Patient-reported outcomes 6 months after enhanced recovery after colorectal surgery.

BackgroundEnhanced recovery after surgery (ERAS) programs have been established as perioperative strategies associated with improved outcomes. However, intermediate and long-term patient-reported outcome data for patients undergoing ERAS interventions remain limited. We utilized an automated telephone survey 6 months post-colorectal surgery from patients who participated in an ERAS program to determine 6-month patient-reported outcomes and associated predictive factors.MethodsWe conducted a prospective observational study, using an automated telephone survey and researcher-administered telephone questionnaire 6 months after patients underwent abdominal colorectal surgery. Six-month significant outcomes were defined by persistent pain, hospital readmission, and patient satisfaction. Patients reporting these outcome variables were compared with patients who met none of these criteria. Additionally, analysis was performed to determine differences between patients that did and did not respond to the 6-month survey. A chi-square test was used to determine any relationship for categorical variables, a two independent sample t test for length of procedure/stay, and a Wilcoxon-Mann-Whitney test for pain scores.ResultsOne hundred fifty-four of 324 patients contacted 6 months after surgery completed the automated telephone survey (47.53%). There was no statistical difference between patient populations completing and not completing the survey. Hospital 6-month readmission was associated with patients with a diagnosis of cancer (P = .049) and with a longer mean length of index procedure (282 vs. 206 minutes, P = .006). Median 6-month pain scores were higher for patients that underwent an open procedure compared to laparoscopic (Z = - 2.06, P = .04).ConclusionsLong-term benefits of an ERAS program were mostly confirmed. Longer procedure time and patients with cancer correlated with an increased likelihood of hospital 6-month readmission, suggesting that perioperative outcomes in complex cancer patients need to be evaluated over a longer time frame. In addition, invasiveness of procedure continues to have a significant effect on pain scores even 6 months later

CONTINGENT VALUATION FOCUS GROUPS: INSIGHTS FROM ETHNOGRAPHIC INTERVIEW TECHNIQUES

Despite the many important uses (and potential abuses) of focus groups in survey design, the CV literature presents few guidelines to aid moderators in their interaction with focus group participants. This paper draws on the theory and practice of ethnographic interviewing to introduce general guidelines that can improve focus groups as an aid to CV research. The proposed guidelines illustrate types of questions that should reduce speculation and moderator-introduced bias in focus group responses, and improve the correspondence between focus group responses and actual behavior. The paper illustrates these ethnographic guidelines through a CV application concerning watershed resources.Research Methods/ Statistical Methods,

Arch height change during sit-to-stand: an alternative for the navicular drop test

Correction to McPoil TG, Cornwall MW, Medoff L, Vicenzion B, Fosberg K, Hilz D. Arch height change during sit-to-stand: an alternative for the navicular drop test. Journal of Foot and Ankle Research 2008; 1:3

Lesion mapping of cognitive abilities linked to intelligence

The Wechsler Adult Intelligence Scale (WAIS) assesses a wide range of cognitive abilities and impairments. Factor analyses have documented four underlying indices that jointly comprise intelligence as assessed with the WAIS: verbal comprehension (VCI), perceptual organization (POI), working memory (WMI), and processing speed (PSI). We used nonparametric voxel-based lesion-symptom mapping in 241 patients with focal brain damage to investigate their neural underpinnings. Statistically significant lesion-deficit relationships were found in left inferior frontal cortex for VCI, in left frontal and parietal cortex for WMI, and in right parietal cortex for POI. There was no reliable single localization for PSI. Statistical power maps and cross-validation analyses quantified specificity and sensitivity of the index scores in predicting lesion locations. Our findings provide comprehensive lesion maps of intelligence factors, and make specific recommendations for interpretation and application of the WAIS to the study of intelligence in health and disease

Intrinsic Functional Connectivity of the Brain in Adults with a Single Cerebral Hemisphere

A reliable set of functional brain networks is found in healthy people and thought to underlie our cognition, emotion, and behavior. Here, we investigated these networks by quantifying intrinsic functional connectivity in six individuals who had undergone surgical removal of one hemisphere. Hemispherectomy subjects and healthy controls were scanned with identical parameters on the same scanner and compared to a large normative sample (n = 1,482). Surprisingly, hemispherectomy subjects and controls all showed strong and equivalent intrahemispheric connectivity between brain regions typically assigned to the same functional network. Connectivity between parts of different networks, however, was markedly increased for almost all hemispherectomy participants and across all networks. These results support the hypothesis of a shared set of functional networks that underlie cognition and suggest that between-network interactions may characterize functional reorganization in hemispherectomy

Archvillin, a muscle-specific isoform of supervillin, is an early expressed component of the costameric membrane skeleton

The membrane skeleton protein supervillin binds tightly to both F-actin and membranes and can potentiate androgen receptor activity in non-muscle cells. We report that muscle, which constitutes the principal tissue source for supervillin sequences, contains a approximately 250 kDa isoform of supervillin that localizes within nuclei and with dystrophin at costameres, regions of F-actin membrane attachment in skeletal muscle. The gene encoding this protein, \u27archvillin\u27 (Latin, archi; Greek, archos; \u27principal\u27 or \u27chief\u27), contains an evolutionarily conserved, muscle-specific 5\u27 leader sequence. Archvillin cDNAs also contain four exons that encode approximately 47 kDa of additional muscle-specific protein sequence in the form of two inserts within the function-rich N-terminus of supervillin. The first of these muscle-specific inserts contains two conserved nuclear targeting signals in addition to those found in sequences shared with supervillin. Archvillin, like supervillin, binds directly to radiolabeled F-actin and co-fractionates with plasma membranes. Colocalization of archvillin with membrane-associated actin filaments, non-muscle myosin II, and--to a lesser extent--vinculin was observed in myoblasts. Striking localizations of archvillin protein and mRNA were observed at the tips of differentiating myotubes. Transfected protein chimeras containing archvillin insert sequences inhibited myotube formation, consistent with a dominant-negative effect during early myogenesis. These data suggest that archvillin is among the first costameric proteins to assemble during myogenesis and that it contributes to myogenic membrane structure and differentiation

AF-M315E Propulsion System Advances and Improvements

Even as for the GR-1 awaits its first on-orbit demonstration on the planned 2017 launch of NASA's Green Propulsion Infusion Mission (GPIM) program, ongoing efforts continue to advance the technical state-of-the-art through improvements in the performance, life capability, and affordability of both Aerojet Rocketdyne's 1-N-class GR-1 and 20-N-class GR-22 green monopropellant thrusters. Hot-fire testing of a design upgrade of the GR-22 thruster successfully demonstrated resolution of a life-limiting thermo-structural issue encountered during prototype testing on the GPIM program, yielding both an approximately 2x increase in demonstrating life capability, as well as fundamental insights relating to how ionic liquid thrusters operate, thruster scaling, and operational factors affecting catalyst bed life. Further, a number of producibility improvements, related to both materials and processes and promising up to 50% unit cost reduction, have been identified through a comprehensive Design for Manufacturing and Assembly (DFMA) assessment activity recently completed at Aerojet Rocketdyne. Focused specifically on the GR-1 but applicable to the common-core architecture of both thrusters, ongoing laboratory (heavyweight) thruster testing being conducted under a Space Act Agreement at NASA Glenn Research Center has already validated a number of these proposed manufacturability upgrades, additionally achieving a greater than 40% increase in thruster life. In parallel with technical advancements relevant to conventional large spacecraft, a joint effort between NASA and Aerojet Rocketdyne is underway to prepare 1-U CubeSat AF-M315E propulsion module for first flight demonstration in 2018