Surgical Repair of Umbilical and Inguinal Hernias in the Bovine

Many different techniques have been described for hernia repair and all are aimed at securing the same result, a firm union of the opposing edges of the hernial ring

A depth camera-based system for estimating cyclist-bike projected frontal area

A major component of total resistive force in cycling is aerodynamic drag. For speeds greater than ~14 m/s aerodynamic drag accounts for approximately 90% of total resistive force (Debraux et al., 2009: International Journal of Sports Medicine, 30, 266-272). Together with the air density, the coefficient of drag and the velocity of the cyclist-bike, an important determinant of aerodynamic drag is projected frontal area. Several techniques have been used to estimate the projected frontal area of a cyclist-bike, including the weighing of photographs and image digitising (Debraux et al., 2009). These techniques are similar as they involve extracting the cyclist-bike from a two-dimensional (2D) image and using scaling information from a plane of known dimensions. With the weighing photographs method this is done physically using sensitive weighing scales whereas image processing software is used for the image digitising technique. Both techniques require the collection of a calibration plane, involve considerable post-processing and cannot be performed in real time. We have developed a depth camera-based system for estimating cyclist-bike projected frontal area which addresses these issues. The depth camera algorithm works by creating a metrically scaled, three-dimensional point cloud of the cyclist-bike. The point cloud is projected on to a 2D representation of the scene and the area of the point cloud is calculated using a technique similar to ‘voxelization’; points in the cloud occupy spaces in a fine grid – the sum of the occupied grid spaces gives total area. The aim of this study was to investigate the agreement between our new method and the image digitising technique.After institutional ethics approval, eight regular cyclists volunteered to participate and provided written informed consent. Participants wore their normal cycling clothing and their bicycle was mounted on a stationary indoor trainer. The bicycle was positioned against a white background to help with the image digitising method. Participants placed their feet on the pedals and held the cranks parallel to the floor. A digital camera (Canon EOS 400D, 10.1 megapixel) and Kinect depth camera (Microsoft, Redmond, WA, USA) were mounted on tripods at a height of 1.1 m and positioned 5 m and 2.2 m in front of the participant, respectively. Similar to Debraux et al. (2009), participants adopted two positions on the bike: 1. Upright – upright torso with hands close to the stem and 2. Drops Position – hands on the drops. Three repeat captures were performed in each position, with the participant relaxing between each capture. The digitising method was performed as described by Debraux et al. (2009). Agreement between methods was assessed using limits of agreement (LOA - Bland and Altman, 1986: Lancet, 1, 307-310). A two-way repeated measures analysis of variance (method by position) was used to assess the effect of cyclist position on the systematic difference between measurement methods.There was no interaction between cyclist position and measurement method (p = 0.201) indicating that the same effect of cyclist position was observed using both measurement techniques. A significant main effect for cyclist position (p = 0.017) indicated that projected frontal area was smaller with hands on the drops (upright: 0.485 m2, drops: 0.434 m2). There was also a significant main effect for measurement method (p < 0.001) indicating a significantly smaller estimation of projected frontal area using the Kinect (Kinect: 0.416 m2, Image: 0.503 m2). A predominantly systematic difference between methods was also suggested by the LOA analysis (upright: 0.086 ± 0.029 m2, drops: 0.090 ± 0.033 m2).The aim of this study was to assess the agreement between a common method of estimating cyclist-bike frontal area and a new depth camera-based technique. The new technique estimated systematically smaller projected frontal area than the image digitisation method but there was relatively little random variation and the same effect of cyclist position was observed with both techniques. Which technique gives the most accurate estimate of projected frontal area is not clear as the image digitisation technique - to which the new technique was compared - has associated errors e.g. identification of the cyclist-bike outline and out-of-plane errors. However, it was apparent during testing that the depth camera-based system often failed to identify parts of the bike and this is most likely the cause of the difference between techniques. Regardless, the results of this study suggest that the new technique can be used to assess changes in projected frontal area – as the cyclist changes position, for example. Further, the new technique offers the possibility of analysing changes in projected frontal area in real time – there is no requirement for calibration or post-processing

