Evaluating narrative operative reports for endoscopic sinus surgery in a residency training program

Objective: The narrative operative report (NR) bears testimony to critical elements of patient care. Residents' NRs also provide insights into their comprehension of the procedure. NR documentation is an informal element of surgical residency training but data regarding quality of such training are scant. We aim to evaluate the NR within a residency training program. Methods: The quality of NRs for endoscopic sinus surgery (ESS) was evaluated through a retrospective analysis of 90 NRs for ESS. Thirty-four elements that the attending surgeon regards as "critical" variables, or quality indicators (QIs), that should be documented, were studied to evaluate quality. A "performance metric (PM)," defined as the average percent of QIs dictated/total word count, was determined. Subgroup analysis by the level of training was additionally performed. Results: Surgical indications, procedural steps, and immediate postoperative findings were accurately documented in 71%, 84%, and 82% of patients, respectively. The attending surgeon had the highest proportion of included key elements (89% +/- 6.2%) followed by junior residents (87% +/- 5.7%) and then senior residents (80% +/- 14%) (P = .008). The attending surgeon also demonstrated the highest PM, followed by senior and then junior residents (P < .0001). Conclusions: The quality of NRs was found to be high overall, but not "perfect" for either the attending or trainee surgeon. The PM among residents was expectedly lower than the attending surgeon. We propose that a synoptic reporting system that ensures inclusion of key elements may be helpful in training residents (and attendings) in creating comprehensive and efficient NRs. Level of Evidence: 3Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

How Many Subpopulations is Too Many? Exponential Lower Bounds for Inferring Population Histories

Reconstruction of population histories is a central problem in population genetics. Existing coalescent-based methods, like the seminal work of Li and Durbin (Nature, 2011), attempt to solve this problem using sequence data but have no rigorous guarantees. Determining the amount of data needed to correctly reconstruct population histories is a major challenge. Using a variety of tools from information theory, the theory of extremal polynomials, and approximation theory, we prove new sharp information-theoretic lower bounds on the problem of reconstructing population structure -- the history of multiple subpopulations that merge, split and change sizes over time. Our lower bounds are exponential in the number of subpopulations, even when reconstructing recent histories. We demonstrate the sharpness of our lower bounds by providing algorithms for distinguishing and learning population histories with matching dependence on the number of subpopulations. Along the way and of independent interest, we essentially determine the optimal number of samples needed to learn an exponential mixture distribution information-theoretically, proving the upper bound by analyzing natural (and efficient) algorithms for this problem.Comment: 38 pages, Appeared in RECOMB 201

5D gravitational waves from complexified black rings

In this paper we construct and briefly study the 5D time-dependent solutions of general relativity obtained via double analytic continuation of the black hole (Myers-Perry) and of the black ring solutions with a double (Pomeransky-Senkov) and a single rotation (Emparan-Reall). The new solutions take the form of a generalized Einstein-Rosen cosmology representing gravitational waves propagating in a closed universe. In this context the rotation parameters of the rings can be interpreted as the extra wave polarizations, while it is interesting to state that the waves obtained from Myers-Perry Black holes exhibit an extra boost-rotational symmetry in higher dimensions which signals their better behavior at null infinity. The analogue to the C-energy is analyzed.Comment: 18 pages, 4 figures. References added, introduction and conclusions are amended, some issues related to singularity structure and symmetries are discussed. Matches the print version to appear in JHE

Light States in Chern-Simons Theory Coupled to Fundamental Matter

Motivated by developments in vectorlike holography, we study SU(N) Chern-Simons theory coupled to matter fields in the fundamental representation on various spatial manifolds. On the spatial torus T^2, we find light states at small `t Hooft coupling \lambda=N/k, where k is the Chern-Simons level, taken to be large. In the free scalar theory the gaps are of order \sqrt {\lambda}/N and in the critical scalar theory and the free fermion theory they are of order \lambda/N. The entropy of these states grows like N Log(k). We briefly consider spatial surfaces of higher genus. Based on results from pure Chern-Simons theory, it appears that there are light states with entropy that grows even faster, like N^2 Log(k). This is consistent with the log of the partition function on the three sphere S^3, which also behaves like N^2 Log(k). These light states require bulk dynamics beyond standard Vasiliev higher spin gravity to explain them.Comment: 58 pages, LaTeX, no figures, Minor error corrected, references added, The main results of the paper have not change

