Cut-off importance sampling of bole volume

Summary

Patients satisfaction in an academic walk-in centre: a new model of residents training achieved by family doctors.

BACKGROUND: Walk-in centres may improve access to healthcare for some patients, due to their convenient location and extensive opening hours, with no need for an appointment. Herein, we describe and assess a new model of walk-in centre, characterised by care provided by residents and supervision achieved by experienced family doctors. The main aim of the study was to assess patients' satisfaction about the care they received from residents and their supervision by family doctors. The secondary aim was to describe walk-in patients' demographic characteristics and to identify potential associations with satisfaction. METHODS: The study was conducted in the walk-in centre of Lausanne. Patients who consulted between 11th and 31st April were automatically included and received a questionnaire in French. We used a five-point Likert scale, ranging from "not at all satisfied" to "very satisfied", converted from values of 1 to 5. We focused on the satisfaction regarding residents' care and supervision by a family doctor. The former was divided in three categories: "Skills", "Treatment" and "Behaviour". A mean satisfaction score was calculated for each category and a multivariable logistic model was applied in order to identify associations with patients' demographics. RESULTS: The overall response rate was 47% [184/395]. Walk-in patients were more likely to be women (62%), young (median age 31), with a high education level (40% of University degree or equivalent). Patients were "very satisfied" with residents' care, with a median satisfaction score between 4.5 and 5, for each category. Over 90% of patients were "satisfied" or "very satisfied" that a family doctor was involved in the consultation. Age showed the greatest association with satisfaction. CONCLUSION: Patients were highly satisfied with care provided by residents and with the involvement of a family doctor in the consultation. Older age showed the greatest positive association with satisfaction with a positive impact. The high level satisfaction reported by walk-in patients supports this new model of walk-in centre.

Accurate and efficient simulation of multiphase flow in a heterogeneous reservoir by using error estimate and control in the multiscale finite-volume framework

The multiscale finite-volume (MSFV) method is designed to reduce the computational cost of elliptic and parabolic problems with highly heterogeneous anisotropic coefficients. The reduction is achieved by splitting the original global problem into a set of local problems (with approximate local boundary conditions) coupled by a coarse global problem. It has been shown recently that the numerical errors in MSFV results can be reduced systematically with an iterative procedure that provides a conservative velocity field after any iteration step. The iterative MSFV (i-MSFV) method can be obtained with an improved (smoothed) multiscale solution to enhance the localization conditions, with a Krylov subspace method [e.g., the generalized-minimal-residual (GMRES) algorithm] preconditioned by the MSFV system, or with a combination of both. In a multiphase-flow system, a balance between accuracy and computational efficiency should be achieved by finding a minimum number of i-MSFV iterations (on pressure), which is necessary to achieve the desired accuracy in the saturation solution. In this work, we extend the i-MSFV method to sequential implicit simulation of time-dependent problems. To control the error of the coupled saturation/pressure system, we analyze the transport error caused by an approximate velocity field. We then propose an error-control strategy on the basis of the residual of the pressure equation. At the beginning of simulation, the pressure solution is iterated until a specified accuracy is achieved. To minimize the number of iterations in a multiphase-flow problem, the solution at the previous timestep is used to improve the localization assumption at the current timestep. Additional iterations are used only when the residual becomes larger than a specified threshold value. Numerical results show that only a few iterations on average are necessary to improve the MSFV results significantly, even for very challenging problems. Therefore, the proposed adaptive strategy yields efficient and accurate simulation of multiphase flow in heterogeneous porous media.

Complications of Valve Lung Volume Reduction in a Case of Previous Pleurodesis.

Lung volume reduction with valves is increasingly used to treat selected patients with severe emphysema. The indications for this procedure have been previously described; however, its contraindications have not yet been conclusively established. This case highlights the potentially severe complications of endobronchial one-way valve placement in the setting of a previous pleurodesis.

Sustained antipsychotic effect of metacognitive training in psychosis: a randomized-controlled study.

Persistent psychotic symptoms represent a major challenge for psychiatric care. Basic research has shown that psychotic symptoms are associated with cognitive biases. Metacognitive training (MCT) aims at helping patients to become aware of these biases and to improve problem-solving. Fifty-two participants fulfilling diagnostic criteria of schizophrenia or schizoaffective disorders and persistent delusions and stabilized antipsychotic medication were enrolled in this study. Following baseline assessment patients were randomized either to treatment as usual (TAU) conditions or TAU+MCT. The intervention consisted of eight weekly 1-hour sessions (maximum: 8 hours). Participants were assessed at 8 weeks and 6-months later by blind assessors. Participants were assessed with the Psychotic Symptoms Rating Scales (PSYRATS) and the positive subscale of the PANSS. Between-group differences in post- and pre-test values were significant at a medium effect size in favor of the MCT for the PSYRATS delusion scale and the positive scale of the PANSS both at post and follow-up. The results of this study indicate that MCT training has a surplus antipsychotic effect for patients suffering from schizophrenia-related disorders who demonstrate only a partial response to antipsychotic treatment and that the effect of the intervention persists for at least 6 months after the intervention.

