Investigation and Mitigation of Noise Contributions in a Compact Heterodyne Interferometer.

We present a noise estimation and subtraction algorithm capable of increasing the sensitivity of heterodyne laser interferometers by one order of magnitude. The heterodyne interferometer is specially designed for dynamic measurements of a test mass in the application of sub-Hz inertial sensing. A noise floor of 3.31×10-11m/Hz at 100 mHz is achieved after applying our noise subtraction algorithm to a benchtop prototype interferometer that showed a noise level of 2.76×10-10m/Hz at 100 mHz when tested in vacuum at levels of 3×10-5 Torr. Based on the previous results, we investigated noise estimation and subtraction techniques of non-linear optical pathlength noise, laser frequency noise, and temperature fluctuations in heterodyne laser interferometers. For each noise source, we identified its contribution and removed it from the measurement by linear fitting or a spectral analysis algorithm. The noise correction algorithm we present in this article can be generally applied to heterodyne laser interferometers.

The influence of high fidelity simulation on first responders retention of CPR knowledge.

INTRODUCTION: The purpose of this study was to identify the impact of high-fidelity simulation on the retention of basic life support cardiopulmonary resuscitation (CPR) knowledge among a group of healthcare providers (HCPs). METHODS: A twenty-five question exam was completed by nurses and nurse technicians over a two-year period before and after mandatory CPR training with high-fidelity simulation. RESULTS: Most HCPs scored near 50% or below the passing score (80%) with a mean range of scores between 28% and 84%. HCPs missed questions on the exam that requested specific details related to technique or human physiology during CPR. CONCLUSION: The current teaching method for basic life support may be enhanced by using high-fidelity simulation, but this modality alone is not enough to support HCPs retention of CPR knowledge. Additional studies are needed to identify strategies that will help HCPs remember specific and detailed information in the CPR algorithm.

Using simulation technology to identify gaps between education and practice among new graduate nurses.

Applied knowledge was observed among nurse groups from a medical-surgical residency program to measure clinical performance during simulation training. Twenty groups of new graduate nurses were observed during five simulated clinical scenarios, and their performances were scored on a 24-item checklist. Nurse groups showed significant improvement (p < 0.001) in applied knowledge in four clinical domains from week 1 to week 5, and the results provided valuable information of the groups' overall performances. In two of the five scenarios, poor decisions and prioritization of competing tasks were factors associated with lower performance group scores. Complex patient conditions may pose a challenge for new graduate nurses, and standardized training during the residency program may help instructors recognize specific factors to address during the transition from education to practice.

Situs Inversus Totalis in Laparoscopic Sleeve Gastrectomy: A Case Report.

Obesity is a pathology that is increasing in incidence globally and threatens public health. Currently, one of its most effective treatments is bariatric surgery, which has shown the best long-term results. One of the most frequently performed surgical procedures in this area is laparoscopic sleeve gastrectomy (LSG) or vertical sleeve. It is a restrictive technique that has had positive results in weight loss. Situs inversus totalis (SIT) is a strange condition with a low incidence in which thoracic and abdominal organs are on the opposite side of the already-known anatomic site, seen on a sagittal plane. The high demand for laparoscopic bariatric surgeries predisposes surgeons to find rare congenital anomalies in patients. Low prevalence and the anatomic mirror image condition may be challenging even for expert surgeons. Medical teams need to have knowledge of these cases and adjust the technique and procedure to complete the surgery without complications. We present a SIT case successfully treated with LSG in a male patient in Mexico.

Olive Bud Dormancy Release Dynamics and Validation of Using Cuttings to Determine Chilling Requirement.

Dormancy release dynamics in olive tree (Olea europaea L.) reproductive buds as affected by cold accumulation, tree bearing status, and budburst temperature was studied under natural and controlled conditions, using both cuttings and container- and field-grown plants. The chilling necessary for dormancy release was acquired at different times within the bud population, presenting a progressive pattern of reproductive budburst. Once sufficient chilling is accumulated, 20 °C is a suitable temperature for reproductive budburst, although higher temperature, e.g., 30 °C, during dormancy release can inhibit budburst. While the bearing status of trees determined the amount of return bloom, dormancy release followed a similar pattern for previously bearing and non-bearing trees. Concurrent with investigating budburst factors, the use of shoot cuttings was tested as a method for olive dormancy release studies by contrasting with results from whole trees. It was found it to be valid for studying reproductive budburst, thus providing a useful method to screen chilling requirements in cultivar evaluation and the breeding programs currently ongoing in this species. However, the method was not valid for vegetative budburst, with varying results between cuttings and the whole plant.

