Surgical assessment of the geriatric oncology patient

BACKGROUND: The aging population in the United States will correlate with an increased number of cancer diagnoses as cancer is primarily a disease of the elderly. Providing this ever-growing group of individuals with quality surgical management, while taking into account the unique needs and desires of this cohort, is a great challenge facing both geriatricians and surgeons going forward. The best approach to ensure that oncogeriatric patients receive the best tailored treatment is through the completion of a pre-surgical geriatric assessment. However, only a minority of oncogeriatric patients is undergoing a comprehensive pre-surgical geriatric assessment despite the majority of geriatricians and surgeons acknowledging its importance in order to properly risk stratify their patients. LITERATURE REVIEW FINDINGS: Multiple theories exist as to why geriatric assessments are not being utilized more frequently, but the most probable answer is that these assessments are very time-consuming, making it virtually impossible for incorporation into a healthcare provider’s busy schedule. Comprehensive literature review regarding geriatric assessments amongst the oncogeriatric population found that the most sensitive and specific domains of the geriatric assessments predicting morbidity and mortality include Frailty Index, Social Support Survey, Mini-Nutritional Assessment, and Geriatric Depression Screening. PROPOSED METHODS: A novel educational intervention will be proposed to teach Physician Assistant and Medical Students about the domains of the geriatric assessment most predictive of post-surgical risk during their surgical clerkship. The curriculum will utilize both simulation- and competency-based education training under the guidance of geriatricians and surgeons. Students will first learn the necessary skills in a controlled classroom environment and then proceed to incorporate these skills during their clerkship with patients on their service. CONCLUSIONS: The goal of the proposed method is to instill the confidence and skills necessary to provide an accurate geriatric assessment for oncogeriatric patients in future clinicians. The field of geriatric oncology is going to grow exponentially in the up-coming years and familiarizing future clinicians with the most predictive domains regarding surgical outcome will improve treatment outcomes for oncogeriatric patients in the immediate and foreseeable future

Variational Convergence of Discrete Geometrically-Incompatible Elastic Models

We derive a continuum model for incompatible elasticity as a variational limit of a family of discrete nearest-neighbor elastic models. The discrete models are based on discretizations of a smooth Riemannian manifold $(M,\mathfrak{g})$, endowed with a flat, symmetric connection $\nabla$. The metric $\mathfrak{g}$ determines local equilibrium distances between neighboring points; the connection $\nabla$ induces a lattice structure shared by all the discrete models. The limit model satisfies a fundamental rigidity property: there are no stress-free configurations, unless $\mathfrak{g}$ is flat, i.e., has zero Riemann curvature. Our analysis focuses on two-dimensional systems, however, all our results readily generalize to higher dimensions.Comment: v3: a more concise version (similar to the published version); proof of Proposition 4.4 corrected, Lemma A.4 adde

Comparison Tables of State Nutrient Trading Programs in the Chesapeake Bay Watershed

Examines opportunities for wastewater treatment plants to trade credits or offsets with other plants or farms releasing lower volumes of nutrients across states. Compares design elements of programs in Maryland, Pennsylvania, Virginia, and West Virginia

A low cost air hybrid concept

This article is a pre-print version of the full and final article which is available at the link below.Copyright © 2010 Institut français du pétrole Permission to make digital or hard copies of part or all of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. Copyrights for components of this work owned by others than IFP must be honored. Abstracting with credit is permitted. To copy otherwise, to republish, to post on servers, or to redistribute to lists, requires prior specific permission and/or a fee: Request permission from Documentation, Institut français du pétrole, fax. +33 1 47 52 70 78, or [email protected] air hybrid engine absorbs the vehicle kinetic energy during braking, stores it in an air tank in the form of compressed air, and reuses it to propel a vehicle during cruising and acceleration. Capturing, storing and reusing this braking energy to give additional power can therefore improve fuel economy, particularly in cities and urban areas where the traffic conditions involve many stops and starts. In order to reuse the residual kinetic energy, the vehicle operation consists of 3 basic modes, i.e. Compression Mode (CM), Expander Mode (EM) and normal firing mode. Unlike previous works, a low cost air hybrid engine has been proposed and studied. The hybrid engine operation can be realised by means of production technologies, such as VVT and valve deactivation. In this work, systematic investigation has been carried out on the performance of the hybrid engine concept through detailed gas dynamic modelling using Ricardo WAVE software. Valve timing optimization has been done for the more efficient operation of air hybrid operation and obtaining higher braking and Motoring mean effective pressure for CM and EM respectively.EPSR

