Average Number Of Applications Research Articles

Intracardiac 3D navigation as a tool to improve the efficiency of ablation of idiopathic ventricular arrhythmias

Aim. Еvaluate the effect of 3D navigation on the effectiveness of ablation idiopathic ventricular arrhythmias. Materials and methods. The paper presents a retrospective postoperative analysis of 57 patients with idiopathic ventricular arrhythmias. Patients were divided into two groups. Group I included 30 (52.6 %) patients who used a 3D navigation system during mapping. Group II – 27 (47.4 %) patients in whom mapping was performed using classical methods. The effectiveness criteria were: frequency of acute suppression of arrhythmia, number of radiofrequency applications for suppression, and time of intervention. Results. Intraoperatively, complete suppression of the arrhythmia was successfully achieved in all cases in both groups. In group I average number of applications in patients with ventricular extrasystole was 5.5 (4.0; 8.0), while in group II – 6.5 (3,5; 9.0), without statistically significant difference (p = 0.414). A similar situation was observed with ventricular tachycardia. Іn group I number of applications was 3.2 (3.0; 4.3), and in group II – 5.0 (2.3; 11.0), which also had no statistically significant difference (р = 0.537). The duration of intervention for ventricular extrasystole in group I was 100.6 ± 26.6 min, while in group II – 136.4 ± 42.2 min, that has statistically significant difference (p = 0.007). During ablation of ventricular tachycardia in group I average duration was 89.3 ± 20.4 min, while in group II – 135.4 ± 55.5 min. The duration of intervention for ventricular tachycardia with the use of 3D navigation had a significantly shorter time compared to classical methods (p = 0.024). Conclusions. Based on the obtained data, we concluded that the use of 3D navigation significantly reduced the intervention time, regardless of the localization and type of arrhythmia. At the same time, no significant difference was found in the frequency of acute arrhythmia suppression and the number of applications to achieve the effect between the studied groups.

The Impact Of Law Number 16 Of 2019 Marriage Dispensation And Child Marriage Gap

Child marriage in Indonesia is quite high. Child marriage is a form of violence against children and is a practice that violates children's basic rights as outlined in the Convention on the Rights of the Child (CRC). Child marriage limits access to essential services, including education and health services, and can have long-term negative impacts on children's well-being and life chances. The legal age limit for marriage in Indonesia is a minimum of 19 years. However, one of the policies in the Marriage Law is a loophole that supports the legality of child marriages, through the granting of dispensations by the Court. The number of requests for marriage dispensation at the Ambarawa Religious Court continues to increase. This data is a reference for the author in studying the impact of the enactment of Law Number 16 of 2019, an amendment to Law Number 1 of 1974 concerning Marriage, on children. This research uses normative juridical methodology, namely reviewing court decisions. As a finding, one of the impacts of the enactment of Law Number 16 of 2019 which amends Law Number 1 of 1974 concerning Marriage is the increase in the number of requests for marriage dispensation at the Ambarawa District Court, Semarang Regency. This increase reached 337%, with the average number of applications per month increasing from 7.44 to 25.07. Changes in the marriage age as stated in Article 7 regarding the minimum marriage age of 19 years are not effective in reducing the number of child marriages. So it is necessary to optimize the implementation of Supreme Court Regulation Number 5 of 2019 concerning Guidelines for Granting Marriage Dispensations to ensure that judges have clear procedures and structured steps in adjudicating marriage dispensation cases.

