Standardized Consent Forms for Surgical Procedures: An Intervention to Improve the Resident-led Informed Consent Process

Objectives and Goals: To provide high quality, consistent consent forms for common surgical procedures and improve resident workflow by creating and implementing standardized printed consents for common surgical procedures. These consents will be used by residents consenting patients in the ED or inpatient setting. Consents shall include standardized procedure descriptions, risks and benefits of the procedure, and alternative treatment option descriptions, risks and benefitshttps://jdc.jefferson.edu/patientsafetyposters/1057/thumbnail.jp

Vaginal hydrolytic enzymes, immunoglobulin A against Gardnerella vaginalis toxin, and risk of early preterm birth among women in preterm labor with bacterial vaginosis or intermediate flora

Objective: The purpose of this study was to determine whether the microbial hydrolytic enzymes, sialidase and prolidase, and immunoglobulin A against the Gardnerella vaginalis cytolysin (anti-Gvh IgA) increase the risk for early preterm birth ( 6434 weeks of gestation) among women with bacterial vaginosis or intermediate flora. Study Design: Two hundred eighteen afebrile women in preterm labor with intact membranes had a vaginal Gram stain performed, and sialidase, prolidase, and anti-Gvh IgA concentrations were determined. Results: Women with bacterial vaginosis or intermediate flora had significantly higher sialidase and prolidase concentrations than women with normal flora. Among women with bacterial vaginosis or intermediate flora, the women with sialidase had a higher rate of early preterm birth (P =.05). Sialidase had a sensitivity of 43% and specificity of 77% for early preterm birth. Prolidase and anti-Gvh IgA did not predict early preterm birth. Conclusion: Women in preterm labor with bacterial vaginosis or intermediate flora and detectable sialidase are at increased risk of early preterm birth

COMPARING THE VALIDITY OF FIVE PARTICIPATION INSTRUMENTS IN PERSONS WITH SPINAL CONDITIONS

Objective: To evaluate and compare the construct validity of 5 participation instruments developed using the International Classification of Functioning, Disability and Health (ICF). Methods: A total of 545 subjects diagnosed and treated for a spinal condition at an acute hospital were followed-up and consented to complete a questionnaire. Subjects completed 5 participation instruments (Impact on Participation and Autonomy (IPA), Keele Assessment of Participation (KAP), Participation Measure-Post Acute Care (PM-PAC), Participation Objective Participation Subjective (POPS), World Health Organization Disability Assessment Schedule II (WHODAS II)). In addition, each subject completed a health status instrument and a quality of life instrument. The dimensionality, convergent/discriminant validity and known-group validity of the participation instruments were assessed. Results: A confirmatory factor analysis of the facture structure for the IPA and PM-PAC demonstrated adequate model fit. For convergent/discriminant validity, correlations were generally higher among similar domains of the WHODAS II, IPA, KAP and PM-PAC, and as expected the lowest correlations were observed with the objective domains of the POPS. Most instruments demonstrated known-group validity. Conclusion: Differences in the construct validity evidence of the POPS compared with the other 4 instruments were noted. To date, there is no gold standard for measuring participation, and clinicians and researchers should consider the type of information required prior to selecting an instrument

Geostationary Operational Environmental Satellite (GOES)-8 mission flight experience

The Geostationary Operational Environmental Satellite (GOES)-8 spacecraft was launched on April 13, 1994, at 06:04:02 coordinated universal time (UTC), with separation from the Atlas-Centaur launch vehicle occurring at 06:33:05 UTC. The launch was followed by a series of complex, intense operations to maneuver the spacecraft into its geosynchronous mission orbit. The Flight Dynamics Facility (FDF) of the Goddard Space Flight Center (GSFC) Flight Dynamics Division (FDD) was responsible for GOES-8 attitude, orbit maneuver, orbit determination, and station acquisition support during the ascent phase. This paper summarizes the efforts of the FDF support teams and highlights some of the unique challenges the launch team faced during critical GOES-8 mission support. FDF operations experience discussed includes: (1) The abort of apogee maneuver firing-1 (AMF-1), cancellation of AMF-3, and the subsequent replans of the maneuver profile; (2) The unexpectedly large temperature dependence of the digital integrating rate assembly (DIRA) and its effect on GOES-8 attitude targeting in support of perigee raising maneuvers; (3) The significant effect of attitude control thrusting on GOES-8 orbit determination solutions; (4) Adjustment of the trim tab to minimize torque due to solar radiation pressure; and (5) Postlaunch analysis performed to estimate the GOES-8 separation attitude. The paper also discusses some key FDF GOES-8 lessons learned to be considered for the GOES-J launch which is currently scheduled for May 19, 1995

