Preoperative predictors of extended hospital length of stay following total knee arthroplasty.

The purpose of this study was to identify the preoperative predictors of hospital length of stay after primary total knee arthroplasty in a patient population reflecting current trends toward shorter hospitalization and using readily obtainable factors that do not require scoring systems. A single-center, multi-surgeon retrospective chart review of two hundred and sixty consecutive patients who underwent primary total knee arthroplasty was performed. The mean length of stay was 3.0 days. Among the different variables studied, increasing comorbidities, lack of adequate assistance at home, and bilateral surgery were the only multivariable significant predictors of longer length of stay. The study was adequately powered for statistical analyses and the concordance index of the multivariable logistic regression model was 0.815.

PenPC: A two-step approach to estimate the skeletons of high-dimensional directed acyclic graphs.

Estimation of the skeleton of a directed acyclic graph (DAG) is of great importance for understanding the underlying DAG and causal effects can be assessed from the skeleton when the DAG is not identifiable. We propose a novel method named PenPC to estimate the skeleton of a high-dimensional DAG by a two-step approach. We first estimate the nonzero entries of a concentration matrix using penalized regression, and then fix the difference between the concentration matrix and the skeleton by evaluating a set of conditional independence hypotheses. For high-dimensional problems where the number of vertices p is in polynomial or exponential scale of sample size n, we study the asymptotic property of PenPC on two types of graphs: traditional random graphs where all the vertices have the same expected number of neighbors, and scale-free graphs where a few vertices may have a large number of neighbors. As illustrated by extensive simulations and applications on gene expression data of cancer patients, PenPC has higher sensitivity and specificity than the state-of-the-art method, the PC-stable algorithm.

Guidelines on artificial nutrition versus hydration in terminal cancer patients

Whether a terminally ill cancer patient should be actively fed or simply hydrated through subcutaneous or intravenous infusion of isotonic fluids is a matter of ongoing controversy among clinicians involved in the care of these patients. Under the auspices of the European Association for Palliative Care, a committee of experts developed guidelines to help clinicians make a reasonable decision on what type of nutritional support should be provided on a case-by-case basis. It was acknowledged that part of the controversy related to the definition of the terminal cancer patient, since this is a heterogeneous group of patients with different needs, expectations, and potential for a medical intervention. A major difficulty is the prediction of life expectancy and the patient's likely response to vigorous nutritional support. In an attempt to reach a decision on the type of treatment support (artificial nutrition vs. hydration) which would best meet the needs and expectations of the patient, we propose a three-step process: Step I: define the eight key elements necessary to reach a decision: Step II: make the decision; and Step III: reevaluate the patient and the proposed treatment at specified intervals. Step I involves assessing the patient concerning the following: 1) oncological/clinical condition; 2) symptoms; 3) expected length of survival; 4) hydration and nutritional status; 5) spontaneous or voluntary nutrient intake; 6) psychological profile; 7) gut function and potential route of administration; and 8) need for special services based on type of nutritional support prescribed. Step II involves the overall assessment of pros and cons, based on information determined in Step I, in order to reach an appropriate decision based on a well-defined end point (i.e. improvement of quality of life; maintaining patient survival; attaining rehydration). Step III involves the periodic reevaluation of the decision made in Step II based on the proposed goal and the attained result.

A nested location-routing heuristic using route length estimation

A nested heuristic approach that uses route length approximation is proposed to solve the location-routing problem. A new estimation formula for route length approximation is also developed. The heuristic is evaluated empirically against the sequential method and a recently developed nested method for location routing problems. This testing is carried out on a set of problems of 400 customers and around 15 to 25 depots with good results.

Reviews: 'The 19th Step' research performance [Performance review]

Review of 'The 19th Step' Research Performance, which took place on 12th April 2008, at the Studio Theatre, Laban, London.

Two steps forward, one step back: developing the curriculum for training teachers for technical and further education England 1945-1956

This paper discusses the development of provision for the training of teachers in English further and technical education from 1945 to 1956. While these years saw little growth in this provision, they were formative in that the institutional and curricular patterns of teacher training for the diverse fields of technical and further education were developed at this time. The work of the three national centres in Bolton, London and Huddersfield, during the period of the Emergency Training Scheme (ETS) is summarised with particular reference to the influence of the Ministry of Education‟s conditions for ETS colleges and courses. With the ending of the ETS in 1951 the three centres were given permanent status as teacher training colleges which in turn brought them into association with their local universities as constituent colleges of their Area Training Organisations. The consequences of this transfer to the universities for the curriculum and assessment of technical teacher training and the 'policy dichotomy' of teacher training for secondary and technical education are examined.

Biological controls on resuspension and the relationship between particle size and the Kolmogorov length scale in a shallow coastal sea

Measurements of suspended particle matter (SPM) and turbulence have been obtained over five tidal surveys during spring and summer 2010 at station L4 (5025 degrees N 04.22 degrees W, depth 50 m), in the Western English Channel. The relationship between turbulence intensity and bed stress is explored, with an in-line holographic imaging system evaluating the extent to which material is resuspended. Image analysis allows for the identification of SPM above a size threshold of 200 pm, capturing particle variability across tidal cycles and the two seasons. Dissipation of turbulent kinetic energy, which exceeds 10(-5) W kg(-1), yields maximum values of bed stress of between 0.17 and 0.20 N m(-2), frequently resulting in the resuspension of material from the bed. Resuspension is shown to promote aggregation of SPM into flocs, where the size of such particles is theoretically determined by the Kolmogorov microscale, l(k). During the spring surveys, flocs of a size larger than lk were observed, though this was not repeated during summer. It is proposed that the presence of gelatinous, biological material in spring allows flocculated particles to exceed l(k). This suggests that under specific circumstances, the limiting factor on the growth of flocculated SPM is not only turbulence, as previously thought, but the presence or absence of certain types of biological particle.

Calorific Ash Carbon And Nitrogen-Content In Relation To Length And Dry-Weight Of Parathemisto-Gaudichaudi (Amphipoda Hyperiidea) In The North-East Atlantic Ocean

The calorific, ash, carbon and nitrogen content, length and dry weight were determined for the hyperiid Parathemisto gaudichaudi (Guerin). Regression equations for all these variables were determined so that they can be estimated by calculation from measurements of length of the hyperiid. Mean values for total nitrogen and carbon were 7.79±0.85% and 36.80±4.18% of the dry weight, respectively. The carbon to calorific equivalent for P. gaudichaudi was 10.37 kcal g-1 carbon (9.13 kcal g-1 when corrected for nitrogen). The calorific value for ash-free adult P. gaudichaudi was 5.138 kcal g-1±1.309 (4.510 kcal g-1 when corrected for nitrogen). This large variation in the calorific content (coefficient of variation of 25.84%) can be accounted for largely by variation in the ash content (coefficient of variation of 21.84%). The calorific value determined for P. gaudichaudi is similar to that measured for other carnivorous crustaceans and adds support to the hypothesis that animals with high calorific content have a low fecundity and an energy-rich store which can be used as a buffer during unfavourable periods in their life.