Hickman Community Hospital

OBJECTIVE: To evaluate the impact of radical prostatectomy (RP) upon quality of life (QOL) in patients with prostate cancer. PATIENTS AND METHODS: Seventy-nine patients with prostate cancer were recruited to evaluate the impact of RP upon QOL. The patients comprised two groups: the first group (n = 51) was evaluated 12 months or longer after RP; and the second group (n = 28) was evaluated 1 month prior to RP. All patients completed two previously reported QOL measures: the Functional Living Index Cancer (FLIC) and Profile of Mood States (POMS), and a series of questions which evaluated bladder, bowel and sexual function. RESULTS: Comparison of patients before RP with those after RP at 12 month follow-up revealed significant (P < 0.05) deterioration in sexual function, continence and hardship scores following RP while tension scores improved significantly. Although 10 other subscale parameters were analysed, no other differences were observed. Of the 51 post-RP patients, 46 (90%) stated that given a choice they would have their surgery again. CONCLUSION: The results reported show that RP has minimal overall impact upon patient QOL. Although minimal voiding and bowel dysfunction was reported, many patients were dissatisfied with post-operative sexual function.

We reported previously the isolation of a novel cell death-suppressing gene from maize (Zea mays) encoded by the Lls1 (Lethal leaf spot-1) gene. Although the exact metabolic function of LLS1 remains elusive, here we provide insight into mechanisms that underlie the initiation and propagation of cell death associated with lls1 lesions. Our data indicate that lls1 lesions are triggered in response to a cell-damaging event caused by any biotic or abiotic agent or intrinsic metabolic imbalance--as long as the leaf tissue is developmentally competent to develop lls1 lesions. Continued expansion of these lesions, however, depends on the availability of light, with fluence rate being more important than spectral quality. Double-mutant analysis of lls1 with two maize mutants oil-yellow and iojap, both compromised photosynthetically and unable to accumulate normal levels of chlorophyll, indicated that it was the light harvested by the plant that energized lls1 lesion development. Chloroplasts appear to be the key mediators of lls1 cell death; their swelling and distortion occurs before any other changes normally associated with dying cells. In agreement with these results are indications that LLS1 is a chloroplast-localized protein whose transcript was detected only in green tissues. The propagative nature of light-dependent lls1 lesions predicts that cell death associated with these lesions is caused by a mobile agent such as reactive oxidative species. LLS1 may act to prevent reactive oxidative species formation or serve to remove a cell death mediator so as to maintain chloroplast integrity and cell survival.

Seven patients with complicated pelviureteric junction (PUJ) obstruction underwent reconstruction by means of ureterocalicostomy; 5 had undergone previous surgery and 2 had primary obstruction. Radiographic studies showed resolution or improvement of the obstruction in 5 patients, who remain asymptomatic 15 to 47 months (mean 30) post-operatively. Obstruction persists in 1 patient and the other developed renal artery thrombosis with subsequent loss of the kidney. It was concluded that ureterocalicostomy can provide long-term, successful reconstruction of a complicated PUJ obstruction, but significant complications may be associated with the procedure.

African Americans suffer disproportionately poor hypertension control despite the availability of efficacious interventions. Using principles of community-based participatory research and implementation science, we adapted established hypertension self-management interventions to enhance interventions' cultural relevance and potential for sustained effectiveness among urban African Americans. We obtained input from patients and their family members, their health care providers, and community members. The process required substantial time and resources, and the adapted interventions will be tested in a randomized controlled trial.

Voice is crucial for communication in all healthcare settings. Evidence-based care highlights the need for clear communication. Clear communication methods must be applied when caring for special populations in order to assess pain effectively. Communication efforts also should be offered to patients who are in end-of-life care and would like to make independent decisions. A computer communication application was offered to patients in intensive care/critical care units in three hospitals in South Florida. Inclusion criteria included the age of 18 years or older, Richmond Agitation Sedation Scale between -1 and +1, ability to read and write English, and willingness to use the computer application. Exclusion criteria included inability to read and write English, agitation as defined by the Richmond Agitation Sedation Scale, and any patient on infection isolation protocol. Four qualitative themes were revealed, which directly relate to two published evidence-based guidelines. These are the End of Life Care and Decision Making Evidence-Based Care Guidelines and the Pain Assessment in Special Populations Guidelines. This knowledge is important for developing effective patient-healthcare provider communication.

