Accuracy of frozen section for the operative management of endometrial cancer

Objective To assess the accuracy of intra-operative frozen section reports at identifying the features of high risk uterine disease compared with final histopathology. Design Retrospective study. Methods The records, of 460 patients with uterine cancer registered with the Queensland Centre for Gynaecological Cancer between January 1, 1996 and December 31, 1998 were reviewed. Intra-operative frozen section was undertaken in 260 patients with endometrial adenocarcinoma. Frozen section pathology was compared with the final histopathology reports. Inter-observer reliability was assessed using percentage agreement and kappa statistics. Clinical notes were also reviewed to determine if errors resulted in sub-optimal patient care. Results Respectively, tumour grade and depth of myometrial invasion were accurately reported in 88.6% of cases (expected 61.5%, Kappa 0.70) and 94.7% (expected 53.8%, Kappa 0.89). Errors were predominantly attributable to difficulties with respect to the interpretation of tumour grade. The error resulted in the patient receiving sub-optimal surgical management in only I I cases (5.3%) Conclusion Frozen section is accurate at identifying the features of high risk uterine disease in the setting of endometrial cancer and can play an important role in directing primary operative management.

Sei whale (Balaenoptera borealis) ecology and management in the North Atlantic

Tese de Doutoramento em Ciências do Mar, especialidade em Ecologia Marinha.

The importance of risk assessment in the context of investment project management: a case study

Risk management is an important component of project management. Nevertheless, such process begins with risk assessment and evaluation. In this research project, a detailed analysis of the methodologies used to treat risks in investment projects adopted by the Banco da Amazonia S.A. was made. Investment projects submitted to the FNO (Constitutional Fund for Financing the North) during 2011 and 2012 were considered for that purpose. It was found that the evaluators of this credit institution use multiple indicators for risk assessment which assume a central role in terms of decision-making and contribute for the approval or the rejection of the submitted projects; namely, the proven ability to pay, the financial records of project promotors, several financial restrictions, level of equity, level of financial indebtedness, evidence of the existence of a consumer market, the proven experience of the partners/owners in the business, environmental aspects, etc. Furthermore, the bank has technological systems to support the risk assessment process, an internal communication system and a unique system for the management of operational risk.

Vacuum-assisted closure device: a useful tool in the management of severe intrathoracic infections.

Background. This study is an evaluation of the vacuum-assisted closure (VAC) therapy for the treatment of severe intrathoracic infections complicating lung resection, esophageal surgery, viscera perforation, or necrotizing pleuropulmonary infections.Methods. We reviewed the medical records of all patients treated by intrathoracic VAC therapy between January 2005 and December 2008. All patients underwent surgical debridement-decortication and control of the underlying cause of infection such as treatment of bronchus stump insufficiency, resection of necrotic lung, or closure of esophageal or intestinal leaks. Surgery was followed by intrathoracic VAC therapy until the infection was controlled. The VAC dressings were changed under general anesthesia and the chest wall was temporarily closed after each dressing change. All patients received systemic antibiotic therapy.Results. Twenty-seven patients (15 male, median age 64 years) underwent intrathoracic VAC dressings for the management of postresectional empyema (n = 8) with and without bronchopleural fistula, necrotizing infections (n = 7), and intrathoracic gastrointestinal leaks (n = 12). The median length of VAC therapy was 22 days (range 5 to 66) and the median number of VAC changes per patient was 6 (range 2 to 16). In-hospital mortality was 19% (n = 5) and was not related to VAC therapy or intrathoracic infection. Control of intrathoracic infection and closure of the chest cavity was achieved in all surviving patients.Conclusions. Vacuum-assisted closure therapy is an efficient and safe adjunct to treat severe intrathoracic infections and may be a good alternative to the open window thoracostomy in selected patients. Long time intervals in between VAC changes and short course of therapy result in good patient acceptance. (Ann Thorac Surg 2011;91:1582-90) (C) 2011 by The Society of Thoracic Surgeons

Inventory of County Records : Appanoose County, 1978.

This is an inventory of public records from Appanoose County. The State Historical Society of Iowa received funding from the National Historical Publications and Records Commission along with 5 other Iowa counties for this two year study.

Inventory of County Records: Dubuque County, 1978.

This is an inventory of public records from Dubuque County. The State Historical Society of Iowa received funding from the National Historical Publications and Records Commission along with 5 other Iowa counties for this two year study

Inventory of County Records: Iowa County, 1978.

This is an inventory of public records from Iowa County. The State Historical Society of Iowa received funding from the National Historical Publications and Records Commission along with 5 other Iowa counties for this two year study.

Inventory of County Records : Ringgold County,1978.

This is an inventory of public records from Ringgold County. The State Historical Society of Iowa received funding from the National Historical Publications and Records Commission along with 5 other Iowa counties for this two year study.

Inventory of County Records : Franklin County,1978.

This is an inventory of public records from Franklin County. The State Historical Society of Iowa received funding from the National Historical Publications and Records Commission along with 5 other Iowa counties for this two year study.

Inventory of county records : Osceola County,1978.

This is an inventory of public records from Osceola County. The State Historical Society of Iowa received funding from the National Historical Publications and Records Commission along with 5 other Iowa counties for this two year study.

