389 results on '"Philip W. Smith"'
Search Results
2. Preoperative Molecular Markers in Thyroid Nodules
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Zeyad T. Sahli, Philip W. Smith, Christopher B. Umbricht, and Martha A. Zeiger
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thyroid cancer ,non-invasive follicular thyroid neoplasm with papillary-like nuclear features ,molecular test ,Afirma ,Thyroseq ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
The need for distinguishing benign from malignant thyroid nodules has led to the pursuit of differentiating molecular markers. The most common molecular tests in clinical use are Afirma® Gene Expression Classifier (GEC) and Thyroseq® V2. Despite the rapidly developing field of molecular markers, several limitations exist. These challenges include the recent introduction of the histopathological diagnosis “Non-Invasive Follicular Thyroid neoplasm with Papillary-like nuclear features”, the correlation of genetic mutations within both benign and malignant pathologic diagnoses, the lack of follow-up of molecular marker negative nodules, and the cost-effectiveness of molecular markers. In this manuscript, we review the current published literature surrounding the diagnostic value of Afirma® GEC and Thyroseq® V2. Among Afirma® GEC studies, sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) ranged from 75 to 100%, 5 to 53%, 13 to 100%, and 20 to 100%, respectively. Among Thyroseq® V2 studies, Se, Sp, PPV, and NPV ranged from 40 to 100%, 56 to 93%, 13 to 90%, and 48 to 97%, respectively. We also discuss current challenges to Afirma® GEC and Thyroseq® V2 utility and clinical application, and preview the future directions of these rapidly developing technologies.
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- 2018
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3. Initial Costs of Ebola Treatment Centers in the United States
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Jocelyn J. Herstein, Paul D. Biddinger, Colleen S. Kraft, Lisa Saiman, Shawn G. Gibbs, Philip W. Smith, Angela L. Hewlett, and John J. Lowe
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Ebola ,United States ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Published
- 2016
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4. Smallpox Vaccination of Laboratory Workers at US Variola Testing Sites
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Sharon Medcalf, Laura Bilek, Teresa Hartman, Peter C. Iwen, Patricia Leuschen, Hannah Miller, Anne O’Keefe, Harlan Sayles, and Philip W. Smith
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smallpox vaccine ,smallpox ,vaccinia ,laboratories ,viruses ,variola ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
To evaluate the need to revaccinate laboratory workers against smallpox, we assessed regular revaccination at the US Laboratory Response Network’s variola testing sites by examining barriers to revaccination and the potential for persistence of immunity. Our data do not provide evidence to suggest prolonging the recommended interval for revaccination.
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- 2015
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5. Assessing the Association between Oral Hygiene and Preterm Birth by Quantitative Light-Induced Fluorescence
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Christopher K. Hope, Qian Wang, Girvan Burnside, Adejumoke A. Adeyemi, Siobhan Quenby, Philip W. Smith, Susan M. Higham, and Melissa Whitworth
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Technology ,Medicine ,Science - Abstract
The aim of this study was to investigate the purported link between oral hygiene and preterm birth by using image analysis tools to quantify dental plaque biofilm. Volunteers (n=91) attending an antenatal clinic were identified as those considered to be “at high risk” of preterm delivery (i.e., a previous history of idiopathic preterm delivery, case group) or those who were not considered to be at risk (control group). The women had images of their anterior teeth captured using quantitative light-induced fluorescence (QLF). These images were analysed to calculate the amount of red fluorescent plaque (ΔR%) and percentage of plaque coverage. QLF showed little difference in ΔR% between the two groups, 65.00% case versus 68.70% control, whereas there was 19.29% difference with regard to the mean plaque coverage, 25.50% case versus 20.58% control. A logistic regression model showed a significant association between plaque coverage and case/control status (P=0.031), controlling for other potential predictor variables, namely, smoking status, maternal age, and body mass index (BMI).
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- 2014
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6. American Association of Endocrine Surgeons Guidelines for Adrenalectomy: Executive Summary
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Linwah Yip, Quan-Yang Duh, Heather Wachtel, Camilo Jimenez, Cord Sturgeon, Cortney Lee, David Velázquez-Fernández, Eren Berber, Gary D. Hammer, Irina Bancos, James A. Lee, Jamie Marko, Lilah F. Morris-Wiseman, Marybeth S. Hughes, Masha J. Livhits, Mi-Ah Han, Philip W. Smith, Scott Wilhelm, Sylvia L. Asa, Thomas J. Fahey, Travis J. McKenzie, Vivian E. Strong, and Nancy D. Perrier
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Surgeons ,Hydrocortisone ,Adrenal Gland Neoplasms ,Cosyntropin ,Humans ,Surgery ,Adrenalectomy ,Pheochromocytoma ,Glucocorticoids - Abstract
ImportanceAdrenalectomy is the definitive treatment for multiple adrenal abnormalities. Advances in technology and genomics and an improved understanding of adrenal pathophysiology have altered operative techniques and indications.ObjectiveTo develop evidence-based recommendations to enhance the appropriate, safe, and effective approaches to adrenalectomy.Evidence ReviewA multidisciplinary panel identified and investigated 7 categories of relevant clinical concern to practicing surgeons. Questions were structured in the framework Population, Intervention/Exposure, Comparison, and Outcome, and a guided review of medical literature from PubMed and/or Embase from 1980 to 2021 was performed. Recommendations were developed using Grading of Recommendations, Assessment, Development and Evaluation methodology and were discussed until consensus, and patient advocacy representation was included.FindingsPatients with an adrenal incidentaloma 1 cm or larger should undergo biochemical testing and further imaging characterization. Adrenal protocol computed tomography (CT) should be used to stratify malignancy risk and concern for pheochromocytoma. Routine scheduled follow-up of a nonfunctional adrenal nodule with benign imaging characteristics and unenhanced CT with Hounsfield units less than 10 is not suggested. When unilateral disease is present, laparoscopic adrenalectomy is recommended for patients with primary aldosteronism or autonomous cortisol secretion. Patients with clinical and radiographic findings consistent with adrenocortical carcinoma should be treated at high-volume multidisciplinary centers to optimize outcomes, including, when possible, a complete R0 resection without tumor disruption, which may require en bloc radical resection. Selective or nonselective α blockade can be used to safely prepare patients for surgical resection of paraganglioma/pheochromocytoma. Empirical perioperative glucocorticoid replacement therapy is indicated for patients with overt Cushing syndrome, but for patients with mild autonomous cortisol secretion, postoperative day 1 morning cortisol or cosyntropin stimulation testing can be used to determine the need for glucocorticoid replacement therapy. When patient and tumor variables are appropriate, we recommend minimally invasive adrenalectomy over open adrenalectomy because of improved perioperative morbidity. Minimally invasive adrenalectomy can be achieved either via a retroperitoneal or transperitoneal approach depending on surgeon expertise, as well as tumor and patient characteristics.Conclusions and RelevanceTwenty-six clinically relevant and evidence-based recommendations are provided to assist surgeons with perioperative adrenal care.
