Long-term follow-up of closed hemorrhoidectomy.

Four hundred forty-one patients who had closed hemorrhoidectomy with local anesthesia were followed for one to seven years postoperatively to assess long-term results and patient satisfaction. Seven and one-half per cent needed further treatment of hemorrhoids, 7.7 per cent developed other anorectal or colonic pathology, and 0.5 per cent had lasting incontinence. Lateral internal sphincterotomy did not predispose to incontinence. Patient satisfaction was 92.6 per cent

GaN micro-light-emitting diode arrays with monolithically integrated sapphire microlenses

A microdisk light emitting diode (micro-LED) with a monolithically integrated microlens array was demonstrated. The capability of the lenses in concentrating light emitted from microdisk LEDs was also demonstrated. The focal lengths of the microlenses were determined to be around 44 νm. The emission pattern of the LED emitters was found to be altered by the optical properties of the microlenses. The light emitted by the hybrid device was also found to be less divergent than a broad-area device.published_or_final_versio

Determining Access of In-Person vs Virtual Clinic Visits in Orthopedic Medicine

INTRODUCTION: Virtual visits in orthopedics provide added benefits compared to in-person visits. We hypothesize that virtual visits will offer patients greater same-day and future access to orthopedic physicians. METHODS: Two previously established methodologies were used to measure orthopedic surgeons: same-day and third-next-available. Same-day access is analyzed using a ratio of unfilled to filled virtual return and in-person return appointments for every clinic day of each physician. Third-next-available is measured as the number of total non-clinic days and clinic days until each physician’s third next-available-virtual and in-person appointments. RESULTS: For same-day access, the ratio of unfilled virtual to filled virtual appointments was 1.04 on average, while the ratio of unfilled in-person to filled return in-person visits was 0.38 on average (p=0.00323). For third-next-available appointments, the in-person opening was 5.81 days out on average compared to the virtual visit being 8.31 days out on average (p=0.01525). Additionally, the in-person appointment was 2.5 clinic-days out on average and the virtual appointment was 3.95 clinic-days out on average (p\u3c0.001). As virtual visits are a fraction of total visits, we divided the third-next-available data by the rate at which each physician books virtual appointments. This resulted in a significantly increased standardized third-next-available measure of access for virtual appointments using both total days (p\u3c0.001) and clinic days (p\u3c0.001). DISCUSSION/CONCLUSION: Virtual return visits offer greater same-day access for patients compared to analogous in-person return visits. However, in-person appointment availability offers better access for patients in terms of scheduling a future visit, which may be due to the increased number of in-person visits offered compared to virtual visits provided at this time. When standardizing the third-next-available data for how often each visit modality is offered, virtual visits displayed greater levels of patient access. Thus, an increased volume of virtual visit appointments may offer patients greater access for scheduling purposes in the future

Use of Quality Improvement Strategies Among Small to Medium-Size US Primary Care Practices

PURPOSE Improving primary care quality is a national priority, but little is known about the extent to which small to medium-size practices use quality improvement (QI) strategies to improve care. We examined variations in use of QI strategies among 1,181 small to medium-size primary care practices engaged in a national initiative spanning 12 US states to improve quality of care for heart health and assessed factors associated with those variations. METHODS In this cross-sectional study, practice characteristics were assessed by surveying practice leaders. Practice use of QI strategies was measured by the validated Change Process Capability Questionnaire (CPCQ) Strategies Scale (scores range from −28 to 28, with higher scores indicating more use of QI strategies). Multivariable linear regression was used to examine the association between practice characteristics and the CPCQ strategies score. RESULTS The mean CPCQ strategies score was 9.1 (SD = 12.2). Practices that participated in accountable care organizations and those that had someone in the practice to configure clinical quality reports from electronic health records (EHRs), had produced quality reports, or had discussed clinical quality data during meetings had higher CPCQ strategies scores. Health system–owned practices and those experiencing major disruptive changes, such as implementing a new EHR system or clinician turnover, had lower CPCQ strategies scores. CONCLUSION There is substantial variation in the use of QI strategies among small to medium-size primary care practices across 12 US states. Findings suggest that practices may need external support to strengthen their ability to do QI and to be prepared for new payment and delivery models

Ocean Surface Winds Drive Dynamics of Transoceanic Aerial Movements

Global wind patterns influence dispersal and migration processes of aerial organisms, propagules and particles, which ultimately could determine the dynamics of colonizations, invasions or spread of pathogens. However, studying how wind-mediated movements actually happen has been hampered so far by the lack of high resolution global wind data as well as the impossibility to track aerial movements. Using concurrent data on winds and actual pathways of a tracked seabird, here we show that oceanic winds define spatiotemporal pathways and barriers for large-scale aerial movements. We obtained wind data from NASA SeaWinds scatterometer to calculate wind cost (impedance) models reflecting the resistance to the aerial movement near the ocean surface. We also tracked the movements of a model organism, the Cory's shearwater (Calonectris diomedea), a pelagic bird known to perform long distance migrations. Cost models revealed that distant areas can be connected through “wind highways” that do not match the shortest great circle routes. Bird routes closely followed the low-cost “wind-highways” linking breeding and wintering areas. In addition, we found that a potential barrier, the near surface westerlies in the Atlantic sector of the Intertropical Convergence Zone (ITCZ), temporally hindered meridional trans-equatorial movements. Once the westerlies vanished, birds crossed the ITCZ to their winter quarters. This study provides a novel approach to investigate wind-mediated movements in oceanic environments and shows that large-scale migration and dispersal processes over the oceans can be largely driven by spatiotemporal wind patterns

Ocean Surface Winds Drive Dynamics of Transoceanic Aerial Movements

Global wind patterns influence dispersal and migration processes of aerial organisms, propagules and particles, which ultimately could determine the dynamics of colonizations, invasions or spread of pathogens. However, studying how wind-mediated movements actually happen has been hampered so far by the lack of high resolution global wind data as well as the impossibility to track aerial movements. Using concurrent data on winds and actual pathways of a tracked seabird, here we show that oceanic winds define spatiotemporal pathways and barriers for large-scale aerial movements. We obtained wind data from NASA SeaWinds scatterometer to calculate wind cost (impedance) models reflecting the resistance to the aerial movement near the ocean surface. We also tracked the movements of a model organism, the Cory's shearwater (Calonectris diomedea), a pelagic bird known to perform long distance migrations. Cost models revealed that distant areas can be connected through “wind highways” that do not match the shortest great circle routes. Bird routes closely followed the low-cost “wind-highways” linking breeding and wintering areas. In addition, we found that a potential barrier, the near surface westerlies in the Atlantic sector of the Intertropical Convergence Zone (ITCZ), temporally hindered meridional trans-equatorial movements. Once the westerlies vanished, birds crossed the ITCZ to their winter quarters. This study provides a novel approach to investigate wind-mediated movements in oceanic environments and shows that large-scale migration and dispersal processes over the oceans can be largely driven by spatiotemporal wind patterns

Methods in Genetics and Clinical Interpretation Randomized Trial of Personal Genomics for Preventive Cardiology Design and Challenges

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Acute epiglottitis as the initial presentation of pediatric Systemic Lupus Erythematosus

We report a case of a 5-year old girl, who initially presented with acute epiglottitis, sepsis and multi-organ failure. She was subsequently diagnosed as having Systemic Lupus Erythematosus. To the best of our knowledge, this article describes the first case of Haemophilus influenzae type f epiglottitis as the initial presentation of SLE in childhood