Efeito do grau de moagem, do tipo de frasco e do volume vazio sobre a variabilidade analítica do fósforo extraído pelos métodos Mehlich-1 e Mehlich-3

Na execução de uma análise química de solo são empregados diversos procedimentos que, mesmo seguindo-se o protocolo preconizado pelo método de análise utilizado, estão sujeitos a variações nos resultados analíticos, causadas por manipulação das amostras ou dos materiais utilizados. Objetivou-se neste estudo avaliar a influência do grau de moagem da amostra, do tipo de frasco e do volume vazio no frasco na execução dos métodos Mehlich-1 e Mehlich-3 para determinar o P no solo. Para tanto, foram conduzidos três experimentos. No primeiro experimento, as amostras de solo foram moídas e tamisadas em peneiras com aberturas de 2,000; 1,700; 0,850; 0,600; e 0,300 mm. No segundo, foram utilizados dois modelos de frasco (erlenmeyer e snap-cap), ambos com volume de 50 mL. Já no terceiro, foi alterado o volume vazio no frasco, mantendo-se a relação solo:solução extratora utilizando-se as quantidades dentro do frasco de 1:10; 1,5:15; 2,5:25; 3:30; e 4:40 cm³ cm-3. O grau de moagem das amostras não influenciou a capacidade de extração do Mehlich-1; entretanto, a capacidade extrativa do Mehlich-3 foi influenciada, principalmente em solos argilosos. Tanto para o Mehlich-1 quanto para o Mehlich-3, os teores de P extraído foram significativamente mais elevados com o uso de frasco tipo snap-cap em relação ao erlenmeyer. O volume vazio no frasco alterou os teores de P extraído para o Mehlich-1 e Mehlich-3 em 100 e 64 % das amostras, respectivamente. Deve-se padronizar a intensidade da moagem das amostras de solo para extração do P pela solução de Mehlich-3. Um modelo único de frasco deve ser adotado pelos laboratórios de rotina para análise do P, independentemente do método de extração, mantendo-se sempre constante no frasco o volume da amostra (cm³) para o volume de solução extratora (cm³).

Intraoperative training on the techniques of sentinel node biopsy in breast cancer

Principles: Surgeon's experience is crucial for proper application of sentinel node biopsy (SNB) in patients with breast cancer. A 20-30 cases learning curve of sentinel node (SN) and axillary lymph node dissection (ALND) was widely practiced. In order to speed up this learning curve, surgeons may be trained intraoperative by an experienced surgeon. The purpose of this report is to evaluate the results of this procedure. Methods: Patients with one primary invasive breast cancer (cT1-T2[<3 cm]cN0) underwent SNB based on lymphoscintigraphy using technetium Tc 99m colloid, intraoperative gamma probe detection, with or without blue dye mapping. This was followed by completion ALND when SN was positive or not found. SNB was performed by one experienced surgeon (teacher) or by 10 junior surgeons trained by the experienced surgeon (trainees). Four groups were defined: (i) SNB with immediate ALND for the teacher's learning curve, (ii) SNB by the teacher, (iii) SNB by the trainees under the teacher's supervision, and (iv) SNB by the trainees alone. Results: Between May 1999 and December 2007, a total of 808 évaluable patients underwent SNB. The SN identification rate was 98% in the teacher's group, and 99% in the trainees' group (p = 0.196). SN were positive in respectively 28% and 29% of patients (p = 0.196). The distribution of isolated tumor cells, micrometastases and metastases was not statistically different between the teacher's and the trainees' groups (p = 0.163). Conclusion: These comparable results confirm the success with which the SNB was taught. This strategy avoided the 20-30 SNB followed by immediate ALND early required per surgeon.