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- 2023
7. A Latency-Tolerant Implementation of a Randomized Global Optimization Algorithm.
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Vijay Cheleenahali, Noé Lopez-Benitez, and Philip W. Smith
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- 2005
8. Stereotactic radiosurgery before bilateral adrenalectomy is associated with lowered risk of Nelson’s syndrome in refractory Cushing’s disease patients
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Adomas Bunevicius, Jason P. Sheehan, Philip W. Smith, Karen Lavezzo, and Mary Lee Vance
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medicine.medical_specialty ,ACTH-Secreting Pituitary Adenoma ,endocrine system diseases ,business.industry ,medicine.medical_treatment ,digestive, oral, and skin physiology ,Nelson's syndrome ,Cushing's disease ,biochemical phenomena, metabolism, and nutrition ,medicine.disease ,Gastroenterology ,Radiosurgery ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Refractory ,Pituitary adenoma ,Internal medicine ,medicine ,Endocrine system ,Surgery ,Neurology (clinical) ,Neurosurgery ,business ,030217 neurology & neurosurgery - Abstract
Nelson’s syndrome is a rare but challenging sequelae of Cushing’s disease (CD) after bilateral adrenalectomy (BLA). We sought to determine if stereotactic radiosurgery (SRS) of residual pituitary adenoma performed before BLA can decrease the risk of Nelson’s syndrome. Consecutive patients with CD who underwent BLA after non-curative resection of ACTH secreting pituitary adenoma and had at least one follow-up visit after BLA were studied. Nelson’s syndrome was diagnosed based on the combination of rising ACTH levels, increasing volume of the pituitary adenoma and/or hyperpigmentation. Fifty patients underwent BLA for refractory CD, and 43 patients (7 men and 36 women) had at least one follow-up visit after BAL. Median endocrine, imaging, and clinical follow-up were 66 months, 69 months, and 80 months, respectively. Nine patients (22%) were diagnosed with the Nelson’s syndrome at median time after BLA at 24 months (range: 0.6–119.4 months). SRS before BLA was associated with reduced risk of the Nelson’s syndrome (HR = 0.126; 95%CI [0.022–0.714], p=0.019), while elevated ACTH level within 6 months after BLA was associated with increased risk for the Nelson’s syndrome (HR = 9.053; 95%CI [2.076–39.472], p=0.003). SRS before BLA can reduce the risk for the Nelson’s syndrome in refractory CD patients requiring BLA and should be considered before proceeding to BLA. Elevated ACTH concentration within 6 months after BLA is associated with greater risk of the Nelsons’ syndrome. When no prior SRS is administered, those with a high ACTH level shortly after BLA may benefit from early SRS.
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- 2021
9. Cast Shadow Identification and Image Restoration by Clustering Technique.
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Ambrose E. Ononye and Philip W. Smith
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- 2003
10. Estimating the Shape of A Surface with Non-Constant Reflectance from a Single Color Image.
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Ambrose E. Ononye and Philip W. Smith
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- 2002
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11. Robust and Efficient Detection of Non-Lint Material in Cotton Fiber Samples.
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Yupeng Zhang and Philip W. Smith
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- 2002
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12. Efficient Techniques for Wide-Angle Stereo Vision Using Surface Projection Models.
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Philip W. Smith, Keith B. Johnson, and Mongi A. Abidi
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- 1999
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13. Stereo Based Registration of Multi-Sensor Imagery for Enhanced Visualization of Remote Environments.
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Mark D. Elstrom and Philip W. Smith
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- 1999
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14. Automatic Feature Correspondence for Scene Reconstruction from Multiple Views.
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Philip W. Smith and Mark D. Elstrom
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- 1999
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15. The ups and downs of general surgery resident experience in endocrine surgery: Analysis of 30 years of ACGME graduate case logs
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John B. Hanks, Philip W. Smith, Anna Z. Fashandi, Adriana G. Ramirez, and John R. Potts
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medicine.medical_specialty ,Descriptive statistics ,business.industry ,General surgery ,medicine.medical_treatment ,Endocrine Surgical Procedures ,MEDLINE ,Internship and Residency ,030230 surgery ,United States ,Endocrine surgery ,03 medical and health sciences ,0302 clinical medicine ,Case mix index ,General Surgery ,030220 oncology & carcinogenesis ,medicine ,Humans ,Endocrine system ,Surgery ,Clinical Competence ,Longitudinal Studies ,business - Abstract
The aim of this study was to determine trends in the experience of general surgery residents with endocrine surgery cases.American Association of Endocrine Surgeons national general surgery case logs from 1989 through 2019 were reviewed. The numbers of individuals completing residency and the mean and median number of endocrine surgery cases by type and by level of operating resident surgeon were abstracted from annual data and analyzed. Descriptive statistics and linear regression analyses were performed modeling endocrine surgery cases over time and stratified by procedure type and resident level.The number of individuals completing general surgery residency each year increased from 981 to 1,219 (P.001). The average total number of endocrine surgery cases performed increased from 17 to 33.2 (P.001) but has declined since its peak at 36.9 in 2010 to 2011 (P = .014). Thyroid operations increased from 11.4 to 19.8 (P.001) but peaked at 23.5 in 2010 to 2011 and have since declined (P.001). Parathyroid operations more than doubled from 4.2 to 9.7 (P.001). Adrenal operations increased from 1 to 2.2 (P.001) and pancreatic endocrine operations increased from 0.2 to 1.5 (P.001). Surgeon Chief endocrine surgery cases peaked at 14.4 in 2003 to 2004 but have since declined by 22.2% (P.001). Surgeon Junior endocrine surgery cases increased overall (P.001) but peaked at 22.8 in 2011 to 2012. There was increasing heterogeneity over time in trainee experience (P.001).After having increased for 2 decades, the number of endocrine surgery cases performed by general surgery residents is currently in decline. Possible contributing factors include growth in the number of general surgery residents, variable and narrowed case mix, and encroachment by other learners.
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- 2020
16. Compliance with the Accreditation Council for Graduate Medical Education duty hours in a general surgery residency program: Challenges and solutions in a teaching hospital
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Charles M. Friel, Susan E. Kirk, Philip W. Smith, Bernadette J. Goudreau, Jacob R. Gillen, David F. Grabski, Bruce D. Schirmer, and Wendy M. Novicoff
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Physician-Patient Relations ,business.industry ,media_common.quotation_subject ,Control (management) ,Graduate medical education ,Punitive damages ,Workload ,Professional responsibility ,Article ,Nursing ,Education, Medical, Graduate ,General Surgery ,Intervention (counseling) ,General partnership ,Humans ,Medicine ,Surgery ,Guideline Adherence ,business ,Duty ,Accreditation ,media_common - Abstract
Background The inception of work hour restrictions for resident physicians in 2003 created controversial changes within surgery training programs. On a recent Accreditation Council for Graduate Medical Education survey at our institution, we noted a discrepancy between low recorded violations of the duty hour restrictions and the surgery resident’s perception of poor duty hour compliance. We sought to identify factors that lead to duty hour violations and to encourage accurate reporting among surgery trainees. Methods The A3/Lean methodology, an industry-derived, systematic, problem-solving approach, was used to investigate barriers to accurate reporting of duty hours by residents within the Department of Surgery at our academic institution. In partnership with our office of Graduate Medical Education, we encouraged a 6-month period where residents were asked to record duty hour accurately and to provide honest, descriptive explanations of violations without punitive effects on residents or the program. We performed a 6-month before-and-after analysis of duty hours violations after the A3/Lean implementation. Quantitative analysis was used to elucidate trends in violations by post graduate year and rotation. Qualitative evaluation by key thematic areas revealed resident attitudes and opinions about duty hour violations. Results Residents reported concern for personal and programmatic, punitive measures, desire to retain control of their education, and frustration with the administrative burden after violations as deterrents to honest duty hour reporting. The intervention was successful in changing logging behavior with 10 total violations prior to A3 meeting and 179 violations afterward (P = .003). This change was driven largely from an increase in short break violations (4 vs 134, P = .021). Analysis of violations revealed trends by post-graduate year, rotation, and weekend cross-coverage. Key findings including less than anticipated violations of the 80-hour work week despite high rates of short break violations. The ability to participate in procedures voluntarily and a sense of professional responsibility emerged as the prevailing themes among surgery residents describing violations. Conclusion Systematic evaluation of duty hour reporting within a surgery training program can identify structural and cultural barriers to accurate reporting of duty hours. Accurate reporting can identify program-specific trends in duty hour violations that can be addressed though programmatic intervention.
