Tactical decisions in the operative treatment of advanced and urgent cases of colorectal cancer

The authors reviewed retrospectively the patients treated in the Clinic of Surgery for colorectal cancer (CRC) during a five-year period (2008-2012). The main purpose was to consider the different tactical decisions for operative treatment in complicated, advanced and urgent cases. There were a total of 706 operated patients who were analyzed according to their age, gender, stage of disease, planned and urgent operative interventions, presence of concomitant diseases, performed operative procedures and mortality rate. The principles of assessment of every different case and those for making decisions for operative tactics and kind of intervention were described. The performed different operations in complicated, advanced and urgent patients were analyzed, too. Conclusions concerning the obtained results and their comparison with literature data available as well as concerning the benefits of differentiated tactical approach to every individual case with CRC were drawn

Pricing and capacity allocation for shared services

We study the pricing and capacity allocation problem of a service provider who serves two distinct customer classes. Customers within each class are inherently heterogeneous in their willingness to pay for service, but their utilities are also affected by the presence of other customers in the system. Specifically, customer utilities depend on how many customers are in the system at the time of service as well as who these other customers are. We find that if the service provider can price discriminate between customer classes, pricing out a class, i.e., operating an exclusive system, can sometimes be optimal and that depends only on classes’ perceptions of each other. If the provider must charge a single price, an exclusive system is even more likely. We extend our analysis to a service provider who can prevent class interaction by allocating separate capacity segments to the two customer classes. Under price discrimination, allocating capacity is optimal if the “net appreciation” between classes, as defined in the paper, is negative. However, under a single–price policy, allocating capacity can be optimal even if this net appreciation is positive. We describe in detail how the nature of asymmetry in classes’ perception of each other determines the optimal strategy

A Hybrid Implementation-Effectiveness Study of a Community Health Worker-Delivered Intervention to Reduce Cardiovascular Disease Risk in a Rural, Underserved Non-Hispanic Black Population: The CHANGE Study

Purpose To evaluate the implementation and effectiveness of the Carolina Heart Alliance Networking for Greater Equity (CHANGE) Program, an adapted evidence-based cardiovascular disease risk reduction intervention delivered by Community Health Workers (CHW) to rural adults. Design Hybrid implementation-effectiveness study with a pre–post design. Setting North Carolina Federally Qualified Health Center and local health department in a rural, medically underserved area. Sample Participants (n = 255) included 87% Non-Hispanic Black with a mean age of 57 years; 84% had diagnosed hypertension, 55% had diabetes, and 65% had hypercholesterolemia. Intervention A CHW-delivered, low-intensity, 4-month behavioral lifestyle intervention promoting a southern-style Mediterranean dietary pattern and physical activity. Measures We measured number and representativeness of participants reached and retained, intervention delivery fidelity, weight, blood pressure, and self-reported dietary and physical activity behaviors. Analysis Pre–post changes at 4 months were analyzed using paired t-tests. Results Study participants completed 90% of planned intervention contacts; 87% were retained. Intervention delivery fidelity measures showed participants receiving a mean of 3.5 counseling visits, 2.7 booster calls, and on average completing 1.7 modules, setting 1.8 goals, and receiving 1.3 referrals per visit. There were significant mean reductions in systolic (−2.5 mmHg, P < .05) and diastolic blood pressure (−2.1 mmHg, P < .01); the proportion of participants with systolic blood pressure <130 increased by 7 % points (P = .05), and diastolic pressure <80 by 9 percentage points (P < .01). Dietary behaviors improved significantly with average weekly servings of nuts increased by .5 serving (P < .0001), and fruits and vegetables by .8 daily serving (P < .0001). Physical activity also increased on average by 45 min./week (P < .001). Weight did not change significantly. Conclusions The CHANGE program showed both implementation and program effectiveness and adds to the evidence supporting CHW-delivered lifestyle interventions to reduce CVD risk among rural, Non-Hispanic Black, and medically underserved populations

Bulk and surface electron dynamics in a p-type topological insulator SnSb2Te4

Under the terms of the Creative Commons Attribution License 3.0 (CC-BY).-- et al.Time-resolved two-photon photoemission was used to study the electronic structure and dynamics at the surface of SnSb2Te4, a p-type topological insulator. The Dirac point is found 0.32±0.03 eV above the Fermi level. Electrons from the conduction band minimum are scattered on a time scale of 43±4 fs to the Dirac cone. From there they decay to the partly depleted valence band with a time constant of 78±5 fs. The significant interaction of the Dirac states with bulk bands is attributed to their bulk penetration depth of ∼3 nm as found from density functional theory calculations.We acknowledge partial support from the Basque Country Government, Departamento de Educacion, Universidades e Investigacion (Grant No. IT-366-07), the Spanish Ministerio de Ciencia e Innovacion (Grant No. FIS2010-19609-C02-00), the Ministry of Education and Science of Russian Federation (Grant No. 2.8575.2013), the Russian Foundation for Basic Research (Grant No. 13-02-12110_ofi_m), and Science Development Foundation under the President of the Republic of Azerbaijan [Grant No. EIF-2011-1(3)-82/69/4-M-50].Peer Reviewe

Family Functioning and Weight Loss in a Sample of African Americans and Whites

Traditionally, weight management behavioral research has focused on individual-level influences, with little attention given to interpersonal factors that relate to the family behavioral context

Ear and Face Mucormycosis; A Case Report.

peer reviewedMucormycosis is an invasive fungal infection belonging to order of Mucorales which causes a high rate of mortality. This infection is mostly common in the immunosuppression conditions such as diabetes mellitus, chemotherapy, organ transplantation and hematologic malignancies

Use of polyethylene glycol coatings for optical fibre humidity sensing

Humidity induced change in the refractive index and thickness of the polyethylene glycol (PEG) coatings are in situ investigated for a range from 10 to 95%, using an optical waveguide spectroscopic technique. It is experimentally demonstrated that, upon humidity change, the optical and swelling characteristics of the PEG coatings can be employed to build a plastic fibre optic humidity sensor. The sensing mechanism is based on the humidity induced change in the refractive index of the PEG film, which is directly coated onto a polished segment of a plastic optical fibre with dip-coating method. It is observed that PEG, which is a highly hydrophilic material, shows no monotonic linear response to humidity but gives different characteristics for various ranges of humidity levels both in index of refraction and in thickness. It undergoes a physical phase change from a semi-crystal line structure to a gel one at around 80% relative humidity. At this phase change point, a drastic decrease occurs in the index of refraction as well as a drastic increase in the swelling of the PEG film. In addition, PEG coatings are hydrogenated in a vacuum chamber. It is observed that the hydrogen has a preventing effect on the humidity induced phase change in PEG coatings. Finally, the possibility of using PEG coatings in construction of a real plastic fibre optic humidity sensor is discussed. (C) 2008 The Optical Society of Japan

Epidural Hematoma Following Cervical Spine Surgery.

STUDY DESIGN: A multicentered retrospective case series. OBJECTIVE: To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine. METHODS: Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified. RESULTS: A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76%. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66%) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33%) who had no delay in the diagnosis or treatment (P = .53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation. CONCLUSION: This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements