Sample records for bleed operating regions

  1. Predictors of re-operation due to post-surgical bleeding in breast cancer patients

    Winther Lietzen, L; Cronin-Fenton, Deirdre; Garne, Jens Peter;


    To assess the risk of re-operation due to post-surgical bleeding after initial breast cancer surgery and to identify predictors of re-operation.......To assess the risk of re-operation due to post-surgical bleeding after initial breast cancer surgery and to identify predictors of re-operation....

  2. A Study on the Operator Decision Support for Feed-and-Bleed Operation

    In the case of a combined accident that includes a failure of the secondary cooling system, it is difficult for operators to recognize the necessity of an feed and bleed (F and B) operation because a lot of parameters and alarms should be checked before a decision, and operators may spend a considerable amount of time arriving at the entry for a proper emergency operating procedure that contains the procedure for an F and B operation. Therefore, a clear identification of the success boundary of an F and B operation would help operators in their decision-making when a combined accident that includes a secondary cooling system failure occurs. This study will provide a useful guideline for the initiation of an F and B operation for operators. Cooling the RCS after a scram is one of the most important safety functions for preventing core damage. To support the operator in decision making whether to initiate the F and B operation, plant conditions requiring the initiation of an F and B operation were identified. Plant conditions are affected by the steam generator inventory, RCS inventory, core inventory, and safety injection availability. The combination of accident types, component availabilities, and the initiation time of an F and B operation affect the success of the F and B operation. Operators need clear information about the RCS condition when the steam generators, the RCS's main residual heat removal mechanism, become unavailable. When this happens, the initiation of an F and B operation becomes necessary. As the number of the state increases, the necessity of an F and B operation increases. Especially, the operator should initiate an F and B operation when the RCS condition enters State 3 for Type 1 incidents or State 3-2 for Type 2 incidents. The results of this study may be useful in providing information regarding the necessity and effects of an F and B operation in a quantitative manner. In particular, in the case of a combined accident including a

  3. Bleeding Frame and Region Detection in the Wireless Capsule Endoscopy Video.

    Yuan, Yixuan; Li, Baopu; Meng, Max Q-H


    Wireless capsule endoscopy (WCE) enables noninvasive and painless direct visual inspection of a patient's whole digestive tract, but at the price of long time reviewing large amount of images by clinicians. Thus, an automatic computer-aided technique to reduce the burden of physicians is highly demanded. In this paper, we propose a novel color feature extraction method to discriminate the bleeding frames from the normal ones, with further localization of the bleeding regions. Our proposal is based on a twofold system. First, we make full use of the color information of WCE images and utilize K-means clustering method on the pixel represented images to obtain the cluster centers, with which we characterize WCE images as words-based color histograms. Then, we judge the status of a WCE frame by applying the support vector machine (SVM) and K-nearest neighbor methods. Comprehensive experimental results reveal that the best classification performance is obtained with YCbCr color space, cluster number 80 and the SVM. The achieved classification performance reaches 95.75% in accuracy, 0.9771 for AUC, validating that the proposed scheme provides an exciting performance for bleeding classification. Second, we propose a two-stage saliency map extraction method to highlight bleeding regions, where the first-stage saliency map is created by means of different color channels mixer and the second-stage saliency map is obtained from the visual contrast. Followed by an appropriate fusion strategy and threshold, we localize the bleeding areas. Quantitative as well as qualitative results show that our methods could differentiate the bleeding areas from neighborhoods correctly. PMID:25675468

  4. Dynamic sequence analysis for feed-and-bleed operation in an OPR1000

    Highlights: • An analysis of the necessity and effects of a feed-and-bleed operation is performed. • Plant conditions requiring an feed-and-bleed operation are identified. • Boundaries for each state are identified to support the operator’s decision. • A thermohydraulic analysis is performed to determine this success boundary. • Analysis results provide a useful guideline under complicated combined accident. - Abstract: A feed-and-bleed (F and B) operation in an OPR1000 provides residual heat removal when the secondary cooling system is not available. Operators may hesitate to initiate F and B operation if a clear cue is not provided because its initiation will result in the release of radioactive coolant into the containment structure. An analysis of the necessity and effects of F and B operation was performed systematically. The plant conditions requiring F and B operation were categorized as type of transients. The factors which affect the necessity and effects of F and B operation are water inventory in the primary and secondary cooling systems, break size and timing of the break-up in the case of loss-of-coolant accident, the availability of the safety injection system and safety depressurization system, and timing of the F and B operation initiation. The boundary of each state in an OPR1000 was identified and the effects of factors were investigated to support the operator’s decision to initiate F and B operation under various reactor conditions. A thermohydraulic analysis was performed using the MARS code to determine this success boundary. This study is expected to provide a useful guideline for the initiation of F and B operation for operators. In particular, in the case of a combined accident including a secondary cooling system failure, the provision of clear information will play a critical role in the operators’ decision to initiate F and B operation

  5. Comparative analysis of assessment methods for operational and anesthetic risks in ulcerative gastroduodenal bleeding

    Potakhin S.N.


    Full Text Available Aim of the investigation: to conduct a comparative analysis of methods of evaluation of surgical and anesthetic risks in ulcerative gastroduodenal bleeding. Materials and methods. A retrospective analysis ofthe extent of the surgical and anesthetic risks and results of treatment of 71 patients with peptic ulcer bleeding has been conducted in the study. To evaluate the surgical and anesthetic risks classification trees are used, scale ТА. Rockall and prognosis System of rebleeding (SPRK, proposed by N. V. Lebedev et al. in 2009, enabling to evaluate the probability of a fatal outcome. To compare the efficacy ofthe methods the following indicators are used: sensitivity, specificity and prediction of positive result. Results. The study compared the results ofthe risk assessment emergency operation by using these methods with the outcome ofthe operation. The comparison ofthe prognosis results in sensitivity leads to the conclusion that the scales ТА. Rockall and SPRK are worse than the developed method of classification trees in recognizing patients with poor outcome of surgery. Conclusion. The method of classification trees can be considered as the most accurate method of evaluation of surgical and anesthetic risks in ulcerative gastroduodenal bleeding.

  6. Transjugular Endovascular Recanalization of Splenic Vein in Patients with Regional Portal Hypertension Complicated by Gastrointestinal Bleeding

    Luo, Xuefeng; Nie, Ling; Wang, Zhu; Tsauo, Jiaywei; Tang, Chengwei; Li, Xiao, E-mail: [West China Hospital, Sichuan University, Department of Gastroenterology (China)


    PurposeRegional portal hypertension (RPH) is an uncommon clinical syndrome resulting from splenic vein stenosis/occlusion, which may cause gastrointestinal (GI) bleeding from the esophagogastric varices. The present study evaluated the safety and efficacy of transjugular endovascular recanalization of splenic vein in patients with GI bleeding secondary to RPH.MethodsFrom December 2008 to May 2011, 11 patients who were diagnosed with RPH complicated by GI bleeding and had undergone transjugular endovascular recanalization of splenic vein were reviewed retrospectively. Contrast-enhanced computed tomography revealed splenic vein stenosis in six cases and splenic vein occlusion in five. Etiology of RPH was chronic pancreatitis (n = 7), acute pancreatitis with pancreatic pseudocyst (n = 2), pancreatic injury (n = 1), and isolated pancreatic tuberculosis (n = 1).ResultsTechnical success was achieved in 8 of 11 patients via the transjugular approach, including six patients with splenic vein stenosis and two patients with splenic vein occlusion. Two patients underwent splenic vein venoplasty only, whereas four patients underwent bare stents deployment and two covered stents. Splenic vein pressure gradient (SPG) was reduced from 21.5 ± 7.3 to 2.9 ± 1.4 mmHg after the procedure (P < 0.01). For the remaining three patients who had technical failures, splenic artery embolization and subsequent splenectomy was performed. During a median follow-up time of 17.5 (range, 3–34) months, no recurrence of GI bleeding was observed.ConclusionsTransjugular endovascular recanalization of splenic vein is a safe and effective therapeutic option in patients with RPH complicated by GI bleeding and is not associated with an increased risk of procedure-related complications.

  7. Bleeding outcome during a dengue outbreak in 2005 in the East-coast region of Peninsular Malaysia: a prospective study.

    Fariz-Safhan, M N; Tee, H P; Abu Dzarr, G A; Sapari, S; Lee, Y Y


    During a dengue outbreak in 2005 in the East-coast region of Peninsular Malaysia, one of the worst hit areas in the country at that time, we undertook a prospective study. We aimed to describe the bleeding outcome and changes in the liver and hematologic profiles that were associated with major bleeding outcome during the outbreak. All suspected cases of dengue admitted into the only referral hospital in the region during the outbreak were screened for WHO 2002 criteria and serology. Liver function, hematologic profile and severity of bleeding outcome were carefully documented. The association between symptoms, liver and hematologic impairments with the type of dengue infection (classical vs. hemorrhagic) and bleeding outcome (major vs. non-major) was tested. Dengue fever was confirmed in 183 cases (12.5/100,000 population) and 144 cases were analysed. 59.7% were dengue hemorrhagic fever, 3.5% were dengue shock syndrome and there were 3 in-hospital deaths. Major bleeding outcome (gastrointestinal bleeding, intracranial bleeding or haemoptysis) was present in 14.6%. Elevated AST, ALT and bilirubin were associated with increasing severity of bleeding outcome (all P dengue hemorrhagic fever was more likely in the presence of abdominal pain (OR 1.1, 95% CI 0.02- 1.6) and elevated AST (OR 1.0, 95% CI 1.0-1.1) but the presence of pleural effusion (OR 5.8, 95% CI: 1.1-29.9) and elevated AST (OR 1.008, 95% CI: 1.005-1.01) predicted a severe bleeding outcome. As a conclusion, the common presence of a severe hemorrhagic form of dengue fever may explain the rising death toll in recent outbreaks and the worst impairment in liver and hematologic profiles was seen in major bleeding outcome. PMID:25134895

  8. Identification of Success Criteria for Automated Function Using Feed and Bleed Operation

    Kim, Bo Gyung; Kim, Sang Ho; Kang, Hyun Gook [Korea Advanced Institute of Science and Technology, Daejeon (Korea, Republic of); Yoon, Ho Joon [Khalifa Univ. of Science, Technology and Research, Abu Dhabi (United Arab Emirates)


    Since NPP has lots of functions and systems, operated procedure is much complicated and the chance of human error to operate the safety systems is quite high. In the case of large break loss of coolant accident (LBLOCA) and station black out (SBO), the dependency of operator is very low. However, when many mitigation systems are still available, operators have several choices to mitigate the accident and the human error can be increased more. To reduce the operator's workload and perform the operation accurate after the accident, automated function for safe cooldown based on the feed and bleed (F and B) operation was suggested. The automated function can predict whether the plant will be safe after the automated function is initiated, and perform the safety functions automatically. To expect the success of cooldown, success criteria should be identified. To perform the operation accurately after the accident, the automated function for safe cooldown based on the F and B operation is suggested. To expect the success of cooldown, sequence of RCS situation when heat removal by secondary system fails is identified. Based on the sequence of RCS situation, four levels of necessity of F and B operation are classified. To obtain the boundary of levels, the TH analysis will be performed.

  9. Bleeding time

    Bleeding time is a medical test that measures how fast small blood vessels in the skin stop bleeding. ... until the bleeding stops. The provider records the time it takes for the cuts to stop bleeding.

  10. Regional and temporal variations in coding of hospital diagnoses referring to upper gastrointestinal and oesophageal bleeding in Germany

    Garbe Edeltraut


    Full Text Available Abstract Background Health insurance claims data are increasingly used for health services research in Germany. Hospital diagnoses in these data are coded according to the International Classification of Diseases, German modification (ICD-10-GM. Due to the historical division into West and East Germany, different coding practices might persist in both former parts. Additionally, the introduction of Diagnosis Related Groups (DRGs in Germany in 2003/2004 might have changed the coding. The aim of this study was to investigate regional and temporal variations in coding of hospitalisation diagnoses in Germany. Methods We analysed hospitalisation diagnoses for oesophageal bleeding (OB and upper gastrointestinal bleeding (UGIB from the official German Hospital Statistics provided by the Federal Statistical Office. Bleeding diagnoses were classified as "specific" (origin of bleeding provided or "unspecific" (origin of bleeding not provided coding. We studied regional (former East versus West Germany differences in incidence of hospitalisations with specific or unspecific coding for OB and UGIB and temporal variations between 2000 and 2005. For each year, incidence ratios of hospitalisations for former East versus West Germany were estimated with log-linear regression models adjusting for age, gender and population density. Results Significant differences in specific and unspecific coding between East and West Germany and over time were found for both, OB and UGIB hospitalisation diagnoses, respectively. For example in 2002, incidence ratios of hospitalisations for East versus West Germany were 1.24 (95% CI 1.16-1.32 for specific and 0.67 (95% CI 0.60-0.74 for unspecific OB diagnoses and 1.43 (95% CI 1.36-1.51 for specific and 0.83 (95% CI 0.80-0.87 for unspecific UGIB. Regional differences nearly disappeared and time trends were less marked when using combined specific and unspecific diagnoses of OB or UGIB, respectively. Conclusions During the study

  11. Bleeding Disorders

    ... as clotting factors. If you have a bleeding disorder, you either do not have enough platelets or ... don't work the way they should. Bleeding disorders can be the result of other diseases, such ...

  12. Management of upper gastrointestinal bleeding from portal hypertension: Elective or emergency operation?

    Liu, Sen


    Objective : To evaluate the clinical outcome of emergency and elective operation of splenectomy with periesophagogastric devascularization in treating upper gastrointestinal hemorrhage resulted from portal hypertension. Methods : We retrospectively reviewed 219 patients of upper gastrointestinal hemorrhage resulted from portal hypertension treated using emergency or elective operation between Jul 2002 and Aug 2010. The clinical data were collected and analyzed. Results : In the group of elect...

  13. Feed and Bleed Operation Analysis during Total Loss of Feedwater Accident for Supporting the PSA of APR+

    For estimating the safety of APR+ design, the probabilistic safety assessment (PSA) is performed. This paper discusses the minimum success criteria for successful feed and bleed procedure verified and decided when the secondary cooling is failed during Total loss of feedwater (TLOFW) accident. For verifying whether the equipment conditions proposed is enough to manage the transient event without core damage, the analysis is performed by RELAP5/MOD 3.3 code. During TLOFW event, the operator's action time is allowed for 80 minutes and the uncovered core could maintain the stable state for a long time, about a half or one hour by the positive effects given by the fast coolant circulation by RCP pump operation. In simulations considering test scenarios, the minimum required equipment for successful F and B managing during TLOFW without LOOP is verified that it is that F and B procedure could be performed successfully as if the operator would open at least one out of four POSRV within 80 minutes after secondary cooling failure for the RCS depressurization. These analysis results can be used for contribute more realistic and accurate performance of a APR+ PSA

  14. [Gastrointestinal bleeding].

