The impact of seasonal operating room closures on wait times for oral cancer surgery

Background Operating room slowdowns occur at specific intervals in the year as a cost-saving measure. We aim to investigate the impact of these slowdowns on the care of oral cavity cancer patients at a Canadian tertiary care centre. Methods A total of 585 oral cavity cancer patients seen between 1999 and 2015 at the London Health Science Centre (lhsc) Head and Neck Multidisciplinary Clinic were included in this study. Operating room hours and patient load from 2006 to 2014 were calculated. Our primary endpoint was the wait time from consultation to definitive surgery. Exposure variables were defined according to wait time intervals occurring during time periods with reduced operating room hours. Results Overall case volume rose significantly from 2006 to 2014 (p \u3c 0.001), while operating room hours remained stable (p = 0.555). Patient wait times for surgery increased from 16.3 days prior to 2003 to 25.5 days in 2015 (p = 0.008). Significant variability in operating room hours was observed by month, with lowest reported for July and August (p = 0.002). The greater the exposure to these months, the more likely patients were to wait longer than 28 days for surgery (odds ratio per day [or]: 1.07, 95% confidence interval [ci]: 1.05 to 1.10, p \u3c 0.001). Individuals seen in consultation preceding a month with below average operating room hours had a higher risk of disease recurrence and/or death (hazard ratio [hr]: 1.59, 95% ci: 1.10 to 2.30, p = 0.014). Conclusions Scheduled reductions in available operating room hours contribute to prolonged wait times and higher disease recurrence. Further work is needed to identify strategies maximizing efficient use of health care resources without negatively affecting patient outcomes

Recycled nitrogen in lactating dairy cows fed high and low grain diets.

Recycled N used by rumen bacteria and reaching the small intestine was studied in 4 duodenally cannuled lactating cows fed diets of 2:1 (C) and 1:2 (F) concentrate to forage

Surgical Explantation of Transcatheter Aortic Valve Bioprostheses: A Statewide Experience

BACKGROUND: Despite the rapid adoption of transcatheter aortic valve replacement (TAVR) since its initial approval in 2011, the frequency and outcomes of surgical explantation of TAVR devices (TAVR-explant) is poorly understood. METHODS: Patients undergoing TAVR-explant between January 2012 and June 2020 at 33 hospitals in Michigan were identified in the Society of Thoracic Surgeons Database and linked to index TAVR data from the Transcatheter Valve Therapy Registry through a statewide quality collaborative. The primary outcome was operative mortality. Indications for TAVR-explant, contraindications to redo TAVR, operative data, and outcomes were collected from Society of Thoracic Surgeons and Transcatheter Valve Therapy databases. Baseline Society of Thoracic Surgeons Predicted Risk of Mortality was compared between index TAVR and TAVR-explant. RESULTS: Twenty-four surgeons at 12 hospitals performed TAVR-explants in 46 patients (median age, 73). The frequency of TAVR-explant was 0.4%, and the number of explants increased annually. Median time to TAVR-explant was 139 days and among known device types explanted, most were self-expanding valves (29/41, 71%). Common indications for TAVR-explant were procedure-related failure (35%), paravalvular leak (28%), and need for other cardiac surgery (26%). Contraindications to redo TAVR included need for other cardiac surgery (28%), unsuitable noncoronary anatomy (13%), coronary obstruction (11%), and endocarditis (11%). Overall, 65% (30/46) of patients underwent concomitant procedures, including aortic repair/replacement in 33% (n=15), mitral surgery in 22% (n=10), and coronary artery bypass grafting in 16% (n=7). The median Society of Thoracic Surgeons Predicted Risk of Mortality was 4.2% at index TAVR and 9.3% at TAVR-explant (P=0.001). Operative mortality was 20% (9/46) and 76% (35/46) of patients had in-hospital complications. Of patients alive at discharge, 37% (17/37) were discharged home and overall 3-month survival was 73±14%. CONCLUSIONS: TAVR-explant is rare but increasing, and its clinical impact is substantial. As the utilization of TAVR expands into younger and lower-risk patients, providers should consider the potential for future TAVR-explant during selection of an initial valve strategy

