Early office-based vs late hospital-based nasolacrimal duct probing. A clinical decision analysis

BACKGROUND: Controversy exists regarding the treatment of infants with symptomatic nasolacrimal duct obstruction. One philosophy advocates "early" nasolacrimal duct probing, generally in the office. An alternate strategy advocates medical management until the infant is approximately 12 months old to allow for spontaneous resolution, with those with persistent nasolacrimal duct obstruction usually treated by "late" probing in the hospital with the use of general anesthesia. METHODS: We used clinical decision analysis to compare these two opposing treatment strategies. A decision tree was constructed with the usual designations for probability nodes and decision points, comparing early probing at 6 months of age in the office and late probing at 12 months of age in the hospital. The initial decision point thus addressed treatment of children who still had symptomatic nasolacrimal duct obstruction at 6 months of age. One repeated probing under same-strategy conditions was performed for patients in whom initial office probing failed. Values for probability nodes were derived from the ophthalmic literature, including a 70% rate of spontaneous resolution of nasolacrimal duct obstruction between the ages of 6 and 12 months. RESULTS: Both the early office probing strategy and the late hospital probing strategy yielded success rates greater than 99%. Based on prevailing fees, the late hospital strategy cost $2,310,000 more than the early office strategy per 10,000 patients, even though fewer procedures were performed. CONCLUSION: Early office probing and late hospital probing have similar high success rates, albeit at a higher cost for the late hospital probing strategy.     

Effects of shear elasticity on sea bed scattering: numerical examples

It is known that marine sediments can support both compressional and shear waves. However, published work on scattering from irregular elastic media has not examined the influence of shear on sea bed scattering in detail. A perturbation model previously developed by the authors for joint roughness-volume scattering is used to study the effects of elasticity for three sea bed types: sedimentary rock, sand with high shear speed, and sand with "normal" shear wave speed. Both bistatic and monostatic cases are considered. For sedimentary rock it is found that shear elasticity tends to increase the importance of volume scattering and decrease the importance of roughness scattering relative to the fluid case. Shear effects are shown to be small for sands.     

Two-Photon Fluorescence Excitation Cross Sections of Biomolecular Probes from 690 to 960 nm

We report on two-photon fluorescence excitation (TPE) action cross sections for five widely used molecular fluorophores. Measurements were performed by use of ultrashort (~100-fs) Ti:sapphire pulsed excitation over the range 690-960 nm. TPE spectra were obtained by comparison with a fluorescein calibration standard. Large cross sections were found for the cyanine reagent Cy 3 (~140 GM) and for Rhodamine 6G (~150 GM), both at 700 nm [1 GM = 10(-50) (cm(4) s)/photon]. Several fluorophores show interesting and desirable blue shifts with respect to twice the one-photon absorption wavelength. Fluorophore fluorescence intensities showed no significant departure (?4%) from quadratic illumination power dependence, indicating genuine two-photon processes. Implications of these measurements for two-photon laser-scanning microscopy are discussed.     

Surgical anatomy for endoscopic subfascial division of perforating veins

PURPOSE: This study was undertaken to define the surgical anatomy of the medial perforating veins (PVs) of the leg and to provide information on how to gain access to all medial PVs from the superficial posterior compartment during a subfascial endoscopic procedure. METHODS: The venous anatomy of 40 limbs (from 23 cadavers) were studied. Medial PVs located between the ankle and the tibial tuberosity were dissected. None of the subjects had pathologic evidence of venous disease. Each PV's type (direct or indirect), size (< 1 mm, 1 to 2 mm, > 2 mm), location (distances from ankle [D1], and tibia [D2]), and accessibility from the superficial posterior compartment were recorded. RESULTS: Five hundred fifty-two PVs were identified (mean, 13.8; range, 7 to 22). Two hundred eighty-seven PVs (52%) directly connected the superficial with the deep systems, 228 (41%) were indirect muscle perforators, and 37 PVs (7%) were undetermined. One hundred thirty-seven PVs (25%) were > 2 mm. Sixty-three percent of PVs were accessible from the superficial posterior compartment. In the distal half of the leg, two groups of direct PVs could be identified (Cockett II: D1, 7 to 9 cm; Cockett III: D1, 10 to 12 cm). In the proximal half of the leg, paratibial direct PVs (D2 < or = 1 cm) were found clustered in three groups (D1, 18 to 22 cm; D1, 23 to 27 cm; D1, 28 to 32 cm). CONCLUSIONS: Our study confirmed the presence of the Cockett II and III PVs and three groups of proximal paratibial PVs, including the "24-cm" perforators. Two thirds of the medial direct PVs are accessible for endoscopic division from the superficial posterior compartment. To divide paratibial PVs, however, incision of the paratibial deep fascia is frequently required.     

