Follow-up analysis of federal process of care data reported from three acute care hospitals in rural Appalachia

BACKGROUND: This investigation evaluated standardized process of care data collected on selected hospitals serving a remote rural section of westernmost North Carolina. METHODS: Centers for Medicare and Medicaid Services data were analyzed retrospectively for multiple clinical parameters at Fannin Regional Hospital, Murphy Medical Center, and Union General Hospital. Data were analyzed by paired t-test for individual comparisons among the three study hospitals to compare the three facilities with each other, as well as with state and national average for each parameter. RESULTS: Centers for Medicare and Medicaid Services "Hospital Compare" data from 2011 showed Fannin Regional Hospital to have significantly higher composite scores on standardized clinical process of care measures relative to the national average, compared with Murphy Medical Center (P = 0.01) and Union General Hospital (P = 0.01). This difference was noted to persist when Fannin Regional Hospital was compared with Union General Hospital using common state reference data (P = 0.02). When compared with national averages, mean process of care scores reported from Murphy Medical Center and Union General Hospital were both lower but not significantly different (-3.44 versus -6.07, respectively, P = 0.54). CONCLUSION: The range of process of care scores submitted by acute care hospitals in western North Carolina is considerable. Centers for Medicare and Medicaid Services "Hospital Compare" information suggests that process of care measurements at Fannin Regional Hospital are significantly higher than at either Murphy Medical Center or Union General Hospital, relative to state and national benchmarks. Further investigation is needed to determine what impact these differences in process of care may have on hospital volume and/or market share in this region. Additional research is planned to identify process of care trends in this demographic and geographically rural area

Stress effect on magnetoimpedance (MI) in amorphous wires at GHz frequencies and application to stress-tunable microwave composite materials

The effect of tensile stress on magnetoimpedance (MI) in CoMnSiB amorphous wires at microwave frequencies (0.5-3 GHz) is investigated both experimentally and theoretically. In the presence of the dc bias magnetic field of the order of the anisotropy field, the impedance shows very large and sensitive change when the wire is subjected to a tensile stress: 100% and 60% per 180 MPa for frequencies 500 MHz and 2.5 GHz, respectively. It is demonstrated that this behavior owes mainly to the directional change in the equilibrium magnetization caused by the applied stress and field, which agrees well with the theoretical results for the surface impedance. This stress effect on MI is proposed to use for creating microwave stress-tunable composite materials containing short magnetic wires. The analysis of the dielectric response from such materials shows that depending on the stress level in the material, the dispersion of the effective permittivity can be of a resonant or relaxation type with a considerable change in its values (up to 100% at 600 MPa). This media can be used for structural stress monitoring by microwave contrast imaging

Magnetostatic bias in multilayer microwires: theory and experiments

The hysteresis curves of multilayer microwires consisting of a soft magnetic nucleus, intermediate non-magnetic layers, and an external hard magnetic layer are investigated. The magnetostatic interaction between magnetic layers is proved to give rise to an antiferromagnetic-like coupling resulting in a magnetostatic bias in the hysteresis curves of the soft nucleus. This magnetostatic biasing effect is investigated in terms of the microwire geometry. The experimental results are interpreted considering an analytical model taking into account the magnetostatic interaction between the magnetic layers.Comment: 6 pages, 7 figure

Polymerization in Magnetic Field. XIX. Thermal Behavior of the Copolymers of Methyl Methacrylate with Glycidyl Methacrylate Synthesized in the Magnetic Field Presence

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Low temperature (down to 450° C) annealed TiAl contacts on N-type gallium nitride characterized by differential scanning calorimetry

International audienceThis work reports on Differential Scanning Calorimetry (DSC) measurements performed on Ti-Al metallic layers stacks deposited on n+-GaN. The aim is to get better understanding of the mechanisms leading to ohmic contact formation during the annealing stage. Two exothermic peaks were found, one below 500°C and the other one around 660°C. They can be respectively attributed to Al3Ti and Al2Ti compounds formation. The locations of these peaks provide clear evidence of solid-solid reac-tions. Lowest contact resistance is well correlated with the presence of Al3Ti compound, corresponding to Al(200nm)/Ti(50nm) stoichiometric ratio. Subsequently, Al(200 nm)Ti(50 nm) stacks on n+-GaN were annealed from 400°C to 650°C. Specific Contact Resistivity (SCR) values stay in the mid 10-5 Ω.cm² range for annealing temperatures between 450°C and 650°C. Such low-temperature annealed contacts on n+-GaN may open new device processing routes, simpler and cheaper, in which Ohmic and Schottky contacts are annealed together

Сахарный диабет 1 типа у детей: клинические и метаболические особенности в начале заболевания

