Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol.

BACKGROUND: Enhanced recovery after surgery (ERAS) is a multimodal approach to perioperative care that combines a range of interventions to enable early mobilization and feeding after surgery. We investigated the feasibility, clinical effectiveness, and cost savings of an ERAS program at a major U. S. teaching hospital. METHODS: Data were collected from consecutive patients undergoing open or laparoscopic colorectal surgery during 2 time periods, before and after implementation of an ERAS protocol. Data collected included patient demographics, operative, and perioperative surgical and anesthesia data, need for analgesics, complications, inpatient medical costs, and 30-day readmission rates. RESULTS: There were 99 patients in the traditional care group, and 142 in the ERAS group. The median length of stay (LOS) was 5 days in the ERAS group compared with 7 days in the traditional group (P < 0.001). The reduction in LOS was significant for both open procedures (median 6 vs 7 days, P = 0.01), and laparoscopic procedures (4 vs 6 days, P < 0.0001). ERAS patients had fewer urinary tract infections (13% vs 24%, P = 0.03). Readmission rates were lower in ERAS patients (9.8% vs 20.2%, P = 0.02). DISCUSSION: Implementation of an enhanced recovery protocol for colorectal surgery at a tertiary medical center was associated with a significantly reduced LOS and incidence of urinary tract infection. This is consistent with that of other studies in the literature and suggests that enhanced recovery programs could be implemented successfully and should be considered in U.S. hospitals.

Using ground reaction force to predict knee kinetic asymmetry following anterior cruciate ligament reconstruction.

Asymmetries in sagittal plane knee kinetics have been identified as a risk factor for anterior cruciate ligament (ACL) re-injury. Clinical tools are needed to identify the asymmetries. This study examined the relationships between knee kinetic asymmetries and ground reaction force (GRF) asymmetries during athletic tasks in adolescent patients following ACL reconstruction (ACL-R). Kinematic and GRF data were collected during a stop-jump task and a side-cutting task for 23 patients. Asymmetry indices between the surgical and non-surgical limbs were calculated for GRF and knee kinetic variables. For the stop-jump task, knee kinetics asymmetry indices were correlated with all GRF asymmetry indices (P < 0.05), except for loading rate. Vertical GRF impulse asymmetry index predicted peak knee moment, average knee moment, and knee work (R(2)  ≥ 0.78, P < 0.01) asymmetry indices. For the side-cutting tasks, knee kinetic asymmetry indices were correlated with the peak propulsion vertical GRF and vertical GRF impulse asymmetry indices (P < 0.05). Vertical GRF impulse asymmetry index predicted peak knee moment, average knee moment, and knee work (R(2)  ≥ 0.55, P < 0.01) asymmetry indices. The vertical GRF asymmetries may be a viable surrogate for knee kinetic asymmetries and therefore may assist in optimizing rehabilitation outcomes and minimizing re-injury rates.

TALLY HORN! ECHOES OF HOOFBEATS AND HAUNTS: RECORDED SELECTIONS FOR HORN AND PIANO

In the 17th and 18th centuries, the European hunting horn was an instrument associated with the thrill of the chase, rustic scenes, and the pageantry of royal hunts. The sound of this horn and the music that evolved from its heritage would inspire composers writing for the modern horn. TALLY HOrn! Echoes of Hoofbeats and Haunts: Recorded Selections for Horn and Piano are two compact discs of works for horn and piano as well as solo horn reflecting this association with the hunt and include additional works of expressive contrast – lyrical pieces and nocturnes. Nine of the pieces reflect the modern horn’s beginnings and they are Abbot’s Alla Caccia, Berge’s Horn-Lokk, Boutry’s Chassacor, Bozza’s En Fôret, Büsser’s La Chasse de St. Hubert, Pessard’s In the Forest, Piantoni’s Air de Chasse, Schmid’s Im Tiefsten Walde, and Vinter’s Hunter’s Moon. By contrast, three of the selections, Gliére’s Nocturne, Strauss’ Nocturno, and Van Ecchaute’s Nachtpoëma are nocturnes that showcase the expressive quality of the horn. In addition, Bush’s Autumn Poem, Bacon’s Song After the Rain, and Webber’s Summer Pastures are included for their lyric qualities and evocations of nature. The largest work of the project is John Williams’s Concerto for Horn. Its five movements feature both hunting horn traits and expressive qualities. Alejandro Hernandez-Valdez and Grace Cho were the two pianists engaged for the recording. The recording engineer was Edward Kelly. The producer was Carlos Rodriquez. The pieces were recorded at the Spencerville Seventh-day Adventist Church sanctuary in Spencerville, Maryland between November 2010 and February 2011.

