Arroyo Grande Community Hospital

BACKGROUND: Revision rotator cuff repair is a surgical challenge, and the results have generally been inferior to those of primary repair. We examined the results of revision rotator cuff repair in a large series of patients and assessed which subgroups of patients had the greatest chance for a satisfactory functional outcome. METHODS: A revision rotator cuff repair was performed in eighty patients after the failure of a previous operative repair. The average age of the patients at the time of the revision was fifty-nine years. Prior to revision, the average pain score was 7.4 points (with 0 points indicating no pain and 10 points, severe pain) and the active range of motion of the shoulder averaged 105 degrees of elevation, 39 degrees of external rotation, and internal rotation to the eleventh thoracic vertebra. All patients underwent repeat repair of the rotator cuff tendons to bone. Additional procedures included revision acromioplasty (fifty-three patients; 66%) and distal clavicular excision (twenty-six patients; 33%), among others. RESULTS: After an average duration of follow-up of forty-nine months, the result was rated as satisfactory (excellent, good, or fair) in fifty-five patients (69%) and as unsatisfactory (poor) in twenty-five (31%). At the time of the latest follow-up, the average pain score had improved to 3.0 points and the active range of motion averaged 130 degrees of elevation, 53 degrees of external rotation, and internal rotation to the tenth thoracic vertebra. Improved results were associated with an intact deltoid origin, good-quality rotator cuff tissue, preoperative active elevation of the arm above the horizontal, and only one prior procedure. All seventeen patients who met all four of these criteria had a satisfactory result. CONCLUSIONS: The results of revision rotator cuff repair are inferior to those of primary repair. While pain relief can be reliably achieved in most patients, the functional results are improved principally in patients with an intact deltoid origin, good-quality rotator cuff tissue, preoperative elevation above the horizontal, and only one prior procedure.

In their recent article, 1 Wolf et al note a decrease in the severity of stroke over the three decades beginning 1953, 1963, and 1973, sequentially. It is of interest that most of this difference was seen between decades two (i.e., 1963-1973) and three (i.e., 1973-1983). This third decade was also the time when aspirin first became widely used for stroke prevention and the first trials demonstrating its efficacy were reported. We have previously questioned whether platelet antiaggregant therapy lessens the severity of stroke, 2 but subsequent placebo controlled platelet antiaggregant trials have either not settled the issue or unfortunately not even addressed it. Is there any way that Dr. Wolf and colleagues can look back at their data to see whether the use of aspirin was an important variable distinguishing patients having strokes in decade two versus decade three of this study?

A within subjects multiple baseline design was employed to evaluate the effects of a cover, copy, and compare intervention on the multiplication rates of four behavior disordered students. The results indicate that the cover, copy, and compare intervention is an efficient method for increasing multiplication fact fluency which requires little student training or teacher time. Opportunities to respond and immediate corrective feedback are discussed as variables which were functionally related to the increased in fluency.

The performance of buried steel pipelines subjected to relative soil movements in the axial direction was investigated using full-scale pullout testing in a soil chamber. Measured axial soil loads from pullout testing of pipes buried in loose dry sand were comparable to those predicted using guidelines commonly used in practice. The peak values of axial pullout resistance observed on pipes buried in dense dry sand were several-fold (in excess of 2 times) higher than the predictions from guidelines; the observed high axial pullout resistance is primarily due to a significant increase in normal soil stresses on the pipelines, resulting from constrained dilation of dense sand during interface shear deformations. This reasoning was confirmed by direct measurement of soil stresses on pipes during full-scale testing and numerical modeling. The research findings herein suggest that the use of the coefficient of lateral earth pressure at-rest (K 0 ) to compute axial soil loads, employing equations recommended in common guidelines, should be undertaken with caution for pipes buried in soils that are likely to experience significant shear-induced dilation.