Catheter Ablation of Atrial Fibrillation with Short Duration Radiofrequency Current using Non-Irrigated Catheters

Introduction. The use of high-power radiofrequency current is considered to be a promising alternative to the currently used technique of catheter ablation of atrial fibrillation (AF) with radiofrequency current of normal power. To date, there are no studies on the application of this technique using catheters without external irrigation.
 The aim. To study direct results of application of high-power radiofrequency current in AF catheter ablation using non-irrigated catheters.
 Materials and methods. We analyzed 30 consecutive patients who underwent primary catheter ablation (12 women and 18 men, mean age of the patients was 57.6 ± 11.7 years). Concomitant pathology (coronary heart disease, hypertension, diabetes mellitus) was observed in 19 (63.3%) patients.
 Wide isolation of pulmonary veins was performed, and in nonparoxysmal forms, applications were added in the places where fragmented activity was registered or in the line of applications between ipsilateral pulmonary veins and inferior left pulmonary vein and mitral valve annulus. The applications were made with a 4 mm electrode without irrigation function with wiping it after every 30 applications. Application parameters were 40-45 Watt power, application time 10 seconds, target temperature 55°C.
 Results. The mean left atrial catheter dwelling time was 1.6 ± 0.3 hours. The mean time of X-ray exposure was 8.2 ± 2.3 minutes. The average number of applications was 127.8 ± 23.6. It was not possible to isolate 3 pulmonary veins in three patients: one superior left pulmonary vein and two inferior right pulmonary veins (2.5% of all pulmonary veins).
 No complications related to the procedure were observed. The occurrence of AF in the early postoperative period was observed in 4 (13.3%) patients.
 Conclusions. The immediate results of applying the radiofrequency current of 40-45 W with the application duration of 10 seconds and the target temperature of 55°C during AF catheter ablation using non-irrigated catheters indicate the safety of this technique. It is necessary to study a larger contingent of patients and long-term results.

Efficacy of different variants of endocardial balloon cryoablation in patients with persistent atrial fibrillation

Aim. To study the effectiveness of “extended” cryoballon ablation in patients with a persistent form of atrial fibrillation (AF) and to determine the risk factors for AF recurrence after cryoablation.Methods. The study included 89 patients (62±10 years, 24 [27%] men) with a persistent form of AF. The patients were randomized into two groups: in the 1st, the pulmonary veins (PV) cryoablation was performed (n=48 [53.9%]); in the 2nd, the PV cryoablation was performed in combination with cryoablation of the posterior wall of the left atrium (n=41 [46.1%]). The number of patients at high risk of thromboembolic events predominated in Group 2 (p=0,03). There is a high frequency of taking antiarrhythmic drugs of class III in this group (p=0.018). The follow-up period was 12 months. Clinical efficacy was assessed during a survey and daily ECG monitoring at face-to-face visits after 3, 6 and 12 months.Results. Antral isolation of PV was achieved in all 89 (100%) patients in both groups. In group 2, the average number of applications in the posterior wall of the PV was 10 [9; 13]. The effectiveness of cryoablation in group 1 by the end of the 12-month follow-up period was 54.2%, in group 2 - 56.1%. The complication rate (6.7%) in both groups did not differ statistically (p=0.683). The risk of arrhythmia recurrence didn’t depend on the strategy of cryoablation in postablation period (p=0.834). When conducting a single-factor analysis, a statistically significant effect on the probability of AF recurrence in the period of 3-12 months in group 1 was caused by AF recurrence in the blind period (95% confidence interval (CI): 1.5-27.7, p=0.013), in group 2 belonging to the female sex (95% CI: 1.2-24.6, p=0.032) and AF relapse in the blind period (95% CI: 1.5-128.5, p=0.020). During multivariate analysis in group 2, a statistically significant influence on the risk of AF recurrence in the period of 3-12 months was exerted by belonging to the female sex (hazard ratio (HR) 7.84; 95% CI 1478-42,23; p=0.016) and the presence of early AF recurrence (HR 20.36; 95% CI 1.99-208.23; p=0.011).Conclusion. Extended cryoablation in terms of efficiency and safety was comparable with the standard cryoablation. Early recurrence of AF (in the first 3 months after the intervention) turned out to be an independent risk factor for AF recurrence in the long-term period up to 12 months after cryoablation in both groups.

The ophthalmology residency match: a new era.

