MGGHAT: Elliptic PDE software with adaptive refinement, multigrid and high order finite elements

MGGHAT (MultiGrid Galerkin Hierarchical Adaptive Triangles) is a program for the solution of linear second order elliptic partial differential equations in two dimensional polygonal domains. This program is now available for public use. It is a finite element method with linear, quadratic or cubic elements over triangles. The adaptive refinement via newest vertex bisection and the multigrid iteration are both based on a hierarchical basis formulation. Visualization is available at run time through an X Window display, and a posteriori through output files that can be used as GNUPLOT input. In this paper, we describe the methods used by MGGHAT, define the problem domain for which it is appropriate, illustrate use of the program, show numerical and graphical examples, and explain how to obtain the software

Surgical site infection and transfusion rates are higher in underweight total knee arthroplasty patients.

BACKGROUND: Underweight (UW) patients undergoing total hip arthroplasty have exhibited higher complication rates, including infection and transfusion. No study to our knowledge has evaluated UW total knee arthroplasty (TKA) patients. We, therefore, conducted a study to investigate if these patients are at increased risk for complications, including infection and transfusion. METHODS: A case-control study was conducted using a prospectively collected institutional database. Twenty-seven TKA patients were identified as UW (body mass index [BMI] \u3c 18.5 kg/m RESULTS: The average BMI was 17.1 kg/m CONCLUSIONS: Our study demonstrates that UW TKA patients have a higher likelihood of developing SSI and requiring blood transfusions. The specific reasons are unclear, but we conjecture that it may be related to decreased wound healing capabilities and low preoperative hemoglobin. Investigation of local tissue coverage and hematologic status may be beneficial in this patient population to prevent SSI. Based on the results of this study, a prospective evaluation of these factors should be undertaken

A Prospective Evaluation of Opioid Utilization After Upper-Extremity Surgical Procedures: Identifying Consumption Patterns and Determining Prescribing Guidelines.

BACKGROUND: Although adequate management of postoperative pain with oral analgesics is an important aspect of surgical procedures, inadvertent overprescribing can lead to excess availability of opioids in the community for potential diversion. The purpose of our study was to prospectively evaluate opioid consumption following outpatient upper-extremity surgical procedures to determine opioid utilization patterns and to develop prescribing guidelines. METHODS: All patients undergoing outpatient upper-extremity surgical procedures over a consecutive 6-month period had the following prospective data collected: patient demographic characteristics, surgical details, anesthesia type, and opioid prescription and consumption patterns. Analysis of variance and post hoc comparisons were performed using t tests, with the p value for multiple pairwise tests adjusted by the Bonferroni correction. RESULTS: A total of 1,416 patients with a mean age of 56 years (range, 18 to 93 years) were included in the study. Surgeons prescribed a mean total of 24 pills, and patients reported consuming a mean total of 8.1 pills, resulting in a utilization rate of 34%. Patients undergoing soft-tissue procedures reported requiring fewer opioids (5.1 pills for 2.2 days) compared with fracture surgical procedures (13.0 pills for 4.5 days) or joint procedures (14.5 pills for 5.0 days) (p \u3c 0.001). Patients who underwent wrist surgical procedures required a mean number of 7.5 pills for 3.1 days and those who underwent hand surgical procedures required a mean number of 7.7 pills for 2.9 days, compared with patients who underwent forearm or elbow surgical procedures (11.1 pills) and those who underwent upper arm or shoulder surgical procedures (22.0 pills) (p \u3c 0.01). Procedure type, anatomic location, anesthesia type, age, and type of insurance were also all significantly associated with reported opioid consumption (p \u3c 0.001). CONCLUSIONS: In this large, prospective evaluation of postoperative opioid consumption, we found that patients are being prescribed approximately 3 times greater opioid medications than needed following upper-extremity surgical procedures. We have provided general prescribing guidelines, and we recommend that surgeons carefully examine their patients\u27 opioid utilization and consider customizing their opioid prescriptions on the basis of anatomic location and procedure type to prescribe the optimal amount of opioids while avoiding dissemination of excess opioids

Intermediate outcomes after the Fontan procedure in the current era

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Coyotes Go “Bridge and Tunnel”: A Narrow Opportunity to Study the Socio-ecological Impacts of Coyote Range Expansion on Long Island, NY Pre- and Post-Arrival

