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Validation study of a computer-based open surgical trainer: SimPraxis simulation platform
Tran LN, Gupta P, Poniatowski LH, Alanee S, Dall’Era MA, Sweet RM
Advances in Medical Education and Practice , 2013, DOI: http://dx.doi.org/10.2147/AMEP.S38422
Abstract: lidation study of a computer-based open surgical trainer: SimPraxis simulation platform Original Research (322) Total Article Views Authors: Tran LN, Gupta P, Poniatowski LH, Alanee S, Dall’Era MA, Sweet RM Published Date March 2013 Volume 2013:4 Pages 23 - 30 DOI: http://dx.doi.org/10.2147/AMEP.S38422 Received: 22 September 2012 Accepted: 05 December 2012 Published: 20 March 2013 Linh N Tran,1 Priyanka Gupta,2 Lauren H Poniatowski,2 Shaheen Alanee,3 Marc A Dall’Era,4 Robert M Sweet2 1Department of Internal Medicine, Loma Linda University, Loma Linda, CA, 2Department of Urology, University of Minnesota, Minneapolis, MN, 3Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, 4Department of Urology, University of California, Davis, CA, USA Background: Technological advances have dramatically changed medical education, particularly in the era of work-hour restrictions, which increasingly highlights a need for novel methods to teach surgical skills. The purpose of this study was to evaluate the validity of a novel, computer-based, interactive, cognitive simulator for training surgeons to perform pelvic lymph node dissection (PLND). Methods: Eight prostate cancer experts evaluated the content of the simulator. Contextual aspects of the simulator were rated on a five-point Likert scale. The experts and nine first-year residents completed a simulated PLND. Time and deviations were logged, and the results were compared between experts and novices using the Mann–Whitney test. Results: Before training, 88% of the experts felt that a validated simulator would be useful for PLND training. After testing, 100% of the experts felt that it would be more useful than standard video training. Eighty-eight percent stated that they would like to see the simulator in the curriculum of residency programs and 56% thought it would be useful for accreditation purposes. The experts felt that the simulator aided in overall understanding, training indications, concepts and steps of the procedure, training how to use an assistant, and enhanced the knowledge of anatomy. Median performance times taken by experts and interns to complete a PLND procedure on the simulator were 12.62 and 23.97 minutes, respectively. Median deviation from the incorporated procedure pathway for experts was 24.5 and was 89 for novices. Conclusion: We describe an interactive, computer-based simulator designed to assist in mastery of the cognitive steps of an open surgical procedure. This platform is intuitive and flexible, and could be applied to any stepwise medical procedure. Overall, experts outperformed novices in their performance on the trainer. Experts agreed that the content was acceptable, accurate, and representative.
Interstate Comparison of Soil Remediation Standards among Six Mid-Atlantic States, USA  [PDF]
Robert P. Blauvelt, Mathew Sweet
Journal of Environmental Protection (JEP) , 2014, DOI: 10.4236/jep.2014.510083

To address and help mitigate potential public health and ecological impacts associated with contaminated soil, most state environmental agencies have promulgated cleanup standards or action level criteria that are based broadly on US Environmental Protection Agency risk assessment methodologies. These standards or criteria often are assembled into easy-to-use look-up tables that allow responsible parties (RPs) to determine quickly the extent of remediation that could be required simply by comparing site investigation data to the listed cleanup goal or standard. This paper compares and contrasts soil remediation standards and criteria for 20 common soil pollutants taken from state environmental agency look-up tables for five Middle Atlantic States: New York, Connecticut, New Jersey, Delaware, Pennsylvania, and Maryland. We examine the differences between numeric remedial goals for these pollutants and propose a relative rank for each state based on the overall degree of soil cleanup standard or criterion stringency. In order to identify and rank the stringency of the residential cleanup goals or standards published by the six Mid-Atlantic States, a three-step process was used that included compiling in one data set, the numerical (mg/kg), residential or unrestricted use look-up values published by state for each of the 20 contaminants; organizing and grouping those values in numerical sequence into one of three categories ranging from lowest (Most Restrictive) to highest (Least Restrictive); and then ranking each state by the number of first place finishes in each stringency category: Most Restrictive, Moderately Restrictive, and Least Restrictive. The socioeconomic consequences of these ranks were examined relative to their effects on gross state product, unemployment, and health.