Computational Journalism: from Answering Question to Questioning Answers and Raising Good Questions

Our media is saturated with claims of ``facts'' made from data. Database research has in the past focused on how to answer queries, but has not devoted much attention to discerning more subtle qualities of the resulting claims, e.g., is a claim ``cherry-picking''? This paper proposes a Query Response Surface (QRS) based framework that models claims based on structured data as parameterized queries. A key insight is that we can learn a lot about a claim by perturbing its parameters and seeing how its conclusion changes. This framework lets us formulate and tackle practical fact-checking tasks --- reverse-engineering vague claims, and countering questionable claims --- as computational problems. Within the QRS based framework, we take one step further, and propose a problem along with efficient algorithms for finding high-quality claims of a given form from data, i.e. raising good questions, in the first place. This is achieved to using a limited number of high-valued claims to represent high-valued regions of the QRS. Besides the general purpose high-quality claim finding problem, lead-finding can be tailored towards specific claim quality measures, also defined within the QRS framework. An example of uniqueness-based lead-finding is presented for ``one-of-the-few'' claims, landing in interpretable high-quality claims, and an adjustable mechanism for ranking objects, e.g. NBA players, based on what claims can be made for them. Finally, we study the use of visualization as a powerful way of conveying results of a large number of claims. An efficient two stage sampling algorithm is proposed for generating input of 2d scatter plot with heatmap, evalutaing a limited amount of data, while preserving the two essential visual features, namely outliers and clusters. For all the problems, we present real-world examples and experiments that demonstrate the power of our model, efficiency of our algorithms, and usefulness of their results.

Investigating the representation of merging behavior at the floor–stair interface in computer simulations of multi-floor building evacuations

In this article, the representation of the merging process at the floor— stair interface is examined within a comprehensive evacuation model and trends found in experimental data are compared with model predictions. The analysis suggests that the representation of floor—stair merging within the comprehensive model appears to be consistent with trends observed within several published experiments of the merging process. In particular: (a) The floor flow rate onto the stairs decreases as the stair population density increases. (b) For a given stair population density, the floor population's flow rate onto the stairs can be maximized by connecting the floor to the landing adjacent to the incoming stair. (c) In situations where the floor is connected adjacent to the incoming stair, the merging process appears to be biased in favor of the floor population. It is further conjectured that when the floor is connected opposite the incoming stair, the merging process between the stair and floor streams is almost in balance for high stair population densities, with a slight bias in favor of the floor stream at low population densities. A key practical finding of this analysis is that the speed at which a floor can be emptied onto a stair can be enhanced simply by connecting the floor to the landing at a location adjacent to the incoming stair rather than opposite the stair. Configuring the stair in this way, while reducing the floor emptying time, results in a corresponding decrease in the descent flow rate of those already on the stairs. While this is expected to have a negligible impact on the overall time to evacuate the building, the evacuation time for those higher up in the building is extended while those on the lower flows is reduced. It is thus suggested that in high-rise buildings, floors should be connected to the landing on the opposite side to the incoming stair. Information of this type will allow engineers to better design stair—floor interfaces to meet specific design objectives.

Traceable Radiometry Underpinning Terrestrial- and Helio-Studies (truths)

The Traceable Radiometry Underpinning Terrestrial- and Helio- Studies (TRUTHS) mission offers a novel approach to the provision of key scientific data with unprecedented radiometric accuracy for Earth Observation (EO) and solar studies, which will also establish well-calibrated reference targets/standards to support other EO missions. This paper presents the TRUTHS mission and its objectives. TRUTHS will be the first satellite mission to calibrate its EO instrumentation directly to SI in orbit, overcoming the usual uncertainties associated with drifts of sensor gain and spectral shape by using an electrical rather than an optical standard as the basis of its calibration. The range of instruments flown as part of the payload will also provide accurate input data to improve atmospheric radiative transfer codes by anchoring boundary conditions, through simultaneous measurements of aerosols, particulates and radiances at various heights. Therefore, TRUTHS will significantly improve the performance and accuracy of EO missions with broad global or operational aims, as well as more dedicated missions. The provision of reference standards will also improve synergy between missions by reducing errors due to different calibration biases and offer cost reductions for future missions by reducing the demands for on-board calibration systems. Such improvements are important for the future success of strategies such as Global Monitoring for Environment and Security (GMES) and the implementation and monitoring of international treaties such as the Kyoto Protocol. TRUTHS will achieve these aims by measuring the geophysical variables of solar and lunar irradiance, together with both polarised and unpolarised spectral radiance of the Moon, Earth and its atmosphere.

