Appropriate Use Criteria for Echocardiography

Transthoracic Echocardiography (TTE) is one of the most common diagnostic imaging tests used in Cardiology. It is portable, noninvasive and provides important data regarding diagnosis and management of many cardiac conditions. In recent years TTE has had an increased in popularity for its use in both inpatient and outpatient settings. This has resulted in an increase of inappropriate use leading to overutilization of resources. At our institution, University of New Mexico Hospitals we evaluated the prevalence rate of appropriateness of TTE with a quality improvement project. During the first phase of the project 100 TTEs each were randomly selected in both the outpatient and inpatient settings. We evaluated appropriateness based on the AUC of TTE published in 2011 by the American College of Cardiology. Results demonstrated inpatient TTE orders had reduced number of inappropriate echo orders compared to outpatient echo orders. The percentage of inappropriate TTE orders in the outpatient setting was unacceptably high approaching 30% of all outpatient TTE requests. Recent studies have shown that education of physicians concerning the appropriate use of echocardiography can improve resource utilization in clinical practice. The purpose of the second phase of this quality improvement project is to reduce the number of inappropriate TTE orders in the outpatient settings at our UNM clinics through multiple and continued mechanisms. This will be achieved through educational material, EMR modifications, follow up audit reports and feedback sessions

A 3D mathematical model for planning ostectomy on long-bone angular deformities

This study describes a 3D mathematical model for planning a corrective ostectomy on long bones with angular deformities based on CT imaging. The use of three-dimensional information allows the model to compute and correct the bone angulation and rotation. The cutting point selection is developed minimizing the bone length reduction inherent in an ostectomy process. An example of its application on a two year old dog is shown at the end of the paper.Veterinari

Polyphenolic composition of Lantana camara and Lippia chevalieri, and their Antioxidant and Antimicrobial Activities

In the present study, the antioxidant and antibacterial activities of methanolic extracts of two Verbenaceae (Lantana camara L. and Lippia chevalieri Moldenke: aerial part) were investigated. Their polyphenolic composition in the ethyl acetate and aqueous fractions were characterized by HPLC-DAD. The antioxidant capability of the methanolic extracts was assessed by the Ferric Reducing Antioxidant Power (FRAP) and the scavenging activity of the free radical 2,2-diphenyl-1-picrylhydrazyl (DPPH). The Minimum Inhibitory Concentrations (MIC) of the methanolic extracts (25 µg mL-1), and the minimum bactericidal concentrations (MBC) (12.5 µg mL-1) against 13 pathogenic bacteria and four serotyped bacteria from the American Type Culture Collection (ATCC) were also determined by the agar-well diffusion method. The results indicated that the L. chevalieri extracts are rich in phenolic compounds (among the 27 polyphenolic compounds detected, 20 belong to L. chevalieri) and showed the highest antioxidant activities, simultaneously on iron (III) to iron (II)-reducing activity and the radical scavenging activity. However, L. camara displayed the best and the broadest antimicrobial spectrum, especially on Shigella flexneri and Pantoea sp. (two Gram-negative strains of bacteria). The nature of polyphenolics compounds detected (phenol acid and flavone) in the L. camara can justify this activity.Key words: Verbenaceae, HPLC-DAD, antioxidant activity, antimicrobial activity, polyphenolic compound

Sarcomas de partes blandas. Análisis de 42 casos

El objetivo de este estudio es valorar el pronóstico a largo plazo de una serie de pacientes tratados en nuestro hospital en relación con diversos factores clínicos, diagnósticos y terapéuticos que podrían condicionarlo. Se revisaron 123 pacientes tratado por tumores malignos de partes blandas entre los años 1979 y 1999, de estos solo 42 cumplieron las características para incluirles en nuestro estudio. Se valoró su evolución teniendo en cuenta las variables pronosticas identificadas en trabajos previamente publicados y nuestra propia experiencia y se realizó el estudio estadístico de las mismas. En el análisis estadístico del estudio se utilizó el programa SPSS versión 8.0WIN y se realizó el análisis de supervivencia mediante el método de Kaplan-Meier. El tiempo de supervivencia total descrito según este método para el total de los casos estudiados presenta una mediana de 33 meses con un error estándar de 8 y un intervalo de confianza del 95% de (17,49), el tiempo libre de enfermedad presenta una mediana de 9 meses con un error estándar de 2 y un intervalo de confianza del 95% de (6,12) y el tiempo de aparición de metástasis presenta una mediana de 26 meses con un error estándar de 5 y un intervalo de confianza del 95% de (17,35). A su vez se realizó el análisis bivariante de las múltiples variables pronosticas. El gran número de variables y la dispersión de la muestra hacen aconsejable estudios multicéntricos prospectivos más numerosos para obtener conclusiones definitivas sobre este tipo de tumores.The aim of this study is to evaluate the long-term prognosis of a series of patients treated in our hospital with regard to various clinical, diagnostic and therapeutic factors. A total of 123 patients who had been treated for malignant soft tissue tumours between 1979 and 1999 were reviewed. Of these, only 42 fulfilled the requirements to be included in our study. The outcome was evaluated taking into account prognostic variables identified in previously published studies and our own experience, and a statistical study of these factors as carried out with the Kaplan-Meier survival analysis method. The total survival time for all the cases studied was 33+8 (median + SE) months with a 95% confidence interval of 17.49 months. The time free of illness was 9+2 (median + SE) months with a 95% confidence interval of 6.12 months. The time-period until metastasis appeared was 26+5 (median + SE) months with a 95% confidence interval of 17.35 months. At the same time, the bivariant analysis of the many prognostic variables was performed. The high number of variables and the dispersion of the sample group suggest that it would be advisable to carry out more prospective, multicentric studies to reach definitive conclusions about this type of tumour

