Showing papers by "Saint Francis University published in 2022"

A Longer Route to the PICU Can Lead to a Longer Stay in the PICU: A Single-Center Retrospective Cohort Study.

Abstract: Introduction:Admission to the pediatric ICU versus general pediatric floor for patients is a significant triage decision for emergency department physicians. Escalation of care within 24 hours of h...

Quality of life and clinical characteristics of self‐improving congenital ichthyosis within the disease spectrum of autosomal‐recessive congenital ichthyosis

Abstract: Autosomal-recessive congenital ichthyosis (ARCI) is a heterogeneous group of ichthyoses presenting at birth. Self-improving congenital ichthyosis (SICI) is a subtype of ARCI and is diagnosed when skin condition improves remarkably (within years) after birth. So far, there are sparse data on SICI and quality of life (QoL) in this ARCI subtype. This study aims to further delineate the clinical spectrum of SICI as a rather unique subtype of ARCI.This prospective study included 78 patients (median age: 15 years) with ARCI who were subdivided in SICI (n = 18) and non-SICI patients (nSICI, n = 60) by their ARCI phenotype.Quality of life (QoL) was assessed using the (Children's) Dermatology Life Quality Index. Statistical analysis was performed with chi-squared and t-Tests.The genetically confirmed SICI patients presented causative mutations in the following genes: ALOXE3 (8/16; 50.0%), ALOX12B (6/16; 37.5%), PNPLA1 (1/16; 6.3%) and CYP4F22 (1/16; 6.3%). Hypo-/anhidrosis and insufficient vitamin D levels (<30 ng/mL) were often seen in SICI patients. Brachydactyly (a shortening of the 4th and 5th fingers) was statistically more frequent in SICI (P = 0.023) than in nSICI patients. A kink of the ear's helix was seen in half of the SICI patients and tends to occur more frequently in patients with ALOX12B mutations (P = 0.005). QoL was less impaired in patients under the age of 16, regardless of ARCI type.SICI is an underestimated, milder clinical variant of ARCI including distinct features such as brachydactyly and kinking of the ears. Clinical experts should be aware of these features when seeing neonates with a collodion membrane. SICI patients should be regularly checked for clinical parameters such as hypo-/anhidrosis or vitamin D levels and monitored for changes in quality of life.

Gas Injection for Pressure Maintenance in Fractured Reservoirs

Abstract: Gas injection into the gas cap which is known as pressure maintenance or crestal gas injection is done to increase the reservoir pressure. Different types of gas may be injected in this method including producing gas, N2, CO2 etc. The injected gas is chosen base on the field development studies. Each of these gases has some advantage and disadvantages. Gas injection in naturally fractured reservoirs is a challenge which needs more investigation on this subject. This chapter summarizes the basic concepts of pressure maintenance and active mechanisms during pressure maintenance in naturally fractured reservoirs. Also, this chapter provides the essential concepts in simulation of pressure maintenance in fractured reservoirs.

Ted Corbitt

Abstract: Sports would be another location where myths linger in the stories told about the movements of athletes and the devotion of fans. Names such as Ted Corbitt figure prominently in this refiguring of the running boom’s mythology. The importance of Corbitt’s recovery is that it demonstrates a collective effort to address the lasting problem of racial inequity within the sport of distance running. In American history, the conventional image of a pioneer relates to the nineteenth-century agent of westward expansion, the breaker of frontier soil, and the remover of native populations. For Corbitt, running was more than a means for fitness and competition, naming it instead as the perfect setting to feed his “fierce competitive spirit.” Corbitt witnessed and participated in these institutional struggles, but he also dealt with racism in his daily life. The mythology of American distance running might also better incorporate the voices of Black women into the story.

