515 research outputs found
Space construction system analysis. Part 2: Construction analysis
The construction methods specific to the end to end construction process for building the ETVP in low Earth orbit, using the space shuttle orbiter as a construction base, are analyzed. The analyses concerned three missions required to build the basic platform. The first mission involved performing the fabrication of beams in space and assembling the beams into a basic structural framework. The second mission was to install the forward support structure and aft support structure, the forward assembly, and a TT&C antenna. The third mission plan was to complete the construction of the platform and activate it to begin operations in low Earth orbit. The integration of the activities for each mission is described along with the construction requirements and construction logic
Diagnostic yield and safety of ultrasound-guided bowel mass biopsies in children
Background Traditionally, ultrasound (US)-guided bowel mass biopsies are avoided in favour of endoscopic or surgical biopsies.
However, endoscopy cannot easily reach lesions between the duodenojejunal flexure and the terminal ileum and lesions not
involving the mucosa may not be accessible via an endoscopic route.
Objective The aim of this study was to report our technique and to assess the diagnostic accuracy and safety of US-guided biopsy
of bowel masses in children.
Materials and methods We conducted a 14-year retrospective review of US-guided bowel mass biopsies at a single
paediatric hospital.
Results Twenty US-guided bowel mass biopsies were performed in 19 patients (median age: 6 years and 6 months, range: 22 monthsâ
17 years, median weight: 22 kg, range: 10.2â48.4 kg). For 14 biopsies, there was no other lesion that could potentially be biopsied. A
percutaneous coaxial technique was used for 19 biopsies and a transanal non-coaxial biopsy was performed in 1. A median of 9 (range:
2â15) cores of tissue was obtained at each biopsy. The technical success rate and adequacy of diagnostic yield were 100%. The most
common diagnosis was lymphoma, which occurred in 16 biopsies. Three biopsies contained mucosa. There was one complication out
of 20 biopsies (5%, 95% confidence interval 0â15%): a self-limiting, post biopsy pyrexia. Nineteen procedures were accompanied by a
bone marrow aspirate and/or trephine within 2 weeks of the bowel biopsy, only one of which was diagnostic.
Conclusion US-guided bowel mass biopsy can be performed safely in children, with a high diagnostic yield and low complication rat
Surgical jejunostomy and radiological gastro-jejunostomy feeding in children: Risks, benefits and nutritional outcomes
PURPOSE:
Radiologically inserted gastrojejunal tubes (RGJ) and surgical jejunostomy (SJ) are established modes of jejunal feeding. The aim of the study is to review nutritional outcomes, complications and the practical consideration to enable patients and carers to make informed choice.
METHODS:
Retrospective review of patient notes with a RGJ or SJ in 2010, with detailed follow-up and review of the literature.
RESULTS:
Both RGJ and SJ are reliable modes to provide stable enteral nutrition. Both have complications and their own associated limitations.
CONCLUSION:
The choice has to be tailored to the individual patient, the social care available, the inherent medical disease and risk/benefit of repeated anaesthetic and radiation exposure. RGJ and SJ are important tools for nutritional management that achieve and maintain growth in a complex group of children. The risk and benefits should be reviewed for each individual patient
Living Dangerously: Culture of Honor, Risk-Taking, and the Nonrandomness of âAccidentalâ Deaths
Collin D. Barnes is a postdoctoral research fellow with the Institute for U.S.-China Issues at the University of Oklahoma.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline
Managing lifestyle change to reduce coronary risk: a synthesis of qualitative research on peoplesâ experiences
Background
Coronary heart disease is an incurable condition. The only approach known to slow its progression is healthy lifestyle change and concordance with cardio-protective medicines. Few people fully succeed in these daily activities so potential health improvements are not fully realised. Little is known about peoplesâ experiences of managing lifestyle change. The aim of this study was to synthesise qualitative research to explain how participants make lifestyle change after a cardiac event and explore this within the wider illness experience.
Methods
A qualitative synthesis was conducted drawing upon the principles of meta-ethnography. Qualitative studies were identified through a systematic search of 7 databases using explicit criteria. Key concepts were identified and translated across studies. Findings were discussed and diagrammed during a series of audiotaped meetings.
Results
The final synthesis is grounded in findings from 27 studies, with over 500 participants (56% male) across 8 countries. All participants experienced a change in their self-identity from what was âfamiliarâ to âunfamiliarâ. The transition process involved âfinding new limits and a life worth livingââ, âfinding support for selfâ and âfinding a new normalâ. Analyses of these concepts led to the generation of a third order construct, namely an ongoing process of âreassessing past, present and future livesâ as participants considered their changed identity. Participants experienced a strong urge to get back to ânormalâ. Support from family and friends could enable or constrain life change and lifestyle changes. Lifestyle change was but one small part of a wider âlifeâ change that occurred.