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- 2020
17. Applications of Smoothed Monotone Regression Splines and Smoothed Bootstrapping in Survival Analysis.
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Donald E. Ramirez and Philip W. Smith
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- 1998
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18. Image-Based Manipulation Planning for Non-Rigid Objects.
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Philip W. Smith
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- 1998
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19. Vision based manipulation of non-rigid objects.
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Philip W. Smith, Nagaraj Nandhakumar, and Arvind K. Ramadorai
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- 1996
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20. Accurate structure and motion computation in the presence of range image distortions due to sequential acquisition.
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Philip W. Smith and Nagaraj Nandhakumar
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- 1994
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21. An automated stereoscopic coal profiling system-CCLPS.
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Philip W. Smith and Nagaraj Nandhakumar
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- 1994
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22. Comparison of Exponential and Biexponential Models of the Unimolecular Decomposition Probability for the Hinshelwood–Lindemann Mechanism
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Bhumika Jayee, William L. Hase, and Philip W. Smith
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RRKM theory ,Physics ,education.field_of_study ,Work (thermodynamics) ,010304 chemical physics ,Population ,Thermodynamics ,Lindemann mechanism ,010402 general chemistry ,01 natural sciences ,0104 chemical sciences ,Exponential function ,Reaction rate constant ,Collision frequency ,0103 physical sciences ,General Materials Science ,Physical and Theoretical Chemistry ,education ,Scaling - Abstract
The traditional understanding is that the Hinshelwood-Lindemann mechanism for thermal unimolecular reactions, and the resulting unimolecular rate constant versus temperature and collision frequency ω (i.e., pressure), requires the Rice-Ramsperger-Kassel-Marcus (RRKM) rate constant k(E) to represent the unimolecular reaction of the excited molecule versus energy. RRKM theory assumes an exponential N(t)/N(0) population for the excited molecule versus time, with decay given by RRKM microcanonical k(E), and agreement between experimental and Hinshelwood-Lindemann thermal kinetics is then deemed to identify the unimolecular reactant as a RRKM molecule. However, recent calculations of the Hinshelwood-Lindemann rate constant kuni(ω,E) has brought this assumption into question. It was found that a biexponential N(t)/N(0), for intrinsic non-RRKM dynamics, gives a Hinshelwood-Lindemann kuni(ω,E) curve very similar to that of RRKM theory, which assumes exponential dynamics. The RRKM kuni(ω,E) curve was brought into agreement with the biexponential kuni(ω,E) by multiplying ω in the RRKM expression for kuni(ω,E) by an energy transfer efficiency factor βc. Such scaling is often done in fitting Hinshelwood-Lindemann-RRKM thermal kinetics to experiment. This agreement between the RRKM and non-RRKM curves for kuni(ω,E) was only obtained previously by scaling and fitting. In the work presented here, it is shown that if ω in the RRKM kuni(ω,E) is scaled by a βc factor there is analytic agreement with the non-RRKM kuni(ω,E). The expression for the value of βc is derived.
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- 2020
23. Effect of Travel Time for Thyroid Surgery on Treatment Cost and Morbidity
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Philip W. Smith, Eric B Schneider, J. Hunter Mehaffey, John B. Hanks, Martha A Zeiger, and Adriana G. Ramirez
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medicine.medical_specialty ,Demographics ,business.industry ,Thyroid disease ,medicine.medical_treatment ,Thyroid ,General Medicine ,medicine.disease ,Surgery ,Travel time ,Endocrine surgery ,medicine.anatomical_structure ,Medicine ,business ,Treatment costs ,Average cost ,Clinical data repository - Abstract
Regionalizing surgical care to high-volume centers has improved outcomes for endocrine surgery. This shift is associated with increased travel time, costs, and morbidity within certain patient populations. We examined travel time–related differences in demographics, health-care utilization, thyroid-specific disease, and cost for patients undergoing thyroid surgery at a single high-volume center. Data were extracted from the 2005 to 2014 ACS-NSQIP and clinical data repository for patients undergoing thyroid surgery. Travel times between patients’ home address and the hospital were calculated using Google Earth under assumptions of standard road conditions and speed restrictions. Travel time was divided into
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- 2019
24. A Novel Thyroid Ultrasound Proficiency Metric Designed Through a Multidisciplinary Delphi Approach
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Worthington G. Schenk, John B. Hanks, Yinin Hu, Philip W. Smith, Rachita Khot, and Alex D. Michaels
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Pathology ,medicine.medical_specialty ,Supine position ,medicine.medical_treatment ,Delphi method ,Thyroid ultrasound ,Vascularity ,Multidisciplinary approach ,medicine ,Medical physics ,Parathyroid adenoma ,computer.programming_language ,Reproducibility ,business.industry ,Ultrasound ,Echogenicity ,Carotid sheath ,General Medicine ,medicine.disease ,Endocrine surgery ,medicine.anatomical_structure ,Learning curve ,Calipers ,Surgery ,Microcalcification ,Metric (unit) ,medicine.symptom ,Nuclear medicine ,business ,computer ,Delphi - Abstract
Background Thyroid ultrasounds extend surgeons’ outpatient capabilities and are essential for operative planning. However, most residents are not formally trained in thyroid ultrasound. The purpose of this study was to create a novel thyroid ultrasound proficiency metric through a collaborative Delphi approach. Methods Clinical faculty experienced in thyroid ultrasound participated on a Delphi panel to design the thyroid Ultrasound Proficiency Scale (UPS-Thyroid). Participants proposed items under the categories of Positioning, Technique, Image Capture, Measurement, and Interpretation. In subsequent rounds, participants voted to retain, revise, or exclude each item. The process continued until all items had greater than 70% consensus for retention. The UPS-Thyroid was pilot tested across 5 surgery residents with moderate ultrasound experience. Learning curves were assessed with cumulative sum. Results Three surgeons and 4 radiologists participated on the Delphi panel. Following 3 iterative Delphi rounds, the panel arrived at >70% consensus to retain 14 items without further revisions or additions. The metric included the following items on a 3-point scale for a maximum of 42 points: Positioning (1 item), Technique (4 items), Image Capture (2 items), Measurement (2 items), and Interpretation (5 items). A pilot group of 5 residents was scored against a proficiency threshold of 36 points. Learning curve inflection points were noted at between 4 to 7 repetitions. Conclusions A multidisciplinary Delphi approach generated consensus for a thyroid ultrasound proficiency metric (UPS-Thyroid). Among surgery residents with moderate ultrasound experience, basic proficiency at thyroid ultrasound is feasible within 10 repetitions.
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- 2021
25. Model-based interpretation of stereo imagery of textured surfaces.
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Wen-Yi Zhao, Nagaraj Nandhakumar, and Philip W. Smith
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- 1997
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26. Object motion and structure recovery for robotic vision using scanning laser range sensors.
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Philip W. Smith, Nagaraj Nandhakumar, and Chiun-Hong Chien
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- 1997
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27. An Improved Power Cepstrum Based Stereo Correspondence Method for Textured Scenes.
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Philip W. Smith and Nagaraj Nandhakumar
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- 1996
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28. A vision-based framework for the discovery-driven manipulation of non-rigid objects.
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Philip W. Smith, Nagaraj Nandhakumar, and Arvind K. Ramadorai
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- 1996
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29. Parametric approximation of data using ODR splines.
