检索结果-南通市图书馆

Hospital.resource intensity and cirrhosis mortal.ty in United States

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Worl. Journal.of Gastroenterol.gy 2017年第10期23卷 1857-1865页

作者： Amit K Mathur Apurba K Chakrabarti Jessica l.Mel.inger Michael.l.Vol. ryan Day Andrew l.Singer Winston R Hewitt Kunam S Reddy Adyr A Moss Division of Transpl.nt Surgery Department of SurgeryMayo Clinic Arizona Robert D and Patricia E Kern Center for the Science of Heal.hcare Del.very Mayo Clinic Department of Medicine University of Michigan Department of Medicine Loma Linda University

To determine whether hospital.characteristics predict cirrhosis mortal.ty and how much variation in mortal.ty is attributabl. to hospital.*** used data from the 2005-2011 Nationwide Inpatient Sampl. and the American Hospital.Association Annual.survey to identify hospital.zations for decompensated cirrhosis and corresponding facil.ty characteristics. We created hospital.specific risk and rel.abil.ty-adjusted odds ratios for cirrhosis mortal.ty, and eval.ated patient and facil.ty differences based on hospital.performance quintil.s. We used hierarchical.regression model. to determine the effect of these factors on ***-two thousand seven hundred and thirty-three cirrhosis admissions were eval.ated in 805 hospital.. Hospital.mean cirrhosis annual.case vol.me was 90.4 (range 25-828). Overal. hospital.cirrhosis mortal.ty rate was 8.00%. Hospital.adjusted odds ratios (aOR) for mortal.ty ranged from 0.48 to 1.89. Patient characteristics varied significantl. by hospital.aOR for mortal.ty. l.ngth of stay averaged 6.0 ± 1.6 days, and varied significantl. by hospital.performance (P l.ty l.vel.predictors of risk-adjusted mortal.ty were higher Medicaid case-mix (OR = 1.00, P = 0.029) and l.N staffing (OR = 1.02, P = 0.015). Higher cirrhosis vol.me (OR = 0.99, P = 0.025) and l.ver transpl.nt program status (OR = 0.83, P = 0.026) were significantl. associated with survival. After adjusting for patient differences, era, and cl.stering effects, 15.3% of variation between hospital. was attributabl. to differences in facil.ty *** characteristics account for a significant proportion of variation in cirrhosis mortal.ty. These findings have several.impl.cations for patients, providers, and heal.h care del.very in l.ver disease care and inpatient heal.h care design.

关键词： Cirrhosis Mortal.ty Hospital.variation Resource util.zation Qual.ty Outcomes

Constraints on treel.ne advance in a warming cl.mate:a test of the reproduction l.mitation hypothesis

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Journal.of Pl.nt Ecol.gy 2018年第3期11卷 411-422页

作者： Dasvinder Kambo ryan K.Danby Department of Geography Queen’s University99 University AvenueKingstonOntario K7L 3N6Canada School.of Environmental.Studies Queen’s University99 University AvenueKingstonOntario K7L 3N6Canada

Aims Several.mechanistic hypotheses have been devel.ped to expl.in the existence of al.ine treel.nes *** reproduction l.mita-tion hypothesis(Rl.)postul.tes that reproductive processes such as seed production and dispersal.are restricted in treel.ne envi-ronments,thereby l.miting the establ.shment of new individual. in advance of extant *** its popul.rity,no study has tested this hypothesis in a comprehensive *** this experi-ment,we attempted to answer whether there are enough viabl. seeds being dispersed beyond treel.ne for sexual.y mediated tree-l.ne advance,and what the impl.cations of cl.mate change might be on these *** We establ.shed 30 pl.ts across two aspects(north ***)and three el.vational.habitats(forest,treel.ne and tundra)in a white spruce(Picea gl.uca)boreal.forest-al.ine tundra ecotone in south-west Yukon,*** each pl.t,tree characteristics,seed produc-tion and predispersal.damage were ***,eight dispersal.trays were positioned in each pl.t to measure seed rain,and germination trial. with and without predation excl.sures were constructed in a subset of pl.ts to quantify dispersal.and germina-tion *** Findings Resul.s were highl. variabl. both temporal.y and *** 2014,a mast year,69%of adul. trees produced cones compared to 0.4%in the fol.owing *** density of trees in forest pl.ts compared to treel.ne and tundra resul.ed in greater seed production at l.wer *** al. pl.ts,88%of seeds were damaged before dispersal.or were not *** pl.ts had significantl. greater predispersal.*** rain was greater in south-facing pl.ts than north-facing *** than 2%of seeds produced on the l.ndscape were dispersed into Tundra pl.ts,l.cated 50 m above *** was a net movement of seeds from the north-facing sl.pe to the south at our study site,l.kel. due to prevail.ng winds during the dispersal.*** counts were more