A new approach for objective identification of turns and steps in organism movement data relevant to random walk modelling

1. A first step in the analysis of complex movement data often involves discretisation of the path into a series of step-lengths and turns, for example in the analysis of specialised random walks, such as Lévy flights. However, the identification of turning points, and therefore step-lengths, in a tortuous path is dependent on ad-hoc parameter choices. Consequently, studies testing for movement patterns in these data, such as Lévy flights, have generated debate. However, studies focusing on one-dimensional (1D) data, as in the vertical displacements of marine pelagic predators, where turning points can be identified unambiguously have provided strong support for Lévy flight movement patterns. 2. Here, we investigate how step-length distributions in 3D movement patterns would be interpreted by tags recording in 1D (i.e. depth) and demonstrate the dimensional symmetry previously shown mathematically for Lévy-flight movements. We test the veracity of this symmetry by simulating several measurement errors common in empirical datasets and find Lévy patterns and exponents to be robust to low-quality movement data. 3. We then consider exponential and composite Brownian random walks and show that these also project into 1D with sufficient symmetry to be clearly identifiable as such. 4. By extending the symmetry paradigm, we propose a new methodology for step-length identification in 2D or 3D movement data. The methodology is successfully demonstrated in a re-analysis of wandering albatross Global Positioning System (GPS) location data previously analysed using a complex methodology to determine bird-landing locations as turning points in a Lévy walk. For this high-resolution GPS data, we show that there is strong evidence for albatross foraging patterns approximated by truncated Lévy flights spanning over 3·5 orders of magnitude. 5. Our simple methodology and freely available software can be used with any 2D or 3D movement data at any scale or resolution and are robust to common empirical measurement errors. The method should find wide applicability in the field of movement ecology spanning the study of motile cells to humans.

Guiding contact by coupling the taus of gaps

Animals control contact with surfaces when locomoting, catching prey, etc. This requires sensorily guiding the rate of closure of gaps between effecters such as the hands, feet or jaws and destinations such as a ball, the ground and a prey. Control is generally rapid, reliable and robust, even with small nervous systems: the sensorimotor processes are therefore probably rather simple. We tested a hypothesis, based on general tau theory, that closing two gaps simultaneously, as required in many actions, might be achieved simply by keeping the taus of the gaps coupled in constant ratio. tau of a changing gap is defined as the time-to-closure of the gap at the current closure-rate. General tau theory shows that tau of a gap could, in principle, be directly sensed without needing to sense either the gap size or its rate of closure. In our experiment, subjects moved an effector (computer cursor) to a destination zone indicated on the computer monitor, to stop in the zone just as a moving target cursor reached it. The results indicated the subjects achieved the task by keeping tau of the gap between effector and target coupled to tau of the gap between the effector and the destination zone. Evidence of tau -coupling has also been found, for example, in bats guiding landing using echolocation. Thus, it appears that a sensorimotor process used by different species for coordinating the closure of two or more gaps between effecters and destinations entails constantly sensing the taus of the gaps and moving so as to keep the taus coupled in constant ratio.

Distribution of Uranium Contamination in Weathered Fractured Saprolite/Shale and Ground Water

The objective of this study was to determine how structure, stratigraphy, and weathering influence fate and transport of contaminants (particularly U) in the ground water and geologic material at the Department of Energy (DOE) Environmental Remediation Sciences Department (ERSD) Field Research Center (FRC). Several cores were collected near four former unlined adjoining waste disposal ponds. The cores were collected, described, analyzed for U, and compared with ground water geochemistry from surrounding multilevel wells. At some locations, acidic U-contaminated ground water was found to preferentially flow in small remnant fractures weathering the surrounding shale (nitric acid extractable U [UNA] usually <50 mg kg–1) into thin (

Physicochemical and mineralogical characteristics of soil/saprolite cores from a field research site, Tennessee

Site characterization is an essential initial step in determining the feasibility of remedial alternatives at hazardous waste sites. Physicochemical and mineralogical characterization of U-contaminated soils in deeply weathered saprolite at Area 2 of the DOE Field Research Center (FRC) site, Oak Ridge, TN, was accomplished to examine the feasibility of bioremediation. Concentrations of U in soil–saprolite (up to 291 mg kg–1 in oxalate-extractable Uo) were closely related to low pH (ca. 4–5), high effective cation exchange capacity without Ca (64.7–83.2 cmolc kg–1), amorphous Mn content (up to 9910 mg kg–1), and the decreased presence of relative clay mineral contents in the bulk samples (i.e., illite 2.5–12 wt. %, average 32 wt. %). The pH of the fill material ranged from 7.0 to 10.5, whereas the pH of the saprolite ranged from 4.5 to 8. Uranium concentration was highest (about 300 mg kg–1) at around 6 m below land surface near the saprolite–fill interface. The pH of ground water at Area 2 tended to be between 6 and 7 with U concentrations of about 0.9 to 1.7 mg L–1. These site specific characteristics of Area 2, which has lower U and nitrate contamination levels and more neutral ground water pH compared with FRC Areas 1 and 3 (ca. 5.5 and