Anterolateral S1 screw malposition detected with intraoperative neurophysiological monitoring during posterior lumbosacral fusion.

BACKGROUND: The standard of care is to utilize intraoperative neurophysiological monitoring (IOM) of triggered electromyography (tEMG) during posterior lumbosacral instrumented-fusion surgery. IOM should theoretically signal misplacement of S1 screws into the neural L5-S1 foramen or spinal canal, utilizing screw stimulation, and recording of the lower limb muscles and the anal sphincter. Here, we evaluated when and whether anterolateral S1 screw malposition could be detected by IOM/tEMG during open posterior lumbosacral instrumented fusion surgery. METHODS: tEMG, somatosensory-evoked potential (SSEP), and transcranial electrical motor-evoked potential (TcMEP) data were retrospectively reviewed from 2015 to 2017 during open posterior lumbosacral instrumented fusions. We utilized screw stimulation alert thresholds of <14 mA (tEMG) and recorded from the lower extremity muscles and anal sphincter. Furthermore, all patients underwent routine postoperative computed tomography (CT) scans to confirm the screw location. RESULTS: There were 106 S1 screws placed in 54 patients: 52 bilateral and 2 unilateral. In 6 patients (11.1%), 7 screws (6.6%) registered at low tEMG thresholds. In 1 patient, the postoperative CT scan documented external malposition of the screw despite no intraoperative IOM/tEMG alert. When S1 misplaced screws were stimulated, the most sensitive muscle was the tibialis anterior; the sensitivity of the IOM/tEMG was 87.5%, the specificity was 97.9%, the positive predictive value was 77.8%, and the negative predictive value was 98.9%. TcMEP and SSEP did not change during any of the operations. Notably, no patient developed a new neurological deficit. CONCLUSION: Anterolateral S1 screw malposition can be detected accurately utilizing IOM/tEMG stimulation of screws. When alerts occur, they can largely be corrected by partially backing out the screw (e.g., a few turns) and/ or changing the screw trajectory.

Women's Choice Regarding Breastfeeding and Its Effect on Well-Being.

Because of the many known maternal and neonatal health benefits of breastfeeding, there have been significant efforts to encourage exclusive breastfeeding, and many hospitals follow the guidelines of the Baby-Friendly Hospital Initiative. However, even with the right support, many women are unable to exclusively breastfeed, which may make them feel anxious and/or depressed. Psychological pressure to exclusively breastfeed has the potential to contribute to postpartum depression symptoms in new mothers who are unable to achieve their breastfeeding intentions. In this commentary, we focus on the well-being of the mother-infant dyad and argue for further research on maternal stress related to breastfeeding difficulties or pressure and the need to physically and psychologically assess and support women who are unable to breastfeed successfully or exclusively.

Traumatic spondyloptosis of L3 with incomplete neurological involvement: A case report.

High-energy traumas frequently result in lumbar spine fractures such as spondyloptosis is the maximum expression of instability and severity. The management of spondyloptosis is complex and, essentially, surgical. It usually presents with irreversible neurological compromise. This paper aimed to present a case of lumbar spondyloptosis and its early confrontation, partial neurological involvement, and progressive postoperative retrieval. CLINICAL CASE: A male patient aged 42 years had multiple injuries with asymmetric paraparesis and sphincter involvement. Computed tomography (CT) revealed L3 vertebral spondyloptosis detached from the rest of the spine, spinal canal stenosis, sagittal imbalance, and angular kyphosis. Surgical resolution was defined by performing an en bloc corpectomy through lumbotomy and the installation of an expandable cage with posterior transpedicular fixation of L2-L4, thereby recovering the spinal canal diameter, lumbar lordosis, sagittal balance, and improving motor function progressively. CONCLUSION: Complex spinal injuries warrant an early resolution by a trained surgical team to ensure normal spinal parameters and to achieve a progressive neurological recovery.

Upper thoracic dumbbell-shaped tumor resected in one stage posterior approach: case report.

