Basic suture technique: Instructional videos explaining suturing for medical students in a qualitative study

Background: Understanding basic surgical skills is important for medical students prior to entering residency regardless of future specialty. In these videos we provide instruction for suturing as it relates to skin closure. Material and methods: Instructional videos were created by the senior faculty (R.A. and M.K.) to teach medical students at the University of Louisville suturing techniques. Results: Entering and exiting the needle at an angle of 90° or greater allows for tissue eversion. Inadequate eversion of tissue or inadequate angling of the needle will lead to tissue inversion. When suturing uneven edges, a deep bite on the low side and a shallow bite on the high side will allow for appropriate tissue leveling. For buried sutures, skin eversion with substantial dermal bites and proper knot location is essential. Conclusion: Understanding the basics of skin apposition will provide students with knowledge about primary wound healing and prepare them for residency

Performance up gradation of static VAR compensator with thyristor binary switched capacitor and reactor using model reference adaptive controller

There are various static var compensator configurations are available and listed in the literature. Their performances are evaluated based on their voltage support, dynamic response, losses, cost, and additional filter requirement, if any. In this paper, efforts are made to improve the dynamic performance parameter such as rise time, settling time, and peak overshoots. A new topology with an adaptive controller is presented, in which capacitor and reactor banks are divided in their binary values and connected in the shunt. Capacitor and reactor banks are operated by thyristorised switches. Both these banks are operated in closed-loop form as a cascade control. Amongst these, capacitor bank operates as coarse control, and reactor bank acts as fine control. For the performance enhancement, a model reference adaptive controller is used. The system identification toolbox is used to evaluate the mathematical model of the plant with Matlab. The model\u27s performance was analyzed deeply by the adaptive controller with different reference models such as critical, under, and overdamped. The performance parameters such as rise time, settling time, and peak overshoot in the form of reactive power swings, are evaluated and plotted for different adaptive gains using MIT rules

Quantifying the Twitter Influence of Third Party Commercial Entities versus Healthcare Providers in Thirteen Medical Conferences from 2011-2013

Introduction Twitter channels are increasingly popular at medical conferences. Many groups, including healthcare providers and third party entities (e.g., pharmaceutical or medical device companies) use these channels to communicate with one another. These channels are unregulated and can allow third party commercial entities to exert an equal or greater amount of Twitter influence than healthcare providers. Third parties can use this influence to promote their products or services instead of sharing unbiased, evidence-based information. In this investigation we quantified the Twitter influence that third party commercial entities had in 13 major medical conferences. Methods We analyzed tweets contained in the official Twitter hashtags of thirteen medical conferences from 2011 to 2013. We placed tweet authors into one of four categories based on their account profile: healthcare provider, third party commercial entity, none of the above and unknown. We measured Twitter activity by the number of tweet authors per category and the tweet-to-author ratio by category. We measured Twitter influence by the PageRank of tweet authors by category. Results We analyzed 51159 tweets authored by 8778 Twitter account holders in 13 conferences that were sponsored by 5 medical societies. A quarter of all authors identified themselves as healthcare providers, while only 18% could be identified as third party commercial entities. Healthcare providers had a greater tweet-to-author ratio than their third party commercial entity counterparts (8.98 versus 6.93 tweets). Despite having less authors and composing less tweets, third party commercial entities had a statistically similar PageRank as healthcare providers (0.761 versus 0.797). Conclusion The Twitter influence of third party commercial entities (PageRank) is similar to that of healthcare providers. This finding is interesting because the number of tweets and third party commercial entity authors required to achieve this PageRank is far fewer than that needed by healthcare providers. Without safety mechanisms in place, the Twitter channels of medical conferences can devolve into a venue for the spread of biased information rather than evidence-based medical knowledge that is expected at live conferences. Continuing to measure the Twitter influence that third parties exert can help conference organizers develop reasonable guidelines for Twitter channel activity

Assessment of Health Care Cost for Complex Surgical Patients: Review of Cost, Re-Imbursement and Revenue Involved in Pancreatic Surgery at a High-Volume Academic Medical Centre

AbstractBackgroundPancreatic surgery is complex with the potential for costly hospitalization.MethodsA retrospective review of patients undergoing a pancreatic resection was performed.ResultsThe median age of the study population was 64 years. Half of the cohort was female (51%), and the majority were white (62%). Most patients underwent a pancreaticoduodenectomy (PD) (69%). The pre-operative age-adjusted Charlson comorbidity index was zero for 36% (n = 50), 1 for 31% (n = 43) and ≥2 for 33% (n = 45). The Clavien–Dindo grading system for post-operative complication was grade I in 17% (n = 24), whereas 45% (n = 62) were higher grades. The medians direct fixed, direct variable, fixed indirect and total costs were $2476,$15 397, $13 207 and$31 631, respectively. There was a positive contribution margin of $7108, whereas the net margin was a loss of$6790. On univariate analyses, age, type of operation and complication grade were associated with total cost (P ≤ 0.05), whereas operation type and complication grade were associated with a net margin (P = 0.01). These findings remained significant on multivariate analysis (P < 0.05).ConclusionsIncreased cost, reimbursement and revenue were associated with type of operation and post-operative complications