Conclusions
The final synthesis presents an interpretation, not evident in the primary studies, of a person-centred model to explain how lifestyle change is situated within âwiderâ life changes. The magnitude of individual responses to a changed health status varied. Participants experienced distress as their notion of self identity shifted and emotions that reflected the various stages of the grief process were evident in participantsâ accounts. The process of self-managing lifestyle took place through experiential learning; the level of engagement with lifestyle change reflected an individualâs unique view of the balance needed to manage ârealistic changeâ whilst leading to a life that was perceived as âworth livingâ. Findings highlight the importance of providing person centred care that aligns with both psychological and physical dimensions of recovery which are inextricably linked
Further investigation of confirmed urinary tract infection (UTI) in children under five years: a systematic review.
Background: Further investigation of confirmed UTI in children aims to prevent renal scarring and future complications. Methods: We conducted a systematic review to determine the most effective approach to the further investigation of confirmed urinary tract infection (UTI) in children under five years of age. Results: 73 studies were included. Many studies had methodological limitations or were poorly reported. Effectiveness of further investigations: One study found that routine imaging did not lead to a reduction in recurrent UTIs or renal scarring. Diagnostic accuracy: The studies do not support the use of less invasive tests such as ultrasound as an alternative to renal scintigraphy, either to rule out infection of the upper urinary tract (LR- = 0.57, 95%CI: 0.47, 0.68) and thus to exclude patients from further investigation or to detect renal scarring (LR+ = 3.5, 95% CI: 2.5, 4.8). None of the tests investigated can accurately predict the development of renal scarring. The available evidence supports the consideration of contrast-enhanced ultrasound techniques for detecting vesico-ureteric reflux (VUR), as an alternative to micturating cystourethrography (MCUG) (LR+ = 14.1, 95% CI: 9.5, 20.8; LR- = 0.20, 95%CI: 0.13, 0.29); these techniques have the advantage of not requiring exposure to ionising radiation. Conclusion: There is no evidence to support the clinical effectiveness of routine investigation of children with confirmed UTI. Primary research on the effectiveness, in terms of improved patient outcome, of testing at all stages in the investigation of confirmed urinary tract infection is urgently required
Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy
Background
A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets.
Methods
Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendallâs tau for dichotomous variables, or JonckheereâTerpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis.
Results
A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both pâ<â0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROCâ=â0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all pâ<â0.001).
Conclusion
We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty
A qualitative study of cardiac rehabilitation patientsâ perspectives on taking medicines: implications for the âmedicines-resistanceâ model of medicine-taking
Background
The appropriate use of medicines continues to be an important area of inter-disciplinary research activity both in the UK and beyond. Key qualitative work in this area in the last decade has included the âmedicines resistanceâ model of medicine-taking, which was based on a meta-ethnography of 37 qualitative studies. This model proposed that patients approach medicine-taking as âpassive acceptersâ, âactive acceptersâ, âactive modifiersâ or âcomplete rejectersâ, of which the latter two categories were considered to show âresistanceâ to medicines. However, critical assessment of the model appears to be currently lacking, particularly in terms of its use in clinical practice. This paper seeks to contribute to the literature in this area by critically examining the practical application of the model in light of the findings from a qualitative, follow-up study of cardiac rehabilitation patientsâ perspectives and experiences of using medicines.
Methods
Following ethical approval, in-depth, audiotaped, qualitative interviews were conducted with fifteen patients who had completed a UK hospital-based cardiac rehabilitation programme. Participants were aged 42â65, white British and from a variety of socioeconomic backgrounds. Interview topics included perspectives on coronary heart disease, medicine-taking and lifestyle changes. Follow-up interviews with ten patients approximately nine months later explored whether their perspectives had changed.
Results
The findings suggest that the active/passive and accepter/modifier distinctions may not allow for clear determination of which profile a patient fits into at any given point, and that definitions such as âaccepterâ and âresistanceâ may be insufficiently discerning to categorise patientsâ use of medicines in practice. These problems appear to arise when the issue of patientsâ accounts about medicines adherence are considered, since patients may have concerns or disquiet about medicines whether or not they are adherent and the model does not consider disquiet in isolation from adherence.
Conclusions
Practical application of the âmedicines resistanceâ model of medicine-taking may be problematic in this patient group. Dissociation of disquiet about medicines from medicines adherence may allow for a focus on helping patients to resolve their disquiet, if possible, without this necessarily having to be viewed in terms of its potential effect on adherence
Understanding the care.data conundrum: new information flows for economic growth
The analysis of data from electronic health records aspires to facilitate healthcare efficiencies and biomedical innovation. There are also ethical, legal and social implications from the handling of sensitive patient information. The paper explores the concerns, expectations and implications of the National Health Service (NHS) England care.data programme: a national data sharing initiative of linked electronic health records for healthcare and other research purposes. Using Nissenbaumâs contextual integrity of privacy framework through a critical science and technology studies (STS) lens, it examines the way technologies and policies are developed to promote sustainability, governance and economic growth as the de facto social values, while reducing privacy to an individualistic preference. The state, acting as a new, central data broker reappropriates public ownership rights and establishes those information flows and transmission principles that facilitate the assetisation of NHS datasets for the knowledge economy. Various actors and processes from other contexts attempt to erode the public healthcare sector and privilege new information recipients. However, such data sharing initiatives in healthcare will be resisted if we continue to focus only on the monetary and scientific values of these datasets and keep ignoring their equally important social and ethical values
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