Upper thoracic tumors may develop spinal cord compression. By surgery at the time of diagnosis, a neurological deficit can be avoided. However, this particular localization requires a double approach to decompress the spinal cord and thoracic structures. The posterior extracavitary approach results in resection of the spinal canal, the foraminal component, and the extraspinal fragment, but is not routinely used by most neurosurgeons. A 56-year-old woman with a two-month history of axial thoracic pain and cough. The patient has a normal neurological examination. Thoracic computed tomography (CT) scan with contrast agent was performed, evincing a dumbbell-shaped tumor on the left T3-T4. Magnetic resonance imaging (MRI) confirms the diagnosis, showing a 4 cm diameter tumor that compresses the spinal cord without myelopathy. The surgery was performed posteriorly, with costotransversectomy, allowing complete resection under intraoperative neurophysiological monitoring. The patient developed no thoracic or neurological complications. One-stage posterior approach is possible and effective during the treatment of the upper thoracic dumbbell-shaped tumors, avoiding a change in surgical position, thoracic morbidity, and dependence on assisting surgeons.

[Complications in diagnostic and therapeutic endoscopic cholangiopancreatography. Prospective study]. / Complicaciones en colangiopancreatografía endoscópica diagnóstica y terapéutica. Estudio prospectivo.

BACKGROUND: Studies of ERCP-related morbidity seldom include a sufficient patient follow-up. The complication rate is variable. AIM: To characterize and to evaluate the frequency of complications in patients after Diagnostic and Therapeutic ERCP. PATIENTS AND METHODS: All patients undergoing ERCP during a 2-year period were included in this prospective study. Complications were assessed at time of ERCP and by personal or telephone contact at 1st, 7, 14 and 30-days after the procedure. RESULTS: A total of 897 ERCPs were included in the analysis, of which 93.9% were therapeutic procedures. 640 were female with age of 49.68 (+/-18.59) and 257 male with age 58.80 (+/-16.67). The 30-day complications rate was 3.19%; the procedure-related mortality rate was 0.11%. Mild hemorrhage occurred in 1.48% and moderate hemorrhage in 0.11%. Post-ERCP pancreatitis occurred in 0.79% and duodenal perforation in 0.45%. The 30-day procedure-no related mortality was 1.14%. CONCLUSION: This prospective study confirms the complications rate of ERCP including therapeutic procedures is low in our experience.

Knowledge and Competency of Nursing Faculty Regarding Evidence-Based Practice.

The Institute of Medicine recommended that 90% of clinical decisions should be evidenced based by 2020. Both the IOM and the American Association of Critical-Care Nurses identified evidenced-based practice (EBP) as a core competency for practice. EBP can reduce costs, improve patient outcomes, and ensure optimal nursing interventions. Because nursing faculty may have deficits in knowledge, attitudes, and competencies to teach EBP, few nursing students conduct EBP reviews. The purpose of this project was to develop EBP educational resources to increase nursing faculty knowledge and competency of EBP in a southeastern college with both a multicultural faculty and student body. A pre- and postsurvey design using Stevens' ACE Star Model of Knowledge Transformation and Evidence Based Practice Readiness Inventory (ACE-ERI) determined the effectiveness of the educational intervention. Results indicated that faculty's self-confidence about their competency in EBP increased significantly from presurvey to postsurvey, t(17) = -2.04, p = .028, but there was no significant change from pretest to posttest, t(17) = -0.576, p =.572, for the EBP knowledge component of ACE-ERI. The results of the study suggest that educational programs for RN-to-BSN faculty are vital in increasing participant's readiness for EBP. J Contin Educ Nurs. 2016;47(9):409-419.

An assessment of CPR skills using simulation: Are first responders prepared to save lives?

The American Heart Association's (AHA) recommendation for biyearly recertification and annual mandatory CPR training may be suboptimal for first responders (nurses and technicians) working in outpatient clinics (American Heart Association, 2013). To determine the efficacy of the AHA guidelines, 40 simulated sudden cardiac arrest (SCA) encounters were conducted followed by debriefing and a subsequent SCA to determine a basic level of CPR proficiency. First responders' CPR skills were evaluated using a 19-item assessment form to quantify the event. A comparison of scores using two different viewing modalities was performed to provide an assessment of the training program. Of the 40 sessions, group mean performance scores for the first encounter were just above the organization's minimum required score of 24. Performance scores increased slightly (27-28) after the second encounter. Proficiency of skills was poor and frequent basic life support training may be indicated to help first responders provide high-quality CPR.