The Short-Term Effect of Weight Loss Surgery on Volumetric Breast Density and Fibroglandular Volume

Purpose: Obesity and breast density are both associated with an increased risk of breast cancer and are potentially modifiable. Weight loss surgery (WLS) causes a significant reduction in the amount of body fat and a decrease in breast cancer risk. The effect of WLS on breast density and its components has not been documented. Here, we analyze the impact of WLS on volumetric breast density (VBD) and on each of its components (fibroglandular volume and breast volume) by using three-dimensional methods. Materials and Methods: Fibroglandular volume, breast volume, and their ratio, the VBD, were calculated from mammograms before and after WLS by using Volpara™ automated software. Results: For the 80 women included, average body mass index decreased from 46.0 ± 7.22 to 33.7 ± 7.06 kg/m2. Mammograms were performed on average 11.6 ± 9.4 months before and 10.1 ± 7 months after WLS. There was a significant reduction in average breast volume (39.4 % decrease) and average fibroglandular volume (15.5 % decrease), and thus, the average VBD increased from 5.15 to 7.87 % (p < 1 × 10−9) after WLS. When stratified by menopausal status and diabetic status, VBD increased significantly in all groups but only perimenopausal and postmenopausal women and non-diabetics experienced a significant reduction in fibroglandular volume. Conclusions: Breast volume and fibroglandular volume decreased, and VBD increased following WLS, with the most significant change observed in postmenopausal women and non-diabetics. Further studies are warranted to determine how physical and biological alterations in breast density components after WLS may impact breast cancer risk.ECU Open Access Publishing Support Fun

Basic suture technique: Instructional videos explaining suturing for medical students in a qualitative study

Background: Understanding basic surgical skills is important for medical students prior to entering residency regardless of future specialty. In these videos we provide instruction for suturing as it relates to skin closure. Material and methods: Instructional videos were created by the senior faculty (R.A. and M.K.) to teach medical students at the University of Louisville suturing techniques.Results: Entering and exiting the needle at an angle of 90° or greater allows for tissue eversion. Inadequate eversion of tissue or inadequate angling of the needle will lead to tissue inversion. When suturing uneven edges, a deep bite on the low side and a shallow bite on the high side will allow for appropriate tissue leveling. For buried sutures, skin eversion with substantial dermal bites and proper knot location is essential.Conclusion: Understanding the basics of skin apposition will provide students with knowledge about primary wound healing and prepare them for residency

The Short-Term Effect of Weight Loss Surgery on Volumetric Breast Density and Fibroglandular Volume

Purpose Obesity and breast density are both associated with an increased risk of breast cancer and are potentially modifi- able. Weight loss surgery (WLS) causes a significant reduc- tion in the amount of body fat and a decrease in breast cancer risk. The effect of WLS on breast density and its components has not been documented. Here, we analyze the impact of WLS on volumetric breast density (VBD) and on each of its components (fibroglandular volume and breast volume) by using three-dimensional methods.Materials and Methods Fibroglandular volume, breast vol- ume, and their ratio, the VBD, were calculated from mammo- grams before and after WLS by using VolparaTM automated software.Mammograms were performed on average 11.6 ± 9.4 months before and 10.1 ± 7 months after WLS. There was a significant reduction in average breast volume (39.4 % decrease) and aver- age fibroglandular volume (15.5 % decrease), and thus, the av- erage VBD increased from 5.15 to 7.87 % (p &lt; 1 × 10−9) after WLS. When stratified by menopausal status and diabetic status, VBD increased significantly in all groups but only perimeno- pausal and postmenopausal women and non-diabetics experi- enced a significant reduction in fibroglandular volume. Conclusions Breast volume and fibroglandular volume decreased, and VBD increased following WLS, with the most significant change observed in postmenopausal women and non-diabetics. Further studies are warranted to determine how physical and biological alterations in breast density components after WLS may impact breast cancer risk.Kathryn M. Verbanac [email protected] Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USAResults For the 80 women included, average body mass index 2decreased from 46.0 ± 7.22 to 33.7 ± 7.06 kg/m2

Popular topics at the 2011, 2012, and 2013 American Society of Nephrology Annual Meetings.

<p>Word clouds exclude prepositions, conjunctions, articles, numbers, Twitter usernames, and official conference-specific hashtags.</p

User categories and examples.

<p>User categories and examples.</p

Popular topics at the 2011, 2012, and 2013 American Society of Clinical Oncology Annual Meetings.

<p>Word clouds exclude prepositions, conjunctions, articles, numbers, Twitter usernames, and official conference-specific hashtags.</p