As a result of the accountability requirements established in Title III of the Elementary and Secondary Educational Act (ESEA) legislation, English Learners (ELs) are expected to make progress in both content area academic achievement and English Language Proficiency (ELP). In Tennessee ELs progress is measured by administering WIDA-Access to assess English language proficiency, and Tennessee Comprehensive Assessment Program (TCAP) standardized assessments to measure content academic achievement. The purpose of this study was to compare and analyze the performance levels of ELs who achieved the exit criteria on WIDA-Access state mandated English proficiency assessment and their subsequent performance on English Language Arts and Math TCAP assessments. Specifically, a comparison of EL’s achievement on TCAP was compared to the achievement on TCAP of non-ELs. Independent samples t-tests were performed on data from 302 elementary and middle school ELs and non-ELs that participated in WIDA-Access and TCAP assessments in 2015. Data analyses concluded that English Language Arts and Math TCAP scale scores were significantly different between ELs and non-ELs. Achievement levels in both English Language Arts TCAP and Math TCAP for ELs, who achieved the exit criteria on WIDA-Access, were lower than the achievement levels of non-ELs. Discussions of the findings in this study along with implications of using these assessments to measure ELs growth is provided in relation to the increased demands on measuring both the academic achievement and English language progress for ELs.

Summary Significant economic benefits can be derived from the application of reservoir management. The key elements in economical reservoir management are the efficient use of available resources and optimization of reservoir exploitation through a multidisciplined approach. This paper describes various aspects of and approaches to reservoir management and provides case histories that support the findings. Introduction The genesis of this article was my participation in an SPE-sponsored reservoir management seminar in 1992. The invitation to speak on the economics of reservoir management arose from my experience in evaluating reservoir exploitation projects. However, after some reflection, I began to have doubts concerning what the economic considerations unique to reservoir management were. Reserve evaluations are not handled differently just because reservoir management is involved. Likewise, economic hurdle rates are unique to the particular company and have nothing to do with the study process. In a previous seminar, methods of financing projects were discussed. This was interesting but not normally the direct concern of those involved in reservoir management. What then are the unique economic aspects of reservoir management, if any? The answer seemed to lie within the reservoir management process itself. What is reservoir management? Haven't reservoir engineers been doing this for years? Why all the hype about something that's not a new technology, not even a new concept? Most literature on reservoir management is centered around exploitation of large reservoirs in frontier areas of the world. Does reservoir management have a meaningful role in small reservoirs or mature producing basins? The leading advocates of reservoir management are usually experts in numeric simulation. Is reservoir modeling the essence of reservoir management? Only as these issues about the nature and use of reservoir management were examined did a rationale for the economic aspects develop. What Is Reservoir Management? Perhaps this question has been best answered in the negative. Reservoir management is neither a new technology nor the latest management consultant buzzword to justify corporate reorganization. While philosophical aspects to reservoir management exist, it is not an attempt to introduce Japanese management philosophy into petroleum engineering (e.g., total quality management). Reservoir management has been described as (1) repackaging existing technology, (2) managing advanced technology, (3) long-range/strategic planning, (4) team approach to problem solving, and (5) common sense. All of these contain an element of truth.