Geosynthetic Reinforced Soil for Low-Volume Bridge Abutments, January 2012

This report presents a review of literature on geosynthetic reinforced soil (GRS) bridge abutments, and test results and analysis from two field demonstration projects (Bridge 1 and Bridge 2) conducted in Buchanan County, Iowa, to evaluate the feasibility and cost effectiveness of the use of GRS bridge abutments on low-volume roads (LVRs). The two projects included GRS abutment substructures and railroad flat car (RRFC) bridge superstructures. The construction costs varied from $43k to $49k, which was about 50 to 60% lower than the expected costs for building a conventional bridge. Settlement monitoring at both bridges indicated maximum settlements ≤1 in. and differential settlements ≤ 0.2 in transversely at each abutment, during the monitoring phase. Laboratory testing on GRS fill material, field testing, and in ground instrumentation, abutment settlement monitoring, and bridge live load (LL) testing were conducted on Bridge 2. Laboratory test results indicated that shear strength parameters and permanent deformation behavior of granular fill material improved when reinforced with geosynthetic, due to lateral restraint effect at the soilgeosynthetic interface. Bridge LL testing under static loads indicated maximum deflections close to 0.9 in and non-uniform deflections transversely across the bridge due to poor load transfer between RRFCs. The ratio of horizontal to vertical stresses in the GRS fill was low (< 0.25), indicating low lateral stress on the soil surrounding GRS fill material. Bearing capacity analysis at Bridge 2 indicated lower than recommended factor of safety (FS) values due to low ultimate reinforcement strength of the geosynthetic material used in this study and a relatively weak underlying foundation layer. Global stability analysis of the GRS abutment structure revealed a lower FS than recommended against sliding failure along the interface of the GRS fill material and the underlying weak foundation layer. Design and construction recommendations to help improve the stability and performance of the GRS abutment structures on future projects, and recommendations for future research are provided in this report.

Glial and axonal body fluid biomarkers are related to infarct volume, severity, and outcome.

Body fluid biomarkers of central nervous system damage may help improve the prognostic and diagnostic accuracy in ischemic stroke. We studied 53 patients. Stroke severity and outcome was rated using the National Institutes of Health Stroke Scale and modified Rankin scale. Ferritin, S100B, and NfH were measured in cerebrospinal fluid (CSF) and serum. Infarct volume was calculated from T2W images. CSF S100B (median 1.00 ng/mL) and CSF ferritin (10.0 ng/mL) levels were elevated in patients with stroke compared with control subjects (0.62 ng/mL, P < .0001; 2.34 ng/mL, P < .0001). Serum S100B (0.09 ng/mL) was higher in patients with stroke compared with control subjects (0.01 ng/mL). CSF S100B levels were higher in patients with a cardioembolic stroke (2.88 ng/mL) than in those with small-vessel disease (0.89 ng/mL, P < .05). CSF S100B levels correlated with the National Institutes of Health Stroke Scale score on admission (R = 0.56, P < .01) and the stroke volume (R = 0.44, P = .01). CSF S100B and NfH-SMI35 levels correlated with outcome on the modified Rankin scale. CSF S100B levels were related to stroke severity and infarct volume and highest in cardioembolic stroke.

Signing on Very Low Volume Rurd Roads Iowa DOT Project HR-262, July, 1984

Research was undertaken to define an appropriate level of use of traffic control devices on rural secondary roads that carry very low traffic volumes. The goal of this research was to improve the safety and efficiency of travel on the rural secondary road system. This goal was to be accomplished by providing County Engineers with guidance concerning the cost-effective use of traffic control devices on very low volume rural roads. A further objective was to define the range of traffic volumes on the roads for which the recommendations would be appropriate. Little previous research has been directed toward roads that carry very low traffic volumes. Consequently, the factual input for this research was developed by conducting an inventory of the signs and markings actually in use on 2,069 miles of rural road in Iowa. Most of these roads carried 15 or fewer vehicles per day. Additional input was provided by a survey of the opinions of County Engineers and Supervisors in Iowa. Data from both the inventory and the opinion survey indicated a considerable lack of uniformity in the application of signs on very low volume rural roads. The number of warning signs installed varied from 0.24 per mile to 3.85 per mile in the 21 counties in which the inventory was carried out. The use of specific signs not only varied quite widely among counties but also indicated a lack of uniform application within counties. County officials generally favored varying the elaborateness of signing depending upon the type of surface and the volume of traffic on different roads. Less elaborate signing would be installed on an unpaved road than on a paved road. A concensus opinion was that roads carrying fewer than 25 vehicles per day should have fewer signs than roads carrying higher volumes. Although roads carrying 0 to 24 vehicles per day constituted over 24% of the total rural secondary system, they carried less than 3% of the total travel on that system. Virtually all of these roads are classified as area service roads and would thus be expected to carry only short trips primarily by local motorists. Consequently, it was concluded that the need for warning signs rarely can be demonstrated on unpaved rural roads with traffic volumes of fewer than 25 vehicles per day. It is recommended that each county designate a portion of its roads as an Area Service Level B system. All road segments with very low traffic volumes should be considered for inclusion in this system. Roads included in this system may receive a lesser level of maintenance and a reduced level of signing. The county is also afforded protection from liability arising from accidents occurring on roads designated as part of an Area Service Level B system. A uniform absence of warning signs on roads of this nature is not expected to have any discernible effect on the safety or quality of service on these very low volume roads. The resources conserved may be expended more effectively to upgrade maintenance and traffic control on roads carrying higher volumes where the beneficial effect on highway safety and service will be much more consequential.