La formación de profesionales nucleares y su contribución al desarrollo de La Habana / The training of nuclear professionals and their contribution to the development of Havana

RESUMEN El presente trabajo muestra el desarrollo que ha tenido la formación de profesionales nucleares en Cuba durante más de treinta y ocho años. Se exponen las características principales de los programas de estudio de las carreras nucleares acreditadas por el sistema nacional de acreditación de la educación superior cubana. Algunos indicadores de la calidad de la formación en ingeniería nuclear, física nuclear y radioquímica, la presencia de la mujer, así como, la contribución de estas carreras al desarrollo de la provincia La Habana a partir de un análisis de la ubicación de sus egresados son presentados.

ABSTRACT This work shows the development that has taken the education of nuclear professionals in Cuba for more than thirty-eight years. The main features of the curriculum for undergraduate specialty for nuclear matters, accredited by the national accreditation system of higher education in Cuba are introduced. Some quality indicators, the women presence and the contribution of the nuclear careers to the development of Havana province beginning from the analysis of graduated distribution in the labor market are discussed.

Anticipación genética en familias cubanas con acné conglobata / Genetic anticipation in Cuban families with acne conglobata

El acné conglobata es una variante grave de acné con una etiología multifactorial. La identificación de cinco familias con esta enfermedad en la región oriental de Cuba aportó evidencias de la existencia de anticipación genética en la misma, sin embargo, no se conocen su frecuencia, magnitud, ni los factores que la influyen o determinan. Este trabajo tiene como objetivo caracterizar el fenómeno de anticipación genética en familias cubanas con acné conglobata. Se realizó un estudio descriptivo en una muestra de 37 pacientes con acné conglobata. El diagnóstico de la enfermedad se estableció sobre criterios clínicos. Se encontró diferencias significativas para la edad de inicio de la enfermedad entre las generaciones (χ2= 12,86; p=0,025). La anticipación tuvo una frecuencia de 100 (percent) y su magnitud varió entre 2 y 32 años con una media de 13,04±8,85 años. Ni el sexo del progenitor transmisor de la enfermedad (p=0,801), ni su edad conceptiva (p=0,197), ni el sexo del descendiente (p=0,20), influyeron significativamente sobre la anticipación genética. Se demostró la ocurrencia de anticipación genética en familias cubanas afectadas por el acné conglobata y que ésta no es influida por el sexo del progenitor transmisor de la enfermedad, la edad conceptiva o el sexo del descendiente…(AU)

Injerto dérmico en la enfermedad de Peyronie: presentación de un caso; revisión de la literatura / Dermic graft in Peyronie's disease: report of a case; review of the literature

La enfermedad de Peyronie presenta 2 vertientes en su tratamiento: médico y quirúrgico. El tratamiento quirúrgico se aplicó a partir de 1827 por Mc Ciellan y hasta el presente han sido muchas las modalidades quirúrgicas empleadas sin obtenerse un consenso general. Se reporta un caso operado de esta afección en el Hospital V.I. Lenin en el que se aplicó la técnica de exéresis de la placa hialinizada del cuerpo cavernoso e injerto dérmico autógeno. Este es el primer paciente alque se aplica esta técnica quirúrgica en nuestro centro. Su evolución al año y medio de operado es satisfactoria. Este reporte enfatiza el valor de la selección correcta del paciente y la anamnesis

Injerto dérmico en la enfermedad de Peyronie. presentación de un caso; revisión de la literatura / Dermic graft in Peyronie's disease: report of a case; review of the literature

La enfermedad de Peyronie presenta 2 vertientes en su tratamiento: médico y quirúrgico. El tratamiento quirúrgico se aplicó a partir de 1827 por Mc Ciellan y hasta el presente han sido muchas las modalidades quirúrgicas empleadas sin obtenerse un consenso general. Se reporta un caso operado de esta afección en el Hospital V.I. Lenin en el que se aplicó la técnica de exéresis de la placa hialinizada del cuerpo cavernoso e injerto dérmico autógeno. Este es el primer paciente alque se aplica esta técnica quirúrgica en nuestro centro. Su evolución al año y medio de operado es satisfactoria. Este reporte enfatiza el valor de la selección correcta del paciente y la anamnesis