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Samuel P. Marin and Philip W. Smith
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- 1994
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30. Performance of parallel Cholesky factorization algorithms using BLAS.
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Glenn R. Luecke, Jae Heon Yun, and Philip W. Smith
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- 1992
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31. New endocrine fellowship programs do not decrease the endocrine surgery experience of residents in co-located general surgery programs
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Anna Z. Fashandi, John B. Hanks, Adriana G. Ramirez, John R. Potts, and Philip W. Smith
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medicine.medical_specialty ,medicine.medical_treatment ,education ,Endocrine Surgical Procedures ,MEDLINE ,Workload ,030230 surgery ,Accreditation ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Case log ,Statistical significance ,medicine ,Endocrine system ,Humans ,Surgeons ,business.industry ,General surgery ,Internship and Residency ,Endocrine surgery ,030220 oncology & carcinogenesis ,General Surgery ,Surgery ,Clinical Competence ,business - Abstract
Background New pediatric and vascular surgical fellowship programs decrease resident operative experience in those subspecialties in co-located general surgery programs.After 2 decades of increases, the mean number of endocrine surgery cases performed by general surgery residents nationally has decreased since 2010 to 2011. We hypothesized that new endocrine surgery fellowship programs lead to a decrease in the number of endocrine surgery cases performed by co-located general surgery residents and may be a contributing factor in the recent national decline in endocrine surgery cases performed by general surgery residents. Methods Endocrine surgery fellowship programs associated with a single, Accreditation Council of Graduate Medical Education–accredited general surgery program that have completed training of 1 fellow by the 2014–2015 academic year were identified. Endocrine surgery cases performed by general surgery residents who completed co-located general surgery programs from 2002 to 2003 through 2017 to 2018 were recorded. Descriptive statistics are shown as mean ± standard deviation. Statistical significance was calculated using the Mann-Whitney U Test. Results In the 13 general surgery programs with 5 years of case log data after the matriculation of the first fellow, the mean number of total endocrine surgery cases/resident increased from 47 ± 23 in year 0 to 57 ± 25 in year 5 (z-score = 2.53; P Conclusion New endocrine surgery fellowship programs do not decrease the endocrine surgery cases performed by general surgery residents and have not contributed to the national decline in endocrine surgery cases by general surgery residents.
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- 2020
32. Vessel Ligation Fundamentals: A Comparison of Technical Evaluations by Crowdsourced Nonclinical Personnel and Surgical Faculty
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Helen Kim, Philip W. Smith, Sara K. Rasmussen, Anneke T. Schroen, Boxiang Jiang, and Yinin Hu
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Male ,medicine.medical_specialty ,Faculty, Medical ,Students, Medical ,Wilcoxon signed-rank test ,Health Personnel ,Video Recording ,030230 surgery ,Crowdsourcing ,Risk Assessment ,Education ,03 medical and health sciences ,0302 clinical medicine ,Cronbach's alpha ,Surgical skills ,medicine ,Humans ,Medical physics ,Technical skills ,Ligation ,Simulation Training ,Reimbursement ,Surgeons ,business.industry ,Virginia ,Internship and Residency ,Construct validity ,Education, Medical, Graduate ,General Surgery ,030220 oncology & carcinogenesis ,Scale (social sciences) ,Female ,Surgery ,Clinical Competence ,business ,Psychology ,Education, Medical, Undergraduate - Abstract
BACKGROUND Evaluation of fundamental surgical skills is invaluable to the training of medical students and junior residents. This study assessed the effectiveness of crowdsourcing nonmedical personnel to evaluate technical proficiency at simulated vessel ligation. STUDY DESIGN Fifteen videos were captured of participants performing vessel ligation using a low-fidelity model (5 attending surgeons and 5 medical students before and after training). These videos were evaluated by nonmedical personnel recruited through Amazon Mechanical Turk, as well as by 3 experienced surgical faculty. Evaluation criteria were based on Objective Structured Assessment of Technical Skills (scale: 5-25). Results were compared using Wilcoxon signed rank-sum and Cronbach's alpha (α). RESULTS Thirty-two crowd workers evaluated all 15 videos. Crowd workers scored attending surgeon videos significantly higher than pretraining medical student videos (20.5 vs 14.9, p < 0.001), demonstrating construct validity. Across all videos, crowd evaluations were more lenient than expert evaluations (19.1 vs 14.5, p < 0.001). However, average volunteer evaluations correlated more strongly with average expert evaluations (α = 0.95) than the strength of correlation between any 2 individual expert evaluators (α = 0.72-0.88). Combined reimbursement for all workers was $80.00. CONCLUSION After adjustments for score inflation, crowdsourced can evaluate surgical fundamentals with excellent validity. This resource is considerably less costly and potentially more reliable than individual expert evaluations.
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- 2018
33. Advancing Preparedness for Highly Hazardous Contagious Diseases: Admitting 10 Simulated Patients with MERS-CoV
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John J. Lowe, Kate Boulter, Angela Vasa, Theodore J. Cieslak, Angela L. Hewlett, Christopher J. Kratochvil, Philip W. Smith, Michelle Schwedhelm, and Elizabeth L. Beam
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Infectious Disease Transmission, Patient-to-Professional ,Health (social science) ,Isolation (health care) ,Health, Toxicology and Mutagenesis ,Disaster Planning ,Management, Monitoring, Policy and Law ,medicine.disease_cause ,Communicable Diseases ,01 natural sciences ,Simulated patient ,Disease Outbreaks ,03 medical and health sciences ,0302 clinical medicine ,Health care ,medicine ,Humans ,030212 general & internal medicine ,0101 mathematics ,Personal protective equipment ,Ebola virus ,business.industry ,010102 general mathematics ,Public Health, Environmental and Occupational Health ,Nebraska ,medicine.disease ,Biocontainment ,United States ,Contagious disease ,Patient Simulation ,Preparedness ,Middle East Respiratory Syndrome Coronavirus ,Emergency Medicine ,Medical emergency ,Coronavirus Infections ,business ,Safety Research - Abstract
The Ebola outbreak of 2014-2016 highlighted the need for the development of a more robust healthcare infrastructure in the United States to provide isolation care for patients infected with a highly hazardous contagious disease. Routine exercises and skills practice are required to effectively and safely prepare care teams to confidently treat this special population of patients. The Nebraska Biocontainment Unit (NBU) at Nebraska Medicine in Omaha has been conducting exercises since 2005 when the unit was opened. Previous activities and exercises conducted by the Nebraska Biocontainment Unit have focused on transporting and caring for up to 3 patients with Ebola virus disease or other special pathogens. Changes in regional and national mandates, as well as the increased potential for receiving multiple patients at once, at a single location, have resulted in a greater demand to exercise protocols for the treatment of multiple patients. This article discusses in detail the planning, execution, and outcomes of a full-scale exercise involving 10 simulated patients with a highly infectious pathogen transmitted by the airborne route.
