor energy consumption. Relatively simpler issue logic and the presence of a large number of function units in the VLIW and the clustered VLIW architectures attribute a large fraction of this leakage energy consumption in the functional units. However, functional units are not fully utilized in the VLIW architectures because of the inherent variations in the ILP of the programs. This underutilization is even more pronounced in the context of clustered VLIW architectures because of the contentions for the limited number of slow intercluster communication channels which lead to many short idle cycles.In the past, some architectural schemes have been proposed to obtain leakage energy bene .ts by aggressively exploiting the idleness of functional units. However, presence of many short idle cycles cause frequent transitions from the active mode to the sleep mode and vice-versa and adversely a ffects the energy benefits of a purely hardware based scheme. In this paper, we propose and evaluate a compiler instruction scheduling algorithm that assist such a hardware based scheme in the context of VLIW and clustered VLIW architectures. The proposed scheme exploits the scheduling slacks of instructions to orchestrate the functional unit mapping with the objective of reducing the number of transitions in functional units thereby keeping them off for a longer duration. The proposed compiler-assisted scheme obtains a further 12% reduction of energy consumption of functional units with negligible performance degradation over a hardware-only scheme for a VLIW architecture. The benefits are 15% and 17% in the context of a 2-clustered and a 4-clustered VLIW architecture respectively. Our test bed uses the Trimaran compiler infrastructure.

Voluntades anticipadas, su valor legal

Resumen: El autor analiza el contenido de las denominadas directivas previas o testamento vital, que una persona puede instrumentar a efectos de instruir a los médicos que en el futuro la atiendan en el supuesto de no poder en ese momento expresar su voluntad, relacionadas con los tratamientos que está dispuesta a que le sean aplicados. Se hace referencia al alcance, los inconvenientes y peligros que traen aparejadas dichas directivas, su tiempo de validez y la situación actual en otros países y en el nuestro, así como una escueta reseña de dos sentencias dictadas en el país al respecto.