To determine whether the relative decline in cardiac myosin isoenzyme V1 with maturation continues progressively into senescence and whether thyroxine could reverse age-associated changes in the myosin isoenzyme profile and contraction, rats 2, 8, and 24 months old were treated with thyroxine, 6.4 mg/kg, for 7 days. Myosin isoenzymes, Ca2+-myosin ATPase activities, and isometric contractile function were measured in cardiac preparations from thyroxine-treated animals and age-matched controls. Right ventricular hypertrophy did not occur with aging in controls. Thyroxine increased right ventricular weight in each age group compared to the control group. Body weight decreased by 10% in all thyroxine-treated rats. The relative right ventricular V1 isoenzyme content progressively decreased from 75 +/- 1% to 54 +/- 1% and 14 +/- 1% in controls at 2, 8, and 24 months, respectively, and was associated with a reciprocal increase in V3 myosin isoenzyme. Ca2+-myosin ATPase activity also progressively declined monotonically with age in the control rats from 854 +/- 28 nmol Pi/mg prot/min at 2 months to 529 +/- 28 nmol Pi/mg prot/min at 24 months. Thyroxine administration increased right ventricular V1 at each age to 97 +/- 2%, 73 +/- 2%, and 59 +/- 2% at 2, 8, and 24 months, respectively. A thyroxine induced increase in the Ca2+-myosin ATPase activity could be detected only in the 24-month-old animals.(ABSTRACT TRUNCATED AT 250 WORDS)

This paper presents a crystallographically-based constitutive model of a single crystal deforming by climb and glide. The proposed constitutive law is an extension of the rate-sensitivity approach for single crystal plasticity by dislocation glide. Based on this description at single crystal level, a homogenization-based polycrystal model for aggregates deforming in a climb-controlled thermal creep regime is developed. To illustrate the capabilities of the proposed model, we present calculations of effective behavior of olivine and texture evolution of aluminum at warm temperature and low strain rate. In both cases, the addition of climb as a complementary single-crystal deformation mechanism improves the polycrystal model predictions.

In this paper a high efficiency and flexible hybrid system representing a new total energy concept for the distributed power market is presented. The hybrid system is composed of a very small size (5 kW) micro gas turbine (named personal turbine—PT) presented in a companion paper by the authors coupled to a small size solid oxide fuel cell (SOFC) stack. The power of the whole system is 36 kW depending on the design parameters assumed for the stack. The design and off-design performance of the hybrid system have been obtained through the use of an appropriate modular code named “HS-SOFC” developed at the University of Genoa and described in detail in this paper. The results of the simulation are presented and discussed with particular regards to: choice of the hybrid system (HS) design point data, HS design point performance, off-design performance of PT and SOFC stack, and off-design performance of the whole HS. Some preliminary economic results are also included based on different fuel and capital cost scenarios and using the cost of electricity as the parameter for comparison between PT and HS.

The performance of pipeline systems during earthquakes is a critical consideration in seismically active areas. Unique approaches to quantitative estimation of regional seismic vulnerability were developed for a seismic vulnerability assessment and upgrading program of a 500‐km‐long natural gas pipeline system in British Columbia, Canada. Liquefaction‐induced lateral spreading was characterized in a probabilistic manner and generic pipeline configurations were modeled using finite elements. These approaches, developed during the early part of this 10‐year program, are more robust than typical approaches currently used to assess energy pipeline systems. The methodology deployed within a GIS environment provided rational means of distinguishing between seismically vulnerable sites, and facilitated the prioritization of remedial works. While ground improvement or pipeline retrofit measures were appropriate for upgrading most of the vulnerable sites, replacement of pipeline segments using horizontal directional drilling to avoid liquefiable zones were required for others.

The Trans‐Alaska Pipeline System is one of the most significant engineering achievements of the 20 th century and the first major pipeline system for which considerable attention was focused on the identification and quantification of potential seismic hazards and the implementation of design and operational features to address those hazards. One of these special design features included the concept for an above‐ground supporting system for the pipeline crossing of the Denali fault. The 2002 M7.9 Denali fault earthquake represents the first successful test of a structure specifically designed for fault displacement. The earthquake also demonstrated the benefits of the multi‐tiered earthquake preparedness and response strategy in place at the time of the earthquake.