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- 2017
34. Gestational Primary Hyperparathyroidism Due to Ectopic Parathyroid Adenoma: Case Report and Literature Review
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Susan E. Kirk, Alan C. Dalkin, William B. Horton, Christian A. Chisholm, Zhenqi Liu, Luke Lancaster, Meaghan M Stumpf, Joseph D Coppock, and Philip W. Smith
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Parathyroidectomy ,medicine.medical_specialty ,Parathyroid, Bone, and Mineral Metabolism ,Cinacalcet ,Adenoma ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Parathyroid hormone ,030209 endocrinology & metabolism ,Case Reports ,03 medical and health sciences ,0302 clinical medicine ,medicine ,primary hyperparathyroidism ,Pregnancy ,business.industry ,hypercalcemia ,medicine.disease ,Surgery ,technetium Tc 99m sestamibi ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Vomiting ,Parathyroid gland ,pregnancy ,medicine.symptom ,business ,hormones, hormone substitutes, and hormone antagonists ,Primary hyperparathyroidism ,medicine.drug - Abstract
Gestational primary hyperparathyroidism (GPHPT) is a rare condition with fewer than 200 cases reported. We present the case of a 21-year-old woman who presented at 10 weeks’ gestation with severe hypercalcemia. Laboratory investigation was consistent with primary hyperparathyroidism. Neck ultrasound did not reveal any parathyroid enlargement. Due to the persistence of severe hypercalcemia, she was treated with 4 weeks of cinacalcet therapy, which was poorly tolerated due to nausea and vomiting. At 14 weeks’ gestation, she underwent neck exploration with right lower, left upper, and partial right upper parathyroid gland excision. Intra- and postoperative parathyroid hormone (PTH) and calcium levels remained elevated. After a thorough discussion of risks/benefits, the patient requested further treatment. A parathyroid sestamibi scan (PSS) revealed an ectopic adenoma in the left mediastinum. The adenoma was removed via video-assisted thorascopic parathyroidectomy with intraoperative PTH declining to nearly undetectable levels. She ultimately delivered a physically and developmentally normal infant at 37 weeks’ gestation. Appropriate treatment of severe GPHPT may prevent the maternal and fetal complications of hypercalcemia. This case, in which cinacalcet therapy and PSS were used, adds to the body of literature regarding treatment of severe GPHPT., We present a case of gestational primary hyperparathyroidism due to ectopic parathyroid adenoma that was successfully diagnosed and treated with parathyroid sestamibi scan, cinacalcet, and surgery.
- Published
- 2017
35. The National Ebola Training and Education Center: Preparing the United States for Ebola and Other Special Pathogens
- Author
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John J. Lowe, Angela Vasa, Nicholas V. Cagliuso, Bruce S. Ribner, Sonia Bell, Sharon Vanairsdale, Ryan Fagan, Abbigail Tumpey, Christopher J. Kratochvil, Philip W. Smith, Richard C. Hunt, Laura Evans, Melissa Cole Harvey, Colleen S. Kraft, John Maher, and Michelle Schwedhelm
- Subjects
medicine.medical_specialty ,Health (social science) ,viruses ,Health, Toxicology and Mutagenesis ,050109 social psychology ,Management, Monitoring, Policy and Law ,medicine.disease_cause ,Article ,Disease Outbreaks ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Health care ,medicine ,Humans ,Infection control ,0501 psychology and cognitive sciences ,030212 general & internal medicine ,Personal protective equipment ,Human services ,Infection Control ,Ebola virus ,business.industry ,Public health ,05 social sciences ,Public Health, Environmental and Occupational Health ,Nebraska ,Hemorrhagic Fever, Ebola ,Ebolavirus ,Biocontainment ,medicine.disease ,United States ,Africa, Western ,Preparedness ,Emergency Medicine ,Medical emergency ,Centers for Disease Control and Prevention, U.S ,business ,Delivery of Health Care ,Safety Research - Abstract
The National Ebola Training and Education Center (NETEC) was established in 2015 in response to the 2014–2016 Ebola virus disease outbreak in West Africa. The US Department of Health and Human Services office of the Assistant Secretary for Preparedness and Response and the US Centers for Disease Control and Prevention sought to increase the competency of healthcare and public health workers, as well as the capability of healthcare facilities in the United States, to deliver safe, efficient, and effective care to patients infected with Ebola and other special pathogens nationwide. NYC Health + Hospitals/Bellevue, Emory University, and the University of Nebraska Medical Center/Nebraska Medicine were awarded this cooperative agreement, based in part on their experience in safely and successfully evaluating and treating patients with Ebola virus disease in the United States. In 2016, NETEC received a supplemental award to expand on 3 initial primary tasks: (1) develop metrics and conduct peer review assessments; (2) develop and provide educational materials, resources, and tools, including exercise design templates; (3) provide expert training and technical assistance; and, to add a fourth task, create a special pathogens clinical research network.
- Published
- 2017
36. A Highly Infectious Disease Care Network in the US Healthcare System
- Author
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Aurora B. Le, Paul D. Biddinger, Philip W. Smith, Jocelyn J. Herstein, Deborah A. Levy, Shawn G. Gibbs, and John J. Lowe
- Subjects
0301 basic medicine ,Infectious Disease Transmission, Patient-to-Professional ,Health (social science) ,International Cooperation ,Health, Toxicology and Mutagenesis ,030106 microbiology ,Disease ,Management, Monitoring, Policy and Law ,medicine.disease_cause ,Communicable Diseases ,Disease Outbreaks ,West africa ,03 medical and health sciences ,0302 clinical medicine ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Epidemics ,Cross Infection ,Ebola virus ,business.industry ,Public Health, Environmental and Occupational Health ,Outbreak ,Hemorrhagic Fever, Ebola ,Ebolavirus ,medicine.disease ,Disease control ,United States ,Africa, Western ,Infectious disease (medical specialty) ,Communicable Disease Control ,Emergency Medicine ,Health Facilities ,Medical emergency ,Centers for Disease Control and Prevention, U.S ,business ,Safety Research ,Healthcare system - Abstract
During the 2014-15 Ebola outbreak in West Africa, the United States responded by stratifying hospitals into 1 of 3 Centers for Disease Control and Prevention (CDC)-designated categories-based on the hospital's ability to identify, isolate, assess, and provide care to patients with suspected or confirmed Ebola virus disease (EVD)-in an attempt to position the US healthcare system to safely isolate and care for potential patients. Now, with the Ebola epidemic quelled, it is crucial that we act on the lessons learned from the EVD response to broaden our national perspective on infectious disease mitigation and management, build on our newly enhanced healthcare capabilities to respond to infectious disease threats, develop a more cost-effective and sustainable model of infectious disease prevention, and continue to foster training so that the nation is not in a vulnerable position once more. We propose the formal creation of a US Highly Infectious Disease Care Network (HIDCN) modeled after 2 previous highly infectious disease consensus efforts in the United States and the European Union. A US Highly Infectious Disease Care Network can provide a common platform for the exchange of training, protocols, research, knowledge, and capability sharing among high-level isolation units. Furthermore, we envision the network will cultivate relationships among facilities and serve as a means of establishing national standards for infectious disease response, which will strengthen domestic preparedness and the nation's ability to respond to the next highly infectious disease threat.
- Published
- 2017
37. Automated Contaminant Source Localization in Spatio-Temporal Fields: A Response Surface and Experimental Design Approach
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A. Alexandre Trindade, Trevor Park, Zhenyi Liu, Philip W. Smith, and Qing Hui
- Subjects
Surface (mathematics) ,0209 industrial biotechnology ,Computer science ,business.industry ,020206 networking & telecommunications ,02 engineering and technology ,Computer Science Applications ,Human-Computer Interaction ,Noise ,020901 industrial engineering & automation ,Control and Systems Engineering ,0202 electrical engineering, electronic engineering, information engineering ,Computer vision ,Artificial intelligence ,Electrical and Electronic Engineering ,business ,Algorithm ,Software - Abstract
We propose a contaminant detection methodology suitable for robotic automation, which is able to not only locate the source(s) of the contaminant but also estimate its intensity in an environment that is allowed to evolve over both space and time. The essential idea is to flexibly model the contaminant field surface nonlinearly via radial basis functions and to utilize basic notions from the statistical design of experiments concerning optimal placement of observations in order to make incremental decisions about robot movements. Algorithms are presented for determining such movements and the subsequent collection of measurements in three different cases corresponding to different modes of spatio-temporal evolution. The result is an iterative scheme that gradually locates the peaks (sources), as well as the entire contaminant surface. The performance of the method is assessed through simulations from known surfaces. Theoretical issues concerning convergence of parameter estimates in a multiple robots scenario are examined. The method can accommodate measurement noise and does not rely on surface gradient information.