Expressed breast milk as 'connection' and its influence on the construction of 'motherhood' for mothers of preterm infants: a qualitative study
Linda Sweet
International Breastfeeding Journal , 2008, DOI: 10.1186/1746-4358-3-30
Abstract: This longitudinal study was conducted using an interpretive phenomenological approach. Data were collected from 17 parents through 45 individual interviews with both mothers and fathers, from birth to 12 months of age. This data was then transcribed verbatim and analysed using thematic analysis.The analysis identified six primary themes: the intention to breastfeed naturally; breast milk as connection; the maternal role of breast milk producer; breast milk as the object of attention; breastfeeding and parenting the hospitalised baby and the demise of breastfeeding. This paper reports on the theme of 'breast milk as connection'.Providing expressed breast milk offered one way the mothers could be physiologically and emotionally connected to their preterm infant while they were in the constant care of hospital staff. Indeed, breast milk was considered the only way the new mother could connect her body (or part there of) to her preterm baby in hospital. This sense of connection however, comes at a cost. On the one hand, the breast milk offers a feeling of connection to the baby, but, on the other, this connection comes only after disconnection of the mother and baby and – through breast expression – mother and her milk. This ability of breast milk to connect mother and baby makes the expressed breast milk highly valued, and places unexpected pressure on the mother to produce milk as integral to her sense of motherhood.The findings of this study have implications for healthcare practice. It is evident that the association of breastfeeding success with mothering success only jeopardises some families' self-esteem and sense of parenting ability. These findings suggest it would be beneficial to find alternate ways to connect preterm infants and their parents in the preterm nursery environment, and find more positive ways to support breastfeeding.Breastfeeding is widely accepted and advocated as the best source of nutrition for newborn infants. While there is a high initiati
The Effects of Race and Space on City-County Consolidation: The Albany-Dougherty Georgia Experience  [PDF]
Kwame Boakye Dankwa, Timothy Sweet-Holp
Current Urban Studies (CUS) , 2015, DOI: 10.4236/cus.2015.33021
Abstract: In this paper the authors summarize the history of government consolidation successes and failures in Georgia, discuss regionalism and functional consolidation, and address social-structural barriers to unified government. The paper focuses on the 60-year consolidation movement and current unification efforts in Albany-Dougherty County, GA. Since knowing citizen perceptions is vital in understanding the resistance to consolidation, the paper concludes with findings from a 2012 Exit Poll in Dougherty County, GA.
Gynecologic Conditions and Bacterial Vaginosis: Implications for the Non-Pregnant Patient
Richard L. Sweet
Infectious Diseases in Obstetrics and Gynecology , 2000, DOI: 10.1155/s1064744900000260
Abstract: Bacterial vaginosis is characterized by a shift from the predominant lactobacillus vaginal flora to an overgrowth of anaerobic bacteria. Bacterial vaginosis is associated with an increased risk of gynecologic complications, including pelvic inflammatory disease, postoperative infection, cervicitis, human immunodeficiency virus (HIV), and possibly cervical intraepithelial neoplasia (CIN). The obstetrical risks associated with bacterial vaginosis include premature rupture of membranes, preterm labor and delivery, chorioamnionitis and postpartum endometritis. Despite the health risks associated with bacterial vaginosis and its high prevalence in women of childbearing age, bacterial vaginosis continues to be largely ignored by clinicians, particularly in asymptomatic women. Infect. Dis. Obstet. Gynecol. 8:184–190, 2000.
Treatment of Acute Pelvic Inflammatory Disease
Richard L. Sweet
Infectious Diseases in Obstetrics and Gynecology , 2011, DOI: 10.1155/2011/561909
Abstract: Pelvic inflammatory disease (PID), one of the most common infections in nonpregnant women of reproductive age, remains an important public health problem. It is associated with major long-term sequelae, including tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. In addition, treatment of acute PID and its complications incurs substantial health care costs. Prevention of these long-term sequelae is dependent upon development of treatment strategies based on knowledge of the microbiologic etiology of acute PID. It is well accepted that acute PID is a polymicrobic infection. The sexually transmitted organisms, Neisseria gonorrhoeae and Chlamydia trachomatis, are present in many cases, and microorganisms comprising the endogenous vaginal and cervical flora are frequently associated with PID. This includes anaerobic and facultative bacteria, similar to those associated with bacterial vaginosis. Genital tract mycoplasmas, most importantly Mycoplasma genitalium, have recently also been implicated as a cause of acute PID. As a consequence, treatment regimens for acute PID should provide broad spectrum coverage that is effective against these microorganisms. 1. Introduction Pelvic inflammatory disease (PID) is a spectrum of upper genital tract infections that includes endometritis, salpingitis, tuboovarian abscess, and/or pelvic peritonitis [1]. Typically, acute PID is caused by ascending spread of microorganisms from the vagina and/or endocervix to the endometrium, fallopian tubes, and/or adjacent structures [1–3]. Acute salpingitis is the most important component of the PID spectrum because of its impact on future fertility [3]. PID is one of the most frequent and important infections that occur among nonpregnant women of reproductive age and remains a major public health problem [4–8]. Among women, it is the most significant complication of sexually transmitted diseases/infections. Unfortunately, women who acquire acute PID are at risk for long-term sequelae including tubal factor infertility, ectopic pregnancy, chronic pelvic pain, and recurrent PID [9–13]. In addition, the estimated annual health care cost for PID and its complications in the United States is over $2 billion [7]. Currently, an estimated 770,000 cases of acute PID are diagnosed annually in the United States. A recent analysis by the Centers for Disease Control and Prevention (CDC) of trends in the incidence of PID demonstrated that from 1985 to 2001 rates of both hospitalized and ambulatory cases of acute PID declined (68% and 47%, resp.) [6]. This good news is mitigated