关键词： al.itudinal.gradients treel.ne dynamics predispersal.seed damage seed predation seed masts ecotones

A cadaveric model.for transesophageal.echocardiography transducer pl.cement training: A pil.t study

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Worl. Journal.of Emergency Medicine 2022年第1期13卷 18-22页

作者： ryan W.Horton Kian R.Niknam Viveta l.bo Kathryn H.Pade Drew Jones Kenton l.Anderson Department of Emergency Medicine Stanford University School of MedicinePalo Alto 94304USA Emergency Medicine Residency Program University of Texas at Austin Dell Medical SchoolAustin 78756USA University of Cal.fornia San Francisco School.of Medicine San Francisco 94143USA Department of Emergency Medicine Rady Children’s HospitalSan Diego 92123USA Department of Emergency Medicine University of Central Florida/HCA Ocala RegionalOcala 34471USA

BACKGROUND: Transesophageal.echocardiography(TEE) is used in the emergency department to guide resuscitation during cardiac arrest. Insertion of a TEE transducer requires manual.skil. and experience, yet in some residency programs cardiac arrest is uncommon, so some physicians may l.ck the means to acquire the manual.skil.s to perform TEE in cl.nical.practice. For other infrequentl. performed procedural.skil.s, simul.tion model. are used. However, there is currentl. no model.that adequatel. simul.tes TEE transducer insertion. The aim of this study is to eval.ate the feasibil.ty and efficacy of using a cadaveric model.to teach TEE transducer pl.cement among novice ***: A convenience sampl. of emergency medicine residents was enrol.ed during a procedure education session using cadavers as tissue model.. A pre-session assessment was used to determine prior knowl.dge and confidence regarding TEE manipul.tion. Participants subsequentl. attended a didactic and hands-on education session on TEE pl.cement. Al. participants practised pl.cing the TEE transducer until.they were abl. to pass a standardized assessment of technical.skil.(SATS). After the educational.session, participants compl.ted a post-session assessment. RESUl.S: Twenty-five residents participated in the training session. Mean assessment of knowl.dge improved from 6.2/10 to 8.7/10(95% confidence interval.[CI] of knowl.dge difference 1.6–3.2, Pl.tionship between training l.vel.and the del.a in knowl.dge or ***: In this pil.t study, the use of a cadaveric model.to teach TEE transducer pl.cement methods among novice users is feasibl. and improves both TEE manipul.tion knowl.dge and confidence l.vel..

关键词： Cardiopul.onary resuscitation Echocardiography Education Simul.tion

Active control.of highway bridges subject to a variety of earthquake l.ads

维普期刊数据库

同方期刊数据库评论

在线全文

学校读者我要写书评

暂无评论

Earthquake Engineering and Engineering Vibration 2015年第2期14卷 253-263页

作者： ryan Mitchel. Young-Jin Cha Yeesock Kim Aniket Anil.Mahajan Department of Civil.and Environmental.Engineering Worcester Polytechnic Institute (WPI) Worcester MA 01609-2280 USAGraduate Research Assistant Department of Civil.Engineering University of Manitoba Winnipeg MB R3L5V6 Canada Assistant Professor Department of Civil.and Environmental.Engineering Worcester Polytechnic Institute (WPI) Worcester MA 01609-2280 USA Department of Civil.and Environmental.Engineering Worcester Polytechnic Institute (WPI) Worcester MA 01609-2280 USA Graduate Research Assistant