The average number of applications per ophthalmology residency applicant continues to rise. The present article reviews the history and negative impacts of this trend, the dearth of effective solutions and the potential promise of preference signalling as an alternative strategy to address this and potentially improve match outcomes. Application inflation adversely impacts applicants and programmes and undermines holistic review. Most recommendations to limit volume have been largely unsuccessful or undesirable. Preference signalling does not restrict applications. Early results from initial pilots in other specialties are promising. Signalling has the potential to facilitate holistic review, reduce interview hoarding and promote equitable distribution of interviews. Preliminary data suggest preference signalling could be a useful strategy to address current issues with the Match. Building upon the blueprints and experiences of our colleagues, Ophthalmology should conduct its own investigation and consider a pilot project.

The Costliness of US Residency Applications: Moving Toward Preference Signaling and Caps.

The Costliness of US Residency Applications: Moving Toward Preference Signaling and Caps.

The Impact of Virtual Interviewing During the COVID-19 Pandemic on the Residency Application Process: One Institution's Experience.

To assess the impact of virtual interviewing during the COVID-19 pandemic on the residency application process and to compare applicant costs and time spent interviewing during the 2020-2021 application cycle with prior years. Fourth-year medical students at the University of Kansas School of Medicine applying for first-year residency positions via the National Resident Matching Program Match completed an electronic 46-item survey after submitting their rank lists during each application cycle from 2015-2016 to 2020-2021. The authors used descriptive statistics and t tests to analyze and compare responses to demographics questions and questions regarding number of submitted applications, offered and completed interviews, ranked programs, costs, and time spent interviewing. They used thematic analysis to code respondents' narrative comments about the virtual interviewing experience. From 2015-2016 to 2020-2021, 994 (of 1,190; 83.5%) respondents completed the survey. From 2019-2020 to 2020-2021, the average total cost of applying to residency per applicant dropped by $3,566 (P < .001) and the average time spent interviewing dropped by 13.3 days (P < .001). At the same time, the average number of applications per applicant dropped by 3.4, and applicants completed the same number of interviews and ranked 2.3 fewer programs, none of which were statistically significant differences. Narrative comments from 113 (79%) respondents in 2020-2021 revealed 4 themes related to virtual interviewing: convenience of time and cost, positive aspects of the process, negative aspects of the process, and overall impressions of the program. Virtual interviewing during the 2020-2021 application cycle resulted in an approximately 80% reduction in cost for applicants and an approximately 50% decrease in time spent interviewing compared with previous years but was not associated with large increases in number of submitted applications, completed interviews, or ranked programs. Applicants generally perceived virtual interviewing as positive although they raised notable concerns.

Shifting the Surgical Residency Match to a 100% Virtual Interview Format During the COVID-19 Pandemic, How has It Affected Placement Into Surgical Training Programs?

The AAMC transitioned to virtual interview formats for the 2020-2021 residency match. This study aims to examine the impact of the 100% virtual interview format for the 2020-2021 residency match on both application and match changes for multiple surgical specialties, including neurosurgery (NS), orthopedic surgery (OS), plastic surgery (PS), general surgery (GS), thoracic surgery (TS), and vascular surgery (VS). Cross-sectional study comparing application and match changes between the in-person 2019-2020 and virtual 2020-2021 residency match cycles for different surgical specialties. There was an overall increase in the number of applicants for 5 of the surgery specialties but not VS, and an overall increase in the number of applications per residency program across all specialties. The average number of applications per applicant also increased, except in TS. There were no major match changes except in TS, which saw an increase in number of spots filled by MDs to nearly 100% from 84.2% in the previous cycle. The switch to the 100% virtual 2020-2021 residency match interview format was associated with an overall increase in the number of applications per program and number of applications per applicant across multiple surgical specialties. There was a decrease in the number of applicants to VS and an increase in the number of applications per applicant. The switch to a virtual interview format in 2020-2021 was also associated with an increase in TS spots filled by MDs to almost 98%, increasing the already concerning TS match disparity for DO and IMG applicants.

