Characterization of resident surgeon participation during carotid endarterectomy and impact on perioperative outcomes

IntroductionThe impact of resident surgeon participation during vascular procedures on postoperative outcomes is incompletely understood. We characterized resident physician participation during carotid endarterectomy (CEA) procedures within the 2005-2009 American College of Surgeons National Surgical Quality Improvement Participant Use Datafile and evaluated associations with procedural characteristics and perioperative adverse events.MethodsCEAs were identified using primary current procedural terminology codes; those performed simultaneously with other major procedures or unknown resident participation status were excluded. Group-wise comparisons based on resident participation status were performed using χ2 or Fisher's exact test for categorical variables and t tests or nonparametric methods for continuous variables. Associations with perioperative adverse events (major = stroke, death, myocardial infarction, or cardiac arrest; minor = peripheral nerve injury, bleeding requiring transfusion, surgical site infection, or wound disruption) were assessed using multivariable logistic regression models adjusting for other known risk factors.ResultsA total of 25,280 CEA procedures were analyzed, of which residents participated in 13,705 (54.2%), while residents were absent in 11,575 (45.8%). Among CEAs with resident physician participation, resident level was categorized as junior (postgraduate year [PGY] 1-2) in 21.9%, senior (PGY 3-5) in 52.7%, and fellow (PGY ≥6) in 25.3%. Major adverse event rates with and without resident participation were 1.9% versus 2.1%, and minor adverse event rates with and without resident participation were 0.9% versus 1.0%, respectively. In multivariable models, resident physician participation was not associated with perioperative risk for major adverse events (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.75-1.08) or minor adverse events (OR, 0.93; 95% CI, 0.72-1.21).ConclusionsResident surgeon participation during CEA is not associated with risk of adverse perioperative events

Pre-distortion adaptive optics for optical feeder links: simulations and performance analyses

Optical feeder links offer immense utility in meeting future communication demands—however, atmospheric turbulence limits their performance. This work targets this challenge through analyses of a bidirectional free-space optical communication (FSOC) link that incorporates pre-distortion adaptive optics (AO) between the next-generation optical ground station at the German Aerospace Center (DLR) Oberpfaffenhofen and the laser communications terminal on Alphasat—a satellite in geostationary orbit (GEO). The analyses are performed via end-to-end Monte Carlo simulations that provide realistic performance estimates of the bidirectional FSOC link for a GEO feeder link scenario. We find that applying pre-distortion AO reduces the total uplink losses of the bidirectional FSOC link by up to 10 dB and lessens the scintillation at the GEO satellite by an order of magnitude. Moreover, applying pre-distortion AO eases the link budget requirements needed for maintaining 99.9% link uptime by as much as 20-40 dB, while its use with a laser guide star shows an additional performance improvement of up to 8 dB. These findings demonstrate the desirability and feasibility of utilizing pre-distortion AO for the realization of optical feeder links

Argus: A 16-pixel Millimeter-Wave Spectrometer for the Green Bank Telescope

We report on the development of Argus, a 16-pixel spectrometer, which will enable fast astronomical imaging over the 85–116 GHz band. Each pixel includes a compact heterodyne receiver module, which integrates two InP MMIC low-noise amplifiers, a coupled-line bandpass filter and a sub-harmonic Schottky diode mixer. The receiver signals are routed to and from the multi-chip MMIC modules with multilayer high frequency printed circuit boards, which includes LO splitters and IF amplifiers. Microstrip lines on flexible circuitry are used to transport signals between temperature stages. The spectrometer frontend is designed to be scalable, so that the array design can be reconfigured for future instruments with hundreds of pixels. Argus is scheduled to be commissioned at the Robert C. Byrd Green Bank Telescope in late 2014. Preliminary data for the first Argus pixels are presented

