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"Davis, Rick"
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Bottle of the planets
When Kandor is threatened by a plague of thefts, Superman and Batman shrink down to super-small size to unravel the mystery.
Book
Impact of Detergent Type, Detergent Concentration, and Friction Modifiers on PM-PN Emissions in an SI Engine Using EEPS
Three TOP TIERTM gasoline deposit control additives (DCAs) of differing chemistries were tested for their impact on particulate matter emissions in terms of particulate mass (PM) and particle number (PN) at operating conditions representative of road load, cold start, and high load on a 2.0 L, 4-cylinder, gasoline direct injection (GDI) spark ignition (SI) engine. The PM-PN emissions were measured using an Exhaust Emissions Particle Sizer (EEPS). Deposit control additives or detergents are gasoline additives used to prevent and clean combustion chamber and injector deposits in gasoline spark ignition (SI) engines. All three gasoline additives were tested at each operating condition at three different treatment rates. In addition, one of the additives was tested with a fuel-based friction modifier (FM). The results showed that of the treatment rates tested, the lowest allowable concentration (LAC) for all additives requires the least time for the emissions to settle. However, the impact of the gasoline additives on PM-PN emissions is not linear and changes with additive concentration depending on the additive chemistry and operating conditions. The additive with the friction modifier resulted in an increase of over 19% particle number and over 30% particulate mass at the road load operating condition, while the increase at high load was over 27% for particle number and 11% for particle mass.
Journal Article
The Flash
\"When Wally West, the adolescent nephew of the Flash's fiancee accidentally gained powers of superspeed, he became the Scarlet Speedster's sidekick. Growing up as his hero's protege, Kid Flash had a childhood of amazing action and adventure. But on the day that The Flash died, Wally's carefree adolescence abruptly ended and his life as an adult began. THE FLASH BY MARK WAID BOOK ONE looks back at Wally's earliest days as the Kid Flash and explores the gamut of his emotions and experiences from his first day as a child hero to his succession of Barry Allen as the new Flash. A journey full of humor and drama, this story shows just how much Wally West loves being the fastest man alive\"-- Provided by publisher.
Book
The use of vancomycin powder reduces surgical reoperation in posterior instrumented and noninstrumented spinal surgery
Background
Surgical site infections can complicate posterior spine surgery. Multiple hospital admissions may be required to adequately treat a surgical site infection, which is associated with increased costs and lower patient satisfaction. The objective of this study was to evaluate the efficacy of prophylactic intra-wound vancomycin powder in reducing the incidence of repeat surgery for infections after posterior instrumented and noninstrumented spine surgery.
Methods
A series of consecutive patients who underwent instrumented or noninstrumented posterior spine surgery for any indication by two surgeons from July 2010 to July 2012 were reviewed. The preoperative antibiotic regimens of both surgeons were identical, except that one surgeon applied 1 g vancomycin powder directly to the surgical bed before wound closure, while the other did not. Patient demographics, operative details, and rates of reoperation for wound infection in the control and the treatment groups were compared.
Results
Both the control group and treatment group consisted of 150 patients; mean ages were 58.33 and 54.14 years, respectively. Both groups had low rates of deep infection requiring surgical intervention. The treatment group had a significantly lower rate of infection requiring reoperation or surgical debridement (0 %; 95 % CI: 0 %–2.4 %) compared with the control group (4 %; 95 % CI: 1.5 %–8.5 %) (
P
= 0.0297). The six infections identified in the control group resulted in 12 repeat operative debridement procedures. Gram-positive organisms were identified in 66.7 % of infections. No complications were related to the application of vancomycin powder.
Conclusions
The results of this study demonstrate that adjunctive vancomycin powder applied directly to the surgical bed before closure seems effective in preventing deep infections that require operative debridement following posterior spine surgery.
Journal Article
Feasibility of Intensity-Modulated and Image-Guided Radiotherapy for Functional Organ Preservation in Locally Advanced Laryngeal Cancer
The study aims to assess the feasibility of intensity-modulated and image-guided radiotherapy (IMRT, and IGRT, respectively) for functional preservation in locally advanced laryngeal cancer. A retrospective review of 27 patients undergoing concurrent chemoradiation for locally advanced laryngeal cancers (8 IMRT, 19 IGRT) was undertaken. In addition to regular clinical examinations, all patients had PET imaging at 4 months and 10 months after radiotherapy, then yearly. Loco-regional control, speech quality and feeding-tube dependency were assessed during follow-up visits.
At a median follow-up of 20 months (range 6-57 months), four out of 27 patients (14.8%) developed local recurrence and underwent salvage total laryngectomy. One patient developed distant metastases following salvage surgery. Among the 23 patients who conserved their larynx with no sign of recurrence at last follow-up, 22 (95%) reported normal or near normal voice quality, allowing them to communicate adequately. Four patients (14.8%) had long-term tube feeding-dependency because of severe dysphagia (2 patients) and chronic aspiration (2 patients, with ensuing death from aspiration pneumonia in one patient).