Inefficiencies in Residency Matching Associated with Gale–Shapley Algorithms

Abstract Objective This study aimed to investigate emerging trends and increasing costs in the National Residency Matching Program (NRMP) and San Francisco Residency and Fellowship Match Services (SF Match) associated with the current applicant/program Gale–Shapley-type matching algorithms. Design A longitudinal observational study of behavioral trends in national residency matching systems with modeling of match results with alternative parameters. Patients and Methods We analyzed publicly available data from the SF Match and NRMP websites from 1985 to 2020 for trends in the total number of applicants and available positions, as well the average number of applications and interviews per applicant for multiple specialties. To understand these trends and the algorithms' effect on the residency programs and applicants, we analyzed anonymized rank list and match data for ophthalmology from the SF Match between 2011 and 2019. Match results using current match parameters, as well as under conditions in which applicant and/or program rank lists were truncated with finalized rank lists, were analyzed. Results Both the number of applications and length of programs' rank lists have increased steadily throughout residency programs, particularly those with competitive specialties. Capping student rank lists at seven programs, or less than 80% of the average 8.9 programs currently ranked, results in a 0.71% decrease in the total number of positions filled. Similarly, capping program rank lists at seven applicants per spot, or less than 60% of the average 11.5 applicants ranked per spot, results in a 5% decrease in the total number of positions filled. Conclusion While the number of ophthalmology positions in the United States has increased only modestly, the number of applications under consideration has increased substantially over the past two decades. The current study suggests that both programs and applicants rank more choices than are required for a nearly complete and stable match, creating excess cost and work for both applicants and programs. “Stable-marriage” type algorithms induce applicants and programs to rank as many counterparties as possible to maximize individual chances of optimizing the match.

More Is More: Drivers of the Increase in Emergency Medicine Residency Applications.

IntroductionThe average number of applications per allopathic applicant to emergency medicine (EM) residency programs in the United States (US) has increased significantly since 2014. This increase in applications has caused a significant burden on both programs and applicants. Our goal in this study was to investigate the drivers of this application increase so as to inform strategies to mitigate the surge.MethodsAn expert panel designed an anonymous, web-based survey, which was distributed to US allopathic senior applicants in the 2017–2018 EM match cycle via the Council of Residency Directors in Emergency Medicine and the Emergency Medicine Residents Association listservs for completion between the rank list certification deadline and release of match results. The survey collected descriptive statistics and factors affecting application decisions.ResultsA total of 532 of 1748 (30.4%) US allopathic seniors responded to the survey. Of these respondents, 47.3% felt they had applied to too many programs, 11.8% felt they had applied to too few, and 57.7% felt that their perception of their own competitiveness increased their number of applications. Application behavior of peers going into EM was identified as the largest external factor driving an increase in applications (61.1%), followed by US Medical Licensing Exam scores (46.9%) – the latter was most pronounced in applicants who self-perceived as “less competitive.” The most significant limiter of application numbers was the cost of using the Electronic Residency Application Service (34.3%).ConclusionA substantial group of EM applicants identified that they were over-applying to residencies. The largest driver of this process was individual applicant response to the behavior of their peers who were also going into EM. Understanding these motivations may help inform solutions to overapplication.

Evaluation of the Hemostatic Efficacy of Two Powdered Topical Absorbable Hemostats Using a Porcine Liver Abrasion Model of Mild to Moderate Bleeding