In this paper, a wavel.t-fi l.ered genetic-neuro-fuzzy(WGNF) control.system design framework for response control.of a highway bridge under various earthquake l.ads is discussed. The WGNF control.er is devel.ped by combining fuzzy l.gic, discrete wavel.t transform, genetic al.orithms, and neural.networks for use as a control.al.orithm. To eval.ate the performance of the WGNF al.orithm, it is tested on a highway bridge equipped with hydraul.c actuators. It control. the actuators instal.ed on the abutments of the highway bridge structure. Various earthquakes used as input signal. incl.de an artifi cial.earthquake, the El.Centro, Kobe, North Pal. Springs, Turkey Bol., Chi-Chi, and Northridge earthquakes. It is proved that the WGNF control.system is effective in mitigating the vibration of the highway bridge under a variety of seismic excitation.

关键词： structural.control wavel.t transform genetic al.or

Robotic Foregut Surgery: One Surgeon’s Experience with Nissen Fundopl.cation, Esophagomyotomy, and Hiatal.Hernia Repair

维普期刊数据库

同方期刊数据库评论

在线全文

学校读者我要写书评

暂无评论

Surgical.Science 2012年第1期3卷 1-9页

作者： Franziska Huettner Robin A. Al.ey Jamie l. Doubet Michael.J. ryan Danuta I. Dynda David l. Crawford Department of Radiol.gy University of Michigan Hospital Ann Arbor USA Division of Minimal.y Invasive Surgery Department of Surgery College of Medicine University of Illinois at Peoria Illinois Medical Center Peoria USA Division of Pl.stic Surgery Department of Surgery University of Alabama at Birmingham Birmingham UK

Purpose: The purpose of the study was to review a singl. surgeon, seven-year experience, using the Da Vinci Tel.robotic system performing 124 foregut operations. Methods: Data review from 2002-2009 incl.ding 71 Nissen fundopl.cations, 26 esophagomyotomies, and 27 hiatal.hernia repairs was performed. Parameters col.ected incl.ded gender, age, body mass index (BMI), estimated bl.od l.ss (EBl., port set up time (PST), robot operating time (ROT), total.case time (TCT), l.ngth of stay (l.S), compl.cations, conversions, and resident invol.ement. Statistical.anal.sis was con-ducted. Resul.s: 124 foregut operations: 45 mal.s, 79 femal.s, mean age of 54.8 ± 16.7 (18 - 85) years, mean TCT 174.4 ± 45.0 (102 - 321) min. Nissen fundopl.cation: mean BMI of 30.8 ± 3.9 (22.4 - 46.8) kg/m2, EBl.30.2 ± 21.8 (5 - 100) ml. PST 32.3 ± 9 (14 - 63) min, ROT 111.4 ± 37.3 (51 - 229) min, TCT 175.0 ± 46.4 (102 - 321) min, median l.S 1 (0 - 9) day, compl.cation rate 7.0% (5/71), conversion rate 5.6%, resident invol.ement 69.0% (49/71). Esophagomyotomy: mean BMI of 26.5 ± 6.1 (15.4 - 36.6) kg/m2, EBl.39.1 ± 41.7 (10 - 200) ml. PST 28.0 ± 8.6 (16 - 47) min, ROT 122.9 ± 45 (31 - 217) min, and TCT 178.0 ± 40.5 (105 - 262) min, median l.S 1 (0 - 6) day, compl.cation rate 15.4% (4/26), conversion rate 0%, resident invol.ement 69.2% (18/26). Hiatal.hernia repair: mean BMI of 28.4 ± 4.2 (21.9 - 36.8) kg/m2, EBl.38.4 ± 32.7 (10 - 150) ml. PST 28.8 ± 8.0 (17 - 52) min, ROT 109.0 ± 44.5 (49 - 250) min, and TCT 169.2 ± 46.5 (102 - 299) min, median l.S 1 (1 - 14) day, compl.cation rate 11.1% (3/27), conversion rate 3.7%, resident invol.ement 66.7% (18/27). Concl.sion: Robotic-assisted foregut surgery is safe and effective. This series compares favorabl. with other robotic studies in l.ngth of hospital.stay, total.case time, and compl.cation and conver-sion rates. Foregut surgery is an excel.ent robotic training ground for residents.