Abstract The automated global real‐time association of phase picks into seismic sources comes with unique challenges when simultaneously monitoring at local, regional, and global scales. High spatial variability in seismic station density, transitory seismic data availability, and time‐varying noise characteristics of individual stations must be considered in the design of an associator that is fast and accurate with a low false association rate. These challenges are particularly apparent at the U.S. Geological Survey National Earthquake Information Center (NEIC), which monitors seismicity in near‐real time on local, regional, and global scales using seismic data from roughly 2100 real‐time seismic stations. To fully leverage this large dataset, NEIC developed a standalone self‐configuring seismic phase associator, GLobal ASSociator 3 (GLASS3) that simultaneously processes variably scaled 3D association webs, each with a unique set of nucleation criteria (e.g., nucleation stack threshold). GLASS3 has many useful features for real‐time monitoring including its computational efficiency, instantaneous pick processing, and on‐the‐fly configurability such as the creation and removal of targeted association webs and updates to supporting station metadata. GLASS3 runs both as part of a real‐time event processing system and as a configurable standalone associator that can be applied to a large variety of seismic problems. Here, we describe the GLASS3 algorithm and demonstrate (including input data and configuration files) its use in associating phase‐ambiguous picks on multiple scales.

The interaction between a buried pipeline and surrounding soil during large ground displacements is typically simulated using numerical nonlinear soil-restraint springs aligned with the longitudinal axis of the pipeline and in the two directions orthogonal to it. There are only very limited experimental data available to characterize the soil springs for simulating pipelines crossing reverse faults where large oblique soil displacements relative to the pipe could occur. Full-scale model testing was undertaken to evaluate this complex soil–pipe interaction problem. The tests simulated the performance of ∼400 mm diameter (nominal pipe size, NPS 16) pipe specimens buried in moist sand and crushed limestone trench backfill. The peak normalized oblique soil restraint (N θ ) values for oblique pipe movement angles (θ), when θ = 0° (horizontal movement) and θ = 90° (vertical movement), estimated based on state-of-practice approaches, were in agreement with those from full-scale testing. The value of N θ was found to depend significantly on the peak friction angle of soil ([Formula: see text]) when θ was closer to 0°, whereas N θ was less sensitive to [Formula: see text] when θ was beyond about 35°. The theoretical values of N θ based on limit-equilibrium approaches compared well with the experimental findings.

The translation of basic behavioral science discoveries into practical strategies represents a promising approach to developing more effective preventive interventions to improve health. Since translational research inevitably involves making use of diverse perspectives from multiple disciplines, it is best conducted as a transdisciplinary enterprise. In this paper, we discuss current strategies used by NIH to support transdisciplinary translational behavioral (TDTB) research, summarize successful efforts, and highlight challenges encountered in conducting such work (ranging from conceptual to organizational to methodological). Using examples from NIH-funded projects we illustrate the potential benefits of, and barriers to, pursuing this type of research and discuss next steps and potential future directions for NIH-supported TDTB research.

Having a personal computer (PC) and related electronic equipment in the majority of U.S. homes today is accepted without question. In the same vein, having a personal turbine (PT) in the home could also be taken for granted in coming decades to assure a constant and reliable source of electrical power, which is paramount in the e-business era. As addressed in this paper, gas turbine technology has advanced to the point where a natural gas-fired PT, rated at about 5 kW could reliably provide the total energy needs of an average home. The Industrial Revolution of the 18th century, in which a centralized factory replaced cottage industries, was made possible by introduction of the steam engine. In the 21st century IT Revolution, the situation will have essentially gone the full circle, with a high percentage of service industry work being done in the home. For individuals using the internet for conducting business a reliable source of electrical power is mandatory. Alas, this can no longer be assured by the U.S. power grid which is quickly reaching its capacity, and increasing outages will become more commonplace. One solution to this could be the use of PTs in homes in both cities and remote areas. Also it would be ideally suited to applications in the developing countries, where it could provide the total energy needs of villages and small communities. In this introductory paper it is projected that when mass produced in very large quantities like automobile turbochargers, the PT unit cost would be competitive.