Granite stone subjected to ultrasonic fatigue tests under three point bending modality

Ultrasonic fatigue tests are carried out under the modality of three points bending on the granite stone. The testing specimens present a prismatic shape with the dimensions: 12 x 3 x 0.8 centimeters, in order to be supported at the two ends (1 centimeter of support each side), and to configure the three points bending modality. Granite specimens are supported on an acrylic structure destined to fix and immobilize the specimens. Vibrating load is applied at the center of testing specimens by a self-designed and fabricated aluminum alloy awl, which dimensions have been obtained by modal numerical analysis to fit the resonance condition, necessary for the ultrasonic fatigue tests. Experimental results are obtained at room temperature and humidity comprised between 60 and 75%. The fatigue endurance is determined on this material under this modality of loading, and the fracture surfaces are analyzed to identify the principal trends related to crack initiation and propagation on this material.  &nbsp

Independent measurement of the Hoyle state β\beta feeding from 12B using Gammasphere

Using an array of high-purity Compton-suppressed germanium detectors, we performed an independent measurement of the $\beta$-decay branching ratio from $^{12}\mathrm{B}$ to the second-excited (Hoyle) state in $^{12}\mathrm{C}$. Our result is $0.64(11)\%$, which is a factor $\sim 2$ smaller than the previously established literature value, but is in agreement with another recent measurement. This could indicate that the Hoyle state is more clustered than previously believed. The angular correlation of the Hoyle state $\gamma$ cascade has also been measured for the first time. It is consistent with theoretical predictions

Granite stone subjected to ultrasonic fatigue tests under three point bending loading

Ultrasonic fatigue tests are carried out under the modality of three point bending on the granite stone. The testing specimens present a prismatic shape with the dimensions: 12 x 3 x 0.8 centimeters, in order to be supported by its two ends, and to configure the three point bending modality. Granite specimens are supported on an acrylic structure destined to fix and immobilize the specimens. Vibrating load is applied at the center of testing specimens by a self-designed and fabricated aluminum alloy awl, whose dimensions have been obtained by modal numerical analysis to fit the resonance condition, necessary for the ultrasonic fatigue tests. Experimental results are obtained at room temperature and humidity between 65 and 75%. The fatigue endurance is determined on the granite under this modality of loading, and the fracture surfaces are analyzed to identify the principal trends related to crack initiation and propagation on this material

A compactness theorem for scalar-flat metrics on manifolds with boundary

Let (M,g) be a compact Riemannian manifold with boundary. This paper is concerned with the set of scalar-flat metrics which are in the conformal class of g and have the boundary as a constant mean curvature hypersurface. We prove that this set is compact for dimensions greater than or equal to 7 under the generic condition that the trace-free 2nd fundamental form of the boundary is nonzero everywhere.Comment: 49 pages. Final version, to appear in Calc. Var. Partial Differential Equation

The first direct measurement of ¹²C (¹²C,n) ²³Mg at stellar energies

Neutrons produced by the carbon fusion reaction ¹²C(¹²C,n)²³Mg play an important role in stellar nucleosynthesis. However, past studies have shown large discrepancies between experimental data and theory, leading to an uncertain cross section extrapolation at astrophysical energies. We present the first direct measurement that extends deep into the astrophysical energy range along with a new and improved extrapolation technique based on experimental data from the mirror reaction ¹²C(¹²C,p)²³Na. The new reaction rate has been determined with a well-defined uncertainty that exceeds the precision required by astrophysics models. Using our constrained rate, we find that ¹²C(¹²C,n)²³Mg is crucial to the production of Na and Al in Pop-III Pair Instability Supernovae. It also plays a non-negligible role in the production of weak s-process elements as well as in the production of the important galacti