Functional laryngeal preservation is feasible with IMRT and IGRT for locally advanced laryngeal cancer. However, dysphagia and aspiration remain serious complications, due most likely to high radiation dose delivery to the pharyngeal musculatures.
Journal Article
Feasibility of Tomotherapy-Based Image-Guided Radiotherapy for Locally Advanced Oropharyngeal Cancer
The study aims to assess the feasibility of tomotherapy-based image-guided (IGRT) radiotherapy for locally advanced oropharyngeal cancer. A retrospective review of 33 patients undergoing concurrent chemoradiation for locally advanced oropharyngeal cancers was conducted. Radiotherapy planning, treatment toxicity and loco-regional control were assessed.
At a median follow-up of 32 months (6-47 months), no patient developed loco-regional recurrence. Two patients (6%) developed distant metastases. Grade 3-4 acute toxicity was respectively 72% and 25% for mucositis and gastrointestinal toxicity. Two patients (6%) had long-term dependence on tube feedings. Dose-volume histogram demonstrated excellent target volume coverage and low radiation dose to the organs at risk for complications.
IGRT provides excellent loco-regional control but acute toxicity remains significant and needs to be addressed in future prospective trials. The feasibility of Tomotherapy to decrease radiation dose to the normal tissues merits further investigations.
Journal Article
Feasibility of Tomotherapy-Based Image-Guided Radiotherapy to Reduce Aspiration Risk in Patients with Non-Laryngeal and Non-Pharyngeal Head and Neck Cancer
The study aims to assess the feasibility of Tomotherapy-based image-guided radiotherapy (IGRT) to reduce the aspiration risk in patients with non-laryngeal and non-hypopharyngeal cancer. A retrospective review of 48 patients undergoing radiation for non-laryngeal and non-hypopharyngeal head and neck cancers was conducted. All patients had a modified barium swallow (MBS) prior to treatment, which was repeated one month following radiotherapy. Mean middle and inferior pharyngeal dose was recorded and correlated with the MBS results to determine aspiration risk.
Mean pharyngeal dose was 23.2 Gy for the whole group. Two patients (4.2%) developed trace aspiration following radiotherapy which resolved with swallowing therapy. At a median follow-up of 19 months (1-48 months), all patients were able to resume normal oral feeding without aspiration.
IGRT may reduce the aspiration risk by decreasing the mean pharyngeal dose in the presence of large cervical lymph nodes. Further prospective studies with IGRT should be performed in patients with non-laryngeal and non-hypopharyngeal head and neck cancers to verify this hypothesis.
Journal Article
I Have a Patient With a Small Disk Herniation but He Continues to Complain of Right Lower Extremity Radiculopathy. Is There an Imaging Study or Test I Can Order to Help Me Confirm My Diagnosis?
It is important to perform a thorough history and physical examination because people who complain of leg pain may have other sources of pathology. Common etiologies of leg pain may include hip and knee arthritis, greater trochanter bursitis, pseudo-radicular pain from sacroilitis, and vascular claudication.
Book Chapter
When Performing a Lumbar Microdiscectomy, Is It Better to Perform Only a Fragmentectomy or Should I Perform an Annulotomy and be More Aggressive About the Disc Removal?
Unsuccessful surgical treatment, including the occurrence of a disc reherniation following lumbar discectomy, is a significant problem in the modern treatment of herniated nucleus pulposus. Previous studies have shown that the recurrence of radiculopathy and reherniation rates following discectomy can be as high as 33%. Historically, discectomy has been performed via a large annulotomy with the removal of as much loose disc material as possible to decrease the likelihood of reherniation. I prefer to use a less invasive method termed a fragmentectomy or a limited discectomy (Figure 2-1). This method involves the removal of only extruded fragments, leaving the internal nuclear architecture intact. Intraoperatively, I also find the annulotomy defect and probe it with a nerve hook and penfield elevator to determine if there are any residual fragments that may be gently released. At no point do I place a pituitary rongeur or curette into the disc space, because I feel this only accelerates the damage to the internal structure of the disc.
Book Chapter
I Have a 34-Year-Old Male With Recurrent Leg Pain 4 Weeks After a Discectomy. What Imaging Study Should I Order?
Lumbar discectomy in a patient with severe intractable sciatica can be one of the most successful surgeries. However, a number of patients do not improve, rapidly relapse, have recurrent herniations, or develop disabling axial symptoms. Depending on the series reviewed, up to 20% to 40% of discectomies done for herniated lumbar intervertebral discs result in serious postoperative difficulties. Carragee et al analyzed 250 patients; their analysis indicated that magnetic resonance imaging (MRI) findings of fragment type, herniation size, and shape were the most consistent predictors of clinical results.1
Book Chapter