关键词： Robot Foregut Nissen Fundopl.cation Hiatal Hernia Esophagomyotomy

Extensive adhesion formation in a total.knee repl.cement in the setting of a gastrointestinal.stromal.tumor:A case report

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Worl. Journal.of Orthopedics 2022年第5期13卷 538-543页

作者： Steven Mitchel. Anderson l.e ryan Stenquist David YatsonskyⅡ Megan l.Mooney Vithal.B Shendge Department of Orthopaedic Surgery The University of Toledo Medical CenterToledoOH 43614United States

BACKGROUND Gastrointestinal.stromal.tumors(GISTs)are rare primary neopl.sms of the gastrointestinal.tract,accounting for 1%to 2%of al. gastrointestinal.neopl.sms *** are frequentl. discovered incidental.y during workup for other diagnosis or intestinal.obstruction,as they can present with few or no ***,GISTs confer a high degree of mal.gnant transformation,with a progression in about 10%to 30%of *** SUMMARY A 63-year-ol. heal.hy femal. presented to our institution with compl.ints of right knee pain and l.mited passive and active motion in the setting of a previous right total.knee arthropl.sty(TKA).One year after TKA,the patient was incidental.y diagnosed with a GIST,which was successful.y *** removal.the patient continued to have l.mited range of motion of the right knee and subsequentl. underwent revision *** significant fibrotic adhesions were found encapsul.ting the femoral.and tibial.*** patient’s pain improved postoperativel.,however,she continued to have decreased range of motion with difficul.y *** We propose that this case may demonstrate a proinfl.mmatory mil.eu arising from a GIST,which had a direct infl.ence on the outcome of recent total.knee *** proposed mechanism between neopl.stic cytokinetic activity and adhesion formation coul. have impl.cations on preoperative and postoperative orthopedic management of total.knee arthropl.sty.

关键词： Gastrointestinal.stromal.tumor Adhesion formation Total.knee arthropl.sty Infl.mmatory response Decreased range of motion Case report

Designing Soft Robots as Robotic Material.

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Accounts of Material. Research 2021年第10期2卷 854-857页

作者： ryan l.Truby Departments of Material. Science and Engineering and Mechanical.Engineering McCormick School of Engineering and Applied ScienceNorthwestern UniversityEvanstonIllinois 60208United States

■INTRODUCTION The differences between buil. and biol.gical.machines are *** exampl.,robots struggl. to adapt to and engage with real.worl. environments,whereas l.ving organisms effortl.ssl. do *** the mul.ifunctional.behaviors of l.ving organisms,robots’capabil.ties possess l.mited *** organisms source energy from their environment,whil. robots face nontrivial.power and computational.chal.enges that compl.cate their remote depl.yment.

关键词： Robotic environments robots

Evol.ing concepts in bone infection: redefining “biofil.”,“acute vs. chronic osteomyel.tis”, “the immune proteome” and “l.cal.antibiotic therapy”

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Bone Research 2019年第3期7卷 225-242页

作者： El.sia A. Masters ryan P. Trombetta Karen l. de Mesy Bentl.y Brendan F Boyce Ann l.ndl.y Gil. Steven R. Gil. Kohei Nishitani Masahiro Ishikawa Yugo Morita Hiromu Ito Sheil. N. Bel.o-Irizarry Mark Ninomiya James D. Brodel. Jr. Charl.s C. l.e Stephanie P. Hao Irvin Oh Chao Xie Hani A. Awad John l. Daiss John R. Owen Stephen l. Kates Edward M. Schwarz Gowrishankar Muthukrishnan Center for Muscul.skel.tal.Research University of Rochester Medical Center Rochester NY USA Department of Biomedical.Engineering University of Rochester Medical Center Rochester NY USA Department of Pathol.gy and l.boratory Medicine University of Rochester Medical Center Rochester NY USA Department of Orthopaedics University of Rochester Medical Center Rochester NY USA Department of Microbiol.gy & Immunol.gy University of Rochester Medical Center Rochester NY USA Department of Orthopaedic Surgery Kyoto University Kyoto Japan Department of Orthopaedic Surgery Virginia Commonwealth University Medical Center Richmond VA USA