Less than half of all US adults report meeting physical activity recommendations of 30 minutes or more of moderate to vigorous physical activity on at least 5 days per week. Thus, community-wide ecological initiatives are needed to create environments that support incorporating physical activity into residents' daily lives. In this article we describe an ongoing collaborative service-learning partnership between Clemson University, a community coalition, and a neighboring small rural town to address local social and physical environment supports for walking. Years 1 to 3 of this collaborative initiative were evaluated using a mixed-method approach to assess physical environment changes, social environment changes, community perceptions of support for walking, community perceptions of collaborating with university students, and students' skill development. Results revealed several key environmental changes such as mapping and marking 3 walking trails in the community, development of broad marketing efforts linked to the trails that promote community health and heritage, and annual community events to promote walking and the newly developed walking trails. Interview data with community leaders identified several key themes critical to facilitating and enhancing our university and community collaboration. Lastly, students developed skills in developing partnerships, mapping, advocacy, event planning, critical reflection, and qualitative and quantitative data collection and analysis. Through this process community members and students learn evidence-based public health skills for using data and planning frameworks to guide local initiatives, engage community members in decision making, and conducting evaluations.

AbstractThe end uses of cemented carbides are probably more diverse than those of any other powder metallurgy product. The commonest use is to resist wear, but so many widely different wear mechanisms are encountered in practice that different grades of carbide must be produced to resist attrition, chemical erosion, micro chipping, and diffusion wear. In metal cutting high temperatures are frequently encountered, generally under conditions of severe temperature gradients so that high-temperature hardness and strength and a resistance to thermal stresses and thermal shock must be provided. Tools for operations such as wire and bar drawing, cold extrusion and cold heading require an optimum combination of hardness and strength. Generally such tools also require a very high quality of surface finish. Special measures are desirable to minimize porosity, and fortunately these also give considerable benefit from improvements in strength. Tools for mining applications show similar diversity in the properties required. The percussive rock drill in particular encounters a wide variety of service conditions and is an application where strength is often a limiting factor. Other tools such as those used for certain coal mining applications are less critical in their demands, and economic factors can influence the choice and quality of product. The paper reviews the properties and wear mechanisms that occur with the commoner uses of cemented carbide alloys. and describes how grades are ‘tailored’ to suit various applications. Notes* Manuscript received 6 August 1974. Contribution to a Symposium on ‘Factors Affecting the Uses of PM Products’, held in Eastbourne on 28–30 October 1974.

Changes in early childhood science, theory, and best practices for improving outcomes of children with motor delay or dysfunction and their families have evolved rapidly since EI began. Changes in daily early intervention (EI) practice have been more elusive. Closing the gap between knowledge and practice requires EI providers to piece together information from a variety of knowledge streams including early childhood special education, pediatric rehabilitation, and cognitive psychology. The purpose of this article is to create a body of shared, evidence-based knowledge among providers responsible for addressing the needs of children with movement disorders and their families to effect changes in practice. This article discusses the evolution of EI practice models for children with motor concerns; examines related theories, interventions, and outcomes; and presents an alternative model based on contemporary evidence and grounded in dynamic systems theory. Researchers describe existing barriers to implementation of family-centered, support-based practices. Recommendations highlight the need for EI providers to collaborate with families to develop meaningful goals and to recognize and create opportunities for children to engage in high volumes of task-specific activity in a meaningful context. Continued research is required to verify effectiveness of this integrated model for improving child and family outcomes.