- Published
- 2017
38. Effect of Travel Time for Thyroid Surgery on Treatment Cost and Morbidity
- Author
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Adriana G, Ramirez, Eric B, Schneider, J Hunter, Mehaffey, Martha A, Zeiger, John B, Hanks, and Philip W, Smith
- Subjects
Adult ,Male ,Medically Uninsured ,Travel ,Time Factors ,Operative Time ,Virginia ,Length of Stay ,Middle Aged ,Patient Acceptance of Health Care ,Thyroid Diseases ,Tertiary Care Centers ,Postoperative Complications ,Humans ,Female ,Hospital Costs ,Hospitals, High-Volume - Abstract
Regionalizing surgical care to high-volume centers has improved outcomes for endocrine surgery. This shift is associated with increased travel time, costs, and morbidity within certain patient populations. We examined travel time-related differences in demographics, health-care utilization, thyroid-specific disease, and cost for patients undergoing thyroid surgery at a single high-volume center. Data were extracted from the 2005 to 2014 ACS-NSQIP and clinical data repository for patients undergoing thyroid surgery. Travel times between patients' home address and the hospital were calculated using Google Earth under assumptions of standard road conditions and speed restrictions. Travel time was divided into2 hours
- Published
- 2019
39. Defining the competencies for laparoscopic transabdominal adrenalectomy: An investigation of intraoperative behaviors and decisions of experts
- Author
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Amin Madani, Quan-Yang Duh, James A. Lee, Philip W. Smith, Elliot J. Mitmaker, Wen T. Shen, Jennifer H. Kuo, Karan Grover, Barbra S. Miller, Rebecca S. Sippel, Toni Beninato, and Masha J. Livhits
- Subjects
Adult ,Male ,medicine.medical_specialty ,Attitude of Health Personnel ,medicine.medical_treatment ,media_common.quotation_subject ,Clinical Decision-Making ,Adrenal Gland Neoplasms ,030230 surgery ,Task (project management) ,Body of knowledge ,03 medical and health sciences ,Intraoperative Period ,0302 clinical medicine ,Cognition ,Medicine ,Humans ,Medical physics ,Qualitative Research ,media_common ,Surgeons ,Teamwork ,business.industry ,Adrenalectomy ,Middle Aged ,Quality Improvement ,Conceptual framework ,Anticipation (artificial intelligence) ,030220 oncology & carcinogenesis ,Surgery ,Female ,Laparoscopy ,Clinical Competence ,business ,Qualitative research - Abstract
Background Safe performance of laparoscopic transabdominal adrenalectomy requires the application of a complex body of knowledge and skills, which are difficult to define, teach, and measure. This qualitative study aims to characterize expert behaviors, decisions, and other cognitive processes required to perform laparoscopic transabdominal adrenalectomy. Method Hierarchical and cognitive task analyses for right and left laparoscopic transabdominal adrenalectomy were performed using semi-structured interviews and field observations of experts. Verbal data was supplemented with published literature, coded and thematically analyzed using constructivist grounded-theory by 2 independent reviewers. Results A conceptual framework was synthesized. Sixty-eight tasks, 46 cognitive behaviors, and 52 potential errors were identified and categorized into 8 procedural steps and 8 fundamental principles: anticipation, exposure, teamwork or communication, physiology, dissection techniques, oncologic margins, tactical modification, and error recovery. Experts emphasized the importance of creating a 3-dimensional mental model of the anatomy or pathology (eg, aberrant vessels, tumor location) that is consistently fine-tuned throughout the operation, with conscious awareness of danger zones (eg, medial arc). Despite variations in dissection techniques, experts highlighted 2 themes: macrodissection and microdissection, with emphasis on nonlinear motions and effective transitions between the 2 when appropriate. Conclusion This study defines behaviors and competencies that are essential to performing laparoscopic transabdominal adrenalectomy effectively and safely.
- Published
- 2019
40. An accurate stereo correspondence method for textured scenes using improved power cepstrum techniques.
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Philip W. Smith and Nagaraj Nandhakumar
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- 1993
- Full Text
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41. Containment Care Units for Managing Patients With Highly Hazardous Infectious Diseases: A Concept Whose Time Has Come
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Mark G. Kortepeter, Angela L. Hewlett, Philip W. Smith, Theodore J. Cieslak, and Elena H. Kwon
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Biosafety level 4 ,Hemorrhagic Fevers, Viral ,030231 tropical medicine ,medicine.disease_cause ,Communicable Diseases ,Medical care ,Disease Outbreaks ,Viral hemorrhagic fever ,03 medical and health sciences ,0302 clinical medicine ,Hazardous waste ,Animals ,Humans ,Immunology and Allergy ,Medicine ,030212 general & internal medicine ,Ebola virus ,business.industry ,Outbreak ,Containment of Biohazards ,Hemorrhagic Fever, Ebola ,medicine.disease ,Virology ,United States ,Hemorrhagic Fevers ,Infectious Diseases ,Infectious disease (medical specialty) ,Communicable Disease Control ,Quarantine ,Medical emergency ,Laboratories ,business - Abstract
The concept of containment care for patients with highly hazardous infectious diseases originated in conjunction with the development of sophisticated biosafety level 4 laboratories at the US Army Medical Research Institute of Infectious Diseases in the late 1960s. Over time, the original containment facility served as a model for the development of other facilities in the United States at government and academic centers. The Ebola outbreak of 2014-2015 brought the issue of containment care into the mainstream and led to the development of such capabilities at strategic points around the country. We describe the original concepts behind development of such facilities, how the concept and acceptance has evolved over time, and how the guidelines for managing patients infected with viral hemorrhagic fevers have evolved as new information has been learned about protecting medical care providers from highly hazardous infectious pathogens.
- Published
- 2016
42. Kinetic Analysis of Biomarkers in a Cohort of US Patients With Ebola Virus Disease
- Author
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Christina F. Spiropoulou, Christopher J. Kratochvil, Bruce S. Ribner, Jay B. Varkey, Anita K. McElroy, Philip W. Smith, Aneesh K. Mehta, Marshall Lyon, Timothy D. Flietstra, Colleen S. Kraft, Peter C. Iwen, Jessica R. Harmon, Shelley Campbell, Stuart T. Nichol, and Rafi Ahmed
- Subjects
0301 basic medicine ,Microbiology (medical) ,Ebola virus ,business.industry ,Inflammation ,Viremia ,Disease ,medicine.disease_cause ,medicine.disease ,Proinflammatory cytokine ,03 medical and health sciences ,030104 developmental biology ,Infectious Diseases ,Immunity ,Severity of illness ,Cohort ,Immunology ,medicine ,medicine.symptom ,business - Abstract
BACKGROUND Ebola virus (EBOV) infection causes a severe and often fatal disease. Despite the fact that more than 30 000 individuals have acquired Ebola virus disease (EVD), the medical and scientific community still does not have a clear understanding of the mechanisms by which EBOV causes such severe disease. METHODS In this study, 54 biomarkers in plasma samples serially collected from 7 patients with EVD were analyzed in an attempt to define the kinetics of inflammatory modulators. Two clinical disease groups were defined (moderate and severe) based on the need for clinical support. Biomarkers were evaluated for correlation with viremia and clinical disease in an effort to identify pathways that could be useful targets of therapeutic intervention. RESULTS Patients with severe disease had higher viremia than those with moderate disease. Several biomarkers of immune activation and control were significantly elevated in patients with moderate disease. A series of pro-inflammatory cytokines and chemokines were significantly elevated in patients with severe disease. CONCLUSIONS Biomarkers that were associated with severe EVD were proinflammatory and indicative of endothelial or coagulation cascade dysfunction, as has been seen historically in patients with fatal outcomes. In contrast, biomarkers that were associated with moderate EVD were suggestive of a strong interferon response and control of both innate and adaptive responses. Therefore, clinical interventions that modulate the phenotype and magnitude of immune activation may be beneficial in treating EVD.