Critical appraisal by reading for medical students--a case study from Pakistan

Doctors read literature to keep abreast of medical advances. A recommendation from the 1993 World Summit for Medical Education is that medical schools should teach medical students to critically appraise scientific reports. The Department of Community Health Sciences of Aga Khan University Medical College teaches basic research methods to medical students. This is now supplemented with "Critical Reading". Critical reading was first taught to 67 third year students between October, 1993 and May, 1994. A "validity check-list for critical readers" was introduced in a two week orientation consisting of three one-hour classroom sessions and four one-hour small group sessions. Thereafter, small groups met monthly to critique clinical epidemiological reports relevant to current organ system teaching. The students reading attitudes and critical appraisal skills were assessed through continuous assessment and a written final examination with questionnaire. All but three students passed the final examination (mean score (74%, standard deviation 12%). Sixty-four of 67 (96%) completed questionnaires. All (73% strongly) agreed that critical reading skills were essential, but only 30% strongly agreed that they had, indeed, mastered the skills. Ninety-seven percent (56% strongly) disagreed that year three was too early to start critical reading. Clinical teaching staff expressed interest in learning these skills. Students benefited from and enjoyed this first critical reading course. It strengthened ties between clinical and community health sciences teaching staff. The critical reading skills of the clinical teaching staff is being addressed in seminars to strengthen institutional research capacity.     

Protein topology of presenilin 1

Mutations in a gene encoding a multitransmembrane protein, termed presenilin 1 (PS1), are causative in the majority of early-onset cases of AD. To determine the topology of PS1, we utilized two strategies: first, we tested whether putative transmembranes are sufficient to export a protease-sensitive substrate across a lipid bilayer; and second, we examined the binding of antibodies to specific PS1 epitopes in cultured cells selectively permeabilized with the pore-forming toxin, streptolysin-O. We document that the "loop," N-terminal, and C-terminal domains of PS1 are oriented toward the cytoplasm.     

Feature-subspace aggregating: ensembles for stable and unstable learners

This paper introduces a new ensemble approach, Feature-Subspace Aggregating (Feating), which builds local models instead of global models. Feating is a generic ensemble approach that can enhance the predictive performance of both stable and unstable learners. In contrast, most existing ensemble approaches can improve the predictive performance of unstable learners only. Our analysis shows that the new approach reduces the execution time to generate a model in an ensemble through an increased level of localisation in Feating. Our empirical evaluation shows that Feating performs significantly better than Boosting, Random Subspace and Bagging in terms of predictive accuracy, when a stable learner SVM is used as the base learner. The speed up achieved by Feating makes feasible SVM ensembles that would otherwise be infeasible for large data sets. When SVM is the preferred base learner, we show that Feating SVM performs better than Boosting decision trees and Random Forests. We further demonstrate that Feating also substantially reduces the error of another stable learner, k-nearest neighbour, and an unstable learner, decision tree.     

Autonomous robot manipulator-based exploration and mapping system for bridge maintenance

This paper presents a system for Autonomous eXploration to Build A Map (AXBAM) of an unknown, 3D complex steel bridge structure using a 6 degree-of-freedom anthropomorphic robot manipulator instrumented with a laser range scanner. The proposed algorithm considers the trade-off between the predicted environment information gain available from a sensing viewpoint and the manipulator joint angle changes required to position a sensor at that viewpoint, and then obtains collision-free paths through safe, previously explored regions. Information gathered from multiple viewpoints is fused to achieve a detailed 3D map. Experimental results show that the AXBAM system explores and builds quality maps of complex unknown regions in a consistent and timely manner.     

Why Audit a Web Server?: Auditing Web servers: IIS 4.0 — Part 1

A Web server is a wonderful business communication channel — it relays information cheaply, conveniently and, in theory, to almost everyone. Traditionally, in my experience at least, the Web is not an area auditors have taken particularly seriously: until recently, it has not been used to transact business, but simply to publicize the organization. Most companies run their Web applications on a firewall interface or interfaces outside the internal network, so the audit, more concerned with the core business applications, could rely on the firewall to protect against hackers, and treat the Web server as, at worst, a bastion host.     

The Australian Incident Monitoring Study. Oesophageal intubation: an analysis of 2000 incident reports

There were 35 oesophageal intubations in the first 2000 incidents reported to the Australian Incident Monitoring Study (AIMS). These reports confirm existing impressions that misplacement of the endotracheal tube can occur in trained as well as untrained hands, and that auscultation is an unreliable test. On the other hand, the value of capnography is emphasised, with no false positives in the 16 cases in which the instrument was used. There was one false negative. Over the 4 years of the AIMS study, reports have declined in frequency. It is possible that the early detection of oesophageal intubation by capnography has altered its status to the extent that anaesthetists no longer regard it as a "critical" incident. It is highly recommended that the presence of the expected concentration of carbon dioxide in expired air be confirmed by capnography immediately after any endotracheal intubation.