    Lanas, Ángel


    In the Digestive Disease Week in 2015 there have been some new contributions in the field of gastrointestinal bleeding that deserve to be highlighted. Treatment of celecoxib with a proton pump inhibitor is safer than treatment with nonselective NSAID and a proton pump inhibitor in high risk gastrointestinal and cardiovascular patients who mostly also take acetylsalicylic acid. Several studies confirm the need to restart the antiplatelet or anticoagulant therapy at an early stage after a gastrointestinal hemorrhage. The need for urgent endoscopy before 6-12 h after the onset of upper gastrointestinal bleeding episode may be beneficial in patients with hemodynamic instability and high risk for comorbidity. It is confirmed that in Western but not in Japanese populations, gastrointestinal bleeding episodes admitted to hospital during weekend days are associated with a worse prognosis associated with delays in the clinical management of the events. The strategy of a restrictive policy on blood transfusions during an upper GI bleeding event has been challenged. Several studies have shown the benefit of identifying the bleeding vessel in non varicose underlying gastric lesions by Doppler ultrasound which allows direct endoscopic therapy in the patient with upper GI bleeding. Finally, it has been reported that lower gastrointestinal bleeding diverticula band ligation or hemoclipping are both safe and have the same long-term outcomes. PMID:26520197

  15. Nuclear safety: operational aspects. 6. Effects of a Feed-and-Bleed Operation Using Pilot-Operated Safety Relief Valves at the Korean Next Generation Reactor

    The Korean Next Generation Reactor (KNGR) design includes four pilot-operated safety relief valves (POSRVs) to avoid core uncover by providing water to the primary system through a feed-and-bleed operation using four high-pressure safety injection pumps (SIPs) when steam generators are not available as a heat sink. If high-pressure SIPs are not working, the inevitable result is a severe accident. However, a rapid depressurization using the POSRVs could still mitigate a severe accident by providing cooling water into a damaged core from safety injection tanks (SITs), which are passive systems. The purpose of this paper is to estimate how long reactor vessel failure can be delayed by using passive SITs in the KNGR for typical high-pressure sequences at 4000 MW(thermal). Calculations with the MAAP code were performed to estimate the mitigating effects using rapid depressurization systems and passive SITs. A total loss-of-feedwater (LOFW) accident, which was initiated by the instantaneous and complete LOFW into steam generators, was selected as a representative sequence. The cases analyzed and the calculation results are summarized in Table I. The POSRVs were designed to open automatically or manually. In the base case (case1), the operator does not open the POSRVs manually. Since the POSRVs make cyclings of open/ close, the system pressure was so high that no cooling water could be injected into the reactor coolant system until the reactor vessel had failed. In the other cases, the operator manually opened the POSRVs at 1470 s after the accident initiation, when the system pressure reached the set-point of the POSRVs and the number of opening valves differed among the cases. Based on the MAAP results, the following observation and conclusions can be drawn: 1. The manual opening of the POSRVs by the operator has the advantage of delaying the reactor vessel failure time for high-pressure core damage scenarios in the KNGR even if active safety injection systems are not

  16. Internal Bleeding

    ... 2 Diabetes, Heart Disease a Dangerous Combo Are 'Workaholics' Prone to OCD, Anxiety? ALL NEWS > Resources First ... pelvis, that are broken. Initially, internal bleeding may cause no symptoms, although an injured organ that is ...

  17. Bleeding Disorders

    ... times I'd miss work and skip the gym because I felt so lousy. So I decided ... cell called platelets. Your body also needs blood proteins called clotting factors. In people with bleeding disorders, ...

  18. A comparative simulation of feed and bleed operation during the total loss of feedwater event by RELAP5/MOD3 and CEFLASH-4AS/REM computer codes

    The Ulchin 3 and 4 nuclear power plants, which are two-loop 2,825 MW(thermal) pressurized water reactors designed by the Korea Atomic Energy Research Institute, adopted a safety depressurization system (SDS) to mitigate the beyond-design-basis event of a total loss of feedwater (TLOFW). A comparative simulation by the CEFLASH-4AS/REM and RELAP5/MOD3 computer codes for the TLOFW event without operator recovery and the TLOFW event with feed and bleed (F and B) operation is performed for Ulchin 3 and 4. In the analyses, the SDS bleed paths are modeled by orifices located on the top of the pressurizer, where the analytical area of the bleed path is based on the Ulchin 3 and 4 SDS design flow capacity. An additional case, where the SDS piping and valves are modeled explicitly, is considered for the RELAP5 analysis. The predictions by the CEFLASH-4AS/REM of the transient two-phase system behavior show good qualitative and quantitative agreement with those by the RELAP5 simulation. The RELAP5 case with explicit piping results in less repressurization and lower reactor coolant system pressure than that of the case without explicit SDS modeling. However, the two cases of RELAP5 analyses result in essentially the same transient scenarios for TLOFW with F and B operation. The results of the simulation demonstrate the validity of the Ulchin 3 and 4 design approach, which employs CEFLASH-4AS/REM computer code and SDS bleed paths modeled by orifices located on the top of the pressurizer. The results also indicate that the decay heat removal and core inventory makeup function can be successfully accomplished by F and B operation by using the SDS for Ulchin 3 and 4

  19. AFRA. African Regional Co-operative Agreement

    This publication provides an outline of the African Regional Co-operation Agreement for research, development and training related to nuclear science and technology (AFRA). The agreement stems from an initiative of several African member states of the IAEA to get the agency to help establish an African regional arrangement which would be similar to arrangements which were already in place in the Asian and Latin American regions. Through this regional approach to development, AFRA seeks to accelerate moves toward self-sufficiency in scientific disciplines and appropriate technologies by coordinating intellectual and physical resources and disseminating innovative methods and practices in a cost-effective manner


    Goodfellow, Paul


    BLEED & BLEND is an ambient artwork that was commissioned by Digital Media in Newcastle University's Culture Lab, as part of their data visualisation screening project: Data Elements. The aim of the project was to take an unconventional approach to interpreting and displaying scientific data through visual artworks. The work was projected onto Newcastle University's Kings Gate building in Newcastle city centre in October 2012. A useful and succinct description of Ambient Art is found in B...

  1. Bleeding Disorders Treatment Options

    ... Pictures Young Voices Compendium of Assessment Tools Educational Games Video Library Find a Treatment Centre Haemophilia Journal About Bleeding Disorders Bleeding Disorders The Clotting Process Drugs That Can Cause Bleeding Hemophilia How Do You ...

  2. Regional Power Authority urged for TMI operations

    If the Three Mile Island (TMI) unit 1 returns to service, state ownership with a Regional Power Authority to oversee its operation and complete the cleanup of unit 2 would benefit ratepayers and avoid lengthy lawsuits, according to an Arthur Young and Company report to the New Jersey Board of Utilities. The report rejects continued ownership by General Public Utilities (GPU), merger, divestiture, and other options. It also outlines several conditions necessary for a Regional Power Authority: adequate rate relief, restart of TMI-1, congressional tax exemption, and approval by the GPU board and stockholders. The report recommends that Jersey Central divest itself of GPU to avoid financial disaster if GPU should declare bankruptcy, but it advises maintaining the flexibility to exercise long-term options

  3. UNAVCO-PBO Southwest Region Network Operations

    Walls, C. P.; Mann, D.; Basset, A.; Sklar, J.; Jarvis, C.; Pitcher, T.; Lawrence, S.; Greathouse, M.; Feaux, K.


    The UNAVCO Southwest region of the Plate Boundary Observatory manages 470 continuously operating GPS stations located principally along the transform system of the San Andreas Fault, Eastern California Shear Zone and the northern Baja peninsula. In the past year, network uptime averaged 98% with greater than 99% data acquisition. Communications range from CDMA modem (314), radio (100), Vsat (30), DSL/T1/other (25) to manual download (1). Thirty-four stations have WXT520 metpacks. Sixty-four stations stream 1 Hz data over the VRS3Net typically with cabling, power systems and enclosures. In 2012 the Nucleus upgrade project was completed.

  4. [Diagnosis and therapy of bleeding in ENT].

    Schulz, T; Eßer, D


    Bleeding in the oral cavity, nose or ear are common events in the daily routine of ENT specialists. Apart from trivial cases that often get outpatient treatment, there are numerous cases of serious bleeding that require stationary treatment and if necessary, an operative or interventional therapy. In the following section the most frequent types of bleeding, their diagnosis and therapy will be explained. PMID:24285208

  5. An Analysis of Effect of Break-up Timing on the Necessity of a Feed-and-Bleed Operation in the case of TLOFW with Local

    A Feed-and-bleed (F and B) operation is a process to cool the reactor by the primary side directly. If adequate residual heat removal through the secondary side is not available, the heat can be removed from the RCS by F and B operation. A total loss of feedwater (TLOFW) accident is used to represent an accident involving the failure of cooling by the secondary cooling system. Even if the secondary cooling system fails, the RCS can be cooled by F and B transients when a loss of coolant accident (LOCA) with a TLOFW accident occurs. During an F and B transient, the RCS has a residual heat removal mechanism. If the break size is large, an F and B transient continuously occurs if the SIS is available. If the break size is small to sufficiently decrease the RCS pressure, the SIS cannot inject the coolant, causing the F and B transient to terminate. After the termination of the F and B transient, the residual heat cannot be removed, and the necessity of an F and B operation increases. The operators may hesitate to initiate F and B operation if a clear cue is not provided, since its initiation implies the radioactive coolant releases into the containment. Therefore, the necessity of F and B operation is needed to be identified. The factors affected the necessity of F and B operation are the availability of the safety injection system and safety depressurization system, water inventory in the primary and secondary cooling systems, break size in a loss-of-coolant accident, and time of accident occurrence. The necessity of F and B operation can be changed according to different timing of break-up despite same break size. Moreover, different timing of break-up makes the operators more complicated. To identify effect of timing of break-up, a thermohydraulic analysis was performed using the MARS code. This study is expected to provide a useful guideline to identify the necessity of an F and B operation under combined accident

  6. EELA Operations: A standalone regional dashboard implementation

    L'Orphelin, Cyril; Cordier, Hélène; Reynaud, Sylvain; Lins, Marcos; Loikkanen, Sinika; Lequeux, Olivier; Veyre, Pierre


    International audience Grid operators in EGEE use a dedicated dashboard as their central operational tool, stable and scalable for the last 5 years despite continuous upgrade from specifications by users, monitoring tools or data providers. In EGEE-III, regionalisation of operations led the tool developers to conceive a standalone instance of this tool. Hereby, we will present the concept and the EELA-II implementation. Indeed, there-engineering of this tool led to an easily deployable pac...

  7. The Massive Bleeding after the Operation of Hip Joint Surgery with the Acquired Haemorrhagic Coagulation Factor XIII(13) Deficiency: Two Case Reports.

    Kanda, Akio; Kaneko, Kazuo; Obayashi, Osamu; Mogami, Atsuhiko


    Two women, aged 81 and 61, became haemorrhagic after surgery. Their previous surgeries were uneventful with no unexpected bleeding observed. Blood tests prior to the current surgeries indicated normal values including those related to coagulation. There were no problems with the current surgeries prior to leaving the operating room. At 3 hours after the surgery, the 81-year-old patient had an outflow of the drain at 1290 grams and her blood pressure decreased. She had disseminated intravascular coagulation (DIC). The 61-year-old woman had repeated haemorrhages after her current surgery for a long time. Their abnormal haemorrhages were caused by a deficiency of coagulation factor XIII(13). The mechanism of haemorrhagic coagulation factor XIII(13) deficiency is not understood, and it is a rare disorder. The only diagnostic method to detect this disorder is to measure factor XIII(13) activity in the blood. In this paper, we used Arabic and Roman numerals at the same time to avoid confusion of coagulation factor XIII(13) with coagulation factor VIII(8) that causes hemophilia A. PMID:23533879

  8. The Massive Bleeding after the Operation of Hip Joint Surgery with the Acquired Haemorrhagic Coagulation Factor XIII(13 Deficiency: Two Case Reports

    Akio Kanda


    Full Text Available Two women, aged 81 and 61, became haemorrhagic after surgery. Their previous surgeries were uneventful with no unexpected bleeding observed. Blood tests prior to the current surgeries indicated normal values including those related to coagulation. There were no problems with the current surgeries prior to leaving the operating room. At 3 hours after the surgery, the 81-year-old patient had an outflow of the drain at 1290 grams and her blood pressure decreased. She had disseminated intravascular coagulation (DIC. The 61-year-old woman had repeated haemorrhages after her current surgery for a long time. Their abnormal haemorrhages were caused by a deficiency of coagulation factor XIII(13. The mechanism of haemorrhagic coagulation factor XIII(13 deficiency is not understood, and it is a rare disorder. The only diagnostic method to detect this disorder is to measure factor XIII(13 activity in the blood. In this paper, we used Arabic and Roman numerals at the same time to avoid confusion of coagulation factor XIII(13 with coagulation factor VIII(8 that causes hemophilia A.