Muscling selection in swine and its effect on carcass traits

We are attempting to develop a well-muscled line of Durocs by selecting for minimum back fat and maximum loin eye area as estimated by the Anscan and to form a control line by randomly selecting from the same base population. The lines will be compared for performance and carcass traits, including incidence of pale soft exudative carcasses. Expected and realized heritability estimates for carcass traits will be calculated.; Swine Day, Manhattan, KS, November 2, 197

Selection for muscling in swine and its effect on carcass traits

Line differences in weight, litter size at different ages, and in age, loin eye area, and backfat thickness of pigs (adjusted to 200 pounds live weight) were not significant. Sex differences in weight and backfat thickness were significant. Dam groups of progeny differed significantly (P\u3c.0l) in-weights at birth and at 14 and 28 days old and in age, loin eye area, and backfat thickness adjusted to 220 pounds live weight. Hams produced by barrows in the select line were significantly (P\u3c.0l) darker and firmer than those from barrows in the control line.; Swine Day, Manhattan, KS, November 14, 197

Muscling selection in swine and its effect on carcass traits

Pigs farrowed in May, 1972, were the first born in the select and control lines. Performances of animals in the two lines were essentially the same. However, ham firmness and color differed significantly (P\u3c0.0l) between lines, with those in the select line firmer and darker than those from the control line.; Swine Day, Manhattan, KS, November, 197

Value of individual surgeon performance metrics as quality assurance measures in oesophagogastric cancer surgery

Background Surgeon‐level operative mortality is widely seen as a measure of quality after gastric and oesophageal resection. This study aimed to evaluate this alongside a compound‐level outcome analysis. Methods Consecutive patients who underwent treatment including surgery delivered by a multidisciplinary team, which included seven specialist surgeons, were studied. The primary outcome was death within 30 days of surgery; secondary outcomes were anastomotic leak, Clavien–Dindo morbidity score, lymph node harvest, circumferential resection margin (CRM) status, disease‐free (DFS), and overall (OS) survival. Results The median number of annual resections per surgeon was 10 (range 5–25), compared with 14 (5–25) for joint consultant teams (P = 0·855). The median annual surgeon‐level mortality rate was 0 (0–9) per cent versus an overall network annual operative mortality rate of 1·8 (0–3·7) per cent. Joint consultant team procedures were associated with fewer operative deaths (0·5 per cent versus 3·4 per cent at surgeon level; P = 0·027). The median surgeon anastomotic leak rate was 12·4 (range 9–20) per cent (P = 0·625 versus the whole surgical range), overall morbidity 46·5 (31–60) per cent (P = 0·066), lymph node harvest 16 (9–29) (P < 0·001), CRM positivity 32·0 (16–46) per cent (P = 0·003), 5‐year DFS rate 44·8 (29–60) per cent and OS rate 46·5 (35–53) per cent. No designated metrics were independently associated with DFS or OS in multivariable analysis. Conclusion Annual surgeon‐level metrics demonstrated wide variations (fivefold), but these performance metrics were not associated with survival

Collaborative action for person-centred coordinated care (P3C): an approach to support the development of a comprehensive system-wide solution to fragmented care