Gonorrhea infection in women: prevalence, effects, screening, and management
Walker CK, Sweet RL
International Journal of Women's Health , 2011, DOI: http://dx.doi.org/10.2147/IJWH.S13427
Abstract: norrhea infection in women: prevalence, effects, screening, and management Review (6519) Total Article Views Authors: Walker CK, Sweet RL Published Date July 2011 Volume 2011:3 Pages 197 - 206 DOI: http://dx.doi.org/10.2147/IJWH.S13427 Cheryl K Walker, Richard L Sweet Women’s Center for Health, Department of Obstetrics and Gynecology, University of California, Davis School of Medicine, Sacramento, CA, USA Abstract: Gonorrhea is a set of clinical conditions resulting from infection with the sexually-acquired bacterial pathogen Neisseria gonorrhoeae. Acquisition may involve multiple mucosal sites in the lower female genital tract, including the urethra, cervix, Bartholin’s and Skene’s glands, as well as the anorectal canal, pharynx, and conjunctivae. It may spread to the upper genital tract, uterine tubes, abdominal cavity, and other systemic sites. Gonorrhea is the second most commonly reported sexually-transmitted infection in the US and rates are higher among women than men. Women and infants are affected disproportionately by gonorrhea, because early infection may be asymptomatic and also because extension of infection is often associated with serious sequelae. Screening is critical for infection identification and the prevention or limitation of upper genital tract spread, and horizontal and vertical transmission. Routine genital screening is recommended annually for all sexually active women at risk for infection, including women aged < 25 years and older women with one or more of the following risks: a previous gonorrhea infection, the presence of other sexually transmitted diseases, new or multiple sex partners, inconsistent condom use, commercial sex work, drug use, or human immunodeficiency virus infection with sexual activity or pregnancy. Pharyngeal gonococcal infections are common in adolescents, and direct culture screening is necessary to identify affected individuals. Nucleic acid amplification tests (NAATs) are considered the standard for screening and diagnosis. Although urine NAAT testing is most commonly used, there is growing support for vaginal swabs collected by providers or patients themselves. Resistance to all antibiotics currently recommended for the treatment of gonorrhea has been documented and complicates therapeutic strategies. The Centers for Disease Control and Prevention recommend treatment of gonorrhea with a single class of drugs, ie, the cephalosporins.
The European Court of Justice and the judicialization of EU governance
Alec Stone Sweet
Living Reviews in European Governance , 2010,
Abstract: This Living Reviews article evaluates the most important strains of social science research on the impact of the European Court of Justice (ECJ) on integration, EU-level policymaking, and national legal orders. Section 2 defines the concepts of judicialization and governance, and discusses how they are related. As the article demonstrates, the “constitutionalization of the EU,” and its effect on EU governance, is one of the most complex and dramatic examples of judicialization in world history. Section 3 discusses the institutional determinants of judicial authority in the EU in light of delegation theory. The European Court, a Trustee of the Treaty system rather than a simple Agent of the Member States, operates in an unusually broad zone of discretion, a situation the Court has exploited in its efforts to enhance the effectiveness of EU law. Section 4 focuses on the extraordinary impact of the European Court of Justice, and of the legal system it manages, on the overall course of market and political integration. Section 5 provides an overview of the process through which the ECJ’s case law – its jurisprudence – influences the decision-making of non-judicial EU organs and officials. Section 6 considers the role of the ECJ and the national courts in monitoring and enforcing Member State compliance with EU law, a task that has provoked a steady Europeanization of national law and policymaking.
Maximum Leftover Energy-Distance routing protocol (MLE-LD) using absolute distance and Euclidean distance in WSNs
International Journal of Innovative Research in Computer and Communication Engineering , 2013,
Abstract: :WSN consists of a large number of sensors nodes which senses data from surrounding environment and gathers data collectively and send to aggregator which are called as clusters. As sensor nodes are deployed in sensing field, they can help people to monitor and aggregate data by consuming some energy through the process. Researchers also try to find more efficient ways of utilizing limited energy of sensor node in order to give longer life time of WSN. Network lifetime, scalability, and load balancing are important requirements for many data gathering sensor network applications. That is why many protocols are introduced for better performance and less consumption of energy. The efficient node-energy utilization is one of important performance factors in wireless sensor networks but besides this reliability is also an issue. In this paper, we proposed a cluster based routing algorithm to ensure high reliability such that the network life time will enhance and energy consumption will decrease and thereby giving better performance measure.
A New Species of Ligyrocoris Stal With a Key to the Northeastern Species (Hemiptera:Lygaeidae)
Merrill H. Sweet
Psyche , 1963, DOI: 10.1155/1963/49672
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