  9. Genome-wide association study identifies a region on chromosome 11q14.3 associated with late rectal bleeding following radiation therapy for prostate cancer*

    Kerns, Sarah L.; Stock, Richard; Stone, Nelson N.; Blacksburg, Seth R.; Rath, Lynda; Vega, Ana; Fachal, Laura; Gómez-Caamaño, Antonio; De Ruysscher, Dirk; Lammering, Guido; Parliament, Matthew; Blackshaw, Michael; Sia, Michael; Cesaretti, Jamie; Terk, Mitchell; Hixson, Rosetta; Rosenstein, Barry S.; Ostrer, Harry


    Background and Purpose Rectal bleeding can occur following radiotherapy for prostate cancer and negatively impacts quality of life for cancer survivors. Treatment and clinical factors do not fully predict for rectal bleeding, and genetic factors may be important. Materials and Methods A genome-wide association study (GWAS) was performed to identify SNPs associated with development of late rectal bleeding following radiotherapy for prostate cancer. Logistic regression was used to test association between 614,453 SNPs and rectal bleeding in a discovery cohort (79 cases, 289 controls), and top-ranking SNPs were tested in a replication cohort (108 cases, 673 controls) from four independent sites. Results rs7120482 and rs17630638, which tag a single locus on chromosome 11q14.3, reached genome-wide significance for association with rectal bleeding (combined p-values 5.4×10−8 and 6.9×10−7 respectively). Several other SNPs had p-values trending towards genome-wide significance, and a polygenic risk score including these SNPs shows a strong rank-correlation with rectal bleeding (Sommers’ d = 5.0×10−12 in the replication cohort). Conclusions This GWAS identified novel genetic markers of rectal bleeding following prostate radiotherapy. These findings could lead to development of a predictive assay to identify patients at risk for this adverse treatment outcome so that dose or treatment modality could be modified. PMID:23719583

  10. Genome-wide association study identifies a region on chromosome 11q14.3 associated with late rectal bleeding following radiation therapy for prostate cancer

    Background and purpose: Rectal bleeding can occur following radiotherapy for prostate cancer and negatively impacts quality of life for cancer survivors. Treatment and clinical factors do not fully predict rectal bleeding, and genetic factors may be important. Materials and methods: A genome-wide association study (GWAS) was performed to identify SNPs associated with the development of late rectal bleeding following radiotherapy for prostate cancer. Logistic regression was used to test the association between 614,453 SNPs and rectal bleeding in a discovery cohort (79 cases, 289 controls), and top-ranking SNPs were tested in a replication cohort (108 cases, 673 controls) from four independent sites. Results: rs7120482 and rs17630638, which tag a single locus on chromosome 11q14.3, reached genome-wide significance for association with rectal bleeding (combined p-values 5.4 × 10−8 and 6.9 × 10−7 respectively). Several other SNPs had p-values trending toward genome-wide significance, and a polygenic risk score including these SNPs shows a strong rank-correlation with rectal bleeding (Sommers’ d = 5.0 × 10−12 in the replication cohort). Conclusions: This GWAS identified novel genetic markers of rectal bleeding following prostate radiotherapy. These findings could lead to the development of a predictive assay to identify patients at risk for this adverse treatment outcome so that dose or treatment modality could be modified

  11. [Acute gastrointestinal bleeding].

    Baumbach, Robert; Faiss, Siegbert; Cordruwisch, Wolfgang; Schrader, Carsten


    Acute gastrointestinal bleeding is a common major emergency (Internal medical or gastroenterological or medical), approximately 85 % of which occur in the upper GI tract. It is estimated that about a half of upper GI bleeds are caused by peptic ulcers. Upper GI bleeds are associated with more severe bleeding and poorer outcomes when compared to middle or lower GI bleeds. Prognostic determinants include bleeding intensity, patient age, comorbid conditions and the concomitant use of anticoagulants. A focused medical history can offer insight into the bleeding intensity, location and potential cause (along with early risk stratification). Initial measures should focus on rapid assessment and resuscitation of unstable patients. The oesophagogastroduodenoscopy (OGD) is the gold standard method for localizing the source of bleeding and for interventional therapy. Bleeding as a result of peptic ulcers is treated endoscopically with mechanical and / or thermal techniques in combination with proton pump inhibitor (PPI) therapy. When variceal bleeding is suspected, pre-interventional use of vasopressin analogues and antibiotic therapies are recommended. Endoscopically, the first line treatment of esophageal varices is endoscopic ligature therapy, whereas that for gastric varices is the use of Histoacryl injection sclerotherapy. When persistent and continued massive hemorrhage occurs in a patient with known or suspected aortic disease the possibility of an aorto-enteric fistula must be considered. PMID:27078246

  12. Nonvariceal upper gastrointestinal bleeding

    Burke, Stephen J.; Weldon, Derik; Sun, Shiliang [University of Iowa, Department of Radiology, Iowa, IA (United States); Golzarian, Jafar [University of Iowa, Department of Radiology, Iowa, IA (United States); University of Iowa, Department of Radiology, Carver College of Medicine, Iowa, IA (United States)


    Nonvariceal upper gastrointestinal bleeding (NUGB) remains a major medical problem even after advances in medical therapy with gastric acid suppression and cyclooxygenase (COX-2) inhibitors. Although the incidence of upper gastrointestinal bleeding presenting to the emergency room has slightly decreased, similar decreases in overall mortality and rebleeding rate have not been experienced over the last few decades. Many causes of upper gastrointestinal bleeding have been identified and will be reviewed. Endoscopic, radiographic and angiographic modalities continue to form the basis of the diagnosis of upper gastrointestinal bleeding with new research in the field of CT angiography to diagnose gastrointestinal bleeding. Endoscopic and angiographic treatment modalities will be highlighted, emphasizing a multi-modality treatment plan for upper gastrointestinal bleeding. (orig.)

  13. Regional Tribal Operations Committee RTOC Areas and Representative Contact Info

    U.S. Environmental Protection Agency — The Regional Tribal Operations Committee (RTOC) is a working committee of EPA and Tribal personnel co-chaired by an EPA representative and a Tribal representative....

  14. Approach to bleeding patient

    Ramachandran Gopinath


    Full Text Available Managing a bleeding patient is very challenging for the perioperative physician. Bleeding in a patient would be due to inherited or acquired disorders of haemostasis. Identifying the patients at risk of bleeding and utilising prophylactic treatment protocols has good outcomes. Along with clinical signs, trends in monitoring coagulation parameters and analysing blood picture are necessary. Management of patients in the postoperative period and in intensive care unit should be focused on normalization of coagulation profile as early as possible with available blood and its products. Available recombinant factors should be given priority as per the approved indications. Exploring the surgical site should be considered for persistent bleeding because haemodynamic compromise, excessive transfusion of fluids, blood and its products and more inotropic support may have a negative impact on the patient outcome.

  15. Understanding Minor Rectal Bleeding

    ... are the possible causes of minor rectal bleeding? Hemorrhoids Anal fissures Proctitis (inflammation of the rectum) Polyps ... can be cured if detected early. What are hemorrhoids? Hemorrhoids (also called piles) are swollen blood vessels ...

  16. Natural gas co-operation in the Baltic region

    Co-operation between the gas companies in the Baltic Region has been in place for several years. The overview given in this paper shows that the co-operation has been developed in trade, investments, privatisation and participation in the restructuring process. Finally, through a broad technical co-operation, significant efforts are made to establish common operational practices, codes and standards and the integrity of gas transmission pipelines. The Baltic Region, from a resource and gas interconnection point of view, enjoys a strategic position in the future development of the gas industry in Europe. The Baltic gas sector represents an interesting and growing gas market with the significant gas storage capacity. The region is also located strategically for planned gas interconnections and could serve as a transit corridor for the future gas supplies from western Siberia or the North Sea. This co-operation in the region is being supported by international regulations and agreements such as the Energy Charter between the European Union and the central and east European countries. However, at present the gas industry in the Baltic Region seems to be ahead of these international agreements. It may well be seen that trade arrangements such as Third Party Access are implemented directly by market forces rather than through international agreements. The regional development may thus be a driving force for the implementation of the Internal Energy Market for the gas industry

  17. Promoting regional energy co-operation in South Asia

    Energy is a key ingredient of the socio-economic development of any region. South Asia is not only one of the fastest growing regions in the world; it is also one of the poorest, which thus puts energy at the very heart of the development process in the region. This paper looks at the challenges faced by the South Asia sub-region for economic co-operation (SASEC) comprised of Bangladesh, Bhutan, India and Nepal, and also at the role of greater regional energy co-operation therein. The region is characterized by pressures of growing economies and increasing population. While the per capita energy consumption is one of the lowest in the world, energy intensity continues to be very high. A large portion of the population lacks access to modern sources of energy and depends on traditional sources that are not only inefficient but also have severe health and environmental problems associated with them. Increasing oil import dependency and huge investment needs for energy market development pose a further challenge. The region has a good resource potential and tremendous scope for energy co-operation, which can play a key role in addressing many of these energy security concerns and in putting it on the path of sustainable development. It is ironic that the record in the area has been so limited and that too in the most basic form of co-operation, i.e. bilateral arrangements between countries. This paper puts forth a multi-pronged strategy for sub-regional energy co-operation encompassing softer options aimed at confidence building to more substantial and larger scale co-operation efforts. Delays in decision making to ensure stronger and mutually beneficial co-operation efforts are associated with high costs not only to the energy sector but also for the entire development agenda. With the precarious energy situation in the region and unprecedented increases in international oil prices seen in recent times, it is high time for policy makers, financing institutions, NGOs

  18. Bleeding during Pregnancy

    ... have placenta accreta, you are at risk of life-threatening blood loss during delivery. Your ob-gyn will plan your ... to be done right after delivery to prevent life-threatening blood loss. Can bleeding be a sign of preterm labor? ...

  19. First trimester bleeding evaluation.

    Dogra, Vikram; Paspulati, Raj Mohan; Bhatt, Shweta


    First trimester bleeding is a common presentation in the emergency room. Ultrasound evaluation of patients with first trimester bleeding is the mainstay of the examination. The important causes of first trimester bleeding include spontaneous abortion, ectopic pregnancy, and gestational trophoblastic disease; 50% to 70% of spontaneous abortions are due to genetic abnormalities. In normal pregnancy, the serum beta hCG doubles or increases by at least 66% in 48 hours. The intrauterine GS should be visualized by TVUS with beta hCG levels between 1000 to 2000 mIU/mL IRP. Visualization of the yolk sac within the gestational sac is definitive evidence of intrauterine pregnancy. Embryonic cardiac activity can be identified with CRL of >5 mm. A GS with a mean sac diameter (MSD) of 8 mm or more without a yolk sac and a GS with an MSD of 16 mm or more without an embryo, are important predictors of a nonviable gestation. A GS with a mean sac diameter of 16 mm or more (TVUS) without an embryo is a sonographic sign of anembryonic gestation. A difference of subchorionic hematoma. The presence of an extra ovarian adnexal mass is the most common sonographic finding in ectopic pregnancy. Other findings include the tubal ring sign and hemorrhage. About 26% of ectopic pregnancies have normal pelvic sonograms on TVUS. Complete hydatidiform mole presents with a complex intrauterine mass with multiple anechoic areas of varying sizes (Snowstorm appearance). Twenty-five percent to 65% of molar pregnancies have associated theca-leutin cysts. Arteriovenous malformation of the uterus is a rare but life-threatening cause of vaginal bleeding in the first trimester. The sonographic findings in a patient with first trimester bleeding should be correlated with serum beta hCG levels to arrive at an appropriate clinical diagnosis. PMID:15905817

  20. Anemia Due to Excessive Bleeding

    ... 2 Diabetes, Heart Disease a Dangerous Combo Are 'Workaholics' Prone to OCD, Anxiety? ALL NEWS > Resources First ... needed to determine the source of bleeding. The cause of bleeding is corrected, and transfusions and iron ...


    WANG Gui-qing


    @@ Dysfunctional uterine bleeding, a common gynecological disorder, is generally of two kinds, pubescent and climacteric, characterized by menorrhagia, menostaxis, irregular bleeding, associated with dysmenorrhea, soreness and bearing down sensation in the lumbosacral region.

  2. Diagnosis of the Bleeding Child

    Yıldız, İnci


    Hemostasis is the body response to bleeding with the interaction of the blood vessel the platelets and the coagulation factors This article reviews the normal physiologic mechanism of hemostasis together with the diagnostic approach to the bleeding child The commonly used tests of hemostasis are described Key words: Bleeding Diagnosis Tests

  3. Operations plan for the Regional Seismic Test Network

    The Regional Seismic Test Network program was established to provide a capability for detection of extremely sensitive earth movements. Seismic signals from both natural and man-made earth motions will be analyzed with the ultimate objective of accurately locating underground nuclear explosions. The Sandia National Laboratories, Albuquerque, has designed an unattended seismic station capable of recording seismic information received at the location of the seismometers installed as part of that specific station. A network of stations is required to increase the capability of determining the source of the seismic signal and the location of the source. Current plans are to establish a five-station seismic network in the United States and Canada. The Department of Energy, Nevada Operations Office, has been assigned the responsibility for deploying, installing, and operating these remote stations. This Operation Plan provides the basic information and tasking to accomplish this assignment

  4. Self-reliance through regional co-operation

    Article 52 of the Charter of the United Nations is concerned with the usefulness of Regional Arrangements which 'are appropriate for regional action'. Such arrangements need not be considered only with regard to their political aspects but also as organizational structures which can be helpful in the development of science and technology in less developed countries. The definition of a 'Region' can be difficult, but is easier if scientific rather than political co-operation is intended. The International Atomic Energy Agency has undertaken a first step in this direction through its Regional Co-operative Agreement for Research, Development and Training related to Nuclear Science and Technology in South and Southeast Asia, the Pacific and the Far East (RCA) which has been signed by six countries so far. This Agreement leaves it to the Member States to initiate cooperative projects. The IAEA will take steps to establish the project if at least three Member States are willing to participate. The implementation of the project will be defined by negotiations with the Member States and the IAEA will only play the role of a co-ordinator. Annual meetings of representatives of those countries which are parties of the RCA and of others from the region which might be interested in joining the Agreement provide the possibility of a continuing exchange of new ideas. Regional activities are also undertaken by means of 'Co-ordinated Research Programmes', which mostly include some co-operation with LDCs. The RCA has initiated two new ideas, that of carrying out the projects exclusively by the countries of the region and that of taking the step from co-ordination to cooperation by means of continuous and intensive exchange of information as well as of personnel. Its main objective is to aim at a reasonable division of labour between the parties and to use expensive equipment jointly. It is to be hoped that this venture will lead to an increasing degree of self-reliance within the

  5. RF Regional Technical Centers for MPC and A Sustainability Operations

    The National Nuclear Security Administration (NNSA) programmatic vision to be a catalyst in Russia's assumption of responsibility for long-term system operation is exemplified in the sustainability cooperation with the RF Ministry of Defense (MOD). An identified goal for the MPC and A Program is to encourage the development of Russian Federation (RF) capabilities and commitments to operate and maintain safeguard improvements. The RF MOD Technical Support Center development fulfills the NNSA mission and MPC and A Program goal. The regional technical center concept involves a systematic approach to aid in the determination of the level of sustainability assistance required to transition operators, maintenance, training, and testing of MPC and A systems to the RF MOD. This paper describes the process used to create the RF MOD Technical support center. First are described the needs analyses conducted to determine the key system sustainability factors requiring support. These sustainability functions are then compiled to influence the form and ultimate physical design of the technical support center. Operational interfaces are described, in detail that show the benefit of the center to the individual sites. Finally, benefits relating to information accessibility and other economies of scale are described that highlight the central center concept's strengths

  6. Crew Factors in Flight Operations XIV: Alertness Management in Regional Flight Operations Education Module

    Rosekind, Mark R.; Co, Elizabeth L.; Neri, David F.; Oyung, Raymond L.; Mallis, Melissa M.