A study was conducted in a commercial strawberry planting on the California central coast to evaluate the relative efficacy of chemical and organic alternatives to methyl bromide fumigation. The three chemical alternatives included Telone/Chloropicrin 70/30, Basamid, and Metam sodium. Organic alternatives included addition of broccoli residues, spent mushroom compost, and a combination of both broccoli and spent mushroom compost. All treatments were compared to standard methyl bromide/chloropicrin 75/25. Weeding costs were five-fold greater in organic treatments than in chemical fumigant treatments and were not statistically different from untreated controls. The weed species in the organic treatments were significantly different than in the untreated or the chemical fumigant treatments, suggesting that these weeds were in the added organic material. Strawberry yields were highest in the methyl bromide/chloropicrin, Basamid and Telone/chloropicrin treatments. Strawberry yields among the organic treatments were not statistically different from the untreated control. Soil microbial biomass measurements and strawberry root pathology indicated that a single application of these particular organic amendments were inadequate in significantly increasing soil food web diversity on this previously fumigated soil to a point where strawberry pathogens could be suppressed to commercially acceptable levels. These results suggest that previously fumigated soil that has been depleted of Vesicular Arbuscular Mycorrhizal (VAM) fungal colonization and other beneficial microbiota require additional reconditioning before the soil would be suitable for commercial strawberry production, given the highly pathogen susceptible cultivars commonly grown in California.

OBJECTIVE: The aim of this study was to investigate the coronal microleakage of endodontically treated teeth prepared to receive an intracanal post and teeth with an intracanal post but without a prosthetic crown and exposed to contamination by fresh human saliva. MATERIAL AND METHODS: A mechanical-chemical preparation following the step-back technique was carried out in 35 extracted single-rooted human teeth. The teeth were randomly divided into five groups: G1=root canals instrumented, obturated, and prepared to receive an intracanal post (N=10); G2=root canals with cemented posts but without coronal sealing (N=10); PC1=positive control root canals instrumented and open (N=5); PC2=positive control 2 root canals without instrumentation and open (N=5); and NC=negative control healthy teeth (N=5). The crowns were removed except for the control group of intact teeth. The root canals were obturated and sterilized with cobalt 60 gamma irradiation and were then adapted in an apparatus using a Brain Heart Infusion (BHI) medium and fresh human saliva for contamination. Microbial growth was indicated by the presence of turbidity in the BHI liquid medium. RESULTS: Data were submitted to the Kaplan-Meier Survival Analysis and the Holm-Sidak statistic method, which observed an index of 90% of microleakage in root canals after 24 hours for G1 and 70% of microleakage in samples at the end of 40 days for G2. CONCLUSION: The results show that root canals with an intracanal post but without a prosthetic crown can be recontaminated when exposed to fresh human saliva in a short period.

This group case study was written by the authors as an investigation into the effects of a 20 week art therapy painting group on parents' self-reported measures of postnatal depression, self-esteem and relationship with their infants. Four parents completed validated and reliable questionnaires to assess postnatal depression, self-esteem and the quality of their relationships with their infants pre and post group. Statistical analysis indicated that group participants experienced a reduction in postnatal depression symptoms, significantly increased self-esteem and improvements in relationship with their infants, and these findings were corroborated by the group co-facilitators' clinical observations. We discuss these findings with reference to relevant literature, highlighting the exploratory, expressive and facilitative elements of painting groups on both verbal and non-verbal levels. We also present relevant literature relating to postnatal depression, and the potential long-term impact of postnatal depression on children's mental health and well-being. This article concludes that the current study indicates clear benefits to parents and their infants from art therapy painting group attendance, and outlines the implications and directions for future research.

The nipple and surrounding area, like other areas of skin, are subject to irritation, inflammation, and infection. Twenty women with persistent sore nipples were first seen by a lactation consultant and later referred to a dermatologist. The dermatologist successfully treated 18 of the 20 mothers. A lactation consultant should be able to identify those women who will benefit from evaluation and treatment by a dermatologist.

