Recent reports have suggested improvement in the last decade in global outcome measures after subarachnoid hemorrhage (SAH), particularly in patients presenting in good initial neurological status. ...We used a standardized self-report instrument, the Reintegration to Normal Living (RNL) Index, to assess a patient-based quality of life measure and a self-report of work status. We tested the hypothesis that several patient-based factors were related to these outcomes, including depressive symptoms, physical disability, age, and initial Hunt and Hess grade. Using these data, we report the total management morbidity and mortality at 1 to 5 years after SAH for patients initially presenting in good neurological condition.
The study population consisted of 246 consecutive patients admitted to our tertiary care center with aneurysmal SAH in good neurological condition (Hunt and Hess Grades I-III). Patients underwent either surgical (92%), endovascular (7%), or medical (1 %) management of aneurysmal SAH. Eighty-three percent of surviving patients completed a written or telephone questionnaire incorporating the Barthel Index, the Zung Self-rating Depression Scale, the RNL Index, and a work status assessment.
An aneurysm-related mortality rate of 6% was observed in the patient population. Fifty-five percent of patients reported a complete reintegration into their normal living situation, as measured by the RNL Index. Sixty-seven percent of previously full-time workers returned to a full-time status. Thirty-six percent of patients reported depressive symptoms, and 23% of patients reported physical disability. In a multivariate model, the two factors that contributed most to an impairment of reintegration were depression and physical disability, whereas a failure to return to work was related to older age and a higher-grade initial neurological status.
In this series of patients undergoing multimodality management of lower-grade SAH, more than one-half of patients subsequently reported a normal reintegration into their social situation, as assessed by the RNL Index. Standardized assessments of cofactors associated with impaired reintegration revealed that depressive symptoms and physical disability played a strong role in overall reintegration. Standardized assessments, such as the RNL Index, offer the potential for improved comparison of different treatment regimens and specific therapeutic targeting of factors, such as depression, which contribute to decreased quality of life.
Background: There is poor information in the literature regarding patients who suffer from bilateral calcaneal fractures. The objective of this study was to analyze demographic characteristics and ...objective clinical features of patients with bilateral calcaneal fractures as well as subjective outcomes following either operative or conservative management. It was a prospective randomized trial. It was performed at four level 1 trauma centers. Methods: Forty-seven patients sustaining bilateral calcaneal fractures were randomized to either operative (open reduction and internal fixation) or conservative treatment groups. Demographic features and fracture patterns were compared between those sustaining unilateral fractures (large calcaneal database) and those sustaining bilateral fractures. Following treatment, comparison of both objective outcome measures (Bohler's angle and subtalar range of motion) and subjective outcomes, as measured by the previously validated visual analogue scale (VAS) and SF-36 scores, was performed. Outcomes were also compared (with existing data from trauma database) for those treated for unilateral calcaneal fracture. Results: No difference in demographic features was found between individuals suffering unilateral and bilateral calcaneal fractures. Among bilaterally injured patients, initial Bohler's angle was slightly, but significantly, more depressed relative to that in the unilateral comparison data (p < .05). Post-treatment range of motion was significantly better when injury was confined to one side regardless of treatment modality (p < .01). Surgical intervention did not significantly affect subjective patient outcome as measured by either SF-36 or the VAS. This remained true following stratification by Worker's Compensation Board (WCB) status. However, those who were treated nonoperatively were significantly more likely to require late subtalar arthrodesis (p < .05). In general, patients whose injury was not associated with a WCB claim demonstrated significantly better subjective outcomes (p < .01 for SF-36 and VAS). Conclusions: Other than demonstrating a slightly more depressed Bohler's angle, patients sustaining bilateral calcaneal fractures are very similar to those in whom the injury is confined to one side. The evidence presented here does not definitively support primary operative intervention for bilateral calcaneal fractures. Neither objective nor subjective functional outcomes are significantly improved following such intervention. However, careful operative patient selection will minimize complications and lessen the need for late subtalar arthrodesis.
This statement asserts that all children should be screened for risk factors associated with amblyopia. Guidelines are suggested for the use of photoscreening as a technique for the detection of ...amblyopia and strabismus in children of various age groups. The American Academy of Pediatrics favors additional research of the efficacy and cost-effectiveness of photoscreening as a vision screening tool.
In this book experts from different disciplines and diverse geographic regions discuss fundamental, often controversial topics in the field of tourism studies. The debates include subjects such as ...the concept of the `tourist', the long-term sustainability of tourism development, the growth of volunteer tourism and the vulnerability of tourism.
High power single mode photonic integration Morrison, Gordon B; Buckley, Bob; Sherman, Jes ...
2019 IEEE High Power Diode Lasers and Systems Conference (HPD),
2019-Oct.
Conference Proceeding
High power single mode lasers with linewidths less than 500 kHz and CW output powers of 200 mW or higher have been integrated with additional optoelectronic components for value-added functionality ...at O-band, C-band and U-band wavelengths. Several different photonic integration techniques are described with results presented. High power functionalities including optical attenuation, amplification, wavelength multiplexing, and wavelength tuning at these high powers are described.
SHERPA1,2, the Shuttle Expendable Rocket for Payload Augmentation, is a highly capable propulsive satellite. The SHERPA is currently approaching a PDR level design. The SHERPA can perform a wide ...range of missions including orbit transfers, small satellite maneuvers, space situational awareness missions, and serve as a platform for experiments. The SHERPA has three versions: The Mark I, is a propulsion unit, the Mark II is a standalone propulsive satellite, and the Mark III, a self contained long-duration propulsive satellite. Each version can support either an electric or chemical propulsion module. The SHERPA integrates several Air Force Research Laboratory developed technologies into one unique package. The SHERPA can also fulfil a number of other mission needs as a low cost satellite bus for the DoD Space Test Program
The DESI Legacy Imaging Surveys are a combination of three public projects (the Dark Energy Camera Legacy Survey, the Beijing-Arizona Sky Survey, and the Mayall z-band Legacy Survey) that will ...jointly image approximately 14,000 deg^2 of the extragalactic sky visible from the northern hemisphere in three optical bands (g, r, and z) using telescopes at the Kitt Peak National Observatory and the Cerro Tololo Inter-American Observatory. The combined survey footprint is split into two contiguous areas by the Galactic plane. The optical imaging is conducted using a unique strategy of dynamically adjusting the exposure times and pointing selection during observing that results in a survey of nearly uniform depth. In addition to calibrated images, the project is delivering a catalog, constructed by using a probabilistic inference-based approach to estimate source shapes and brightnesses. The catalog includes photometry from the grz optical bands and from four mid-infrared bands (at 3.4, 4.6, 12 and 22 micorons) observed by the Wide-field Infrared Survey Explorer (WISE) satellite during its full operational lifetime. The project plans two public data releases each year. All the software used to generate the catalogs is also released with the data. This paper provides an overview of the Legacy Surveys project.