The Grizzly, December 6, 1985

Contemporary Women Playwrites Recent Lecture Focus • Faculty Carries Heavy Work Load • A Radio Station in the Making • Letters: RA System not Fair for Anyone; Does our School Paper Have a Monopoly? • Campus Memo: Learn to say no Effectively • In Search of Success: Mary Lou Happy as Claims Adjuster • Campus Briefs: Financial Aid Office Sends out Survey; Davidson Conducts Workshop on Athletic Tech.; Open Dailog Considers Scrapping U.S. Constitution • CPP Offers Lecture on Careers in Sales • Lady Bears Battle Tough Division II Competition • Matmen Finish Third in Invitational • Women\u27s Gymnastics Drops to Montclair State • Final Exam Schedule • Boxing Brother: Hammerin\u27 Hankhttps://digitalcommons.ursinus.edu/grizzlynews/1154/thumbnail.jp

Impacts of a Post-Transport/Pre-Processing Rest Period on the Growth Performance and Serum Metabolites of Cattle Entering a Feedlot

Objective: The objective of this study was to evaluate the impact of a post-transport rest period on receiving calf growth performance and blood serum metabolites as indicators of immune function. Study Description: Eighty heifers were purchased from a sale barn and transported 6 hours to the Kansas State University Beef Cattle Research Center where they were processed at one of four times: immediately upon arrival or after a 6-, 24-, or 48-hour rest period. Cattle were then fed for 35 days with growth performance data collected weekly. Blood samples were also collected and analyzed for serum infectious bovine rhinotracheitis (IBR) titer and biochemical parameters. Results: Processing time did not impact (P \u3e 0.05) heifer average daily gain. Overall, dry matter intake (DMI) decreased linearly (P = 0.027) as the rest time increased. The number of days for heifers to reach a targeted DMI of 2.5% body weight was linearly increased (P = 0.023) as time of rest increased. Serum IBR titer for heifers processed at either 0 or 6 hours upon arrival was higher (P \u3c 0.01) on day 35 compared to day 0. This response was expected, as these cattle were vaccinated immediately or shortly after arrival. Interestingly, no difference in IBR titer was observed (P \u3e 0.05) between day 0 and day 35 for heifers processed at either 24 or 48 hours upon arrival, indicating potential seroconversion of IBR antibodies before vaccination. The Bottom Line: These results indicate that rest time after arrival and prior to processing may not affect calf growth performance, but there is evidence that a 6-hour rest period could maximize DMI upon arrival to a feedlot. Additional research with greater replication and more industry-standard experimental conditions should be conducted to further evaluate these parameters

Portal drained visceral flux, hepatic metabolism, and mammary uptake of free and peptide-bound amino acids and milk amino acid output in dairy cows fed diets containing corn grain steam flaked at 360 orsteam rolled at 490 g/L.