Introduction Topical hemostatic agents, used alone or in combination, have become common adjuncts to manage tissue and organ bleeding resulting from trauma and surgical procedures. Oxidized regenerated cellulose (ORC) is one of the most commonly used adjunctive hemostatic agents. The aim of the present study was to compare the hemostatic efficacy of a novel ORC-based product, SURGICEL® Powder Absorbable Hemostat (Surgicel-P) to that of HEMOBLAST™ Bellows (Hemoblast-B), a collagen-based combination powder. Methods Using an established porcine liver abrasion model, we randomly tested Surgicel-P and Hemoblast-B in 60 experimental lesion sites (30 per product tested). Primary endpoints included hemostatic efficacy measured by absolute time to hemostasis (TTH) within 5 minutes. We also examined number of applications required to achieve hemostasis, and sustained hemostasis following saline irrigation of test sites that achieved hemostasis. Results Surgicel-P demonstrated significantly higher hemostatic efficacy and lower TTH (p < 0.01) than Hemoblast-B. Surgicel-P-treated lesion sites achieved hemostasis in 73.3% of cases following one product application vs. 3.3% of Hemoblast-B-treated sites. Of all sites that were assessed, hemostasis was achieved and sustained following irrigation at 93.3% of Surgicel-P-treated sites vs. 50.0% of Hemoblast-B-treated sites. The average number of Surgicel-P applications per site was 51% lower than the average number of applications used for Hemoblast-B. Conclusion Surgicel-P provided more effective and sustained hemostasis and faster TTH than Hemoblast-B. Surgicel-P represents a novel clinical alternative to provide adjunctive control of diffuse mild and moderate bleeding. Surgicel-P combines an ORC powder formulation and a delivery system in a device that is particularly useful for application on large surfaces and difficult-to-access anatomical locations where application of other forms of topical hemostats may be impractical.

Negative pressure therapy with the ULTRAVAC instillation in the therapy of infected laparotomies with fascitis − temporary results of a prospective randomized study

Introduction: Negative pressure wound therapy is a healing modality utilizing continuous or intermittently applied vacuum to the wound bed. Nowadays is available a vacuum system supported by an automated instillation with volumetric control. It`s main therapeutic benefit is the dilution of the exudate, which reduces the viscosity and secures the «delicate» necrectomy. Method: Presentation of the temporary results of a prospective randomized study comparing the effectiveness of both therapeutic techniques. Entirely 41 patients were enrolled in the study from November 2016 to September 2018. The primary goal of the project is to compare the length of therapy, the number of surgical debridements and evaluation the financial costs. Secondary targets are observed changes in biological load and bacterial spectrum. Results: The duration of the therapy was 2 days shorter in the experimental group compared to the control sample. However, the average number of applications was higher. Defects with the instillation system were characterized by a shorter cleaning phase (p=0.057). The secondary suture was reached in the experimental group at 84.2% and in the control group at 72.7%. The differences in these parameters were not statistically significant. Fascial disruption was observed in the trial group in 2 patients. The financial costs of the material used was significantly higher in patients with irrigation system (p&lt;0.001). However, the total hospitalization costs did not differ statistically (p=0.097). There were no significant changes in the bacterial spectrum observed during therapy. There was a significant reduction in the bacterial burden during therapy in the experimental group (p= 0,035). Conclusion: Vacuum system supported by automated instillation is an effective method, accelerating cleaning phase of the wound healing. A potential risk could be the disruption of the fascia during instillation of the solution. However, the results of our work are not definitive and a larger group of patients is needed for valid conclusions.

Within-Season Shift in Fungicide Resistance Profiles of Botrytis cinerea in California Strawberry Fields.

Sensitivity of Botrytis cinerea to seven fungicide chemical classes was determined for 888 isolates collected in 2016 from 47 California strawberry fields. Isolates were collected early season (minimum fungicide exposure) and late season (maximum fungicide exposure) from the same planting block in each field. Resistance was determined using a mycelial growth assay, and variable frequencies of resistance were observed to each fungicide at both sampling times (early season %, late season %): boscalid (12, 35), cyprodinil (12, 46), fenhexamid (53, 91), fludioxonil (1, 4), fluopyram (2, 7), iprodione (25, 8), isofetamid (0, 1), penthiopyrad (8, 25), pyraclostrobin (77, 98), and thiophanate-methyl (81, 96). Analysis of number of chemical class resistances (CCRs) revealed an increasing shift in CCR from the early to late season. Phenotypes of 40 isolates that were resistant or sensitive to different chemical classes were associated with presence or absence of mutations in target genes. Fungicide-resistance phenotypes determined in the mycelial growth assay closely matched (93.8%) the genotype observed. Previously described resistance-conferring mutations were found for each gene. A survey of fungicide use from 32 of the sampled fields revealed an average of 15 applications of gray mold-labeled fungicides per season at an average interval of 12 days. The most frequently applied fungicides (average number of applications during the 2016 season) were captan (7.3), pyraclostrobin (2.5), cyprodinil (2.3), fludioxonil (2.3), boscalid (1.8), and fenhexamid (1.4). Multifungicide resistance is widespread in California. Resistance management tactics that reduce selection pressure by limiting fungicide use, rotating among Fungicide Resistance Action Committee codes, and mixing/rotating site-specific fungicides with multisite fungicides need to be improved and implemented.

