A Brief History of Quality Improvement in Health Care and Spinal Surgery.

While medical and technological advances continue to shape and advance health care, there has been growing emphasis on translating these advances into improvement in overall health care quality outcomes in the United States. Innovators such as Abraham Flexner and Ernest Codman engaged in rigorous reviews of systems and patient outcomes igniting wider spread interest in quality improvement in health care. Codman\u27s efforts even contributed to the founding of the American College of Surgeons. This society catalyzed a quality improvement initiative across the United States and the formation of the Joint Commission on Accreditation of Hospitals. Since that time, those such as Avedis Donabedian and the Institute of Medicine have worked to structure the process of improving both the quality and delivery of health care. Significant advances include the defining of minimum standards for hospital accreditation, 7 pillars of quality in medicine, and the process by which quality in medicine is evaluated. All of these factors have affected current practice more each day. In a field such as spinal surgery, cost and quality measures are continually emphasized and led to large outcome databases to better evaluate outcomes in complex, heterogeneous populations. Going forward, these databases will be instrumental in developing practice patterns and improving spinal surgery outcomes

A modular, programmable measurement system for physiological and spaceflight applications

The NASA-Ames Sensors 2000! Program has developed a small, compact, modular, programmable, sensor signal conditioning and measurement system, initially targeted for Life Sciences Spaceflight Programs. The system consists of a twelve-slot, multi-layer, distributed function backplane, a digital microcontroller/memory subsystem, conditioned and isolated power supplies, and six application-specific, physiological signal conditioners. Each signal condition is capable of being programmed for gains, offsets, calibration and operate modes, and, in some cases, selectable outputs and functional modes. Presently, the system has the capability for measuring ECG, EMG, EEG, Temperature, Respiration, Pressure, Force, and Acceleration parameters, in physiological ranges. The measurement system makes heavy use of surface-mount packaging technology, resulting in plug in modules sized 125x55 mm. The complete 12-slot system is contained within a volume of 220x150x70mm. The system's capabilities extend well beyond the specific objectives of NASA programs. Indeed, the potential commercial uses of the technology are virtually limitless. In addition to applications in medical and biomedical sensing, the system might also be used in process control situations, in clinical or research environments, in general instrumentation systems, factory processing, or any other applications where high quality measurements are required

The HR 4796A Debris System: Discovery of Extensive Exo-Ring Dust Material

The optically and IR bright, and starlight-scattering, HR 4796A ring-like debris disk is one of the most (and best) studied exoplanetary debris systems. The presence of a yet-undetected planet has been inferred (or suggested) from the narrow width and inner/outer truncation radii of its r = 1.05" (77 au) debris ring. We present new, highly sensitive, Hubble Space Telescope (HST) visible-light images of the HR 4796A circumstellar debris system and its environment over a very wide range of stellocentric angles from 0.32" (23 au) to ~ 15" (1100 au). These very high contrast images were obtained with the Space Telescope Imaging Spectrograph (STIS) using 6-roll PSF-template subtracted coronagraphy suppressing the primary light of HR 4796A and using three image plane occulters and simultaneously subtracting the background light from its close angular proximity M2.5V companion. The resulting images unambiguously reveal the debris ring embedded within a much larger, morphologically complex, and bi-axially asymmetric exoring scattering structure. These images at visible wavelengths are sensitive to, and map, the spatial distribution, brightness, and radial surface density of micron size particles over 5 dex in surface brightness. These particles in the exo-ring environment may be unbound from the system and interacting with the local ISM. Herein we present a new morphological and photometric view of the larger than prior seen HR 4796A exoplanetary debris system with sensitivity to small particles at stellocentric distances an order of magnitude greater than has previously been observed.Comment: 28 pages, 17 figures, accepted for publication in the Astronomical Journal 21 December 201