Objectives were to measure net fluxes of free (FAA) and peptide bound amino acids (AA) (PBAA) across portal-drained viscera (PDV), liver, splanchnic, and mammary tissues, and of milk AA output of lactating Holstein cows (n = 6, 109 +/- 9 d in milk) as influenced by flaking density of corn grain. Cows were fed alfalfa-based total mixed ration (TMR) containing 40% steam-flaked (SFC) or steam-rolled corn (SRC) grain. The TMR were offered at 12-h intervals in a crossover design. Six sets of blood samples were obtained from indwelling catheters in portal, hepatic, and mammary veins and mesenteric or costoabdominal arteries every 2 h from each cow and diet. Intake of dry matter (18.4 +/- 0.4 kg/d), N, and net energy for lactation were not altered by corn processing. Milk and milk crude protein yields (kg/12-h sampling) were 14.2 vs. 13.5 and 0.43 vs. 0.39 for cows fed SFC or SRC, respectively. The PDV flux of total essential FAA was greater (571.2 vs. 366.4 g/12 h, SEM 51.4) in cows fed SFC. The PDV flux of total essential PBAA was 69.3 +/- 10.8 and 51.5 +/- 13.2 g/12 h for cows fed SFC and SRC, respectively, and differed from zero, but fluxes of individual PBAA rarely differed between treatments. Liver flux of essential FAA was greater in cows fed SRC, but only the PBAA flux in cows fed SRC differed from zero. Splanchnic flux of FAA and PBAA followed the pattern of PDV flux, but variation was greater. Mammary uptake (g/12 h) of total essential FAA was greater in cows fed SFC than SRC (224.6 vs. 198.3, SEM 7.03). Mammary uptake of essential PBAA was 25.0 vs. 15.1, SEM 5.2, g/12 h for cows fed SFC or SRC, respectively, and differed from zero in half of the PBAA. Milk output of EAA was 187.8 vs 175.4, SEM 4.4 g/12 h in cows fed SFC and SRC, respectively, and output of most essential AA consistently tended to be greater in cows fed SFC. It is apparent that PBAA comprise a portion of total AA flux across PDV and are affected by grain processing. Further, this pool supplies an important component of AA taken up by the mammary gland. Quantifying the contribution of PBAA may improve diet formulation with respect to intestinal absorption and mammary uptake of AA

Multiwavelength studies of MHD waves in the solar chromosphere: An overview of recent results

The chromosphere is a thin layer of the solar atmosphere that bridges the relatively cool photosphere and the intensely heated transition region and corona. Compressible and incompressible waves propagating through the chromosphere can supply significant amounts of energy to the interface region and corona. In recent years an abundance of high-resolution observations from state-of-the-art facilities have provided new and exciting ways of disentangling the characteristics of oscillatory phenomena propagating through the dynamic chromosphere. Coupled with rapid advancements in magnetohydrodynamic wave theory, we are now in an ideal position to thoroughly investigate the role waves play in supplying energy to sustain chromospheric and coronal heating. Here, we review the recent progress made in characterising, categorising and interpreting oscillations manifesting in the solar chromosphere, with an impetus placed on their intrinsic energetics.Comment: 48 pages, 25 figures, accepted into Space Science Review

PREDICTING THE SUMMER TEMPERATURE OF SMALL STREAMS IN SOUTHWESTERN WISCONSIN 1

One of the biggest challenges in managing cold water streams in the Midwest is understanding how stream temperature is controlled by the complex interactions among meteorologic processes, channel geometry, and ground water inflow. Inflow of cold ground water, shade provided by riparian vegetation, and channel width are the most important factors controlling summer stream temperatures. A simple screening model was used to quantitatively evaluate the importance of these factors and guide management decisions. The model uses an analytical solution to the heat transport equation to predict steady-state temperature throughout a stream reach. The model matches field data from four streams in southwestern Wisconsin quite well (typically within 1°C) and helps explain the observed warming and cooling trends along each stream reach. The distribution of ground water inflow throughout a stream reach has an important influence on stream temperature, and springs are especially effective at providing thermal refuge for fish. Although simple, this model provides insight into the importance of ground water and the impact different management strategies, such as planting trees to increase shade, may have on summer stream temperature.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74032/1/j.1752-1688.2005.tb03714.x.pd

Sensory Input Pathways and Mechanisms in Swallowing: A Review

Over the past 20 years, research on the physiology of swallowing has confirmed that the oropharyngeal swallowing process can be modulated, both volitionally and in response to different sensory stimuli. In this review we identify what is known regarding the sensory pathways and mechanisms that are now thought to influence swallowing motor control and evoke its response. By synthesizing the current state of research evidence and knowledge, we identify continuing gaps in our knowledge of these mechanisms and pose questions for future research