Surgical assessment of the geriatric oncology patient

BACKGROUND: The aging population in the United States will correlate with an increased number of cancer diagnoses as cancer is primarily a disease of the elderly. Providing this ever-growing group of individuals with quality surgical management, while taking into account the unique needs and desires of this cohort, is a great challenge facing both geriatricians and surgeons going forward. The best approach to ensure that oncogeriatric patients receive the best tailored treatment is through the completion of a pre-surgical geriatric assessment. However, only a minority of oncogeriatric patients is undergoing a comprehensive pre-surgical geriatric assessment despite the majority of geriatricians and surgeons acknowledging its importance in order to properly risk stratify their patients. LITERATURE REVIEW FINDINGS: Multiple theories exist as to why geriatric assessments are not being utilized more frequently, but the most probable answer is that these assessments are very time-consuming, making it virtually impossible for incorporation into a healthcare provider’s busy schedule. Comprehensive literature review regarding geriatric assessments amongst the oncogeriatric population found that the most sensitive and specific domains of the geriatric assessments predicting morbidity and mortality include Frailty Index, Social Support Survey, Mini-Nutritional Assessment, and Geriatric Depression Screening. PROPOSED METHODS: A novel educational intervention will be proposed to teach Physician Assistant and Medical Students about the domains of the geriatric assessment most predictive of post-surgical risk during their surgical clerkship. The curriculum will utilize both simulation- and competency-based education training under the guidance of geriatricians and surgeons. Students will first learn the necessary skills in a controlled classroom environment and then proceed to incorporate these skills during their clerkship with patients on their service. CONCLUSIONS: The goal of the proposed method is to instill the confidence and skills necessary to provide an accurate geriatric assessment for oncogeriatric patients in future clinicians. The field of geriatric oncology is going to grow exponentially in the up-coming years and familiarizing future clinicians with the most predictive domains regarding surgical outcome will improve treatment outcomes for oncogeriatric patients in the immediate and foreseeable future

ExaGridPF: A Parallel Power Flow Solver for Transmission and Unbalanced Distribution Systems

This paper investigates parallelization strategies for solving power flow problems in both transmission and unbalanced, three-phase distribution systems by developing a scalable power flow solver, ExaGridPF, which is compatible with existing high-performance computing platforms. Newton-Raphson (NR) and Newton-Krylov (NK) algorithms have been implemented to verify the performance improvement over both standard IEEE test cases and synthesized grid topologies. For three-phase, unbalanced system, we adapt the current injection method (CIM) to model the power flow and utilize SuperLU to parallelize the computing load across multiple threads. The experimental results indicate that more than 5 times speedup ratio can be achieved for synthesized large-scale transmission topologies, and significant efficiency improvements are observed over existing methods for the distribution networks

Comparison Tables of State Nutrient Trading Programs in the Chesapeake Bay Watershed

Examines opportunities for wastewater treatment plants to trade credits or offsets with other plants or farms releasing lower volumes of nutrients across states. Compares design elements of programs in Maryland, Pennsylvania, Virginia, and West Virginia

Image Processing Instrumentation for Giardia lamblia Detection

Currently, the identification and enumeration of Giardia Iamblia cysts are based upon microscopic methods requiring individuals proficient in this area. It is a tedious process which consumes time that could be constructively used elsewhere. This project attempts to alleviate that burden by employing a computer to automatically process Indirect Fluorescent Antibody (IFA) prepared slides using digital image processing techniques. A computer controlled frame grabber, in conjunction with a CCD TV camera mounted on the epi-fluorescence microscope phototube, captures the light intensities of the objects in view under the microscope objective. The captured image is stored as pixels, with each pixel having a numerical value that can be altered using linear contrast enhancement and bit-slicing to emphasize the cysts and eliminate the majority of unwanted objects from the image. The altered image is then analyzed by a vector trace routine for typical area and perimeters characteristic to Giardia lamblia cysts. Objects in the image matching these characteristics are most likely cysts and are added to a running tally of the number of cysts present on the slide