Measuring persistent and transient energy efficiency in the US

The promotion of US energy efficiency policy is seen as a very important activity. Generally, the level of energy efficiency of a country or state is approximated by energy intensity, commonly calculated as the ratio of energy use to GDP. However, energy intensity is not an accurate proxy for energy efficiency given that changes in energy intensity are a function of changes in several factors including the structure of the economy, climate, efficiency in the use of resources, behaviour and technical change. The aim of this paper is to measure persistent and transient energy efficiency for the whole economy of 49 states in the US using a stochastic frontier energy demand approach. A total US energy demand frontier function is estimated using panel data for 49 states over the period 1995 to 2009 using two panel data models: the Mundlak version of the random effects model (which estimates the persistent part of the energy efficiency) and the true random effects model (which estimates the transient part of the energy efficiency). The analysis confirms that energy intensity is not a good indicator of energy efficiency, whereas, by controlling for a range of economic and other factors, the measures of energy efficiency obtained via the approach adopted here are. Moreover, the estimates show that although for some states energy intensity might give a reasonable indication of a state’s relative energy efficiency, this is not the case for all states.ISSN:1570-646XISSN:1570-647

Virtual finger boosts three-dimensional imaging and microsurgery as well as terabyte volume image visualization and analysis

Three-dimensional (3D) bioimaging, visualization and data analysis are in strong need of powerful 3D exploration techniques. We develop virtual finger (VF) to generate 3D curves, points and regions-of-interest in the 3D space of a volumetric image with a single finger operation, such as a computer mouse stroke, or click or zoom from the 2D-projection plane of an image as visualized with a computer. VF provides efficient methods for acquisition, visualization and analysis of 3D images for roundworm, fruitfly, dragonfly, mouse, rat and human. Specifically, VF enables instant 3D optical zoom-in imaging, 3D free-form optical microsurgery, and 3D visualization and annotation of terabytes of whole-brain image volumes. VF also leads to orders of magnitude better efficiency of automated 3D reconstruction of neurons and similar biostructures over our previous systems. We use VF to generate from images of 1,107 Drosophila GAL4 lines a projectome of a Drosophila brain. © 2014 Macmillan Publishers Limited. All rights reserved

Prenatal hypoxia induces increased cardiac contractility on a background of decreased capillary density.

Background: Chronic hypoxia in utero (CHU) is one of the most common insults to fetal development and may be associated with poor cardiac recovery from ischaemia-reperfusion injury,yet the effects on normal cardiac mechanical performance are poorly understood. Methods: Pregnant female wistar rats were exposed to hypoxia (12% oxygen, balance nitrogen)for days 10–20 of pregnancy. Pups were born into normal room air and weaned normally. At 10 weeks of age, hearts were excised under anaesthesia and underwent retrograde 'Langendorff' perfusion. Mechanical performance was measured at constant filling pressure (100 cm H2O) with intraventricular balloon. Left ventricular free wall was dissected away and capillary density estimated following alkaline phosphatase staining. Expression of SERCA2a and Nitric Oxide Synthases (NOS) proteins were estimated by immunoblotting. Results: CHU significantly increased body mass (P < 0.001) compared with age-matched control rats but was without effect on relative cardiac mass. For incremental increases in left ventricular balloon volume, diastolic pressure was preserved. However, systolic pressure was significantly greater following CHU for balloon volume = 50 μl (P < 0.01) and up to 200 μl (P < 0.05). For higher balloon volumes systolic pressure was not significantly different from control. Developed pressures were correspondingly increased relative to controls for balloon volumes up to 250 μl (P < 0.05).Left ventricular free wall capillary density was significantly decreased in both epicardium (18%; P <0.05) and endocardium (11%; P < 0.05) despite preserved coronary flow. Western blot analysis revealed no change to the expression of SERCA2a or nNOS but immuno-detectable eNOS protein was significantly decreased (P < 0.001) in cardiac tissue following chronic hypoxia in utero. Conclusion: These data offer potential mechanisms for poor recovery following ischaemia, including decreased coronary flow reserve and impaired angiogenesis with subsequent detrimental effects of post-natal cardiac performance

Activation of Ventral Tegmental Area 5-HT2C Receptors Reduces Incentive Motivation

FUNDING AND DISCLOSURE The research was funded by Wellcome Trust (WT098012) to LKH; and National Institute of Health (DK056731) and the Marilyn H. Vincent Foundation to MGM. The University of Michigan Transgenic Core facility is partially supported by the NIH-funded University of Michigan Center for Gastrointestinal Research (DK034933). The remaining authors declare no conflict of interest. ACKNOWLEDGMENTS We thank Dr Celine Cansell, Ms Raffaella Chianese and the staff of the Medical Research Facility for technical assistance. We thank Dr Vladimir Orduña for the scientific advice and technical assistance.Peer reviewedPublisher PD