    Regional operations encompass a broad range of pilots and equipment. This module is intended to help all those involved in regional aviation, including pilots, schedulers, dispatchers, maintenance technicians, policy makers, and others, to understand the physiological factors underlying fatigue, how flight operations affect fatigue, and what can be done to counteract fatigue and maximize alertness and performance in their operations. The overall purpose of this module is to promote aviation safety, performance, and productivity. It is intended to meet three specific objectives: (1) to explain the current state of knowledge about the physiological mechanisms underlying fatigue; (2) to demonstrate how this knowledge can be applied to improving flight crew sleep, performance, and alertness; and (3) to offer strategies for alertness management. Aviation Safety Reporting System (ASRS) and National Transportation Safety Board (NISH) reports are used throughout this module to demonstrate that fatigue is a safety issue in the regional operations community. The appendices at the end of this module include the ASRS reports used for the examples contained in this publication, brief introductions to sleep disorders and relaxation techniques, summaries of relevant NASA publications, and a list of general readings on sleep, sleep disorders, and circadian rhythms.

  7. Training of tissue bank operators in Asia Pacific region

    To raise quality standards of Tissue Bank in Asia Pacific Region and to meet training needs of tissue bank operators. Singapore (NUH Tissue Bank) was officially appointed by IAEA on 18 September 1996 in Vienna to be the IAEA/NUS Regional Training Centre for RCA (Regional Co-operative Agreement). Member of States including Bangladesh, China, India, Indonesia, Korea, Malaysia, Myanmar, Pakistan, Philippines, Thailand, Sri Lanka and Vietnam. The Singapore Ministry of Environment gave a grant of $225,500 for setting up of this centre with National Science and Technology Board as funding agency, $100,000 being allocated for production of IAEA Developed Curriculum into Multi-Media. (authors being National Project Co-ordinators, Directors of Tissue Banks in the region). The Modules included Guide to Curriculum, Historical Background (0), Rules and Regulation (1), Organisation (2), Quality Assurance (3), Procurement (4), Processing (5), Distribution and Utilisation (6) and Future Developments (7). The Distance Learning Package included case studies from the region in text, in slides and videotapes. A new purpose-built NUH Tissue Bank with separate Wet and Dry Processing laboratories equipped with hands-on facilities was completed in July 1997. This was inaugurated as; IAEA/NUS Regional Training Centre for RCA; IAEA/NUS Interregional Training Centre; and NUS Diploma Course on Tissue Banking also launched by Deputy vice-chancellor, NUS, in conjunction with the IAEA/RCA Regional Training Course on 3 November 1997. One year NUS Open Distance Learning Diploma Course started with two weeks Intensive Course with Core Lectures on Modules (0-7) in the Curriculum and Practical Hands-on Demonstrations. One theory and two practical assessments were conducted. Nineteen participants registered for the Diploma Course. Production of IAEA Multi-Media Curriculum was completed and the Curriculum was distributed to member States during a 2-week-RCA 'Train the Trainers' Workshop on 27 April

  8. The selective bleed variable cycle engine

    Nascimento, M. A. R.


    A new concept in aircraft propulsion is described in this work. In particular, variable jet engine is investigated for supersonic ASTOVL aircraft. This engine is a Selective Bleed Variable Cycle, twin shaft turbofan. At low flight speeds the engine operates as a medium bypass turbofan. At supersonic cruise it operates as low bypass turbofan without reheat. The performance of the engine and its components is analyzed using a novel matching procedure. Off-design engine performance characterist...

  9. Story: A Bleeding Watermelon

    Nor bzang


    Full Text Available A Bleeding Watermelon was written by Norsang (Nor bzang;b. 1988, a native of Dpa ris (Rab rgyas (Huazangsi 华藏寺 Township, Tianzhu 天祝 Tibetan Autonomous County,Gansu 甘肃 Province. Norsang writes: I heard that a university student opened an elevator door in a campus building still under construction. The elevator shaft was empty and he fell to his death. Many people had questions about his death. This inspired me to write this story.

  10. The nursing effect of postoperative adenoid-tonsillectomy bleeding by low-temperature plasma in children

    Chen, Xin


    To observe the nursing effect of postoperative adenoid tonsil bleeding by low-temperature plasma in children. 12 patients received the operation successfully without bleeding. The nursing methods include psychological nursing, observation, apnea prevention and diet nursing. Low-temperature plasma is an effective and safe way to cure postoperative bleeding without complications.

  11. Dysfunctional uterine bleeding (DUB).

    Bulletti, C; Flamigni, C; Prefetto, R A; Polli, V; Giacomucci, E


    Cyclic or irregular uterine bleeding is common in perimenarchal and perimenopausal women with or without endometrial hyperplasia. The disturbance often requires surgical treatment because of its negative effects on both blood loss and abnormal endometrial growth including the development of endometrial cancer. The endometrium is often overstimulated during the perimenopausal period when estrogen/progesterone production is unbalanced. A therapeutical approach with gonadotropin-releasing hormone agonist (GnRHa) was proposed in a depot formulation (Zoladex) that induces a sustained and reversible ovarian suppression. To avoid the risk of osteoporosis and to obtain adequate endometrial proliferation and differentiation during ovarian suppression, transdermal 17-beta-estradiol and oral progestin were administered. Results of 20 cases versus 20 controls showed a reduction of metrorrhagia, a normalization of hemoglobin plasma concentration, and an adequate proliferation and secretory differentiation of the endometrium of patients with abnormal endometrial growth. Abnormal uterine bleeding is mainly due to uterine fibrosis and an inadequate estrogen and/or progesterone production or to a disordered estrogen transport from blood into the endometrium. In premenopausal women, endometrial hyperplasia may be part of a continuum that is ultimately manifested in the histological and biological pattern of endometrial carcinoma. The regression of endometrial hyperplasia obtained by using the therapeutic regimen mentioned above represents a preventive measure for endometrial cancer. Finally the normalization of blood loss offers a good medical alternative to surgery for patients with DUB. PMID:7978956

  12. Operational flood forecasting system of Umbria Region "Functional Centre

    Berni, N.; Pandolfo, C.; Stelluti, M.; Ponziani, F.; Viterbo, A.


    The hydrometeorological alert office (called "Decentrate Functional Centre" - CFD) of Umbria Region, in central Italy, is the office that provides technical tools able to support decisions when significant flood/landslide events occur, furnishing 24h support for the whole duration of the emergency period, according to the national directive DPCM 27 February 2004 concerning the "Operating concepts for functional management of national and regional alert system during flooding and landslide events for civil protection activities purposes" that designs, within the Italian Civil Defence Emergency Management System, a network of 21 regional Functional Centres coordinated by a central office at the National Civil Protection Department in Rome. Due to its "linking" role between Civil Protection "real time" activities and environmental/planning "deferred time" ones, the Centre is in charge to acquire and collect both real time and quasi-static data: quantitative data from monitoring networks (hydrometeorological stations, meteo radar, ...), meteorological forecasting models output, Earth Observation data, hydraulic and hydrological simulation models, cartographic and thematic GIS data (vectorial and raster type), planning studies related to flooding areas mapping, dam managing plans during flood events, non instrumental information from direct control of "territorial presidium". A detailed procedure for the management of critical events was planned, also in order to define the different role of various authorities and institutions involved. Tiber River catchment, of which Umbria region represents the main upper-medium portion, includes also regional trans-boundary issues very important to cope with, especially for what concerns large dam behavior and management during heavy rainfall. The alert system is referred to 6 different warning areas in which the territory has been divided into and based on a threshold system of three different increasing critical levels according

  13. Coronary interventions in patients with bleeding and bleeding tendency

    Thach Nguyen; Lan Nguyen


    @@ In general, percutaneous coronary intervention (PCI)is contra-indicated in patients with bleeding and those that are easy to bleed because during PCI the patients need full anticoagulation to counter any thrombotic formation caused by introduction and manipulation of devices in the vascular system.

  14. Use of selective serotonin reuptake inhibitors and risk of re-operation due to post-surgical bleeding in breast cancer patients: a Danish population-based cohort study

    Gärtner, Rune; Cronin-Fenton, Deirdre; Hundborg, Heidi Holmager;


    Selective serotonin reuptake inhibitors (SSRI) decrease platelet-function, which suggests that SSRI use may increase the risk of post-surgical bleeding. Few studies have investigated this potential association.......Selective serotonin reuptake inhibitors (SSRI) decrease platelet-function, which suggests that SSRI use may increase the risk of post-surgical bleeding. Few studies have investigated this potential association....

  15. Regional Disparities in Romania. Contribution of the Regional Operational Program to Health Infrastructure



    Full Text Available Health infrastructure is one of the weaknesses of socio-economic development in Romania and in other European states. In order to get a better picture of the Romanian health system issues, this paper analyzes a number of statistical indicators considered representative for the national and European health infrastructure for a 20 years period, between 1990 and 2010. Our paper has three main objectives: (a to identify the main trends for health infrastructure in some of the European Union countries; (b to describe the evolution of the health system in Romania, the comparative situation at the European level as well as regional level indicators dynamics; (c to overview the Regional Operational Program in Romania, how much does it help the regional health infrastructure in our country. At the European level, there is a constant decrease in the number of hospital beds. For this indicator, Romania has slightly higher values than the European average. We must mention that the hospital beds indicator offers limited information on health infrastructure which also includes medical equipment and specific devices and practices. The number of hospitals in Romania increased with 18.9% during the last 20 years (1990-2010. During the observed timeline, the number of hospitals in Romania had a constant positive evolution at regional level. The number of doctors in hospitals has an increasing trend at the local as well as at the international level. Romania has a number of doctors twice lower than the European average (3.6 doctors for one thousand inhabitants. The Regional Operational Program (ROP has a limited influence in achieving the objectives stated in Applicants Guide for Priority Axis 3. Major Intervention Area 3.1. This happens because supporting infrastructure improvements will not create institutional modernization. The financial contribution through ROP will result in the modernization of 11% of the existing hospitals in Romania.

  16. Regional higher education co-operation: a research proposal to compare the Baltic Sea and the Black Sea regions

    Stefan Ewert


    Full Text Available While the Baltic Sea Region is considered to be a pioneer region in the development of regional integration and identity, the Black Sea Region is regarded to be a laggard in terms of regionali¬zation and region building. My paper summarizes the role of regional higher education co-operation in the Baltic Sea regionalization process in theory and analyzes the empirical background of these assumptions. Yet, inasmuch an evaluation of the regions` status as a pioneer is possible only in a comparative perspective, I propose to compare the Black Sea and the Baltic Sea Region regarding their higher education networks systematically. My paper asks for the transferability of arguments in favor of a strong regional higher education co-operation in the Baltic Sea Region since the 1990s to today’s situation of the Black Sea Region. It concludes with some fundamental considerations on a comparative research project.

  17. Data report of ROSA/LSTF experiment TR-LF-07; Loss-of-feedwater transient with primary feed-and-bleed operation

    竹田 武司


    The TR-LF-07 test simulated a loss-of-feedwater transient in a PWR. A SI signal was generated when steam generator (SG) secondary-side collapsed liquid level decreased to 3 m. Primary depressurization was initiated by fully opening a power-operated relief valve (PORV) of pressurizer (PZR) 30 min after the SI signal. High pressure injection (HPI) system was started in loop with PZR 12 s after the SI signal, while it was initiated in loop without PZR when the primary pressure decreased to 10.7 ...

  18. PBO Southwest Region: Baja Earthquake Response and Network Operations

    Walls, C. P.; Basset, A.; Mann, D.; Lawrence, S.; Jarvis, C.; Feaux, K.; Jackson, M. E.


    The SW region of the Plate Boundary Observatory consists of 455 continuously operating GPS stations located principally along the transform system of the San Andreas fault and Eastern California Shear Zone. In the past year network uptime exceeded an average of 97% with greater than 99% data acquisition. Communications range from CDMA modem (307), radio (92), Vsat (30), DSL/T1/other (25) to manual downloads (1). Sixty-three stations stream 1 Hz data over the VRS3Net typically with Security was enhanced at these sites through fencing and more secure station configurations. In the past 12 months, 4 new stations were installed to replace removed stations or to augment the network at strategic locations. Following the M7.2 El Mayor-Cucapah earthquake CGPS station P796, a deep-drilled braced monument, was constructed in San Luis, AZ along the border within 5 weeks of the event. In addition, UNAVCO participated in a successful University of Arizona-led RAPID proposal for the installation of six continuous GPS stations for post-seismic observations. Six stations are installed and telemetered through a UNAM relay at the Sierra San Pedro Martir. Four of these stations have Vaisala WXT520 meteorological sensors. An additional site in the Sierra Cucapah (PTAX) that was built by CICESE, an Associate UNAVCO Member institution in Mexico, and Caltech has been integrated into PBO dataflow. The stations will be maintained as part of the PBO network in coordination with CICESE. UNAVCO is working with NOAA to upgrade PBO stations with WXT520 meteorological sensors and communications systems capable of streaming real-time GPS and met data. The real-time GPS and meteorological sensor data streaming support watershed and flood analyses for regional early-warning systems related to NOAA's work with California Department of Water Resources. Currently 19 stations are online and streaming with 7 more in preparation. In 2008 PBO became the steward of 209 existing network stations of which

  19. Splenic angiosarcoma metastasis to small bowel presented with gastrointestinal bleeding

    Jun-Te Hsu; Chin-Yew Lin; Ting-Jun Wu; Han-Ming Chen; Tsann-Long Hwang; Yi-Yin Jan


    Primary splenic angiosarcoma is a very rare,aggressive neoplasm with a high metastatic rate and dismal prognosis. This neoplasm usually presents with abdominal pain, splenomegaly, anemia, and thrombocytopenia. Splenic angiosarcoma with bleeding gastrointestinal metastases is extremely rare. The literature contains only two case reports. This study reported a 44-year-old male patient with splenic angiosarcoma with sustained repeated gastrointestinal bleeding due to small bowel metastases. Salvage surgery was performed by splenectomy and resection of the metastatic small bowel tumors. The post-operative course was uneventful; the patient survived with the disease and had no GI bleeding, 7 mo after surgery.

  20. Linear operating region in the ozone dial photon counting system

    Andrawis, Madeleine


    photocathode, however, at higher rates the limitations of the discrimination/counting system will cause the observed count rate to be non-linear with respect to the true count rate. Depending on the pulse height distribution and the discriminator level, the overlapping of pulses (pulse pile-up) can cause count loss or even an additional apparent count gain as the signal levels increase. Characterization of the system, including the pulse height distribution, the signal to noise ratio, and the effect of the discriminator threshold level, is critical in maximizing the linear operating region of the system, thus greatly increasing the useful dynamic range of the system.