- Published
- 2016
43. Use of Postexposure Prophylaxis After Occupational Exposure toZaire ebolavirus
- Author
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Tara N. Palmore, Mark Wolcott, Colleen S. Kraft, Aneesh K. Mehta, Anthony F. Suffredini, Timothy M. Uyeki, William Dorman, Allison Beck, Mark J. Mulligan, Karen K. Wong, Christopher J. Kratochvil, Philip W. Smith, Ute Ströher, Richard T. Davey, Lilin Lai, Angela L. Hewlett, and Susan Rogers
- Subjects
Adult ,Male ,0301 basic medicine ,Microbiology (medical) ,Zaire ebolavirus ,medicine.medical_treatment ,medicine.disease_cause ,West africa ,03 medical and health sciences ,0302 clinical medicine ,Occupational Exposure ,medicine ,Humans ,030212 general & internal medicine ,Post-exposure prophylaxis ,Retrospective Studies ,Ebola virus ,biology ,business.industry ,Hemorrhagic Fever, Ebola ,Middle Aged ,Ebolavirus ,biology.organism_classification ,Virology ,United States ,Africa, Western ,030104 developmental biology ,Infectious Diseases ,Vesicular stomatitis virus ,Female ,Brief Reports ,Occupational exposure ,Post-Exposure Prophylaxis ,business - Abstract
From September 2014 to April 2015, 6 persons who had occupational exposures to Zaire ebolavirus in West Africa received investigational agent rVSV-ZEBOV or TKM-100802 for postexposure prophylaxis and were monitored in the United States. All patients experienced self-limited symptoms after postexposure prophylaxis; none developed Ebola virus disease.
- Published
- 2016
44. U.S. Ebola Treatment Center Clinical Laboratory Support
- Author
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John J. Lowe, Angela L. Hewlett, Philip W. Smith, Lisa Saiman, Peter C. Iwen, Jocelyn J. Herstein, Katelyn C. Jelden, Paul D. Biddinger, Shawn G. Gibbs, and Colleen S. Kraft
- Subjects
0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,030106 microbiology ,Laboratory testing ,Patient care ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Virology ,Biosafety level ,medicine ,Humans ,030212 general & internal medicine ,Site Visit ,Clinical Laboratory Techniques ,Diagnostic Tests, Routine ,business.industry ,Public health ,Containment of Biohazards ,Hemorrhagic Fever, Ebola ,Biocontainment ,medicine.disease ,United States ,Treatment center ,Patient room ,Medical emergency ,Laboratories ,business - Abstract
Fifty-five hospitals in the United States have been designated Ebola treatment centers (ETCs) by their state and local health authorities. Designated ETCs must have appropriate plans to manage a patient with confirmed Ebola virus disease (EVD) for the full duration of illness and must have these plans assessed through a CDC site visit conducted by an interdisciplinary team of subject matter experts. This study determined the clinical laboratory capabilities of these ETCs. ETCs were electronically surveyed on clinical laboratory characteristics. Survey responses were returned from 47 ETCs (85%). Forty-one (87%) of the ETCs planned to provide some laboratory support (e.g., point-of-care [POC] testing) within the room of the isolated patient. Forty-four (94%) ETCs indicated that their hospital would also provide clinical laboratory support for patient care. Twenty-two (50%) of these ETC clinical laboratories had biosafety level 3 (BSL-3) containment. Of all respondents, 34 (72%) were supported by their jurisdictional public health laboratory (PHL), all of which had available BSL-3 laboratories. Overall, 40 of 44 (91%) ETCs reported BSL-3 laboratory support via their clinical laboratory and/or PHL. This survey provided a snapshot of the laboratory support for designated U.S. ETCs. ETCs have approached high-level isolation critical care with laboratory support in close proximity to the patient room and by distributing laboratory support among laboratory resources. Experts might review safety considerations for these laboratory testing/diagnostic activities that are novel in the context of biocontainment care.
- Published
- 2016
45. Airborne Geiger-Mode LiDAR for Large-Scale, High-Resolution Wide-Area Mapping
- Author
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Thomas Bahr and Philip W. Smith
- Subjects
Geospatial analysis ,business.industry ,Noise reduction ,Geography, Planning and Development ,Point cloud ,computer.software_genre ,Avalanche photodiode ,Computer Science Applications ,Education ,Lidar ,Photogrammetry ,Analytics ,Computers in Earth Sciences ,Scale (map) ,business ,computer ,Remote sensing - Abstract
This presentation describes a new solution for geospatial Geiger-mode Avalanche Photodiode (GmAPD) LiDAR – a suite of sensors, processing tools and analytics born from a 15-year GmAPD legacy within certain DoD environments that will bring a significant increase in production efficiency to the commercial market. The objective of the sensor design was to support USGS LiDAR Quality Level 1 (and higher) data production over large areas from pressurized, fixed-wing aircrafts flying at altitudes of between 4 km and 10 km AGL. Topics to be covered include: 1) why GmAPD sensing is a significant advance in LiDAR collection efficiency, 2) how the ITI-1000 GmAPD LiDAR sensor supports cost-effective, wide-area, high-density collection, with coverage rates much greater than 1,000 km2/hr, and 3) how a high-volume production system, including noise reduction and photogrammetric registration techniques, is designed to reduce the production time for the GmAPD 3D point clouds while increasing data accuracy.
- Published
- 2016
46. Preoperative Molecular Markers in Thyroid Nodules
- Author
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Martha A. Zeiger, Philip W. Smith, Christopher B. Umbricht, and Zeyad T. Sahli
- Subjects
Thyroid nodules ,Pathology ,medicine.medical_specialty ,non-invasive follicular thyroid neoplasm with papillary-like nuclear features ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Review ,medicine.disease_cause ,lcsh:Diseases of the endocrine glands. Clinical endocrinology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Endocrinology ,Molecular marker ,Thyroseq ,thyroid cancer ,Medicine ,Afirma ,Thyroid cancer ,Thyroid neoplasm ,lcsh:RC648-665 ,business.industry ,Gene expression classifier ,medicine.disease ,molecular test ,Predictive value ,chemistry ,030220 oncology & carcinogenesis ,business - Abstract
The need for distinguishing benign from malignant thyroid nodules has led to the pursuit of differentiating molecular markers. The most common molecular tests in clinical use are Afirma® Gene Expression Classifier (GEC) and Thyroseq® V2. Despite the rapidly developing field of molecular markers, several limitations exist. These challenges include the recent introduction of the histopathological diagnosis “Non-Invasive Follicular Thyroid neoplasm with Papillary-like nuclear features”, the correlation of genetic mutations within both benign and malignant pathologic diagnoses, the lack of follow-up of molecular marker negative nodules, and the cost-effectiveness of molecular markers. In this manuscript, we review the current published literature surrounding the diagnostic value of Afirma® GEC and Thyroseq® V2. Among Afirma® GEC studies, sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) ranged from 75 to 100%, 5 to 53%, 13 to 100%, and 20 to 100%, respectively. Among Thyroseq® V2 studies, Se, Sp, PPV, and NPV ranged from 40 to 100%, 56 to 93%, 13 to 90%, and 48 to 97%, respectively. We also discuss current challenges to Afirma® GEC and Thyroseq® V2 utility and clinical application, and preview the future directions of these rapidly developing technologies.