Summary The evaluation engineer generates not only reserve projections, but alsocash flows and often fair-market-value (FMV) estimates. These tasks requireecopolitical assumptions in addition to the technology involved. This paperdiscusses the evolution of economic and risk considerations into current"industry-accepted" practices and the engineer's role in the evaluationprocess. Introduction Given that a company's reserve base is its collateral and source ofoperating funds, it is not surprising that a need has long existed for reserveevaluations to facilitate financial reporting requirements. These uses requireprojections of cash flow, net profit, payout, and expenditure. The generalpayout, and expenditure. The general acceptance of the "time value ofmoney" concept added the need for discounting and rate-of-returnindicators. Increasingly, political considerationse.g., conservation, politicalconsiderationse.g., conservation, prorationing, and pricing regulationshaveprorationing, and pricing regulationshave affected U.S. domestic reserveevaluations. Converting a reserve estimate to a cash-flow projection oftenrequires reservoir engineers projection often requires reservoir engineers toexercise judgments on subjects beyond their areas of technical expertise. Although reserve evaluations traditionally exclude quantitative riskconsideration, the engineer is frequently requested to estimate FMV, whichinvolves producing property risk in all its many guises. In response toindustry's increasingly complex evaluation needs, evaluation engineering hasevolved into a distinct subdiscipline. The typical evaluator is an experiencedreservoir engineer with sufficient exposure to evaluation requirements torecognize both the physical and the ecopolitical uncertainties involved. Thehighest degree of professionalism is required because the reserve evaluator hasa fiduciary responsibility to the investor or management. These "endusers" depend on the evaluator to use "accepted" or"standard" industry practices when such standards are seldom defined. Estimating FMV and the evaluation engineer's role in this process is not fullyunderstood within industry and remains a mystery to outsiders. Reserve Evaluation The first reserve evaluation apparently has been lost in history, but thefirst bank oil loan was reported in 1928. Petroleum engineering was in itsinfancy. Because of the lack of accurate technical data and the chaos thatexisted in marketing, early evaluations could hardly have been more than roughestimates. The introduction of conservation, prorationing, and tax laws duringthe 1930's prorationing, and tax laws during the 1930's and 1940's gave a morereliable data base from which to estimate reserves. After the East Texas fieldwas prorated and the U.S. economy strengthened in the late 1930's, domesticdemand began to exceed supply. Oil prices improved enough to allow expansion tobe financed by cash flow. After World War II, supply overtook demand owing tolarge U.S. discoveries and some displacement of U.S. crude by gas and non-U.S.oil. As a result, producing rates, particularly in Texas, were further limitedby particularly in Texas, were further limited by prorationing, making itharder to finance prorationing, making it harder to finance operations out of areduced cash flow. Bank borrowing became necessary, which increased the demandfor reserve evaluations. Postwar technical advances greatly improved theaccuracy of reserve projections. Industry-accepted reserve evaluation methodsbegan to emerge and reserve definitions were established. Evaluating reservesbecame a fairly routine engineering procedure where the only ecopoliticalprocedure where the only ecopolitical considerations were the allowable and thenumber of producing days in Texas. Pricing was constant and reserve projectionswere based on top allowable or exponential declines. More than 90% of theevaluation effort dealt with the technical aspects. Reservoir engineering andpetroleum geology continued to mature as disciplines. Data-gathering tools forlogging, coring, and testing became more accurate and comprehensive. Theevaluator needed increased expertise as secondary recovery became widespreadand offshore drilling introduced new concepts in the 1960's. The threatened orshort-lived oil embargoes in the late 1960's were an unheeded presage. When oilprices increased in 1973, presage. When oil prices increased in 1973, engineerswere faced with the need to forecast economic parameters. Close on the heels ofescalating energy prices was political reality in the form of oil pricepolitical reality in the form of oil price controls, the 1978 Natural Gas Policy Act, and the U.S. government's ultimate solution to the energy crisisthe Windfall Profit Tax. These political constraints combined with increasingoptimism about oil and gas prices began to relegate engineering to a secondary role. JPT P. 220

ABSTRACT The value of long life reserves is greatly reduced by conventional discounted cash flow approaches due to the present worth effect. However, the prices often paid for such reserves indicate that some buyers use alternate evaluation techniques and/or give considerable weight to nonquantifiable aspects. The impact of various evaluation methods is investigated. While some methods are more representative than others, all fail to express the strategic considerations involved in the business decision to buy reserves. Some buyers are better positioned by virtue of their orientation and capital source to acquire long life reserves.

ABSTRACT The effect of depressed oil and gas prices on investors' confidence has been reflected by the low activity levels in the Permian Basin as elsewhere. Yet, even during the 1986-87 period viable projects were available to the industrious and imaginative.One example is the Wentz (Clearfork) Field where a small independent operator recognized potential in what appeared to be a very marginal waterflood prospect. Through data gathering and engineering, the potential was documented to the point that investor funding became available.A cooperative waterflood plan was agreed to with the field's other operator. The project was installed with an emphasis on practicality, cost savings and attention to details. After a year of injection, production response is exceeding expectations.