An Electronic Interview Tracking Tool to Guide Medical Students Through the Match: Improvements in Advising and Match Outcomes.

Medical students are applying to increasing numbers of residency programs to increase their likelihood of success in the Match. However, they have limited data to help them understand their level of competitiveness or identify programs to which they should apply. In 2014-2015 (Match year 2015), the University of Maryland School of Medicine's (UMSOM's) Office of Student Affairs (OSA) implemented an electronic interview tracking tool in which students update their residency application interview status on an ongoing basis. OSA deans can filter and sort data by student, specialty, program, academic metrics, and interview status. The deans use these data to advise students in real time, provide students with examples of programs to consider, and engage clinical faculty to support students at risk of not matching. In the Match years 2015, 2016, and 2017, respectively, 86% (n = 135/157), 87% (n = 138/159), and 94% (n = 151/161) of UMSOM students participated actively in this tracking tool, adding over 3,000 data points per year. Following the tool's launch, the average number of applications per student remained stable. The UMSOM's Match rate and percentages of students self-reporting a match in their top three choices and rating the school's advising as "very useful" all increased, without comparable increases in national data. This tool, which provides students with data-driven examples of programs to which they should consider applying, may be beneficial to students, faculty, and program directors at other institutions-and to the residency application process, if adopted broadly.

Radiology Residency Match: The Cost of Being in the Dark

The Electronic Resident Application Service (ERAS) publishes monthly statistics before the match and the National Resident Matching Program publishes the match outcomes. We sought to determine whether early ERAS data influences applicant behavior and correlates with match outcomes. We searched the 2007-2017 ERAS archives for the applicant pool size (PS), the average number of applications per program (AP), and the average number of applications per applicant (AA) in November, before radiology match, and the 2007-2017 National Resident Matching Program archives for the average number of ranked applicants needed to fill each position (ANRA) and the number of unfilled positions (UP) in radiology match. Correlation coefficients were calculated for each pair. PS correlated very strongly with AP (r = 0.80, p = 0.001708), UP (r = -0.92, p = 0.000063) and ANRA (r = -0.90, p = 0.000164). UP correlated strongly with ANRA (r = 0.76, p = 0.006349) and AP (r = -0.77, p = 0.005339). A trend to moderate correlation between AP and ANRA (r = 0.58, p = 0.062686) and AA (r = 0.53, p = 0.074395) did not reach statistical significance. There was no correlation between AA and PS in the same (r = -0.05, p = 0.878585) or the following year (r = 0.35, p = 0.297166), and AA and UP in the same (r = 0.13, p = 0.701983) or the following year (r = 0.32, p = 0.336136). The real-time data reported by ERAS in November, before match, is a predictor of radiology match outcomes and can be used by all participants to limit their application and recruitment costs. Medical students applying to radiology do not consider either the real-time or historic data when submitting ERAS applications.