Quality of life in adults with muscular dystrophy

Background Muscle weakness is a defining characteristic of Muscular Dystrophy (MD); however, yet while speculated, objective measures of muscle weakness has not been reported in relation to quality of life in adults with MD. Objectives 1) compare the self-reported QoL of adults with Duchenne MD (DMD), Beckers MD (BMD), Limb-Girdle MD (LGMD) and Fascioscapulohumeral MD (FSHD, and a non-MD (CTRL) group; 2) present and compare between groups measures of Impairment (Muscle Strength and Activities of Daily Living) and Perception (Fatigue, Pain and Self-Efficacy); and 3) identify associations between QoL domains and measures of Impairment and Perception (See above). Methods Seventy-Five males, including MD classifications DMD, BMD, LGMD, FSHD and CTRL, completed measures for QoL, Knee-Extension Maximal Voluntary Contraction (KEMVC), Fatigue, Pain, Self-Efficacy and Activities of Daily Living (ADL). Results QoL was lower across many domains in MD than CTRL. FSHD scored lower than DMD for mental wellbeing domains. KEMVC associated with Physical-Function domain for BMD. Pain, Self-Efficacy and ADLs associated with QoL domains, with Fatigue the most consistently associated. Conclusion The present study identified differences between MD classifications within self-perceptions of mental-health. Muscle weakness is a defining feature of MD; however, it doesn’t define QoL in adults with MD. A greater understanding of mental wellbeing, independence, and management of fatigue and pain, are required to improve QoL for adults with MD

12-Month changes of muscle strength, body composition and physical activity in adults with dystrophinopathies

Purpose Muscular dystrophy (MD) is an umbrella term for muscle wasting conditions, for which longitudinal changes in function and body composition are well established in children with Duchenne (DMD), however, changes in adults with DMD and Beckers (BMD), respectively, remain poorly reported. This study aims to assess 12-month changes in lower-limb strength, muscle size, body composition and physical activity in adults with Muscular Dystrophy (MD). Methods Adult males with Duchenne MD (DMD; N = 15) and Beckers MD (BMD; N = 12) were assessed at baseline and 12-months for body composition (Body fat and lean body mass (LBM)), Isometric maximal voluntary contraction (Knee-Extension (KEMVC) and Plantar-Flexion (PFMVC)) and physical activity (tri-axial accelerometry). Results 12-Month change in strength was found as −19% (PFMVC) and −14% (KEMVC) in DMD. 12-Month change in strength in BMD, although non-significant, was explained by physical activity (R 2=0.532–0.585). Changes in LBM (DMD) and body fat (BMD) were both masked by non-significant changes in body mass. Discussion 12-Month changes in adults with DMD appear consistent with paediatric populations. Physical activity appears important for muscle function maintenance. Specific monitoring of body composition, and potential co-morbidities, within adults with MD is highlighted. Implications for rehabilitation Quantitative muscle strength assessment shows progressive muscle weakness in adults with Duchenne Muscular Dystrophy is comparable to paediatric reports (−14 to −19%). Physical activity should be encouraged in adults with Beckers Muscular Dystrophy, anything appears better than nothing. Body composition, rather than body mass, should be monitored closely to identify any increase in body fat

CLASS Observations of Atmospheric Cloud Polarization at Millimeter Wavelengths

The dynamic atmosphere imposes challenges to ground-based cosmic microwave background observation, especially for measurements on large angular scales. The hydrometeors in the atmosphere, mostly in the form of clouds, scatter the ambient thermal radiation and are known to be the main linearly polarized source in the atmosphere. This scattering-induced polarization is significantly enhanced for ice clouds due to the alignment of ice crystals under gravity, which are also the most common clouds seen at the millimeter-astronomy sites at high altitudes. This work presents a multifrequency study of cloud polarization observed by the Cosmology Large Angular Scale Surveyor (CLASS) experiment on Cerro Toco in the Atacama Desert of northern Chile, from 2016 to 2022, at the frequency bands centered around 40, 90, 150, and 220 GHz. Using a machine-learning-assisted cloud classifier, we made connections between the transient polarized emission found in all four frequencies with the clouds imaged by monitoring cameras at the observing site. The polarization angles of the cloud events are found to be mostly $90^\circ$ from the local meridian, which is consistent with the presence of horizontally aligned ice crystals. The 90 and 150 GHz polarization data are consistent with a power law with a spectral index of $3.90\pm0.06$, while an excess/deficit of polarization amplitude is found at 40/220 GHz compared with a Rayleigh scattering spectrum. These results are consistent with Rayleigh-scattering-dominated cloud polarization, with possible effects from supercooled water absorption and/or Mie scattering from a population of large cloud particles that contribute to the 220 GHz polarization.Comment: 16 pages, 14 figures, submitted to Ap