Enzymatic conformational fluctuations along the reaction coordinate of cytidine deaminase

Analysis of the crystal structures for cytidine deaminase complexed with substrate analog 3-deazacytidine, transition-state analog zebularine 3,4-hydrate, and product uridine establishes significant changes in the magnitude of atomic-scale fluctuations along the (approximate) reaction coordinate of this enzyme. Differences in fluctuations between the substrate analog complex, transition-state analog complex, and product complex are monitored via changes in corresponding crystallographic temperature factors. Previously, we reported that active-site conformational disorder is substantially reduced in the transition-state complex relative to the two ground-state complexes. Here, this result is statistically corroborated by crystallographic data for fluorinated zebularine 3,4-hydrate, a second transition-state analog, and by multiple regression analysis. Multiple regression explains 70% of the total temperature factor variation through a predictive model for the average B-value of an amino acid as a function of the catalytic state of the enzyme (substrate, transition state, product) and five other physical and structural descriptors. Furthermore, correlations of atomic fluctuation magnitudes throughout the body of each complex are quantified through an auto-correlation function. The transition-state analog complex shows the greatest correlations between temperature factor magnitudes for spatially separated atoms, underscoring the strong ability of this reaction-coordinate species to "organize" enzymatic fluctuations. The catalytic significance for decreased atomic-scale motions in the transition state is discussed. A thermodynamic argument indicates that the significant decreases in local enzymatic conformational entropy at the transition state result in enhanced energetic stabilization there

Cytogenetic and Array-CGH Characterization of a Complex de novo Rearrangement Involving Duplication and Deletion of 9p and Clinical Findings in a 4-Month-Old Female

Approximately 15 patients with partial trisomy 9p involving de novo duplications have been previously described. Here, we present clinical, cytogenetic, FISH and aCGH findings in a patient with a de novo complex rearrangement in the short arm of chromosome 9 involving an inverted duplication at 9p24→p21.3 and a deletion at 9pter→p24.2. FISH probes generated from BACs selected from the UCSC genome browser were utilized to verify this rearrangement. It is likely that some previously described duplications of 9p may also be products of complex chromosomal aberrations. This report in which FISH and aCGH were used to more comprehensively characterize the genomic rearrangement in a patient with clinical manifestations of 9p duplication syndrome underscores the importance of further characterizing cytogenetically detected rearrangements

A New Class of Exact Hairy Black Hole Solutions

We present a new class of black hole solutions with minimally coupled scalar field in the presence of a negative cosmological constant. We consider a one-parameter family of self-interaction potentials parametrized by a dimensionless parameter $g$. When $g=0$, we recover the conformally invariant solution of the Martinez-Troncoso-Zanelli (MTZ) black hole. A non-vanishing $g$ signals the departure from conformal invariance. All solutions are perturbatively stable for negative black hole mass and they may develop instabilities for positive mass. Thermodynamically, there is a critical temperature at vanishing black hole mass, where a higher-order phase transition occurs, as in the case of the MTZ black hole. Additionally, we obtain a branch of hairy solutions which undergo a first-order phase transition at a second critical temperature which depends on $g$ and it is higher than the MTZ critical temperature. As $g\to 0$, this second critical temperature diverges.Comment: 18 pages, 6 figures, minor changes, references added, published versio

Temperature dependence of surface reconstructions of Au on Pd(110)

Surface reconstructions of Au film on Pd(110) substrate are studied using a local Einstein approximation to quasiharmonic theory with the Sutton-Chen interatomic potential. Temperature dependent surface free energies for different coverages and surface structures are calculated. Experimentally observed transformations from $(1\times1)$ to $(1 \times 2)$ and $(1 \times 3)$ structures can be explained in the framework of this model. Also conditions for Stranski-Krastanov growth mode are found to comply with experiments. The domain of validity of the model neglecting mixing entropy is analyzed.Comment: 7 pages, REVTeX two-column format, 3 postscript figures available on request from [email protected] To appear in Phys. Rev. Letter