Factores explicativos de las actitudes hacia el castigo juvenil. Evidencias de un diseño factorial

El rol desempeñado por la opinión pública en el desarrollo de la política criminal actual justifica el incremento de investigaciones destinadas a evaluar las actitudes de los ciudadanos hacia el castigo. No obstante, los avances en este ámbito han sido limitados debido a la utilización de rudimentarios instrumentos de medida. Por ello, el presente trabajo tiene como propósito explorar el efecto que generan en la opinión ciudadana ciertas variables referidas al hecho delictivo y al infractor, precisando su contribución relativa y la interacción existente entre ellas. Para satisfacer este objetivo se recurrió a un diseño factorial de la encuesta, creando una población de 256 casos-escenario fruto de la combinación de cuatro factores: la edad del joven, su historial delictivo, el grado de implicación en el hecho y el tipo de delito cometido. Los mismos fueron distribuidos en grupos de ocho casos ordenados aleatoriamente y fueron suministrados a 32 sujetos. Posteriormente se aplicaron análisis de regresión logística binaria. Los resultados obtenidos revelan que la naturaleza violenta de los hechos, la implicación activa de los jóvenes y el historial delictivo son predictores importantes de las condenas punitivas. Sin embargo la edad, una variable fundamental en la configuración de la justicia juvenil, no resulta significativa. De este modo, el trabajo muestra el potencial explicativo de este conjunto de factores y debate sus implicaciones teóricas y metodológicas para la investigación futura en este terreno.

Finite temperature dense matter studies on next-generation light sources

The construction of short-pulse tunable soft x-ray free electron laser sources based on the self-amplified spontaneous emission process will provide a major advance in capability for dense plasma-related and warm dense matter (WDM) research. The sources will provide 10(13) photons in a 200-fs duration pulse that is tunable from approximately 6 to 100 nm. Here we discuss only two of the many applications made possible for WDM that has been severely hampered by the fact that laser-based methods have been unavailable because visible light will not propagate at electron densities of n(e) greater than or equal to 10(22) cm(-3). The next-generation light sources will remove these restrictions.

Serendipitous Asteroid Lightcurve Survey Using SuperWASP

The SuperWASP project is an ultra-wide angle search for extra solar planetary transits. However, it can also serendipitously detect solar system objects, such as asteroids and comets. Each SuperWASP instrument consists of up to eight cameras, combined with high-quality peltier-cooled CCDs, which photometrically survey large numbers of stars in the magnitude range 7 15. Each camera covers a 7.8 × 7.8 degree field of view. Located on La Palma, the SuperWASP-I instrument has been observing the Northern Hemisphere with five cameras since its inauguration in April 2004. The ultra-wide angle field of view gives SuperWASP the possibility of discovering new fast moving (near to Earth) asteroids that could have been missed by other instruments. However, it provides an excellent opportunity to produce a magnitude-limited lightcurve survey of known main belt asteroids. As slow moving asteroids stay within a single SuperWASP field for several weeks, and may be seen in many fields, a survey of all objects brighter than magnitude 15 is possible. This will provide a significant increase in the total number of lightcurves available for statistical studies without the inherent bias against longer periods present in the current data sets. We present the methodology used in the automated collection of asteroid data from SuperWASP and some of the first examples of lightcurves from numbered asteroids.

Fast model based feature matching technique applied to airport lighting

The use of image processing techniques to assess the performance of airport landing lighting using images of it collected from an aircraft-mounted camera is documented. In order to assess the performance of the lighting, it is necessary to uniquely identify each luminaire within an image and then track the luminaires through the entire sequence and store the relevant information for each luminaire, that is, the total number of pixels that each luminaire covers and the total grey level of these pixels. This pixel grey level can then be used for performance assessment. The authors propose a robust model-based (MB) featurematching technique by which the performance is assessed. The development of this matching technique is the key to the automated performance assessment of airport lighting. The MB matching technique utilises projective geometry in addition to accurate template of the 3D model of a landing-lighting system. The template is projected onto the image data and an optimum match found, using nonlinear least-squares optimisation. The MB matching software is compared with standard feature extraction and tracking techniques known within the community, these being the Kanade–Lucus–Tomasi (KLT) and scaleinvariant feature transform (SIFT) techniques. The new MB matching technique compares favourably with the SIFT and KLT feature-tracking alternatives. As such, it provides a solid foundation to achieve the central aim of this research which is to automatically assess the performance of airport lighting.