Chromosome mapping of dragline silk genes in the genomes of widow spiders (araneae, theridiidae)

With its incredible strength and toughness, spider dragline silk is widely lauded for its impressive material properties. Dragline silk is composed of two structural proteins, MaSp1 and MaSp2, which are encoded by members of the spidroin gene family. While previous studies have characterized the genes that encode the constituent proteins of spider silks, nothing is known about the physical location of these genes. We determined karyotypes and sex chromosome organization for the widow spiders, Latrodectus hesperus and L. geometricus (Araneae, Theridiidae). We then used fluorescence in situ hybridization to map the genomic locations of the genes for the silk proteins that compose the remarkable spider dragline. These genes included three loci for the MaSp1 protein and the single locus for the MaSp2 protein. In addition, we mapped a MaSp1 pseudogene. All the MaSp1 gene copies and pseudogene localized to a single chromosomal region while MaSp2 was located on a different chromosome of L. hesperus. Using probes derived from L. hesperus, we comparatively mapped all three MaSp1 loci to a single region of a L. geometricus chromosome. As with L. hesperus, MaSp2 was found on a separate L. geometricus chromosome, thus again unlinked to the MaSp1 loci. These results indicate orthology of the corresponding chromosomal regions in the two widow genomes. Moreover, the occurrence of multiple MaSp1 loci in a conserved gene cluster across species suggests that MaSp1 proliferated by tandem duplication in a common ancestor of L. geometricus and L. hesperus. Unequal crossover events during recombination could have given rise to the gene copies and could also maintain sequence similarity among gene copies over time. Further comparative mapping with taxa of increasing divergence from Latrodectus will pinpoint when the MaSp1 duplication events occurred and the phylogenetic distribution of silk gene linkage patterns. © 2010 Zhao et al

Image Processing Instrumentation for Giardia lamblia Detection

Currently, the identification and enumeration of Giardia Iamblia cysts are based upon microscopic methods requiring individuals proficient in this area. It is a tedious process which consumes time that could be constructively used elsewhere. This project attempts to alleviate that burden by employing a computer to automatically process Indirect Fluorescent Antibody (IFA) prepared slides using digital image processing techniques. A computer controlled frame grabber, in conjunction with a CCD TV camera mounted on the epi-fluorescence microscope phototube, captures the light intensities of the objects in view under the microscope objective. The captured image is stored as pixels, with each pixel having a numerical value that can be altered using linear contrast enhancement and bit-slicing to emphasize the cysts and eliminate the majority of unwanted objects from the image. The altered image is then analyzed by a vector trace routine for typical area and perimeters characteristic to Giardia lamblia cysts. Objects in the image matching these characteristics are most likely cysts and are added to a running tally of the number of cysts present on the slide

Mechanisms of sensorineural cell damage, death and survival in the cochlea.

The majority of acquired hearing loss, including presbycusis, is caused by irreversible damage to the sensorineural tissues of the cochlea. This article reviews the intracellular mechanisms that contribute to sensorineural damage in the cochlea, as well as the survival signaling pathways that can provide endogenous protection and tissue rescue. These data have primarily been generated in hearing loss not directly related to age. However, there is evidence that similar mechanisms operate in presbycusis. Moreover, accumulation of damage from other causes can contribute to age-related hearing loss (ARHL). Potential therapeutic interventions to balance opposing but interconnected cell damage and survival pathways, such as antioxidants, anti-apoptotics, and pro-inflammatory cytokine inhibitors, are also discussed