Adaptive Mesh Refinement Algorithm Development and Dissemination

This is the final report of a three-year, Laboratory Directed Research and Development (LDRD) project at the Los Alamos National Laboratory (LANL). The project objective was to develop and disseminate adaptive mesh refinement (AMR) algorithms for structured and unstructured meshes. Development of ARM algorithms will continue along several directions. These directions include algorithms for parallel architectures, techniques for the solution of partial differential equations on adaptive meshes, mesh generation, and algorithms for nontraditional or generic applications of AMR. Dissemination of AMR algorithms is also a goal of the project. AMR algorithms are perceived as difficult to meld to current algorithms. The authors are developing tools that diminish this perception and allow more computational scientists to use AMR within their own work

Ultrasound Assessment of the Vertebral Level of the Intercristal Line in Pregnancy

(Anesth Analg. 2011;113(3):559–64

Frontal enhancement of dimethylsulfide concentrations across a Gulf Stream meander

Aqueous and atmospheric dimethyl sulfide (DMS) concentrations (0.4-4 nM, 5-350 ppt) were determined across a Gulf Stream meander in April 1989. Physical processes along and across the front were expected to result in biological changes also reflected in DMS levels. Highest concentrations of aqueous DMS (3-4 nM) were observed in surface waters coinciding with Slope waters at, or inshore of, the Gulf Stream north wall. This water also contained the highest chlorophyll levels (up to 2.6 pg chl/l) which co-varied with the sea surface DMS concentrations. Concentrations of atmospheric DMS were lower and more constant (21 * 9 ppt) outside the frontal area, either in Slope or Stream waters. At the northern wall of the Gulf Stream, a strikingly sharp increase in atmospheric DMS (up to 350 ppt) was observed. 1

Adequate endocrine and cardiovascular response to social stress in survivors of childhood acute lymphoblastic leukemia.

Item does not contain fulltextSurvivors of childhood ALL have been demonstrated to have increased morning cortisol levels compared to healthy controls. Information regarding the response of the HPA axis and the sympathetic nervous system to stress in childhood ALL survivors is not available. The present study aimed at assessing the endocrine and cardiovascular stress response in childhood ALL survivors and healthy controls by evaluating perceived stress on visual analog scales, by determining saliva cortisol, blood pressure and heart rate in response to the Trier Social Stress Test for Children (TSST-C). Fifty survivors who had completed their treatment for childhood ALL 57 (IQR 47.0-72.3) months before and 50 healthy age and sex matched controls were included. Exposure to the TSST-C induced a significant response of perceived stress, saliva cortisol and cardiovascular outcome variables in the total study group. These responses did not significantly differ between survivors of childhood ALL and healthy controls. We conclude that the endocrine and cardiovascular response to social stress are intact in survivors of childhood ALL.1 december 201

Prospective study of enhanced recovery after surgery protocol in children undergoing reconstructive operations

BACKGROUND: Enhanced recovery after surgery (ERAS) protocol is a set of peri-operative strategies to increase speed of recovery. ERAS is well established in adults but has not been well studied in children. OBJECTIVE: The purpose of the current study was to establish the safety and efficacy of an ERAS protocol in pediatric urology patients undergoing reconstructive operations. It was hypothesized that ERAS would reduce length of stay and decrease complications when compared with historical controls. STUDY DESIGN: Institutional Review Board approval was obtained to prospectively enroll patients agedpreparation, administration of pre-operative oral carbohydrate liquid, avoidance of opioids, regional anesthesia, laparoscopy when feasible, no postoperative nasogastric tube, early feeding, and early removal of intravenous fluids (IVF). Recent (2009-2014) historical controls were propensity matched in a 2:1 ratio on age, sex, ventriculoperitoneal shunt status and whether the patient was undergoing bladder augmentation. Outcomes were protocol adherence, length of stay (LOS), emergency department (ED) visits, re-admission within 30 days, re-operations and adverse events occurring within 90 days of surgery. RESULTS: A total of 26 historical and 13 ERAS patients were included. Median ages were 10.4 (IQR 8.0-12.4) and 9.9 years (IQR 9.1-11), respectively (P = 0.94) (see Summary Table). There were no significant between-group differences in prior abdominal surgery (38% vs 62%), rate of augmentation (88% vs 92%) or primary diagnosis of spina bifida (both 62%). ERAS significantly improved use of pre-operative liquid load (P \u3c 0.001), avoidance of opioids (P = 0.046), early discontinuation of IVF (P \u3c 0.001), and early feeding (P \u3c 0.001). Protocol adherence improved from 8/16 (IQR 4-9) historically to 12/16 (IQR 11-12) after implementation of ERAS. LOS decreased from 8 days to 5.7 days (P = 0.520). Complications of any grade per patient decreased from 2.1 to 1.3 (OR 0.71, 95% CI 0.51-0.97). There were fewer complications per patient across all grades with ERAS. No differences were seen in emergency department (ED) visits, re-admissions and re-operations. DISCUSSION: Implementation improved consistency of care delivered. Tenets of ERAS that appeared to drive improvements included maintenance of euvolemia through avoidance of excess fluids, multimodal analgesia, and early feeding. CONCLUSION: ERAS decreased length of stay and 90-day complications after pediatric reconstructive surgery without increased re-admissions, re-operations or ED visits. A multicenter study will be required to confirm the potential benefits of adopting ERAS