- Published
- 2018
- Full Text
- View/download PDF
47. Time series evaluation of the 3M™ Clean-Trace™ ATP detection device to confirm swab effectiveness
- Author
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John J. Lowe, Erica M. Colbert, Shawn G. Gibbs, Oleg V. Chaika, Harlan Sayles, and Philip W. Smith
- Subjects
biology ,business.industry ,Clostridium difficile ,biology.organism_classification ,medicine.disease_cause ,Endospore ,Enterococcus faecalis ,Bacillus anthracis ,Microbiology ,Acinetobacter baumannii ,Infectious Diseases ,Staphylococcus aureus ,medicine ,Candida albicans ,business ,Escherichia coli - Abstract
Background As of 2012, a downward trend in infection rates for hospital onset of both Clostridium difficile infections and methicillin-resistant Staphylococcus aureus bloodstream infections (2% and 4% decrease respectively) has been noted. Despite the success with these two organisms, several infectious pathogens in the healthcare setting have not decreased. This lack of downward trend highlights the importance of continuing to find and assess rapid detection methods to help confirm that hospital cleaning efforts meet and exceed standards of cleanliness demonstrated to reduce numbers of healthcare- associated infections (HAIs) of these pathogens. Methods This study set out to determine the effectiveness of the swab 3M™ Clean-Trace™ Adenosine Triphosphate (ATP) System over time by comparing the ATP measurements of the culturable organisms to the corresponding quantitative microbiology. The organisms evaluated included: Acinetobacter baumannii, Bacillus anthracis Sterne endospores and vegetative cells, Candida albicans, Clostridium difficile, Escherichia coli, Enterococcus faecalis, methicillin-resistant Staphylococcus aureus and Mycobacterium smegmatis. Results A combined organisms analysis did not demonstrate a significant reduction in measured ATP levels over the course of the organisms' exposures in a controlled environment. The quantitative microbiology did, however, demonstrate a large initial organism die-off within the first 60 min (P Conclusions This study did not demonstrate a significant effect of time in reducing ATP measures over the time periods evaluated. ATP measurements were approximately the same, regardless of the initial organism die-off. Additionally, the live versus dead analysis confirms that ATP bioluminescence is not sensitive enough to distinguish between viable organisms and organic debris remnants on sterilised equipment.
- Published
- 2015
48. Surrogate Testing Suggests That Chlorine Dioxide Gas Exposure Would Not Inactivate Ebola Virus Contained in Environmental Blood Contamination
- Author
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Shawn G. Gibbs, John J. Lowe, Philip W. Smith, Peter C. Iwen, and Angela L. Hewlett
- Subjects
Colony-forming unit ,Chlorine dioxide ,Ebola virus ,biology ,viruses ,Disinfectant ,Public Health, Environmental and Occupational Health ,Human decontamination ,biology.organism_classification ,medicine.disease_cause ,Virology ,Enterococcus faecalis ,Microbiology ,Bacillus anthracis ,chemistry.chemical_compound ,Enterococcus ,chemistry ,medicine - Abstract
The ability to decontaminate a room potentially containing the Ebola virus is important to healthcare facilities in the United States. The Ebola virus remains viable in body fluids, a room that has housed a patient with Ebola virus disease must have all surfaces manually wiped with an approved disinfectant, which increases occupational exposure risk. This study evaluated the efficacy of gaseous chlorine dioxide inactivation of bacterial organisms in blood as the Ebola virus surrogates and as the organisms used by the Nebraska Biocontainment Unit to provide the margin of safety for decontamination. Bacillus anthracis, Escherichia coli, Enterococcus faecalis, and Mycobacterium smegmatis blood suspensions that were exposed to ClO2 gas concentrations and exposure limits. The log reduction in Colony Forming Units (CFU) was determined for each bacterial blood suspension. Exposure parameters approximating industry practices for ClO2 environmental decontamination (360 ppm concentration to 780 ppm-hr exposure, 65%...
- Published
- 2015
49. Ebola virus disease
- Author
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Bruce S. Ribner, Angela L. Hewlett, Philip W. Smith, and Jay B. Varkey
- Subjects
Microbiology (medical) ,Infection Control ,medicine.medical_specialty ,Georgia ,Ebola virus ,Civil defense ,business.industry ,Extramural ,viruses ,Civil Defense ,Nebraska ,Disease ,Hemorrhagic Fever, Ebola ,Biocontainment ,medicine.disease_cause ,Article ,Patient care ,3. Good health ,Infectious Diseases ,Preparedness ,Humans ,Medicine ,Infection control ,business ,Intensive care medicine - Abstract
This review details infection control issues encountered in the management of patients with Ebola virus disease (EVD), with emphasis on how these issues were confronted in two biocontainment patient care units in the United States.There is a notable paucity of medical literature to guide infection control policies and procedures when caring for patients with EVD. Thus, the experience of the Serious Communicable Diseases Unit at Emory University Hospital and the Nebraska Biocontainment Unit at the University of Nebraska Medical Center serves as the basis for this review. Facility issues, staffing, transportation logistics, and appropriate use of personal protective equipment are detailed. Other topics addressed include the evaluation of patients under investigation and ethical issues concerning the safe utilization of advanced life support.This review intends to serve as a reference for facilities that are in the process of creating protocols for managing patients with EVD. Given the lack of literature to support many of the recommendations discussed, it is important to utilize the available referenced guidelines, along with the practical experiences of biocontainment units, to optimize the care provided to patients with EVD while strictly adhering to infection control principles.
- Published
- 2015
50. Lessons Learned
- Author
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Craig A. Piquette, James N. Sullivan, Kristina L. Bailey, Philip W. Smith, Andre C. Kalil, Daniel W. Johnson, Angela L. Hewlett, and Steven J. Lisco
- Subjects
medicine.medical_specialty ,Ebola virus ,Isolation (health care) ,business.industry ,viruses ,Medical record ,Intensivist ,Critical Care and Intensive Care Medicine ,Biocontainment ,medicine.disease_cause ,Intensive care ,medicine ,Disease management (health) ,Intensive care medicine ,business ,Personal protective equipment - Abstract
Objective This report will describe the preparations for and the provision of care of two patients with Ebola virus disease in the biocontainment unit at the University of Nebraska Medical Center. Data sources Patient medical records. Study selection Not applicable. Data extraction Not applicable. Data synthesis Not applicable. Conclusions Safe and effective care of patients with Ebola virus disease requires significant communication and planning. Adherence to a predetermined isolation protocol is essential, including proper donning and doffing of personal protective equipment. Location of the patient care area and the logistics of laboratory testing, diagnostic imaging, and the removal of waste must be considered. Patients with Ebola virus disease are often dehydrated and need adequate vascular access for fluid resuscitation, nutrition, and phlebotomy for laboratory sampling. Advanced planning for acute life-threatening events and code status must be considered. Intensivist scheduling should account for the significant amount of time required for the care of patients with Ebola virus disease. With appropriate precautions and resources, designated hospitals in the United States can safely provide care for patients with Ebola virus disease.
- Published
- 2015
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