  1. Fibrinogen concentrate in bleeding patients

    Wikkelsø, Anne; Lunde, Jens; Johansen, Mathias;


    Hypofibrinogenaemia is associated with increased morbidity and mortality, but the optimal treatment level, the use of preemptive treatment and the preferred source of fibrinogen remain disputed. Fibrinogen concentrate is increasingly used and recommended for bleeding with acquired haemostatic...

  2. Treatment of acute variceal bleeding

    Bendtsen, Flemming; Krag, Aleksander Ahm; Møller, Søren


    The management of variceal bleeding remains a clinical challenge with a high mortality. Standardisation in supportive and new therapeutic treatments seems to have improved survival within the last 25 years. Although overall survival has improved in recent years, mortality is still closely related...... to failure to control initial bleeding or early re-bleeding occurring in up to 30-40% of patients. Initial procedures are to secure and protect the airway, and administer volume replacement to stabilize the patient. Treatment with vasoactive drugs should be started as soon as possible, since a...... adhesives should be used. In conclusion: Improvements in resuscitation and prevention of complications have together with introduction of vasoactive drugs and refinement of endoscopic therapy majorily changed the prognosis of the patient presenting with variceal bleeding....

  3. Bleeding in the Digestive Tract

    ... lining of the esophagus, stomach, or duodenum. The bacteria Helicobacter pylori (H. pylori) and use of nonsteroidal ... paleness shortness of breath vomit that looks like coffee grounds weakness A person with acute bleeding may ...

  4. PBO Operations in Alaska and Cascadia, Combining Regions and Collaborating with our Regional Partners

    Austin, K. E.; Boyce, E. S.; Dausz, K.; Feaux, K.; Mattioli, G. S.; Pyatt, C.; Willoughby, H.; Woolace, A. C.


    During the last year, the Alaska and the Cascadia regions of the EarthScope Plate Boundary Observatory (PBO) network were combined into a single management unit. While both remain distinct regions with their own challenges and engineering staff, every effort has been made to operate as a single team to improve efficiency and provide the highest possible data quality and uptime. Over the last several years a concerted effort has been made to work collaboratively with other institutions and stakeholders to defray ongoing costs by sharing staff and resources. UNAVCO currently operates four integrated GPS/seismic stations in collaboration with the Alaska Earthquake Center, eight with the Alaska Volcano Observatory, and three with the EarthScope TA. By the end of 2015, PBO and TA plan to install another 3 integrated and/or co-located geodetic and seismic systems. While most of these are designed around existing PBO stations, the 2014 installation at Middleton Island is a new station for both groups, providing PBO with an opportunity to expand geodetic data in Alaska. There were two major joint maintenance efforts in 2015:, the largest was a 5 day mission among PBO, AVO, and TA, which shared boat, helicopter, and staff on and around Augustine Volcano; the second, was a 10 day helicopter mission shared between AVO and PBO on Unimak Island. PBO Pacific Northwest is working closely with University of Washington to co-locate at least 9 Earthquake Early Warning Systems, which include the addition of strong motion sensors and high speed RT telemetry at PBO sites. The project is managed by University of Washington but UNAVCO is providing land contact information and infrastructure support. Summer 2015 upgrades include a complete overhaul of aging radio technology at two major networks and several small radio networks in Cascadia. The upgrades will increase reliability and enhance the speed of existing telemetry infrastructure and will continue through summer 2018.

  5. Intraoperative bleeding control by uniportal video-assisted thoracoscopic surgery†.

    Gonzalez-Rivas, Diego; Stupnik, Tomaz; Fernandez, Ricardo; de la Torre, Mercedes; Velasco, Carlos; Yang, Yang; Lee, Wentao; Jiang, Gening


    Owing to advances in video-assisted thoracic surgery (VATS), the majority of pulmonary resections can currently be performed by VATS in a safe manner with a low level of morbidity and mortality. The majority of the complications that occur during VATS can be minimized with correct preoperative planning of the case as well as careful pulmonary dissection. Coordination of the whole surgical team is essential when confronting an emergency such as major bleeding. This is particularly important during the VATS learning curve, where the occurrence of intraoperative complications, particularly significant bleeding, usually ends in a conversion to open surgery. However, conversion should not be considered as a failure of the VATS approach, but as a resource to maintain the patient's safety. The correct assessment of any bleeding is of paramount importance during major thoracoscopic procedures. Inadequate management of the source of bleeding may result in major vessel injury and massive bleeding. If bleeding occurs, a sponge stick should be readily available to apply pressure immediately to control the haemorrhage. It is always important to remain calm and not to panic. With the bleeding temporarily controlled, a decision must be made promptly as to whether a thoracotomy is needed or if the bleeding can be solved through the VATS approach. This will depend primarily on the surgeon's experience. The operative vision provided with high-definition cameras, specially designed or adapted instruments and the new sealants are factors that facilitate the surgeon's control. After experience has been acquired with conventional or uniportal VATS, the rate of complications diminishes and the majority of bleeding events are controlled without the need for conversion to thoracotomy. PMID:26424873

  6. [Bleeding gastric inflammatory fibroid polyp (Vanek's tumor)].

    Guţu, E; Ghidirim, Gh; Mişin, I; Iakovleva, Iraida; Vozian, M


    Inflammatory fibroid polyp's (IFP) or Vanek tumor of the gastrointestinal tract represents a relatively unusual entity. IFP is an extremely rare cause of upper gastrointestinal bleeding. We report herein a case of a 30-year-old woman who had a gastric IFP complicated by gastrointestinal bleeding and obstructive symptoms. The lesion was mistaken on endoscopic, radiologic examination and in the operating room for a gastrointestinal stromal tumor (GIST). Preoperative endoscopic examination revealed a protruding oval-shaped submucosal lesion (approximately 7 cm in size) of the gastric antrum, with ulceration of the mucosal surface. Multiple endoscopic biopsies were negative for neoplastic changes. Barium meal study disclosed a large tumor in the prepyloric area of the stomach. Presumptive preoperative diagnosis was GIST. Subtotal Bilroth II gastrectomy en bloc with the mass and lymphadenectomy was performed. Surprisingly, the final histological diagnosis was IFP. Postoperative course was uneventful and no recurrences were observed during 4 years follow-up. With reference to case report, the etiology, diagnosis and treatment strategy of IFP will be discussed. This case highlights an unusual presentation of IFP. Although bleeding may represent a rare complication due IFP, it should be considered in the differential diagnosis of upper gastrointestinal hemorrhage of uncertain etiology. PMID:20405696

  7. Phase-space-region operators and the Wigner function: Geometric constructions and tomography

    Ellinas, Demosthenes; Bracken, Anthony J.


    Quasiprobability measures on a canonical phase space give rise through the action of Weyl’s quantization map to operator-valued measures and, in particular, to region operators. Spectral properties, transformations, and general construction methods of such operators are investigated. Geometric trace-increasing maps of density operators are introduced for the construction of region operators associated with one-dimensional domains, as well as with two-dimensional shapes (segments, canonical polygons, lattices, etc.). Operational methods are developed that implement such maps in terms of unitary operations by introducing extensions of the original quantum system with ancillary spaces (qubits). Tomographic methods of reconstruction of the Wigner function based on the radon transform technique are derived by the construction methods for region operators. A Hamiltonian realization of the region operator associated with the radon transform is provided, together with physical interpretations.

  8. Nuclear energy in Asia and regional co-operation

    There is increasing concern in East Asia about regional cooperation in the field of nuclear power. At the APEC conference in Osaka in 1995, APEC (Asia Pacific Economic Cooperation) established an Energy Research Center. The center has started to perform joint research forecasts on energy supply and demand for the region. Japan proposed the inauguration of a Conference on Nuclear Safety in Asia at the Moscow Nuclear Energy Summit in 1996. The first conference was held in Tokyo that year. This year, the conference will be held in Seoul. Japan's Atomic Energy Commission sponsors the International Conference for Nuclear Cooperation in Asia every year. This year marks the eighth conference. The outstanding feature of this year's conference was that so many countries stressed regional cooperation. South Korea proposed the installation of a regional online radiation monitoring system. The Philippines asserted the need for a cooperative mechanism on the lines of ASIATOM. Why is so much concern now being focused on nuclear power cooperation in East Asia? What kind of regional cooperation is necessary, and what kind is possible? What are the unique features of nuclear power cooperation in East Asia? These are the points addressed in this paper. (author)

  9. Latin American regional co-operative programme on food irradiation

    The ''Latin American Regional Co-ordinated Research Programme on Food Irradiation'' was established in 1986 with the participation of research scientists from countries in the region to investigate the efficacy of food irradiation as a treatment to reduce post-harvest losses and improve the hygienic quality of food, to conduct techno-economic feasibility studies, and to disseminate knowledge about the scientific, health, legal and commercial aspects of food irradiation. This publication contains the final report of the Co-ordinated Research Programme and summaries of individual research reports presented by the participating scientists

  10. Can Plasma Fibrinogen Levels Predict Bleeding After Coronary Artery Bypass Grafting?

    Jalali, Alireza; Ghiasi, Mohammadsaeid; Aghaei, Aghdas; Khaleghparast, Shiva; Ghanbari, Behrooz; Bakhshandeh, Hooman


    Background: Fibrinogen is the main biomarker for bleeding. To prevent excessive postoperative bleeding, it would be useful to identify high-risk patients before coronary artery bypass grafting (CABG). Objectives: In order to predicating bleeding after CABG, we sought to determine whether preoperative fibrinogen concentration was associated with the amount of bleeding following CABG. Patients and Methods: A total of 144 patients (mean age = 61.50 ± 9.42 years; 65.7% men), undergoing elective and isolated CABG, were included in this case-series study. The same anesthesia technique and medicines were selected for all the patients. In the ICU, the patients were assessed in terms of bleeding at 12 and 24 hours post-operation, amount of contingent blood products received, and relevant tests. Statistical tests were subsequently conducted to analyze the correlation between preoperative fibrinogen concentration and the amount of post-CABG bleeding. Results: The mean ± standard deviation of bleeding at 12 and 24 hours post-operation was 285.37 ± 280.27 and 499.31 ± 355.57 mL, respectively. The results showed that postoperative bleeding was associated with different factors whereas pre-anesthesia fibrinogen was not correlated with bleeding at 12 (P = 0.856) and 24 hours (P = 0.936) post-operation. There were correlations between the extra-corporal circulation time and bleeding at 12 hours post-operation (ρ = 0.231, P = 0.007) and bleeding at 24 hours post-operation (ρ = 0.218, P = 0.013). Conclusions: Preoperative assessment of plasma fibrinogen levels failed to predict post-CABG bleeding. PMID:25478546

  11. Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

    Supot Pongprasobchai; Sireethorn Nimitvilai; Jaroon Chasawat; Sathaporn Manatsathit


    AIM: To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding (UGIB) Etiology Score for predicting the types of UGIB and validate the score.METHODS: Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected.Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB.RESULTS: Among 261 patients with UGIB, 47 (18%) had variceal and 214 (82%) had non-variceal bleeding.Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding;previous diagnosis of cirrhosis or signs of chronic liver disease (OR 22.4, 95% CI 8.3-60.4, P < 0.001), red vomitus (OR4.6, 95% CI 1.8-11.9, P = 0.02), and red nasogastric (NG) aspirate (OR 3.3, 95% CI 1.3-8.3, P = 0.011).The UGIB Etiology Score was calculated from (3.1 x previous diagnosis of cirrhosis or signs of chronic liver disease) + (1.5 × red vornitus) + (1.2 × red NG aspirate), when 1 and 0 are used for the presence and absence of each factor, respectively. Using a cutoff ≥ 3.1, the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) in predicting variceal bleeding were 85%, 81%,82%, 50%, and 96%, respectively. The score was prospectively validated in another set of 195 UGIB cases (46 variceal and 149 non-variceal bleeding). The PPV and NPV of a score ≥3.1 for variceal bleeding were 79% and 97%, respectively.CONCLUSION: The UGIB Etiology Score, composed of 3 parameters, using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.

  12. Transcatheter embolization for treatment of acute lower gastrointestinal bleeding

    Treatment of lower gastrointestinal bleeding was attempted in 13 patients by selective embolization of branches of the mesenteric arteries with Gelfoam. Bleeding was adequately controlled in 11 patients with active bleeding during the examination. One patient improved after embolization but bleeding recurred within 24 hours and in another patient the catheterization was unsuccessful. Five patients with diverticular hemorrhage were embolized in the right colic artery four times, and once in the middle colic artery. Three patients had embolization of the ileocolic artery because of hemorrhage from cecal angiodysplasia, post appendectomy, and leukemia infiltration. Three patients had the superior hemorrhoidal artery embolized because of bleeding from unspecific proctitis, infiltration of the rectum from a carcinoma of the bladder, and transendoscopic polypectomy. One patient was septic and bled from jejunal ulcers. Ischemic changes with infarction of the large bowel developed in two patients and were treated by partial semi-elective colectomy, three and four days after embolization. Four other patients developed pain and fever after embolization. Transcatheter embolization of branches of mesenteric arteries in an effective way to control acute lower gastrointestinal bleeding, but still has a significant rate of complications that must be seriously weighed against the advantages of operation. (orig.)

  13. Endoscopic Management of Diverticular Bleeding

    Tarun Rustagi


    Full Text Available Diverticular hemorrhage is the most common reason for lower gastrointestinal bleeding (LGIB with substantial cost of hospitalization and a median length of hospital stay of 3 days. Bleeding usually is self-limited in 70–80% of cases but early rebleeding is not an uncommon problem that can be reduced with proper endoscopic therapies. Colonoscopy is recommended as first-line diagnostic and therapeutic approach. In the vast majority of patients diverticular hemorrhage can be readily managed by interventional endotherapy including injection, heat cautery, clip placement, and ligation to achieve endoscopic hemostasis. This review will serve to highlight the various interventions available to endoscopists with specific emphasis on superior modalities in the endoscopic management of diverticular bleeding.

  14. [Direct oral anticoagulant associated bleeding].

    Godier, A; Martin, A-C; Rosencher, N; Susen, S


    Direct oral anticoagulants (DOAC) are recommended for stroke prevention in atrial fibrillation and for the treatment of venous thromboembolism. However, they are associated with hemorrhagic complications. Management of DOAC-induced bleeding remains challenging. Activated or non-activated prothrombin concentrates are proposed, although their efficacy to reverse DOAC is uncertain. Therapeutic options also include antidotes: idarucizumab, antidote for dabigatran, has been approved for use whereas andexanet alpha, antidote for anti-Xa agents, and aripazine, antidote for all DOAC, are under development. Other options include hemodialysis for the treatment of dabigatran-associated bleeding and administration of oral charcoal if recent DOAC ingestion. DOAC plasma concentration measurement is necessary to guide DOAC reversal. We propose an update on DOAC-associated bleeding, integrating the availability of dabigatran antidote and the critical place of DOAC concentration measurements. PMID:27297642

  15. Null controllable region of delta operator systems subject to actuator saturation

    Yang, Hongjiu; Yan, Ce; Xia, Yuanqing; Zhang, Jinhui


    In this paper, we give exact description of null controllable regions for delta operator systems subject to actuator saturation. The null controllable region is in terms of a set of extremal trajectories of anti-stable subsystems. For the delta operator system with real eigenvalues or complex eigenvalues, the description is simplified to an explicit formula which is used to characterise the boundary of a null controllable region. The relations of null controllable regions are shown separately for continuous-time systems, discrete-time systems and delta operator systems. Two numerical examples are given to illustrate the effectiveness of the proposed techniques on null controllable regions.