Department of Pediatric Endocrinology, Emil Cotaga Children’s Republican Hospital, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaThe aim of the study was to determine the clinical and biochemical characteristics of type 1 diabetes mellitus (DM) at presentation in children. The registered data set comprised blood glucose, pH, serum bicarbonate levels, glycosylated hemoglobin and clinical symptoms at disease manifestation. 53 children with type 1 DM were included in this study. Polydipsia (90.1%), polyuria (81.4%), and weight loss (84.1%) were the most frequent symptoms anticipating disease detection. Enuresis was recorded in 32.8%. A total of 73.6% patients had DKA (pH < 7.3) at disease onset. Children under 10 years showed more pronounced ketoacidosis that developed in a shorter period of time. Blood glucose testing in children with enuresis, weight loss and family history of diabetes is essential for timely diagnosis.Данное исследование было выполнено с целью определения клинических и биохимических характеристик впервые выявленного сахарного диабета 1 типа у детей. Были регистрированы и проанализированы следующие показатели: уровень глюкозы, рН и бикарбонат крови, гликированный гемоглобин, клинические симптомы заболевания. Были исследованы 53 детей. Полидипсия (90,1%), полиурия (81,4%) и потеря веса (84,1%) были выявлены как самые распространенные симптомы до подтверждения диагноза. Энурез был зарегистрирован у 32,8% детей. 73,6% пациентов имели диабетический кетоацидоз (рН < 7,3) в момент установления диагноза. Дети до 10 лет показали более выраженный кетоацидоз, который развился в более короткие сроки. Энурез, потеря веса и семейная предрасположенность к сахарному диабету являются показаниями к определению глюкозы в крови у детей для своевременной диагностики заболевания

‘The International Teacher Leadership project,’ a case of international action research.

Copyright CARNThe paper arises from the International Teacher Leadership project, a research and development project involving researchers and practitioners in 14 European countries. The paper provides a conceptual exploration of the idea of teacher leadership and its role in educational reform, central to which is the idea that teachers, regardless of their level of power and organisational position, can engage in the leadership of enquiry-based development activity aimed at influencing their colleagues and embedding improved practices in their schools. The paper provides an outline of the project’s methodology which builds on that used in the Carpe Vitam Leadership for Learning project (Frost, 2008a). It is a form of collaborative action research which is highly developmental and discursive. It seeks to identify principles, strategies and tools that can be applied in a range of cultural settings. The paper includes a thematic analysis of the cultural contexts and policy environments of the participating countries in order to identify the obstacles to teacher leadership and to inform the nature of the support strategies employed

Heliorhodopsin Evolution Is Driven by Photosensory Promiscuity in Monoderms

Rhodopsins are light-activated proteins displaying an enormous versatility of function as cation/anion pumps or sensing environmental stimuli and are widely distributed across all domains of life. Even with wide sequence divergence and uncertain evolutionary linkages between microbial (type 1) and animal (type 2) rhodopsins, the membrane orientation of the core structural scaffold of both was presumed universal. This was recently amended through the discovery of heliorhodopsins (HeRs; type 3), that, in contrast to known rhodopsins, display an inverted membrane topology and yet retain similarities in sequence, structure, and the light-activated response. While no ion-pumping activity has been demonstrated for HeRs and multiple crystal structures are available, fundamental questions regarding their cellular and ecological function or even their taxonomic distribution remain unresolved. Here, we investigated HeR function and distribution using genomic/metagenomic data with protein domain fusions, contextual genomic information, and gene coexpression analysis with strand-specific metatranscriptomics. We bring to resolution the debated monoderm/diderm occurrence patterns and show that HeRs are restricted to monoderms. Moreover, we provide compelling evidence that HeRs are a novel type of sensory rhodopsins linked to histidine kinases and other two-component system genes across phyla. In addition, we also describe two novel putative signal-transducing domains fused to some HeRs. We posit that HeRs likely function as generalized light-dependent switches involved in the mitigation of light-induced oxidative stress and metabolic circuitry regulation. Their role as sensory rhodopsins is corroborated by their photocycle dynamics and their presence/function in monoderms is likely connected to the higher sensitivity of these organisms to light-induced damage. IMPORTANCE Heliorhodopsins are enigmatic, novel rhodopsins with a membrane orientation that is opposite to all known rhodopsins. However, their cellular and ecological functions are unknown, and even their taxonomic distribution remains a subject of debate. We provide evidence that HeRs are a novel type of sensory rhodopsins linked to histidine kinases and other two-component system genes across phyla boundaries. In support of this, we also identify two novel putative signal transducing domains in HeRs that are fused with them. We also observe linkages of HeRs to genes involved in mitigation of light-induced oxidative stress and increased carbon and nitrogen metabolism. Finally, we synthesize these findings into a framework that connects HeRs with the cellular response to light in monoderms, activating light-induced oxidative stress defenses along with carbon/nitrogen metabolic circuitries. These findings are consistent with the evolutionary, taxonomic, structural, and genomic data available so far