Influence of hypoxia and neoangiogenesis on the growth of pancreatic cancer

As with other solid tumors, the growth and metastasis of pancreatic cancer is critically dependent on tumor angiogenesis. A major stimulus for a tumor's recruitment of additional blood vessels is cellular hypoxia, a condition which is especially pronounced in this neoplasm. Hypoxia induces transcriptional activation of genes that alter cellular metabolism and promote neoangiogenesis. Pancreatic cancer cells have demonstrated activation of such adaptive pathways even in the absence of hypoxia. A highly-angiogenic response in this neoplasm correlates with increased tumor growth, increased metastasis, and decreased survival. Pancreatic cancers expressing high levels of vascular endothelial growth factor, a potent pro-angiogenic cytokine, also have a higher incidence of metastasis and poorer prognosis. Pancreatic cancer cells uniquely express receptors for vascular endothelial growth factor, indicating a role for an autocrine loop in tumor proliferation and invasion. Multiple experimental anti-angiogenic strategies, many of which target vascular endothelial growth factor, reduce pancreatic cancer growth, spread, and angiogenesis. Anti-angiogenic treatments for pancreatic cancer will likely be most effective when used as an integral part of a combination chemotherapeutic regimen

Nanosatellite Launch Adapter System (NLAS)

The utility of small spacecraft based on the University cubesat standard is becoming evident as more and more agencies and organizations are launching or planning to include nanosatellites in their mission portfolios. Cubesats are typically launched as secondary spacecraft in enclosed, containerized deployers such as the CalPoly Poly Picosat Orbital Deployer (P-POD) system. The P-POD allows for ease of integration and significantly reduces the risk exposure to the primary spacecraft and mission. NASA/ARC and the Operationally Responsive Space office are collaborating to develop a Nanosatellite Launch Adapter System (NLAS), which can accommodate multiple cubesat or cubesat-derived spacecraft on a single launch vehicle. NLAS is composed of the adapter structure, P-POD or similar spacecraft dispensers, and a sequencer/deployer system. This paper describes the NLAS system and it s future capabilities, and also provides status on the system s development and potential first use in space

Examining the diversity of MRCS examiners

Acknowledgements The authors would like to acknowledge Gregory Ayre from the Intercollegiate Committee for Basic Surgical Examinations for his support during this project. Funding Royal College of Surgeons of Edinburgh, Royal College of Surgeons of Ireland. Royal College of Physicians and Surgeons of Glasgow and Royal College of Surgeons of England.Peer reviewedPublisher PD

Color Gradients Detected in the HD 15115 Circumstellar Disk

We report HST/NICMOS coronagraphic images of the HD 15115 circumstellar disk at 1.1\micron. We find a similar morphology to that seen in the visible and at H band--an edge-on disk that is asymmetric in surface brightness. Several aspects of the 1.1\micron data are different, highlighting the need for multi-wavelength images of each circumstellar disk. We find a flattening to the western surface brightness profile at 1.1\micron interior to 2\arcsec (90 AU) and a warp in the western half of the disk. We measure the surface brightness profiles of the two disk lobes and create a measure of the dust scattering efficiency between 0.55-1.65\micron at 1\arcsec, 2\arcsec, and 3\arcsec. At 2\arcsec the western lobe has a neutral spectrum up to 1.1\micron and a strong absorption or blue spectrum $>$1.1\micron, while a blue trend is seen in the eastern lobe. At 1\arcsec the disk has a red F110W-H color in both lobes.Comment: 4 pages, 4 figures, emulateapj; accepted to ApJ

Characterization of bacterial lipooligosaccharides by delayed extraction matrix-assisted laser desorption ionization time-of-flight mass spectrometry