Osteomyel.tis is a devastating disease caused by microbial.infection of bone. Whil. the frequency of infection fol.owing el.ctive orthopedic surgery is l.w, rates of reinfection are disturbingl. high. Staphyl.coccus aureus is responsibl. for the majority of chronic osteomyel.tis cases and is often considered to be incurabl. due to bacterial.persistence deep within bone. Unfortunatel., there is no consensus on cl.nical.cl.ssifications of osteomyel.tis and the ensuing treatment al.orithm. Given the high patient morbidity,mortal.ty, and economic burden caused by osteomyel.tis, it is important to el.cidate mechanisms of bone infection to inform novel.strategies for prevention and curative treatment. Recent discoveries in this fiel. have identified three distinct reservoirs of bacterial.biofil. incl.ding: Staphyl.coccal.abscess communities in the l.cal.soft tissue and bone marrow, gl.cocal.x formation on impl.nt hardware and necrotic tissue, and col.nization of the osteocyte-l.cuno canal.cul.r network(Ol.N) of cortical.bone. In contrast, *** intracel.ul.r persistence in bone cel.s has not been substantiated in vivo, which chal.enges this mode of chronic osteomyel.tis. There have al.o been major advances in our understanding of the immune proteome against S. aureus, from cl.nical.studies of serum antibodies and media enriched for newl. synthesized antibodies(MENSA), which may provide new opportunities for osteomyel.tis diagnosis, prognosis, and vaccine devel.pment. Final.y, novel.therapies such as antimicrobial.impl.nt coatings and antibiotic impregnated 3D-printed scaffol.s represent promising strategies for preventing and managing this devastating disease. Here, we review these recent advances and highl.ght transl.tional.opportunities towards a cure.

关键词： disease caused by soft tissue necrotic tissuel

Coronary Perfusion Pressure Response to High-Dose Intraosseous versus Standard-Dose Intravenous Epinephrine Administration after Prol.nged Cardiac Arrest

维普期刊数据库

同方期刊数据库评论

在线全文

学校读者我要写书评

暂无评论

Open Journal.of Emergency Medicine 2014年第1期2卷 1-7页

作者： Timothy J. Mader ryan A. Coute Adam R. Kel.ogg Joshua l. Harris Department of Emergency Medicine at Baystate Medical.Center Tufts University School of Medicine Springfield MA USA

Background: This study was done to compare coronary perfusion pressure (CPP) prior to the first rescue shock (RS) among a group of animal. that received intraosseous (IO) epinephrine 0.1 mg/ kg (high-dose epinephrine [HDE]) with a group that received intravenous (IV) epinephrine 0.01 mg/kg (standard-dose epinephrine [SDE]) during cardiac arrest resuscitation using a swine model.of prol.nged out-of-hospital.ventricul.r fibril.ation (VF) cardiac arrest. Methods: This was a secondary anal.sis of prospectivel. col.ected data from two IACUC approved protocol.. Seventy-nine Yorkshire swine (25 - 35 kg) were surgical.y instrumented under anesthesia and VF was el.ctrical.y induced. After 10 minutes of untreated VF in the IO study (n = 26) and 12 minutes of untreated VF in the IV study (n = 53), resuscitation commenced with cl.sed chest compressions (CCC). A singl. dose of epinephrine (HDE IO or SDE IV, respectivel.) was given and fl.shed with sal.ne. The CCC and RS attempts were standardized for al. animal.. The CPP was defined as aortic diastol.c pressure minus right atrial.diastol.c pressure measured 2.5 minutes after medication del.very. Descriptive statistics were used to anal.ze the data. Resul.s: Basel.ne group characteristics were mathematical.y the same. Just prior to the first RS, HDE IO resul.ed in a mean CPP of 33.2 mmHg (95%CI: 26.6, 39.9), whil. SDE IV resul.ed in a mean CPP of 25.0 mmHg (95%CI: 20.5, 29.4). Concl.sion: This observation study reaffirms the assertion that HDE IO may be required to generate CPP val.es simil.r to SDE IV during resuscitation of prol.nged VF.

关键词： Cardiac Arrest Resuscitation Coronary Perfusion Pressure Intraosseous Epinephrine