  16. Hydroturbine operating region partitioning based on analyses of unsteady flow field and dynamic response


    The operating states of hydroelectric generating units vary widely as the operating condition change. The details of the operating characteristics and the operating region partitioning method are discussed for two types of large Francis turbines in the Wanjiazhai Hydropower Plant and two same type large Kaplan turbines in the Shuikou Hydropower Plant. For the Wanjiazhai Hydropower units, the most critical factor affecting the operating stability is the hydraulic pressure fluctuations caused by the vortex rope in the draft tube. For Shuikou Hydropower units, the dynamic stresses as in the piston rod and the blade and the hydraulic thrust on the runner induced by the pressure fluctuations in the flow passage should be used to partition the operating regions. Analyzing the distribution cloud of operating characteristic factors which affects the operating stability in the hill-chart for each individual unit, the forbidden, stable and transient operating regions can be obtained.

  17. Traumatic intercostal arterial bleeding controlled with a novel surgical technique: a case report

    Miettinen Simo; Hakala Tapio


    Abstract Introduction A blunt thoracic trauma may cause arterial bleeding requiring operative treatment or endovascular embolization or endovascular aortic stenting. A novel damage control technique to stop such bleeding is presented. Case presentation We present the case of an 82-year-old Caucasian man who experienced rib fractures I-VII on the left side and bleeding from damaged intercostal arteries after a blunt thoracic trauma. Emergency thoracotomy was performed. Conclusions Effective he...

  18. Production operation of small petroleum enterprises in Tomsk region

    Sharf, I.; Filjushin, V.; Shenderova, I.; Kochetkova, O.


    Implementing resource-innovative strategy to develop Russian fuel-and-energy sector implies the promotion of small oil production enterprises developing fields with the reserves of less than 5 mln. tons. However, the efficiency of such enterprises, investigated on the example of Tomsk region (considering the indexes of oil extraction, growth of reserves, amount of capital expenditures and geological surveys), signifies the presence of definite tendencies. Consequently, management decisions concerning economic, organizational, financial and fiscal character should be taken in order to eliminate detrimental factors.

  19. The Kaarstoe gas terminal during operation - regional economic effects

    In the period 1981-1989 a comprehensive study was made of the impact on society of the establishment of Statoil's gas terminal at Kaarstoe, Norway. Some of this work is updated in the present report. The organization at Kaarstoe is Statoil's transport division for gas (GASS-T) and is described in Chapter 2. A survey is given in Chapter 3 of how the employees are associated with the local community, their distribution in age, sex and type of job. Chapter 4 treats the importance for the Haugesund region of the company's purchasing in the area, in particular from suppliers within the Tysvaer municipality. The development of the structure of industry in Tysvaer and the employment situation are described in Chapter 5. Population trends and housebuilding in Tysvaer are described in Chapter 6 and the impact of GASS-T on the municipal economy is described in Chapter 7. Finally, Chapter 8 discusses whether what is learned from Kaarstoe can be transferred to other regions where gas terminals have been established. 14 refs., 24 figs., 12 tabs

  20. Superselective transarterial embolization for the management of acute gastrointestinal bleeding

    Lee, In Kyoung; Kim, Young Min; Kim, Jeong; Shin, Sang Soo; Yoon Woong; Kim, Jae Kyu; Park, Jin Gyoon [Chonnam National University Hospital, Gwangju (Korea, Republic of); Cho, Chol Kyoon; Kang, Heoung Keun [Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of)


    We wanted to evaluate the safety and effectiveness of superselective transarterial embolization for the management of gastrointestinal bleeding. We evaluated 97 of 115 patients who had undergone diagnostic angiography and transarterial embolization for gastrointestinal bleeding from February 2001 to July 2004, and they subsequently underwent superselective transarterial embolization. Their ages ranged from 17 to 88 years (mean age: 58.5 years), and 73 were men and 24 were women. The etiologies were a postoperative condition (n=31), ulcer (n=23), Mallory-Weiss syndrome (n=3), trauma (n=3), pseudoaneurysm from pancreatitis (n=3), diverticula (n=2), inflammatory bowel disease (n=2), tumor (n=2), Behcet's disease (n=2), hemobilia (n=1), and unknown origin (n=25). The regions of bleeding were the esophagus (n=3), stomach and duodenum (n=41), small bowel (n=38) and colon (n=15). All the patients underwent superselective transarterial embolization using microcoils, gelfoam or a combination of microcoils and gelfoam. Technical success was defined as devascularization of targeted vascular lesion or the disappearance of extravasation of the contrast media, as noted on the angiography after embolization. Clinical success was defined as the disappearance of clinical symptoms and the reestablishment of normal cardiovascular hemodynamics after transarterial embolization without any operation or endoscopic management. The technical success rate was 100%. The primary clinical success rate was 67% (65 of 97 patients). Of the 32 primary failures, fourteen patients underwent repeat embolization; of these, clinical success was achieved in all the patients and so the secondary clinical success rate was 81% (79 of 97 patients). Of the 18 patients with primary failures, five patients underwent operation, one patient underwent endoscopic management and the others died during the observation period due to disseminated coagulopathy or complications of their underlying diseases. During

  1. 76 FR 23470 - Version One Regional Reliability Standard for Transmission Operations


    ... Regional Reliability Standard for Transmission Operations, Notice of Proposed Rulemaking, 75 FR 81,157 (Dec... Commission finds that Requirement R2 is not administrative in nature as it prohibits a transmission operator... regard to such matters as format, aligning WECC regional definitions with the NERC Glossary of Terms...

  2. Gastrointestinal Bleeding Secondary to Calciphylaxis.

    Gupta, Nancy; Haq, Khwaja F; Mahajan, Sugandhi; Nagpal, Prashant; Doshi, Bijal


    BACKGROUND Calciphylaxis is associated with a high mortality that approaches 80%. The diagnosis is usually made when obvious skin lesions (painful violaceous mottling of the skin) are present. However, visceral involvement is rare. We present a case of calciphylaxis leading to lower gastrointestinal (GI) bleeding and rectal ulceration of the GI mucosa. CASE REPORT A 66-year-old woman with past medical history of diabetes mellitus, hypertension, end-stage renal disease (ESRD), recently diagnosed ovarian cancer, and on hemodialysis (HD) presented with painful black necrotic eschar on both legs. The radiograph of the legs demonstrated extensive calcification of the lower extremity arteries. The hospital course was complicated with lower GI bleeding. A CT scan of the abdomen revealed severe circumferential calcification of the abdominal aorta, celiac artery, and superior and inferior mesenteric arteries and their branches. Colonoscopy revealed severe rectal necrosis. She was deemed to be a poor surgical candidate due to comorbidities and presence of extensive vascular calcifications. Recurrent episodes of profuse GI bleeding were managed conservatively with blood transfusion as needed. Following her diagnosis of calciphylaxis, supplementation with vitamin D and calcium containing phosphate binders was stopped. She was started on daily hemodialysis with low calcium dialysate bath as well as intravenous sodium thiosulphate. The clinical condition of the patient deteriorated. The patient died secondary to multiorgan failure. CONCLUSIONS Calciphylaxis leading to intestinal ischemia/perforation should be considered in the differential diagnosis in ESRD on HD presenting with abdominal pain or GI bleeding. PMID:26572938

  3. Management of bleeding gastroduodenal ulcers

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B


    Description: A multidisciplinary group of Danish experts developed this guideline on management of bleeding gastroduodenal ulcers. Sources of data included published studies up to March 2011. Quality of evidence and strength of recommendations have been graded. The guideline was approved by the...

  4. An unusual cause of gastrointestinal bleed

    C K Adarsh


    Full Text Available Gastrointestinal (GI bleed often brings the patient to the emergency medical service with great anxiety. Known common causes of GI bleed include ulcers, varices, Mallory-Weiss among others. All causes of GI bleed should be considered however unusual during the evaluation. Aortoenteric fistula (AEF is one of the unusual causes of GI bleed, which has to be considered especially in patients with a history of abdominal surgery in general and aortic surgery in particular.

  5. Vitamin K deficiency bleeding of the newborn

    Vitamin K deficiency bleeding of the newborn (VKDB) is a bleeding disorder in babies. It most often develops shortly ... A lack of vitamin K may cause severe bleeding in newborn babies. Vitamin K plays an important role in blood clotting. Babies often have a ...

  6. Obscure gastrointestinal bleeding: preoperative CT-guided percutaneous needle localization of the bleeding small bowel segment.

    Heiss, Peter; Feuerbach, Stefan; Iesalnieks, Igors; Rockmann, Felix; Wrede, Christian E; Zorger, Niels; Schlitt, Hans J; Schölmerich, Jürgen; Hamer, Okka W


    A 57-year-old woman presented with obscure gastrointestinal bleeding. Double balloon enteroscopy, angiography, and surgery including intraoperative enteroscopy failed to identify the bleeding site. Multidetector computed tomography (CT) depicted active bleeding of a small bowel segment. The bleeding segment was localized by CT-guided percutaneous needle insertion and subsequently removed surgically. PMID:19328430

  7. Management of severe perioperative bleeding

    Kozek-Langenecker, Sibylle A; Afshari, Arash; Albaladejo, Pierre;


    The aims of severe perioperative bleeding management are three-fold. First, preoperative identification by anamesis and laboratory testing of those patients for whom the perioperative bleeding risk may be increased. Second, implementation of strategies for correcting preoperative anaemia and...... with an assessment of the quality of the evidence in order to allow anaesthetists throughout Europe to integrate this knowledge into daily patient care wherever possible. The Guidelines Committee of the European Society of Anaesthesiology (ESA) formed a task force with members of scientific...... cross-sectional surveys were selected. At the suggestion of the ESA Guideline Committee, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was initially used to assess the level of evidence and to grade recommendations. During the process of guideline development, the official...

  8. Diagnostic accuracy of CT angiography in acute gastrointestinal bleeding

    Full text: The aim of the study was to carry out a systematic review determining the accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding. A search of published work in Medline and manual searching of reference lists of articles was conducted. Studies were included if they compared CT angiography to a reference standard of upper gastrointestinal endoscopy, colonoscopy, angiography or surgery in the diagnosis of acute gastrointestinal bleeding. Eight published studies evaluating 129 patients were included. Data were used to form 2x2 tables. Computed tomography angiography showed pooled sensitivity of 86% (95% confidence interval 78-92%) and specificity of 95% (95% confidence interval 76-100%), without showing significant heterogeneity (x2 = 3.5, P=0.6) and (x2 - 5.4, P = 0.6), respectively. Summary receiver operating characteristic analysis showed an area under the curve of 0.93. Computed tomography angiography is accurate in the diagnosis of acute gastrointestinal bleeding and can show the precise location and aetiology of bleeding, thereby directing further management. Strong recommendations for use of CT cannot be made from this review because of the methodological limitations and further large prospective studies are needed to define the role of CT in acute gastrointestinal bleeding.

  9. Role of videocapsule endoscopy for gastrointestinal bleeding

    Cristina Carretero; Ignacio Fernandez-Urien; Maite Betes; Miguel Mu(n)oz-Navas


    Obscure gastrointestinal bleeding (OGIB) is defined as bleeding of an unknown origin that persists or recurs after negative initial upper and lower endoscopies.Several techniques,such as endoscopy,arteriography,scintigraphy and barium radiology are helpful for recognizing the bleeding source;nevertheless,in about 5%-10% of cases the bleeding lesion cannot be determined.The development of videocapsule endoscopy (VCE) has permitted a direct visualization of the small intestine mucosa.We will analyze those techniques in more detail.The diagnostic yield of CE for OGIB varies from 38% to 93%,being in the higher range in those cases with obscure-overt bleeding.

  10. Scintigraphic diagnosis of lower GI bleeding

    Abdominal scintigraphy with 99mTc HSA, 99mTc Sn colloid, or 99mTc RBC was performed in 28 patients with melena to detect bleeding and determine the bleeding site in the lower gastrointestinal tract. Active bleedings and/or vascular lesions were identified in 16 patients. They were proved by antiography, endoscopy or barium enema in 14. We concluded that scintigraphy was an accurate and effective method to detect the bleeding and determine the bleeding site in the lower gastrointestinal tract. (author)

  11. Otorrhagia bleeding due to leech bite

    Narges Askari


    Full Text Available Leeches are blood-sucking hermaphroditic parasites that attach to vertebrate hosts, bite through the skin, and suck out blood. When leeches feed, they secrete an anticoagulant (hirudin, which helps them get a full meal of blood. This is the first report of leech removal from external auditory canal. Previous leech involvement cases were explained in nasopharynx, larynx, pharynx, eye, and gastrointestinal tract. Prominent sign of all cases was active bleeding from the leech attachment site; that stopped with leech removal. A 24-year-old man was presented to Al-Zahra hospital with left otorrhagia and otalgia from 2 days ago. After suction of ear a small soft foreign body was seen in the external ear near the tympanic membrane, then the ear filled with glycerine phenice, the patient explained decreased movement of foreign body. Four hours later the bloody discharge stopped and otalgia decreased. After suction of clots, a leech was extruded from external auditory canal by alligator. Leech infestation is a rare cause of otorrhagia and should be suspected in the endemic region in all of unusual bleeding; it can be diagnosed and treated by exact inspection and removal.

  12. Histopathological correlation of adenomyosis and leiomyoma in hysterectomy specimens as the cause of abnormal uterine bleeding in women in different age groups in the Kumaon region: A retroprospective study

    Rizvi, Ghazala; Pandey, Harishankar; Pant, Hema; Chufal, Sanjay Singh; Pant, Prabhat


    Objective: To study adenomyosis and leiomyoma as the cause of Abnormal Uterine Bleeding AUB in hysterectomy specimens. Study Method: A descriptive study was carried out on 184 hysterectomy specimens of patients with AUB during the period of Jan 2010 to Dec 2011. Data including age, parity, symptoms and clinical indication for hysterectomy was collected for the study. The specimens were processed routinely and stained with hematoxylin and eosin stain and examined microscopically. Results: Wome...