Impact of exposure measurement error in air pollution epidemiology: effect of error type in time-series studies

<p>Abstract</p> <p>Background</p> <p>Two distinctly different types of measurement error are Berkson and classical. Impacts of measurement error in epidemiologic studies of ambient air pollution are expected to depend on error type. We characterize measurement error due to instrument imprecision and spatial variability as multiplicative (i.e. additive on the log scale) and model it over a range of error types to assess impacts on risk ratio estimates both on a per measurement unit basis and on a per interquartile range (IQR) basis in a time-series study in Atlanta.</p> <p>Methods</p> <p>Daily measures of twelve ambient air pollutants were analyzed: NO₂, NO_x, O₃, SO₂, CO, PM₁₀mass, PM_2.5mass, and PM_2.5components sulfate, nitrate, ammonium, elemental carbon and organic carbon. Semivariogram analysis was applied to assess spatial variability. Error due to this spatial variability was added to a reference pollutant time-series on the log scale using Monte Carlo simulations. Each of these time-series was exponentiated and introduced to a Poisson generalized linear model of cardiovascular disease emergency department visits.</p> <p>Results</p> <p>Measurement error resulted in reduced statistical significance for the risk ratio estimates for all amounts (corresponding to different pollutants) and types of error. When modelled as classical-type error, risk ratios were attenuated, particularly for primary air pollutants, with average attenuation in risk ratios on a per unit of measurement basis ranging from 18% to 92% and on an IQR basis ranging from 18% to 86%. When modelled as Berkson-type error, risk ratios per unit of measurement were biased away from the null hypothesis by 2% to 31%, whereas risk ratios per IQR were attenuated (i.e. biased toward the null) by 5% to 34%. For CO modelled error amount, a range of error types were simulated and effects on risk ratio bias and significance were observed.</p> <p>Conclusions</p> <p>For multiplicative error, both the amount and type of measurement error impact health effect estimates in air pollution epidemiology. By modelling instrument imprecision and spatial variability as different error types, we estimate direction and magnitude of the effects of error over a range of error types.</p

Development and psychometric evaluation of a new patient -reported outcome measure for stroke self -management: The Southampton Stroke Self - Management Questionnaire (SSSMQ).

BACKGROUND: Self-management is important to the recovery and quality of life of people following stroke. Many interventions to support self-management following stroke have been developed, however to date no reliable and valid outcome measure exists to support their evaluation. This study outlines the development and preliminary investigation of the psychometric performance of a newly developed patient-reported outcome measure (PROM) of self-management competency following stroke; the Southampton Stroke Self-Management Questionnaire (SSSMQ). METHODS: A convenience sample of 87 people who had had a stroke completed responses to the SSSMQ, the Stroke Self-Efficacy Questionnaire and the Stroke Impact Scale. Scaling properties were assessed using Mokken Scale Analysis. Reliability and construct validity were assessed using intra-class correlation coefficient (ICC), Mokken and Cronbach's reliability coefficients and Spearman rank order correlations with relevant measures. RESULTS: Mokken scaling refined the SSSMQ to 28 scalable items. Internal consistency reliability (Mokken r = 0.89) and test-retest reliability (ICC = 0.928) were excellent. Hypotheses of expected correlations with additional measures held, demonstrating good evidence for construct validity. CONCLUSIONS: Early findings suggest the Southampton Stroke Self-Management Questionnaire is a reliable and valid scale of self-management competency. The SSSMQ represents a potentially valid PROM for the evaluation of self-management following stroke