Abstract QS60: The Plastic Surgery Prisoner’s Dilemma: The Relationship Between Applications and Match Rate

PURPOSE: Plastic surgery is one of the most competitive residency matches. The mean number of applications per applicant is correspondingly high, creating significant time and financial strains. With the increasing cost of the application process in time and money, limiting the number of applications per applicant may offer a potential solution. In this study we examine whether an increased number of applications confers a benefit to applicants. METHODS: The authors analyzed annual data from NRMP and ERAS for integrated plastic surgery programs between 2010 and 2017. The number of U.S. seniors that matched in each year, and the number of applicant U.S. seniors that year, was obtained from NRMP’s Main Residency Match Results and Data report and used to calculate the match rate for that year. The average number of applications per year reported by ERAS was used for our calculations. RESULTS: Presents a summary of our findings. The number of integrated Plastic Surgery programs has increased from 31 in 2010 to 73 in 2017. The average number of applications per US senior in 2017 was 58.36, which corresponds to 80% of programs. In 2010 the average number of applications was 22.75, or 73% of programs. Two programs went unfilled in 2017, one in 2016 and three in 2015. The number of positions offered has increased from 69 in 2010 to 159 in 2017. However, the number of applicant has increased at a slower rate from 168 in 2010 to 200 in 2017. Accordingly, there has been an increase in the match rate from 36% in 2010 to 74% in 2017. Overall, since 2010, there is a statistically significant correlation between the mean number of applications and the match rate (p=0.005). However, if the increased number of positions available each year is taken into account by using the percentage of programs applied to instead of the mean number of applications, there is no statistically significant relationship between percentage of programs applied to and match rate (p=0.78). CONCLUSIONS: Our study suggests that there is no benefit to students applying to a greater number of programs as the percentage of programs applied to does not correlate with a higher match rate. Additionally, even though integrated plastic surgery programs are extremely competitive there have been unfilled positions every year since 2015. This could be explained by the Prisoner’s Dilemma in Game theory. The economic theory that all parties are worse off when individuals act in their own self interest. In other words, while a student may increase their own chances by applying to as many programs as possible while other students do not, if every student applies to most programs, all students have a reduced chance of matching. F. Molina Burbano: None. A. Yao: None. J. Stock: None. P. Taub: None.

Inappropriate amounts of topical tacrolimus applied on Korean patients with eczema

Background: The limited efficacy of topical tacrolimus may result from insufficient frequency of application or amount applied in eczema patients.Objective: To investigate the frequency of application and amount of use of topical tacrolimus in patients with various types of eczema.Methods: The frequency of application and the applied amount of topical tacrolimus were assessed over two weeks.Results: A total of 200 eczema patients completed this study. The average number of applications per day was 1.75 ± 0.53, despite instructions to apply the topical tacrolimus twice daily. With respect to the frequency of application, 147 (73.5%) and 122 (61.0%) of patients followed the prescription in the first and second weeks, respectively. The average amount applied per 2% of total body surface area (TBSA) was 0.54 ± 0.52 g. Only 53 (26.5%) patients applied between 80 and 120% of expected amount of topical tacrolimus.Limitations: The frequency of application was self-reported, possibly resulting in limited accuracy.Conclusion: Korean patients with eczema tend to apply topical tacrolimus less frequently and in inappropriate amounts. Clear instructions regarding both the frequency and amount of application are needed to improve the therapeutic outcome with treatment with topical tacrolimus.

Small-Scale Trials Suggest Increasing Applications of Natular™ XRT and Natular™ T30 Larvicide Tablets May Not Improve Mosquito Reduction in Some Catch Basins.

Stormwater catch basins are commonly treated with larvicides by mosquito control agencies to reduce local populations of mosquito species capable of transmitting West Nile virus. Recent evidence suggests that extended-release larvicides formulated to last up to 180 days in catch basins may not be effective in some basins due to chronic flushing, rapid dissolution, or burying of treatment in sump debris. To investigate if increasing the number of applications could improve effectiveness, a small study was performed over 13 weeks in 2015 to evaluate two extended-release larvicides (Natular™ XRT 180-day tablets and Natular™ T30 30-day tablets) and a larvicide oil (CocoBear™). Over the course of 13 weeks, three groups of eight basins were monitored for mosquitoes, each group receiving Natular™ XRT, Natular™ T30, or CocoBear™ larvicides. All basins received a single application at the beginning of the study period. Once mosquitoes in a basin surpassed the treatment threshold during weekly monitoring, an additional application of the associated larvicide was given to that basin. The number of applications during the study period ranged from 1 to 10 for CocoBear™ basins, 1 to 7 for T30 basins, and 2 to 8 for XRT basins. Overall, the average number of applications and the cost of larvicide per basin were 4.4 applications at $0.66 per Coco-Bear™ basin, 4.4 applications at $6.26 per T30 basin, and 4 applications at $16.56 per XRT basin. Basins treated with XRT and T30 needed reapplications more often than expected, yet were no more effective than CocoBear™, suggesting that increasing the frequency of application of these larvicide formulations may not provide increased mosquito reduction in some basins.