25 Background: Low cytotoxic T lymphocyte (CTLs) infiltration in colorectal cancer (CRC) tumors is a challenge to treatment with immune checkpoint inhibitors. Consensus molecular subtypes (CMS) classify patients based on tumor attributes, and CMS1 patients include the majority of patients with high CTL infiltration and “inflamed” tumors. Epigenetic modification plays a critical role in gene expression and therapy resistance. Therefore, in this study we compared DNA methylation, gene expression, and CTL infiltration of CMS1 patients to other CMS groups to determine targets for improving immunotherapy in CRC. Methods: RNA-seq (n = 511) and DNA methylation (n = 316) from The Cancer Genome Atlas databases were used to determine gene expression and methylation profiles based on CMSs. CMS1 was used as a reference and compared to other subtypes (CMS2-4). Microenvironment Cell Populations- counter (MCPcounter) was used to determine tumor CTL infiltration. Genes with significantly different expression (p &lt; 0.01, LogFC≥|1.5|) and difference of mean methylation β value ≥|0.25| were integrated for Pearson correlation coefficient analysis with MCPcounter score (r &gt; |0.7|). Results: Comparing CMS1 and CMS2, ARHGAP9, TBX21, and LAG3 were differentially methylated and correlated with CTL scores. ARHGAP9 and TBX21 were decreased and hypomethylated in CMS2. Comparing CMS1 and CMS3, ARHGAP9, TBX21, FMNL1, HLA-DPB1, and STX11 were downregulated in CMS3 and highly correlated with CTL scores. ARHGAP9, FMNL1, HLA-DPB1, and STX11 were hypomethylated in CMS3 and TBX21 was methylated in both, but had a higher methylation ratio in CMS1. Comparing CMS1 and CMS4, TBX21 was the only gene downregulated, hypomethylated, and highly correlated with CTL scores in CMS4 patients. Conclusions: We found six genes differentially expressed, differentially methylated, and highly correlated with CTL infiltration when comparing CMS1 to other CMS groups. Specifically, TBX21 was the only gene highly correlated with CTL scores with differential gene expression and methylation in CMS2-4 when compared to CMS1. Thus, T-bet may be a critical regulator of T cell responses in CRC.

SPE MembersAbstract. The effect of depressed oil and gas prices on investors' confidence has been reflected by the low activity levels in the Permian Basin as elsewhere. Yet, even during the 1986-87 period viable projects were available to the industrious and projects were available to the industrious and imaginative. One example is the Wentz (Clearfork) Field where a small independent operator recognized potential in what appeared to be a very marginal potential in what appeared to be a very marginal waterflood prospect. Through data gathering and engineering, the potential was documented to the point that investor funding became available. A point that investor funding became available. A cooperative waterflood plan was agreed to with the field's other operator. The project was installed with an emphasis on practicality, cost savings and attention to details. After a year of injection, production response is exceeding expectations. production response is exceeding expectationsIntroduction. Most of the major carbonate oil reservoirs on the Central Basin Platform of the Permian Basin were discovered and developed during the 1940's and 1950's before modern logging tools at a time when reservoirs were usually visualized as

Only 0.8% of the scientific Ph.D. workforce is employed teaching kindergarten through grade 12 (K-12), according to Jeffrey Mervis's News Focus article “How to produce better math and science teachers” (1 Sept., p. [1454][1]). A National Research Council committee “suggests tapping a talent pool that is relatively underrepresented among teachers [to teach K-12]: newly minted Ph.D.'s.” I am a newly minted Ph.D. (October 2000) teaching high school. I find my extensive education in science to be a benefit in teaching my advanced-placement classes, but not so in teaching my standard classes. Teaching the latter challenges not my depth of knowledge, but my skills in interacting with adolescents. This is a different field from the one for which I pursued my degree. I also find the lack of time available for professional development as a scientist to be greatly limiting. A Ph.D. in science is trained to pursue research. These skills are not exercised in the general high school experience. Using science Ph.D.'s to teach general high school classes is a misappropriation of resources. Assigning them to teach advanced classes or to serve as advisors for curriculum development and research projects would be a more efficient use of resources, and this should be accompanied by the opportunity for such individuals to pursue professional development to prevent their dissatisfaction. [1]: /lookup/doi/10.1126/science.289.5484.1454