Currently, Long Island, NY is without a breeding population of northeastern coyote (Canis latras var.), yet recent evidence of dispersing individuals on the island, coupled with the “dogged” momentum of coyote range expansion across North America, suggests a Long Island coyote population is close at hand. We highlighted the fleeting opportunity to takes advantage of this natural experiment by developing a multidisciplinary research framework to investigate the ecological and social impacts of the coyote, pre- and post- range expansion. We reviewed coyote spatial ecology, community ecology, and human dimensions research and identified three components of future investigation: predicting future occupancy, monitoring colonization, testing hypotheses of trophic cascades by leveraging and expanding existing ecological data, and exploring attitudes towards coyotes to better understand and mitigate human-wildlife conflicts. Each proposed component will integrate for a comprehensive investigation to advance theory and applied management of northeastern coyotes

Tocilizumab in early progressive rheumatoid arthritis: FUNCTION, a randomised controlled trial

OBJECTIVES: The efficacy of tocilizumab (TCZ), an anti-interleukin-6 receptor antibody, has not previously been evaluated in a population consisting exclusively of patients with early rheumatoid arthritis (RA). METHODS: In a double-blind randomised controlled trial (FUNCTION), 1162 methotrexate (MTX)-naive patients with early progressive RA were randomly assigned (1:1:1:1) to one of four treatment groups: 4 mg/kg TCZ+MTX, 8 mg/kg TCZ+MTX, 8 mg/kg TCZ+placebo and placebo+MTX (comparator group). The primary outcome was remission according to Disease Activity Score using 28 joints (DAS28-erythrocyte sedimentation rate (ESR) \u3c 2.6) at week 24. Radiographic and physical function outcomes were also evaluated. We report results through week 52. RESULTS: The intent-to-treat population included 1157 patients. Significantly more patients receiving 8 mg/kg TCZ+MTX and 8 mg/kg TCZ+placebo than receiving placebo+MTX achieved DAS28-ESR remission at week 24 (45% and 39% vs 15%; p \u3c 0.0001). The 8 mg/kg TCZ+MTX group also achieved significantly greater improvement in radiographic disease progression and physical function at week 52 than did patients treated with placebo+MTX (mean change from baseline in van der Heijde-modified total Sharp score, 0.08 vs 1.14 (p=0.0001); mean reduction in Health Assessment Disability Index, -0.81 vs -0.64 (p=0.0024)). In addition, the 8 mg/kg TCZ+placebo and 4 mg/kg TCZ+MTX groups demonstrated clinical efficacy that was at least as effective as MTX for these key secondary endpoints. Serious adverse events were similar among treatment groups. Adverse events resulting in premature withdrawal occurred in 20% of patients in the 8 mg/kg TCZ+MTX group. CONCLUSIONS: TCZ is effective in combination with MTX and as monotherapy for the treatment of patients with early RA. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, number NCT01007435

Crew Exploration Vehicle (CEV) Avionics Integration Laboratory (CAIL) Independent Analysis

Two approaches were compared to the Crew Exploration Vehicle (CEV) Avionics Integration Laboratory (CAIL) approach: the Flat-Sat and Shuttle Avionics Integration Laboratory (SAIL). The Flat-Sat and CAIL/SAIL approaches are two different tools designed to mitigate different risks. Flat-Sat approach is designed to develop a mission concept into a flight avionics system and associated ground controller. The SAIL approach is designed to aid in the flight readiness verification of the flight avionics system. The approaches are complimentary in addressing both the system development risks and mission verification risks. The following NESC team findings were identified: The CAIL assumption is that the flight subsystems will be matured for the system level verification; The Flat-Sat and SAIL approaches are two different tools designed to mitigate different risks. The following NESC team recommendation was provided: Define, document, and manage a detailed interface between the design and development (EDL and other integration labs) to the verification laboratory (CAIL)

High Pressure Insulator-Metal Transition in Molecular Fluid Oxygen

We report the first experimental evidence for a metallic phase in fluid molecular oxygen. Our electrical conductivity measurements of fluid oxygen under dynamic quasi-isentropic compression show that a non-metal/metal transition occurs at 3.4 fold compression, 4500 K and 1.2 Mbar. We discuss the main features of the electrical conductivity dependence on density and temperature and give an interpretation of the nature of the electrical transport mechanisms in fluid oxygen at these extreme conditions.Comment: RevTeX, 4 figure