Effectiveness of Endoluminal Vacuum-assisted Closure Therapy (Endosponge) for the Treatment of Pelvic Anastomotic Leakage After Colorectal Surgery.

Anastomotic leakage is a serious complication with significant morbidity and mortality. The popularity of endoscopic treatment (Endo-SPONGE) is increasing for distally located colorectal pouch-anal anastomotic leakages. This was a retrospective study of 15 cases involving the application of the Endo-SPONGE for anastomotic leakage following proctectomy between May 2009 and May 2014. Of the 15 cases, lower anterior resection occurred in 12 cases (80%), and pouch-anal anastomosis in 3 cases (18%). In 8 patients (55%), the endosponge was applied during the early term, and in 7 patients (45%) during the late term. The average number of applications was 2.2 (range, 1 to 5). Treatment was discontinued due to the progression of pelvic sepsis in 2 patients and due to bleeding in 1 patient. Lumen integrity was achieved in 12 cases. Lumen integrity after anastomotic leakages can be preserved by endoluminal vacuum therapy, which permits the closure of the stoma without requiring reconstructive surgery.

XGN: A Game Changer in the Field of E-Governance.

Touted to eclipse China as the most populous nation in this world by 2028, India requires a very robust E-Governance framework if it wishes to ensure that the benefits of E-governance penetrate uniformly into even the remotest sections of the society. Thus, the development of a standardized prototype for E-Governance with the potential for wide-scale implementation, replete with value propositions which consider every faction of India’s burgeoning population within its ambit, is imperative to further augment India’s strong resurgence in the global scenario. The eXtended Green Node (XGN), one of the cornerstones of Gujarat’s vibrant E-Governance policy, is one such platform which holds the potential to effectively “fit the bill” if tweaked appropriately to further enhance its appeal as per the pan-Indian perspective. The XGN project, jointly developed by the Gujarat Pollution Control Board (GPCB) and the National Informatics Centre (NIC), initiated operations in 2008 and has since not only received several awards but has also gone on to be considered as a paradigm shift in the domain of government process re-engineering. Deployed at all the offices of the GPCB, XGN has succeeded in obliterating a host of bottlenecks prevalent in the suite of services provided by the board to citizens, businesses and other government departments. The crux of XGN’s success lies in the fact that it completely extirpates the need for any physical movement of files in various government departments by including a complete vista of service/analysis resources in its website including the facilitation of consent/authorization applications, live tracking of waste-movement, E-transactions, etc. With its service currently extending to more than 54000 entities, the success of XGN in terms of concrete statistics is quite tangible, most notably with the average number of applications being processed yearly multiplying to approximately 5 times. XGN has found espousers in each and every section of the Indian polity, especially in Goa with the state migrating to the XGN model of E-Governance in 2012. In this paper, the policy of XGN has been analyzed objectively with a two-fold perspective prominent throughout: the drawbacks of the current structure and the feasibility of launching a holistic, tweaked version of XGN to suit the palette of a pan-Indian crowd. More specifically, this paper analyzes the potential of enhancing the host of services offered by XGN within the purview of E-waste management, and driving value by inculcating better standard operating practices such as GPS-based waste-tracking & more compartmentalized storage-recycling of hazardous wastes, thereby enhancing productivity. Finally, the paper undertakes a cross-functional study of the XGN model using the Strategy Diamond framework, proposed by Hambrick & Fredickson, to establish a systematic model for the same with a definitive scheme to enforce checks & balances at every step.