Societal Impact Statement Recent surveys conducted on Amazonian cocoa trees in their home range are a unique opportunity to assess the aromas, diversity and potential of the Ecuadorian Amazon to create new aromatic cocoa varieties. Our results reveal informations about the diversity and genesis of aromas in Ecuadorian fine cocoa. The great aromatic diversity could enrich cocoa flavour selection programmes and provide Amazonian populations with new income linked to aromatic varieties, which could lead to a ‘ grand cru ’ chocolate. Until now, breeding programmes have been mainly focused on improving characteristics for production, but in recent years cocoa quality has been increasingly examined to meet market expectations. Summary Ecuador is known worldwide for its fine or flavour cocoa from the Nacional variety. Currently, farmers mainly grow the modern Nacional variety of cocoa trees (hybrids between the ancestral Nacional and Trinitario) while the ancestral Nacional variety tends to be neglected. In order to enlarge the genetic resources related to this ancestral variety, several surveys were carried out in its area of origin located in the South Ecuadorian Amazonia. The 202 trees resulting from these surveys were genotyped using GBS (Genotyping By Sequencing) markers and their dried‐fermented beans were characterised for both their aromatic volatile compounds and sensorial quality. A genome wide association study (GWAS) was carried out with the aim to study the genetic and biochemical bases of the aroma traits of this population and to better exploit them in breeding programmes. Some association areas and candidate genes related to spicy and woody aromas were found for the first time in Theobroma cacao . Some association areas and candidate genes related to floral and fruity aromas common to other studies were identified. Our results support the hypothesis that aroma formation may be related to a defence reaction to biotic and abiotic stresses generated by the fermentation process.

Coseismic fault displacement has been recognized as a critical hazard to natural gas transmission pipelines crossing earthquake faults. Prior studies on pipeline response to fault displacement were limited to specific types of pipes and faults, which were indeed constrained by the computational resources. As part of an effort to develop a Bayesian model to relate ground displacement in pipeline strain, we analyze more than 217,000 finite element models of gas pipeline fault crossings, which consider the pipe–soil interactions with both pipe and soil material nonlinearities. Such an enormous number of simulations are selected based on comprehensive sensitivity analyses and cover the most important parameters of gas pipelines in terms of combinations of the following: (1) pipe dimensions and materials, (2) soil properties, and (3) style of faulting and characteristics of fault movements. We devise an automated workflow for input generation–simulation submission–output extraction, by utilizing more than 10,000 cores high‐performance super‐computing facilities. Finally, we examine the pipeline response for every combination, by investigating the evolution of maximum compressive and tensile strains in the axial direction along the pipe over the fault displacement. These numerical analyses resulted in a comprehensive database of pipeline fragilities crossing earthquake fault for seismic risk analysis of natural gas infrastructure in an earthquake region.

Abstract Almost four decades of study of Desmoinesian strata of Middle Pennsylvanian age in south-central Iowa and north-central Missouri have provided the stratigraphic control required to test the variation of clay mineralogy vertically and laterally within various paralic clay and shale facies. Local and regional variations in clay mineralogy within Desmoinesian strata are generally predictable and are in agreement with current knowledge of deltaic deposition. A principal environmental variation within a deltaic system is the change from normal marine salinities in deltaic marine environments to brackish- and fresh-water conditions in the marshy delta plains, in upper interdistributary bays, and within flanking interdeltaic embayments. Changes from marine to nonmarine facies coincide with a decrease in illite, and an increase in kaolin, mixed-layer clays, and in the percentage of expansible layers in the mixed-layer clay. The principal clay detritus entering the area was illite, which underwent various degrees of alteration in different aqueous and subaerial environments within deltaic and interdeltaic areas. Clay-mineral composition alone does not provide unique environmental answers. The distribution of clay-mineral suites within these systems, however, both supports the deltaic-interdeltaic depositional model and can be understood within the context of this framework.