ABSTRACT Because a majority of petroleum engineers fall under the industrial exemption, registration is usually taken for granted as a procedure that is always available if needed. Even registered engineers in public practice tend to view it as a governmental requirement without relating registration to their status as a professional and their responsibility to the public's health, safety and welfare. Professional registration is not exempt from the winds of change originating in our increasingly consumer-oriented, environmenţly-conscious society. Although petroleum engineering has been a well established discipline for over fifty years, it is classified as a "minor" discipline because of the number of licensed practitioners. The increase in the number of recognized minor engineering disciplines in the last two decades has led to proposed revisions in the registering process. Lacking a well developed professional image, petroleum engineering is vulnerable to these proposed changes. Recently, two states proposed revisions that would make it more difficult to register as a petroleum engineer. Periodically, industrial exemptions come under question. These are few of the current issues that pose a possible threat to registering as a petroleum engineer. The practice of engineering is not a natural or constitutional right. The separate states have the authority to determine who is qualified to practice as an engineer. If the majority of petroleum engineers are content to earn a paycheck and achieve passable competency in a limited area with little regard for the broader aspects of professionalism, we may lack sufficient credibility as a discipline to control our destiny.

Under newly restructured Centers for Medicare and Medicaid Services guidelines, hospitals are at risk for reduction in reimbursement for patients with heart failure (HF) who are readmitted within 30 days after discharge. Patients with HF who are admitted for an implantable cardioverter defibrillator (ICD) are routinely admitted with a primary diagnosis of HF. To reduce the occurrence of readmission, this article identifies the causes of 30-day readmission and recommends that patient follow-up after ICD placement should include assessment and management of HF symptoms.

Abstract In view of the asset concentration strategy being pursued in the US by major oil companies, trading producing interests appears to be an ideal approach. Interest in trading is at an all time high. Most easy trades have been done. New trade proposals are more complex and consequently are harder to accomplish. A major barrier to trades is the traditional competitive mind set of management. Trades will increase as attitudes evolve.

Abstract Investors formulate strategies about their future ownership of oil and gas reserves based on perceptions about future economic conditions, particularly oil and gas prices. If a major change in the economic environment is perceived, then the strategies are rethought. The basic decision faced by all oil field investors is whether to increase or decrease their reserve position since there is usually no neutral position. Reserves are either being depleted through production or added through drilling, enhancement or acquisition. The data available on finding costs indicate it has usually been cheaper to buy rather than drill for reserves in recent years. This comparison may be distorted since the true finding cost is not known until the discovery is fully developed, which usually takes years. However, it is obvious from Figures 1 and 2 that the current decision is normally to buy, not drill. The drastic drop in rig count continues even though oil prices have strengthened in 1989. In contrast, the number of acquisition transactions tracked quarterly by Strevig &amp; Associates has soared since mid–1986. Formulating a strategy for the acquisition of reserves involves consideration of (1) the availability, amount and source of capital, (2) minimum economic return, (3) geographic area of interest, (4) ability to operate and (5) minimum size and exposure per transaction. A decrease in reserves can occur automatically through production depletion or by a deliberate decision to sell. A seller must decide (1) what is to be sold, (2) how it will be sold (bid or negotiation), (3) who will sell it (in-house or outside expertise) and (4) selling price. Unlike acquisitions which are made for profit motives, the decision to sell can result from changing business objectives, a deteriorating financial position, legal action or the death or retirement of a principle.