  13. High efficiency optical beamsplitter designed for operation in the infrared region

    Bastien, R. C.; Heinrich, P. L.


    Beamsplitter system uses potassium bromide as substrate for operating in the spectral region between 5 and 30 microns and calcium fluoride for narrowband applications. It uses a 13-layer film which yields nearly equal broadband infrared reflectance and transmittance.

  14. /sup 99m/Tc-labeled RBC scan. Diagnostic method for lower gastrointestinal bleeding

    The experience with 62 /sub 99m/Tc-labeled in vivo scans performed for lower gastrointestinal bleeding is discussed. Thirty-seven scans were deemed positive. The tendency of scans to become positive correlated with observations of active bleeding. Five patients had fulminant hemorrhage, necessitating emergency operation. In this group, scanning accurately located the bleeding sources prior to intervention. Seven other patients having later operations bled less rapidly. The bleeding site was localized accurately by scanning in three of these patients. Two studies were falsely positive and two were negative, whereas angiography was positive in two patients studied. Labeled RBC scanning is a useful technique in the early evaluation of patients with lower gastrointestinal bleeding, obviating the need of arteriography in some cases

  15. Regional co-operation in radioactive waste management from an IAEA perspective

    This paper is intended to be a lead in to a Round Table discussion on Regional Co-operation in Radioactive Waste Management at the International Conference on Nuclear Option in Countries with Small and Medium Electricity Grids, which will be held from 19 to 22 June 2000 in Dubrovnik, Croatia. The Round Table discussion will focus on international co-operation in the Eastern European region

  16. Bleeding

    ... Latex gloves should be in every first aid kit. People allergic to latex can use a nonlatex glove. You can catch viral hepatitis if you touch infected blood. HIV can be spread if infected blood gets into ...

  17. Guangxi Shanglin Aluminum Plant cross-regional technical upgrade project(phase 1)put into operation


    <正>The project(Phase 1)of cross-regional techni- cal upgrade of the aluminum plant of Guangxi Shanglin Nannan Industrial Co.was completed and put into operation on June 8,2007.The plant is a cross-regional technical upgrade pro- ject of Nanning Aluminum Plant,featuring the integration of coal,electricity and aluminum.

  18. Banking Operational Cost in the Balkan Region under a Quadratic Loss Function

    Mamatzakis, Emmanuel


    This paper presents of theoretical specification of a quadratic loss function based on forward looking rational expectations to model the underlying dynamics of operational performance of the banking industry. As an empirical application we examine the determinants of total operating costs within a dynamic panel analysis in the Balkan region that is the South East Europe (SEE) over the period 1998-2005. Results show that operating performance is positively related to loan quality and the asse...

  19. Detection of acute gastrointestinal bleeding by means of technetium-99m in vivo labelled red blood cells

    Prognosis of gastrointestinal (GI) bleeding depends on the timely and accurate detection of the source of bleeding and sequential surgical or endoscopy therapy. Scintigraphy with red blood cells (RBCs) in vivo labelled by means of technetium-99m hastened detection of source of GI bleeding and improved management of the particular disease. Gastrointestinal endoscopy is the method of choice for the diagnostics of bleeding from upper tract and large bowel. For diagnostics of bleeding from the small bowel we can use scintigraphy with in vivo labelled autological red blood cells if pushenteroscopy, intra-operative enteroscopy or angiography are not available. 31 patients (13 men, 18 women, aged 20-91, mean 56 years) underwent this investigation from 1998 till 2001 at the Department of Nuclear Medicine. All patients had melaena or enterorrhagia associated with acute anaemia. Gastroscopy, colonoscopy, enteroclysis or X-ray angiography did not detect the source of bleeding. Twenty-one patients had positive scintigraphy with in vivo labelled RBCs - 9 patients were already positive on dynamic scintigraphy, and 12 patients were positive on static images. Scintigraphy with in vivo labelled RBCs was negative in 10 patients. GI bleeding stopped spontaneously in these 10 patients with negative scintigraphy. These patients did not undergo intra-operative enteroscopy or surgery. The final diagnosis of the 21 patients with positive scintigraphy was determined in 16 patients by push-enteroscopy (6 patients), intra-operative enteroscopy (6 patients) or by surgery (4 patients). Of these 16 patients the correct place of bleeding was determined by scintigraphy with labelled RBCs in 11 (69%) patients. Final diagnoses of our 16 patients with positive scintigraphy with autological labelled RBCs were: bleeding small bowel arteriovenous malformation (6 patients), uraemic enteritis with bleeding erosions in ileum and jejunum (2 patients), Osler-Rendu- Weber disease (1 patient), pseudocyst of

  20. Management of bleeding gastroduodenal ulcers

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B.


    serious ulcer bleeding is suspected and blood found in gastric aspirate, endoscopy within 12 hours will result in faster discharge and reduced need for transfusions. Endoscopic hemostasis remains indicated for high-risk lesions. Clips, thermocoagulation, and epinephrine injection are effective in...... achieving endoscopic hemostasis. Use of endoscopic monotherapy with epinephrine injection is not recommended. Intravenous high-dose proton pump inhibitor (PPI) therapy for 72 hours after successful endoscopic hemostasis is recommended as it decreases both rebleeding rate and mortality in patients with high...

  1. Bleeding complications of femoral catheterization

    CT has been used to evaluate hematomas resulting from femoral catheterization (percutaneous transluminal coronary angioplasty, cardiac catheterization, angioplasty, valvuloplasty, and venous access) in 21 patients. Four distinct types of hematoma have been identified: retroperitoneal (N = 12); intraperitoneal (N = 3); groin/thigh (N = 9); and abdominal wall (N = 5). Seven patients had hematomas in two locations. CT contributed by estimating transfusion requirement, indicating the need for more intensive monitoring, and predicting the potential need for surgery. Type 1 and 2 bleeds were the most serious and had the most sequelae. Sequelae included transfusion in 17 patients (mean, 5 units/patient) and surgery in two patients

  2. Sandostatin therapy of acute oesophageal variceal bleeding.

    McKee, R F


    This communication deals with the emergency control of variceal bleeding rather than the prevention of rebleeding. The current main options of oesophageal tamponade, emergency sclerotherapy and drug therapy are discussed, with particular reference to the use of somatostatin. Sandostatin (Sandoz, Basel), a synthetic long-acting somatostatin analogue, was found to reduce transhepatic venous gradient by 30% with no effect on systemic haemodynamics in a study of 16 stable cirrhotic patients. In a trial comparing intravenous infusion of Sandostatin (SMS) to oesophageal tamponade (OT) in active variceal bleeding, 18 of 20 bleeds in the SMS group and 19 of 20 bleeds in the OT group were controlled at 4 h. Ten in the SMS group and 14 in the OT group had no further bleeding during the 48-hour study period. Thus SMS may be useful in the temporary control of active variceal bleeding. PMID:8359565

  3. Cyclical rectal bleeding in colorectal endometriosis.

    Levitt, M D; Hodby, K J; van Merwyk, A J; Glancy, R J


    Three case reports of cyclical rectal bleeding in endometriosis affecting rectum and sigmoid colon emphasize the close relationship between such cyclical bleeding and intestinal endometriosis. The cause of bleeding, however, is still unclear. The predilection of endometriotic deposits for the outer layers of the bowel wall suggests that mucosal involvement is not a prerequisite for rectal bleeding. The frequent absence of identifiable intramural haemorrhage casts doubt on the premise that intestinal endometriotic deposits 'menstruate'. The cause may simply be a transient tear in normal mucosa due to swelling of an underlying endometriotic deposit at the time of menstruation. PMID:2597100

  4. Bleed condenser tube failure in KAPP-1

    Bleed condenser, a vertical, tube and shell type heat exchanger employed in bleed circuit of primary heat transport system of PHWR is used for condensing the flashing bleed (heavy water) on shell side and cold heavy water on the tubes side. Examinations conducted at various places indicate failure due to inadequate tube expansion (hydraulic expansion) followed by crevice corrosion. Mechanical rolling of tubes to larger extent (3 to 6% wall thinning) have been specified for this particular type of service in all bleed condensers for subsequent projects. 1 tab., 4 figs

  5. LPV Control for the Full Region Operation of a Wind Turbine Integrated with Synchronous Generator


    Wind turbine conversion systems require feedback control to achieve reliable wind turbine operation and stable current supply. A robust linear parameter varying (LPV) controller is proposed to reduce the structural loads and improve the power extraction of a horizontal axis wind turbine operating in both the partial load and the full load regions. The LPV model is derived from the wind turbine state space models extracted by FAST (fatigue, aerodynamics, structural, and turbulence) code linear...

  6. Diagnostic Strategies for Postmenopausal Bleeding

    M. C. Breijer


    Full Text Available Postmenopausal bleeding (PMB is a common clinical problem. Patients with PMB have 10%–15% chance of having endometrial carcinoma and therefore the diagnostic workup is aimed at excluding malignancy. Patient characteristics can alter the probability of having endometrial carcinoma in patients with PMB; in certain groups of patients the incidence has been reported to be as high as 29%. Transvaginal sonography (TVS is used as a first step in the diagnostic workup, but different authors have come to different conclusions assessing the accuracy of TVS for excluding endometrial carcinoma. Diagnostic procedures obtaining material for histological assessment (e.g., dilatation and curettage, hysteroscopy, and endometrial biopsy can be more accurate but are also more invasive. The best diagnostic strategy for diagnosing endometrial carcinoma in patients with PMB still remains controversial. Future research should be focussed on achieving a higher accuracy of different diagnostic strategies.


    Munteanu Nicolae-Eugen


    Full Text Available It is very important to be found methods to increase the competitiveness between the Romanian administrative-territorial units, under the current conditions of the economic crisis, by means of the existing economic levers successfully used within the European Union regions. The development regions of Romania do not have the statute of administrative units, but they represent territorial units large enough to constitute a good basis for the elaboration and implementation of regional development strategies, allowing an efficient use of the financial and human resources. The scope for which these development regions were created had in view the support granted for the larger communities in their action to settle the problems which go beyond the administrative borders and which surpass the financial possibilities of one county. In Romania, the communes, towns, municipalities and counties are defined as administrative-territorial units within which the local autonomy is exercised and the authorities of the local public administration are organized and operate. The local, communal, town, municipality and county councils, as deliberative authorities, and also the mayors and the presidents of county councils as executive authorities have the duties to solve the public matters of the community, acting as authorities of the Romanian public administration. In Romania, the local autonomy is only administrative and financial, having as objective the organization, operation, competencies and tasks, and also the management of the inland resources. The principle of the local financial autonomy implies the fact that the administrative-territorial units have the right to financial resources, which can be used by the authorities of the local public administration when exercising their tasks. According to the Law of the local public finances, the local budget incomes could be made also of the non-reimbursable funds granted by the European Union. Based on the

  8. First trimester bleeding and maternal cardiovascular morbidity

    Lykke, Jacob A; Langhoff-Roos, Jens


    First trimester bleeding without miscarriage is a risk factor for complications later in the pregnancy, such as preterm delivery. Also, first trimester miscarriage has been linked to subsequent maternal ischemic heart disease. We investigated the link between maternal cardiovascular disease prior...... to and subsequent to first trimester bleeding without miscarriage....

  9. Obstetric management of adolescents with bleeding disorders.

    James, Andra H


    Adolescents with bleeding disorders who become pregnant must contend with the dual challenges of their bleeding disorder and their pregnancy. Adolescents are more likely to terminate a pregnancy than adult women, and when they do carry a pregnancy, they are more likely to deliver prematurely. Otherwise, they are at risk for the same complications that adult women with bleeding disorders experience, particularly bleeding complications postpartum. Since one half to two thirds of adolescent pregnancies are unplanned, issues related to reproduction should be addressed during routine visits with the pediatrician, hematologist or gynecologist. Girls who are at risk of being carriers for hemophilia A and B, severe von Willebrand disease, and other severe bleeding disorders should have their bleeding disorder status determined before they become pregnant. During pregnancy, a plan should be established to ensure that both mother and fetus deliver safely. Young women at risk for severe bleeding or at risk of having a severely affected infant should be referred for prenatal care and delivery to a center where, in addition to specialists in high-risk obstetrics, there is a hemophilia treatment center or a hematologist with expertise in hemostasis. Prior to delivery or any invasive procedures, young women at risk for severe bleeding should receive prophylaxis. Since administration of desmopressin may result in hyponatremia, whenever available, virally inactivated or recombinant clotting factor concentrates should be used for replacement as opposed to fresh frozen plasma or cryoprecipitate. PMID:20934895

  10. Hemospray Application in Nonvariceal Upper Gastrointestinal Bleeding

    Smith, Lyn A; Stanley, Adrian J; Bergman, Jacques J; Kiesslich, Ralf; Hoffman, Arthur; Tjwa, Eric T; Kuipers, Ernst J; von Holstein, Christer Stael; Oberg, Stefan; Brullet, Enric; Schmidt, Palle N; Iqbal, Tariq; Mangiavillano, Benedetto; Masci, Enzo; Prat, Frederic; Morris, Allan J


    Hemospray TM (TC-325) is a novel hemostatic agent licensed for use in nonvariceal upper gastrointestinal bleeding (NVUGIB) in Europe.......Hemospray TM (TC-325) is a novel hemostatic agent licensed for use in nonvariceal upper gastrointestinal bleeding (NVUGIB) in Europe....