Optimizing surgical techniques in extra-anatomical ilio-femoral bypasses

Scopul lucrării. Bypass-ul extraanatomic ilio-femural crossover este o procedura chirurgicala utilizată pentru revascularizarea segmentului aorto-femural, când intervențiile endovasculare nu sunt posibile, iar aplicarea unui bypass aorto sau ilio-femural este dificilă sau chiar imposibilă din cauza condițiilor tehnice sau a stării pacientului. Scopul este studierea rezultatelor precoce și tardive pentru favorizarea unor schimbări și implementarea unor gesturi tehnice în aplicarea bypass-urilor crossover ilio-femural, pentru a crea o geometrie cât mai fiziologică ce poate oferi o soluție durabilă pe termen lung. Materiale și metode. Pe parcursul anilor 2001-2022 au fost efectuate 142 bypass-uri crossover ilio-femurale. Rezultate. În perioada postoperatorie a fost un singur deces și s-au efectuat 3 amputații. Au fost analizate duplex scanările și CT angiografiile în primele 12 luni postoperatorii, pentru aprecierea altor leziuni aterosclerotice, care ar necesita revascularizare deschisă s-au endovasculară atît in bazinul recipient cât și cel donator. Totodată, a fost apreciata poziția și forma bypass-ului ce a dus la folosirea ulterioară a unor noi procedee tehnice ce diferă de cele descrise anterior. Concluzii. Optimizarea tehnicilor chirurgicale creând o geometrie cât mai fiziologică, excluderea maximală a angulărilor stenozante ale grefei poate oferi bypass-ului extraanatomic crossover ilio-femural o durabilitate îndelungată. Acest lucru poate favoriza creșterea frecvenței indicațiilor la folosirea bypass-urilor crossover ilio-femural.Aim of study. The extra-anatomic ilio-femoral crossover bypass is a surgical procedure used for revascularizing the aorto-femoral segment when endovascular interventions are not possible, and when applying an aorto- or ilio-femoral bypass is difficult or even impossible due to technical conditions or the patient's condition. The aim was to study the early and late outcomes to promote changes and implement technical gestures in the application of ilio-femoral crossover bypasses, aiming to create a more physiological geometry that can provide a durable long-term solution. Materials and methods. Between 2001 and 2022, a total of 142 ilio-femoral crossover bypasses were performed. Results. There was one death and three amputations in the postoperative period. Duplex scans and CT angiography were analyzed in the first 12 months postoperatively to assess other atherosclerotic lesions that would require open or endovascular revascularization in both the recipient and donor areas. Additionally, the position and shape of the bypass were evaluated, leading to the subsequent use of new technical procedures that differ from those previously described. Conclusions. Optimizing surgical techniques by creating a more physiological geometry and minimizing stenotic angles of the graft can provide the extra-anatomic ilio-femoral crossover bypass with long-lasting durability. This may increase the frequency of indications for using ilio-femoral crossover bypasses

Resection of a juxtarenal aneurysm complicated by rupture. Clinical case

Caz clinic. Se prezintă un caz clinic de tratament chirurgical soldat cu succes al unui anevrism de aortă juxtarenal complicat cu ruptură al unui pacient de 76 ani. Boala a debutat de 3 zile cu dureri puternice în regiunea lombară, cu iradiere în abdomen. Internat în spitalul orășenesc, unde la CT angiografie s-a depistat un anevrism al aortei abdominale complicat cu ruptură in spațiul retroperitoneal. Pacientul a fost transferat în SCR ,,T. Moșneaga” operat în mod urgent. La laparotomie xifopubiană s-a depistat circa un litru de lichid sero-sangvinolent, anevrism juxtarenal cu hematom retroperitoneal. După clamparea aortei suprarenale s-a efectuat rezecția anevrismului rupt, cu protezare aorto-femurală pe dreapta și iliacă pe stânga. Perioada postoperatorie fără complicații. Externat la a 11-a zi în stare satisfăcătoare. CT angiografie de control peste 6 luni- proteza aortală funcțională, fără alte patologii. Concluzie. În cazul anevrismelor aortei abdominale complicate cu ruptură, care nu pot fi rezolvate endovascular din diferite motive (anatomie nepotrivită, lipsa utilajului necesar la moment etc) este necesar tratamentul chirurgical deschis în mod urgent. Posedarea metodelor deschise nu trebuie exclusă din arsenalul chirurgului vascular.Clinical case. We present a clinical case of a successful surgical treatment of a ruptured juxtarenal aortic aneurysm in a 76-year-old patient. The disease started three days ago with severe pain in the lower back, radiating to the abdomen. The patient was transferred to the local hospital, where a CT angiography revealed an abdominal aortic aneurysm complicated by retroperitoneal rupture. The patient was urgently transferred to the "T. Moșneaga'' Intensive Care Unit for surgery. Xipho-pubic laparotomy revealed approximately one liter of serosanguinous fluid, a juxtarenal aneurysm with a retroperitoneal hematoma. After clamping the suprarenal aorta, resection of the ruptured aneurysm was performed, followed by aortic-femoral grafting on the right side and iliac grafting on the left side. The postoperative period was uneventful. The patient was discharged in satisfactory condition on the 11th day. A follow-up CT angiography after 6 months showed a functional aortic graft without any other pathologies. Conclusions. In cases of abdominal aortic aneurysms complicated by rupture, which cannot be resolved endovascularly due to various reasons (inappropriate anatomy, lack of necessary equipment at the moment, etc.), urgent open surgical treatment is necessary. Proficiency in open surgical techniques should not be excluded from the vascular surgeon's armamentarium