BACKGROUND: Fragmented care results in poor outcomes for individuals with complexity of need. Person-centred coordinated care (P3C) is perceived to be a potential solution, but an absence of accessible evidence and the lack of a scalable 'blue print' mean that services are 'experimenting' with new models of care with little guidance and support. This paper presents an approach to the implementation of P3C using collaborative action, providing examples of early developments across this programme of work, the core aim of which is to accelerate the spread and adoption of P3C in United Kingdom primary care settings. METHODS: Two centrally funded United Kingdom organisations (South West Collaboration for Leadership in Applied Health Research and Care and South West Academic Health Science Network) are leading this initiative to narrow the gap between research and practice in this urgent area of improvement through a programme of service change, evaluation and research. Multi-stakeholder engagement and co-design are core to the approach. A whole system measurement framework combines outcomes of importance to patients, practitioners and health organisations. Iterative and multi-level feedback helps to shape service change while collecting practice-based data to generate implementation knowledge for the delivery of P3C. The role of the research team is proving vital to support informed change and challenge organisational practice. The bidirectional flow of knowledge and evidence relies on the transitional positioning of researchers and research organisations. RESULTS: Extensive engagement and embedded researchers have led to strong collaborations across the region. Practice is beginning to show signs of change and data flow and exchange is taking place. However, working in this way is not without its challenges; progress has been slow in the development of a linked data set to allow us to assess impact innovations from a cost perspective. Trust is vital, takes time to establish and is dependent on the exchange of services and interactions. If collaborative action can foster P3C it will require sustained commitment from both research and practice. This approach is a radical departure from how policy, research and practice traditionally work, but one that we argue is now necessary to deal with the most complex health and social problems

Histoplasmosis infection in patients with rheumatoid arthritis, 1998-2009

<p>Abstract</p> <p>Background</p> <p>Patients with rheumatic diseases including rheumatoid arthritis (RA) are at increased risk for infections related to both the disease and its treatments. These include uncommonly reported infections due to histoplasmosis.</p> <p>Methods</p> <p>Medical record review of all patients with a diagnosis of RA who developed new histoplasmosis infection in an endemic region between Jan 1, 1998 and Jan 30, 2009 and who were seen at Mayo Clinic in Rochester, Minnesota was performed.</p> <p>Results</p> <p>Histoplasmosis was diagnosed in 26 patients. Most patients were on combination therapies; 15 were on anti-tumor necrosis factor (anti-TNF) agents, 15 on corticosteroids and 16 on methotrexate. Most received more than 6 months of itraconazole and/or amphotericin treatment. Two patients died of causes unrelated to histoplasmosis. Anti-TNF treatment was restarted in 4/15 patients, with recurrence of histoplasmosis in one.</p> <p>Conclusions</p> <p>In this largest single center series of patients with RA and histoplasmosis in the era of immunomodulatory therapy, we found that most patients had longstanding disease and were on multiple immunomodulatory agents. Most cases were pulmonary; typical signs and symptoms of disease were frequently lacking.</p

The Effect of Arc Proximity on Hydrothermal Activity Along Spreading Centers: New Evidence From the Mariana Back Arc (12.7°N-18.3°N)

Back-arc spreading centers (BASCs) form a distinct class of ocean spreading ridges distinguished by steep along-axis gradients in spreading rate and by additional magma supplied through subduction. These characteristics can affect the population and distribution of hydrothermal activity on BASCs compared to mid-ocean ridges (MORs). To investigate this hypothesis, we comprehensively explored 600 km of the southern half of the Mariana BASC. We used water column mapping and seafloor imaging to identify 19 active vent sites, an increase of 13 over the current listing in the InterRidge Database (IRDB), on the bathymetric highs of 7 of the 11 segments. We identified both high and low (i.e., characterized by a weak or negligible particle plume) temperature discharge occurring on segment types spanning dominantly magmatic to dominantly tectonic. Active sites are concentrated on the two southernmost segments, where distance to the adjacent arc is shortest (48 mm/yr), and tectonic extension is pervasive. Re-examination of hydrothermal data from other BASCs supports the generalization that hydrothermal site density increases on segments <90 km from an adjacent arc. Although exploration quality varies greatly among BASCs, present data suggest that, for a given spreading rate, the mean spatial density of hydrothermal activity varies little between MORs and BASCs. The present global database, however, may be misleading. On both BASCs and MORs, the spatial density of hydrothermal sites mapped by high-quality water-column surveys is 2–7 times greater than predicted by the existing IRDB trend of site density versus spreading rate