Registries Tell Us What We Are Actually Doing

Abstract: Commentary The choice of a total knee arthroplasty (TKA) implant may seem relatively straightforward. We are guided by our exposure to implant types during orthopaedic training, literature with regard to implant kinematics and longevity, and our individual experience with patient outcomes. Whether to save or to sacrifice the posterior cruciate ligament is a common controversy, with adamant opinions on either side. Kendall et al. analyze data from the American Joint Replacement Registry (AJRR) to note that posterior-stabilized bearings are associated with a higher all-cause revision rate compared with minimally stabilized, cruciate-retaining designs. Has this study finally decided the endless debate over cruciate-substituting and cruciate-retaining TKA designs? Probably not. Nevertheless, the AJRR data give us pause. Registry data analytics are a definite advance in real-world patient outcomes, substantially augmenting and legitimately challenging the opinions that we have developed through training and personal experience. There is a profound difference between scientific studies generated from administrative databases and inquiries based on clinical registry data. The orthopaedic literature on joint replacement outcomes is replete with retrospective reviews based on administrative or claims data. Administrative records and insurance claims databases are driven by reimbursement policies, billing codes, and short-term outcomes, which are recognizably devoid of direct contact with patients and their actual outcomes after treatment1. Infection rates and mechanical failures of joint replacement implants, for instance, are often determined solely on the basis of whether or not a claim was submitted for an infection or revision surgery code. Although such studies may have substantial validity, the inherently missing data elements or errors in coding leave room for erroneous conclusions. Unlike administrative databases, registries are clinical databases that focus on treatment-based, longitudinal outcomes2. Large data registries in any medical discipline have the power to illuminate subtle findings that might otherwise be missed in smaller administrative database analyses. One noteworthy example of the clinical effectiveness of registry data is the detection of high revision rates in the metal-on-metal Articular Surface Replacement (ASR; DePuy Synthes Orthopaedics) total hip replacements noted in the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Abnormal reaction to metal wear debris was initially described in case reports as an elusive anomaly. The AOANJRR first published concerns about metal-on-metal bearings in its 2006 annual report3. By 2009, the ASR was a clear outlier with a high revision rate. The AOANJRR findings and reports from the U.K. National Joint Registry quickly illuminated a substantial number of clinically important metallosis cases. There were approximately 93,000 ASR implants placed worldwide, with a 13.6% cumulative percent revision rate after only 1.5 years. The ASR was voluntarily recalled by DePuy in 2010 and was removed from the marketplace, potentially saving millions of patients from substantial harm4. The Mayo Clinic created the first registry of joint replacement prostheses in 1969. The first national total joint replacement registry was the Swedish Knee Arthroplasty Register, established in 1975. Numerous other national arthroplasty registries subsequently have been established2, with the AJRR starting in 2009. The AJRR has become the largest joint replacement registry in the world5,6. The AJRR allows orthopaedic surgeons to benchmark their own results within the context of a massive number of procedures, procedural trends, and specific outcomes related to devices implanted. Scientific registry insights often have enough statistical power to reveal outcomes that we would otherwise not see as individual clinicians or hospital organizations. The goals of both local and national registry databases are to compare a surgeon’s practice with performance benchmarks, quality reports, and dashboards and to facilitate the longitudinal tracking and monitoring of patient outcomes7. Any individual or local joint replacement quality improvement program should evaluate the specific joint replacement implant and prosthetic design in the context of larger registry data sets. National registries place a surgeon’s small set of data points in a larger and more utilitarian context of big data, thereby providing valid alerts for early prosthesis failures. The AJRR thereby places the surgeon’s implant choice and the patient’s outcomes under a broader, long-term, and more relevant clinical lens. The International Society of Arthroplasty Registries (ISAR; https://www.isarhome.org) meets annually to evaluate and discuss global trends and outcomes in joint replacement. The AJRR is responsible for housing and maintaining the International Prosthesis Library developed by ISAR, allowing surgeons to contribute to a single source of medical device information6. Although national registry data can provide early warnings, it is important to evaluate registry findings in a cautionary context. Registry data are observational only; associations are noted, but causality cannot necessarily be determined. Kendall et al. crystalize the AJRR data to demonstrate an association of posterior-stabilized bearings with a higher all-cause revision rate compared with minimally stabilized designs. There are numerous confounding variables that may be causes of the differences between posterior-stabilized and minimally stabilized knee implant survivorship, including surgeon choice, surgeon skill, operating room time, preoperative deformity, bearing surfaces, patellar resurfacing or not, and implant manufacturer, just to name a few. The unique aspect of this study is that supplemental U.S. Centers for Medicaid and & Medicare Services (CMS) data were linked to cases, augmenting the potential to determine causality. One might argue that surgeons preferentially choose posterior-stabilized TKA designs rather than minimally stabilized TKA designs for patients with more deformity. Kendall et al. note that the substantial size of the AJRR, as well as the wide-reaching distribution of surgeons and institutions submitting data to the AJRR, mitigates against this potential surgeon bias. I encourage readers to look at the most recent AJRR Annual Report8. Some of the findings fit within our usual expectations. It is not surprising, for instance, that ceramic femoral heads in total hip replacements are now more commonly used than cobalt-chromium heads. Other findings may be surprising or seem counterintuitive. Early results for cementless TKA are looking better compared with our historical gold standard of cemented TKA fixation. The AJRR Annual Report also warned us of unexpected early failure rates. Cumulative incidence function curves were used to present the cumulative percent revision over time for hip resurfacing. Notably, hip-resurfacing failure for female patients in all age groups was clearly higher (4%) compared with primary total hip arthroplasty (THA) at the 5-year follow-up. Notice also that the cause-specific survivorship curves demonstrated that THA femoral component cemented fixation was associated with a significant reduction in revision due to periprosthetic fracture compared with cementless fixation in patients who underwent elective primary THA and were ≥65 years of age. Participating in registries and scrutinizing registry data move us closer to evidence-based decision-making and away from eminence-based decisions9,10. An eminence-based decision relies solely on the physician’s opinion, irrespective of relevant scientific evidence. “I do it this way because I do it this way, and my patients are just fine” is an example of an eminence-based opinion. Opinions are important. Evidence-based data from registries are more salient. The unique relationship between scientific research, clinical practice, and registry data was emphasized by Dr. Lukas Kappenberger, who stated11: “Science tells us what we can do; guidelines what we should do; and registries what we are actually doing.” In the era of big data, it is incumbent upon us to move toward a better understanding of real-world data analytics and outcomes that matter most to patients. Submitting data to the AJRR and paying attention to timely, practice-specific, quality dashboards will improve the value of care that we deliver to our patients12-15. Kendall et al. have taken a meaningful step forward in this noble direction. Pay attention; registries will play an increasingly meaningful role in real-world data analytics that focus on the continuous journey toward improved patient outcomes.

Introduction to Gas Injection

Abstract: This chapter describes the different methods and the application of gas injection in the oil and gas industry and environmental purposes. For this purpose, first the worldwide hydrocarbon distribution is studied which categorized as conventional and unconventional resources. Also, the graphical distribution is reported using the latest statistics of conventional and unconventional hydrocarbon resources. Second, the steps of recovery of oil reservoirs are studied which consist of primary, secondary and tertiary oil recovery. Gas injection is performed for improvement of oil recovery in the secondary and tertiary oil recovery. Environmental protection and reduction of greenhouse gases is another goal of gas injection. Third, various relevant aspects including, historical evolution, screening criteria, sources of gas and economic of gas injection are investigated.