Matrix-assisted laser desorption ionization (MALDI) with a time-of-flight analyzer has been used to analyze bacterial lipooligosaccharides (LOS). Crude LOS preparations from pathogenic strains of Haemophilus influenzae and Haemophilus ducreyi and a commercial preparation of lipopolysaccharide from Salmonella typhimurium were treated with hydrazine to remove O-linked fatty acids on the lipid A moiety. The resulting O-deacylated LOS forms were water soluble and more amenable to cocrystallization with standard MALDI matrices such as 2,5-dihydroxybenzoic acid and 1-hydroxyisoquinoline. Under continuous extraction conditions, O-deacylated LOS yielded broad peaks with abundant salt adducts as well as forming prompt fragments through β-elimination of phosphoric acid, that is, [M-H3PO4-H]. However, when a time delay was used between ionization and extraction (“delayed extraction”) a significant improvement was seen in both mass resolution and the stability of the molecular ions against β-elimination of phosphoric acid, especially in the negative-ion mode. Both an external two-point calibration and an internal single-point calibration were used to assign masses, the latter of which provided the highest degree of accuracy (better than 0.01% in most cases). At higher laser powers, the LOS molecules cleave readily between the oligosaccharide and lipid A moieties yielding a number of prompt fragments. Postsource decay (PSD) analysis of selected molecular ions provided a set of fragments similar to those seen in the linear spectra, although they were more limited in number because they were derived from a single LOS-glycoform. Both the prompt and PSD fragments provided important structural information, especially in assigning the phosphate and phosphoethanolamine substitution pattern of the lipid A and oligosaccharide portions of LOS. Last, with the addition of ethylenediaminetetraacetic acid followed by pulsed sonication, the relatively insoluble (and impure) LOS preparations yielded MALDI spectra similar to the O-deacylated LOS, although these intact LOS preparations required higher laser powers to ionize and were generally more affected by competing impurities

Discovery of an 86 AU Radius Debris Ring Around HD 181327

HST/NICMOS PSF-subtracted coronagraphic observations of HD 181327 have revealed the presence of a ring-like disk of circumstellar debris seen in 1.1 micron light scattered by the disk grains, surrounded by a di use outer region of lower surface brightness. The annular disk appears to be inclined by 31.7 +/- 1.6 deg from face on with the disk major axis PA at 107 +/-2 deg . The total 1.1 micron flux density of the light scattered by the disk (at 1.2" < r < 5.0") of 9.6 mJy +/- 0.8 mJy is 0.17% +/- 0.015% of the starlight. Seventy percent of the light from the scattering grains appears to be confined in a 36 AU wide annulus centered on the peak of the radial surface brightness (SB) profile 86.3 +/- 3.9 AU from the star, well beyond the characteristic radius of thermal emission estimated from IRAS and Spitzer flux densities assuming blackbody grains (~ 22 AU). The light scattered by the ring appears bilaterally symmetric, exhibits directionally preferential scattering well represented by a Henyey-Greenstein scattering phase function with g = 0.30 +/- 0.03, and has an azimuthally medianed SB at the 86.3 AU radius of peak SB of 1.00 +/- 0.07 mJy arcsec^-2. No photocentric offset is seen in the ring relative to the position of the central star. A low surface brightness diffuse halo is seen in the NICMOS image to a distance of ~ 4" Deeper 0.6 micron HST/ACS PSF-subtracted coronagraphic observations reveal a faint outer nebulosity, asymmetrically brighter to the North of the star. We discuss models of the disk and properties of its grains, from which we infer a maximum vertical scale height of 4 - 8 AU at the 87.6 AU radius of maximum surface density, and a total maximum dust mass of collisionally replenished grains with minimum grain sizes of ~ 1 micron of ~ 4 M(moon).Comment: 45 pages, 15 figures, accepted for publication in Ap

Establishing the predictive validity of the intercollegiate membership of the Royal Colleges of surgeons written examination : MRCS part B

Acknowledgements The authors would like to acknowledge Iain Target at the Royal College of Surgeons of England, and Gregory Ayre from the Intercollegiate Committee for Basic Surgical Examinations for their support during this project. Funding Royal College of Surgeons of Ireland, Royal College of Physicians and Surgeons of Glasgow, Royal College of Surgeons of England and Royal College of Surgeons of Edinburgh (Award/Grant number is not applicable).Peer reviewedPublisher PD