Access Management Awareness Program Phase II Report, TR-402, 1997

This report presents the results of a number of detailed Iowa access management case studies. Case studies were selected to provide a cross-section of locations and community sizes in Iowa as well as a variety of project types. Generally, access management projects completed during the mid-1990s were chosen as case studies. Projects ranging from driveway consolidation to full raised medians were analyzed on a before and after basis in terms of traffic safety, traffic operations, and adjacent business vitality. Sources of information used for the case study analysis included: road project files; traffic accident records; state sales tax records; and personal interviews of business owners, business customers, and local officials. The case study results from Iowa essentially confirm results of previous access management research from around the nation. Recent access in Iowa had significant, positive impacts in terms of traffic safety. The average reduction of annual accidents and accident rates on improved roadways was approximately 40%. Improvements in access management also led to significantly better roadway operations for most case studies. Although a small number of individual businesses do report sales losses and/or customer complaints once projects have been completed, access management projects in Iowa have not had an adverse impact on the majority of businesses located along them. In fact, some access management projects in Iowa seem to have contributed to an improved business environment along the corridors that have been improved. The results from the Iowa case studies presented in this report will be used to develop access management education materials for Iowa transportation professionals and other audiences interested in the impacts of access management.

Development of the Des Moines Access Management Plan, 2004

According to Iowa crash records, almost 10% of all crashes in Iowa occur at commercial driveways. Most of these crashes occur on arterials within municipalities. In recent years, nearly a quarter of these crashes have occurred in the Des Moines metropolitan area. This makes the Des Moines metropolitan area a prime candidate for improved access management. Case study research in Iowa has shown that access management is an extremely effective highway safety tool—well-managed routes are, on average, 40% safer than poorly managed routes. The Des Moines metropolitan area has many miles of four-lane, undivided arterials constructed when less was known about the importance of managing access to adjacent land development. This project involved a cooperative effort of the Des Moines Area Metropolitan Planning Organization (Des Moines Area MPO) and the Center for Transportation Research and Education (CTRE) at Iowa State University to develop a comprehensive access management study and program for the Des Moines metropolitan area. The goal of the study is to use the knowledge developed to make improvements that will reduce access-related crashes. It is also anticipated that this project will help local officials make better decisions about access management so that future safety and operational problems can be avoided.

Fishery of the Goliath grouper, Epinephelus itajara (Teleostei: Epinephelidae) based on local ecological knowledge and fishery records in Yucatan, Mexico

The Goliath grouper, Epinephelus itajara, a large-bodied (similar to 2.5 m TL, > 400 kg) and critically endangered fish (Epinephelidae), is highly Vulnerable to overfishing. Although protected from fishing in many countries, its exploitation in Mexico is unregulated; a situation that puts its populations at risk. Fishery records of E. itajara are scarce, which prevents determination of its fishery status. This work aimed to elucidate the E itajara fishery in the northern Yucatan Peninsula by 1) analyzing available catch records and 2) interviewing veteran fishermen (local ecological knowledge) from two traditional landing sites: Dzilam de Bravo and Puerto Progreso. Historic fishery records from two fishing cooperatives were analyzed in order to elucidate the current situation and offer viable alternatives for conservation and management. Catches have decreased severely. Local knowledge obtained from fishermen represented a very important source of information for reconstructing the fisheries history of this species. Conservation measures that incorporate regional and international regulations on critically endangered fish species are suggested

Impact of extracardiac findings during cardiac MR on patient management and outcome.

BACKGROUND: Cardiac magnetic resonance (CMR) is increasingly used to assess heart diseases. Relevant non-cardiac diseases may also be incidentally found on CMR images. The aim of this study was to determine the prevalence and nature of incidental extra-cardiac findings (IEF) and their clinical impact in non-selected patients referred for CMR. MATERIAL/METHODS: MR images of 762 consecutive patients (515 men, age: 56±18 years) referred for CMR were prospectively interpreted by 2 radiologists blinded for any previous imaging study. IEFs were classified as major when requiring treatment, follow-up, or further investigation. Clinical follow-up was performed by checking hospital information records and by calling referring physicians. The 2 endpoints were: 1) non-cardiac death and new treatment related to major IEFs, and 2) hospitalization related to major IEFs during follow-up. RESULTS: Major IEFs were proven in 129 patients (18.6% of the study population), 14% of those being unknown before CMR. During 15±6 month follow-up, treatment of confirmed major IEFs was initiated in 1.4%, and no non-cardiac deaths occurred. Hospitalization occurred in 8 patients (1.0% of the study population) with confirmed major IEFs and none occurred in the remaining 110 patients with unconfirmed/unexplored major IEFs (p<0.001). CONCLUSIONS: Screening for major IEFs in a population referred for routine CMR changed management in 1.4% of patients. Major IEFs unknown before CMR but without further exploration, however, carried a favorable prognosis over a follow-up period of 15 months.

Learning on human resources management in the radiology residency program

Objective To investigate the process of learning on human resource management in the radiology residency program at Escola Paulista de Medicina – Universidade Federal de São Paulo, aiming at improving radiologists' education. Materials and Methods Exploratory study with a quantitative and qualitative approach developed with the faculty staff, preceptors and residents of the program, utilizing a Likert questionnaire (46), taped interviews (18), and categorization based on thematic analysis. Results According to 71% of the participants, residents have clarity about their role in the development of their activities, and 48% said that residents have no opportunity to learn how to manage their work in a multidisciplinary team. Conclusion Isolation at medical records room, little interactivity between sectors with diversified and fixed activities, absence of a previous culture and lack of a training program on human resources management may interfere in the development of skills for the residents' practice. There is a need to review objectives of the medical residency in the field of radiology, incorporating, whenever possible, the commitment to the training of skills related to human resources management thus widening the scope of abilities of the future radiologists.