  11. Peri-operative nursing of infants with cavernous transformation of the portal vein and gastrointestinal bleeding undergoing distal splenorenal shunt%小儿门静脉海绵样变并消化道出血行远端脾肾分流术的围手术期护理

    刘新文; 何小琼; 甘红霞


    Objective To summarize the nursing of infants with cavernous transformation of the portal vein (CTPV) and gastrointestinal bleeding undergoing distal splenorenal shunt.Methods 3 cases of infants with CTPV and gastrointestinal bleeding were given with preoperative nursing for upper gastrointestinal bleeding,strengthening nutritional support; strengthening prevention measures of thrombosis and bleeding complications,monitoring of urine and urine gravity,completing the artery piezometer tube care,paying attention to the discharge guidance and follow-up work.Results The platelet increased in 3 cases post-operation.1 cases occurred abdominal bleeding,but improved after symptomatic treatment.1 case occurred leakage on the site of venous indwelling needle during intravenous infusion of high nutrient solution.3 cases of children received 3 months to 3 years follow-up after discharge,no complications such as liver,kidney and blood clots occurred.Conclusions Infants with CTPV and gastrointestinal bleeding undergoing distal splenorenal shunt is very rare in clinic.Good perioperative care and strengthening the observation of the postoperative complications,attaching great importance to the discharge guidance and follow-up work,are the assurances of successful treatment.%目的 总结门静脉海绵样变并消化道出血患儿行远端脾肾分流术的护理要点.方法 对3例门静脉海绵样变并消化道出血患儿术前做好上消化道出血的护理,加强营养支持;术后加强血栓和出血等并发症的防范工作,监测尿量和尿密度,做好动脉测压管的护理,重视出院指导和随访工作.结果 本组3例患儿术后均出现不同程度的血小板增高,1例患儿出现腹腔少量出血,经对症处理后好转,1例患儿输注静脉高营养液发生静脉留置针处渗漏;3例患儿出院后跟踪随访3个月~3年,无肝、肾功能异常及血栓等并发症发生.结论 小儿门静脉海绵样变脾肾分流术临床非常少

  12. Dynamic of gastroduodenal bleeding distribution after Chernobyl catastrophe

    It was investigated the evidence of gastroduodenal bleeding between Belarus population from 1989 to 1996 period. 27981 occurrences of this disease were registered. The annual permanent growth of the disease was revealed. Between persons, having worked in the Chernobyl region in the first year after the catastrophe, it was found the ulcer disease distribution in 7 times greater than between the whole population. It was concluded about heavy course of ulcer disease in residents of Belarus in the modern conditions

  13. The Texts of the Agency's Co-operation Agreements with Regional Intergovernmental Organizations

    The texts of the Agency's agreements for co-operation with the regional inter-governmental organizations listed below, together with the respective protocols authenticating them, are reproduced in this document in the order in which the agreements entered into force, for the information of all Members of the Agency

  14. Embolization of a Hemorrhoid Following 18 Hours of Life-Threatening Bleeding

    Hemorrhoids usually do not pose diagnostic difficulties and they rarely cause massive bleeding. We report a case of massive rectal bleeding over 18 h needing 22 U blood transfusion treated by superselective transcatheter coil embolization 12 h following operative treatment performed in a different hospital. Diagnostic angiography with a view to superselective embolization, following failure of sigmoidoscopy to localize and treat the cause of hemorrhage, might act as a life-saving treatment in massive rectal bleeding, obviating the need for repeated endoscopy or emergency surgery

  15. Primary evaluation of 99mTc-RBC imaging for the diagnosis of lower gastrointestinal bleeding

    99mTc-RBC gastrointestinal (GI) scintigraphy was performed in 10 patients with lower GI bleeding which was confirmed by operation later. The results suggested that 99mTc-RBC imaging was an effective method for the diagnosis of intestinal hemorrhage, especially the small intestine. However, there was some difficulty in accurately localizing the bleeding site due to the movement of the blood containing labelled RBC from original bleeding site to lower portion during intestinal peristalsis and also displacement of the moving colon. Therefore it is necessary to completely explore the intestine carefully and awareness of the possibility of biliary hemorrhage

  16. MBE growth of active regions for electrically pumped, cw-operating GaSb-based VCSELs

    Kashani-Shirazi, K.; Bachmann, A.; Boehm, G.; Ziegler, S.; Amann, M.-C.


    Electrically pumped, cw-operating, single-mode GaSb-based VCSELs are attractive light sources for trace-gas sensing systems using tunable diode laser absorption spectroscopy (TDLAS) [A. Vicet, D.A. Yarekha, A. Pérona, Y. Rouillard, S. Gaillard, Spectrochimica Acta Part A 58 (2002) 2405-2412]. Only recently, the first electrically pumped (EP) devices emitting at 2.325 μm in cw-mode at room temperature have been reported [A. Bachmann, T. Lim, K. Kashani-Shirazi, O. Dier, C. Lauer, M.-C. Amann, Electronics Letters 44(3) (2008) 202-203]. The fabrication of these devices employs the molecular beam epitaxy (MBE) growth of GaSb/AlAsSb-distributed Bragg mirrors, a multi-quantum-well active region made of AlGaAsSb/InGaAsSb and an InAsSb/GaSb-buried-tunnel junction. As VCSELs are usually driven under high injection rates, an optimum electrical design of active regions is essential for high-performance devices. In this paper we present an enhanced simulation of current flow in the active region under operation conditions. The calculation includes carrier transport by drift, diffusion and tunneling. We discuss different design criteria and material compositions for active regions. Active regions with various barrier materials were incorporated into edge emitter samples to evaluate their performance. Aluminum-containing barriers show better internal efficiency compared to active regions with GaSb as the barrier material.

  17. To observe the clinical effect of vaginal bleeding of medroxyprogesterone acetate combined with gynecologic Qianjin tablets in the treatment of medicine after operation%安宫黄体酮联合妇科千金片治疗药流术后阴道出血的临床效果观察



    Objective To further study the actual effect of the treatment of clinical vaginal bleeding clinical medicine after operation is adopted in the process of medroxyprogesterone acetate combined with gynecologic Qianjin tablets treatment,so as to provide reference for clinical practice.Methods The period in our hospital from 2010 December to 2013 January,196 patients with uterine hemorrhage after vaginal bleeding patients as the research object,the clinical data of the patients were analyzed retrospectively.Results The two groups of patients with different treatment methods after the total efficiency comparison between groups,the observation group than in the control group(96.94%VS79.59%)and compared with P<0.05 group,the difference was statistically significant;com-pare the hemostatic effect between group,vaginal bleeding time is less than 4D the proportion of patients,the observation group was significantly higher than the control group(83.67%VS50.00%),P<0.05 and group,the difference was statistically significant.Conclusion In the clinical practice of vaginal bleeding af-ter operation in clinical medicine,clinical therapeutic effect of the treatment of medroxyprogesterone acetate combined with gynecologic Qianjin tablets is remarka-ble,is safe and reliable choice of vaginal bleeding after drug treatment.%目的:为了进一步研究临床治疗药流术后阴道出血过程中采用安宫黄体酮联合妇科千金片治疗的临床实际治疗效果,从而为临床实践提供借鉴和参考。方法本文以我院2010年12月~2013年1月期间入院治疗的196例药流术后阴道出血患者为研究对象,对患者的临床资料进行了回顾性分析。结果两组患者采用不同治疗方法后总有效率组间比较,观察组优于对照组(96.94%VS79.59%)且组间比较P<0.05,差异具有统计学意义;止血效果组间比较,阴道出血时间小于4d患者的比例,观察组明显高于对照组(83.67%VS50

  18. Endoscopic management of bleeding peptic ulcers

    Peptic ulcers account for more than half of the cases of non variceal upper gastrointestinal (GI) bleeding and therefore, are the focus of most of the methods of endoscopic hemostasis. Surgical intervention is now largely reserved for patients in whom endoscopic hemostasis has failed. A variety of endoscopic techniques have been employed to stop bleeding and reduce the risk of rebleeding, with no major differences in outcome between these methods. These include injection therapy, fibrin injection, heater probe, mono polar electrocautery, bipolar electrocautery, lasers and mechanical hemo clipping. The most important factor in determining outcome after gastrointestinal bleeding is rebleeding or persistent bleeding. The endoscopic appearance of an ulcer, however, provides the most useful prognostic information for bleeding. Recurrent bleeding after initial endoscopic hemostasis occurs in 15-20% of patients with a bleeding peptic ulcer. The best approach to these patients remains controversial; the current options are repeat endoscopic therapy with the same or a different technique, emergency surgery or semi elective surgery after repeat endoscopic hemostasis. The combination of epinephrine injection with thermal coagulation may be more effective than epinephrine injection alone. Newer modalities such as fibrin injection or the application of hemo clips appear promising and comparative studies are awaited. (author)

  19. Optimal Operation System of the Integrated District Heating System with Multiple Regional Branches

    Kim, Ui Sik; Park, Tae Chang; Kim, Lae-Hyun; Yeo, Yeong Koo

    This paper presents an optimal production and distribution management for structural and operational optimization of the integrated district heating system (DHS) with multiple regional branches. A DHS consists of energy suppliers and consumers, district heating pipelines network and heat storage facilities in the covered region. In the optimal management system, production of heat and electric power, regional heat demand, electric power bidding and sales, transport and storage of heat at each regional DHS are taken into account. The optimal management system is formulated as a mixed integer linear programming (MILP) where the objectives is to minimize the overall cost of the integrated DHS while satisfying the operation constraints of heat units and networks as well as fulfilling heating demands from consumers. Piecewise linear formulation of the production cost function and stairwise formulation of the start-up cost function are used to compute nonlinear cost function approximately. Evaluation of the total overall cost is based on weekly operations at each district heat branches. Numerical simulations show the increase of energy efficiency due to the introduction of the present optimal management system.

  20. Statistical analysis of regional capital and operating costs for electric power generation

    Sanchez, L.R.; Myers, M.G.; Herrman, J.A.; Provanizano, A.J.


    This report presents the results of a three and one-half-month study conducted for Brookhaven National Lab. to develop capital and operating cost relationships for seven electric power generating technologies: oil-, coal-, gas-, and nuclear-fired steam-electric plants, hydroelectric plants, and gas-turbine plants. The methodology is based primarily on statistical analysis of Federal Power Commission data for plant construction and annual operating costs. The development of cost-output relationships for electric power generation is emphasized, considering the effects of scale, technology, and location on each of the generating processes investigated. The regional effects on cost are measured at the Census Region level to be consistent with the Brookhaven Multi-Regional Energy and Interindustry Regional Model of the United States. Preliminary cost relationships for system-wide costs - transmission, distribution, and general expenses - were also derived. These preliminary results cover the demand for transmission and distribution capacity and operating and maintenance costs in terms of system-service characteristics. 15 references, 6 figures, 23 tables.

  1. Compressor bleed cooling fluid feed system

    Donahoo, Eric E; Ross, Christopher W


    A compressor bleed cooling fluid feed system for a turbine engine for directing cooling fluids from a compressor to a turbine airfoil cooling system to supply cooling fluids to one or more airfoils of a rotor assembly is disclosed. The compressor bleed cooling fluid feed system may enable cooling fluids to be exhausted from a compressor exhaust plenum through a downstream compressor bleed collection chamber and into the turbine airfoil cooling system. As such, the suction created in the compressor exhaust plenum mitigates boundary layer growth along the inner surface while providing flow of cooling fluids to the turbine airfoils.

  2. Preventive effect of carboprost tromethamine on intra-operative and postoperative bleeding%卡前列素氨丁三醇预防剖宫产术中及术后出血的疗效观察

    朱群飞; 陈健


    Objectives:To explore the preventive effect of carboprost tromethamine on intraoperative and postoperative bleeding.Methods:120 hospitalized patients who had indication of caesarean section were divided into the observing group and the control group randomly.All the puerperae got caesarean section by intrafacial transverse incision under continuous epidural anesthesia.Puerperae in the control group were injected in ureters with oxytocin 20U after birth immediately,and got another 20U by intramuscular injection 2h after surgery.The drug used for puerperae of the observing group was carboprost tromethamine corresponding to that used in the control group.We observed the blood loss of intraoperation,2h and 24h postoperation,and observed the adverse reaction during treatment.Results:The blood loss of intraoperation,2h and 24h postoperation of the observing group were significantly less than those of the control group (P < 0.05).Nine cases of adverse reaction were found during treatment in the observing group with slight symptoms,and these symptoms disappeared without treatment,and none was found in the control group.Conclusion:Carboprost tromethamine can reduce and prevent intraoperative and postoperative bleeding effectively and safely,with slight symptom of adverse reaction.It is especially suitable for popularization and application in primary care hospitals.%目的:对卡前列素氨丁三醇预防剖宫产术中及术后出血的疗效观察.方法:选择住院并有指征行剖宫产手术的产妇120例,随机分为观察组和对照组.两组产妇均采用连续硬膜外麻醉下行常规的筋膜内子宫下段横切口剖宫产术.对照组产妇在术中胎儿娩出后宫体注射缩宫素20U,术后2h肌肉注射缩宫素20U.观察组产妇在术中胎儿娩出后宫体注射卡前列素氨丁三醇250ug,术后2h肌肉注射卡前列素氨丁三醇250ug.观察两组产妇术中、产后2h、产后24h出血量,并观察治疗期间的不良反应.结果:

  3. Extending the Operational Envelope of a Turbofan Engine Simulation into the Sub-Idle Region

    Chapman, Jeffryes Walter; Hamley, Andrew J.; Guo, Ten-Huei; Litt, Jonathan S.


    In many non-linear gas turbine simulations, operation in the sub-idle region can lead to model instability. This paper lays out a method for extending the operational envelope of a map based gas turbine simulation to include the sub-idle region. This method develops a multi-simulation solution where the baseline component maps are extrapolated below the idle level and an alternate model is developed to serve as a safety net when the baseline model becomes unstable or unreliable. Sub-idle model development takes place in two distinct operational areas, windmilling/shutdown and purge/cranking/startup. These models are based on derived steady state operating points with transient values extrapolated between initial (known) and final (assumed) states. Model transitioning logic is developed to predict baseline model sub-idle instability, and transition smoothly and stably to the backup sub-idle model. Results from the simulation show a realistic approximation of sub-idle behavior as compared to generic sub-idle engine performance that allows the engine to operate continuously and stably from shutdown to full power.

  4. High duty cycle operation of quantum cascade lasers based on graded superlattice active regions

    High duty cycle operation of quantum cascade superlattice lasers with graded superlattice active regions is investigated with the goal of achieving high average optical power. The optical output power increases with pulse width and decreases with heat sink temperature. This behavior is explained on the basis of the laser core temperature oscillations during the pulsed, high duty cycle operation. Between 175 and 325 K heat sink temperature, optimum duty cycles vary from 10% to 1% and average power levels vary from 50 to 1 mW for various lasers used in this study. [copyright] 2001 American Institute of Physics

  5. The impact of reverse trendelenburg versus head-up position on intraoperative bleeding of elective rhinoplasty

    Navid Nooraei


    Full Text Available Background: In spite of several efforts for decreasing blood loss, our experience sometimes shows that some patients bleed more profusely during rhinoplasty. Patient position could have deep impact on bleeding amount during surgical procedures. Objective: In this study, we aimed to compare reverse trendelenburg position and head-up position on intra-operative bleeding of elective rhinoplasty. This was to check the effects of reverse trendelenburg position and head up position on the intraoperative bleeding of elective rhinoplasty. Methods: In this study, 30 ASA I (American Society of Anesthesiology physical condition classification patients between 18 and 40 years of age who were candidate to rhinoplasty operations for first time were included. Patients were randomly assigned to reverse trendelenburg or head-up position. Exclusion criteria was any history or lab indicating coagulation problems or using any drug. All gauzes used and the blood that accumulated in the aspirator throughout the operation were calculated. Results: Our results showed that the mean amount of blood loss in reverse trendelenburg was lower (77.00 ΁ 13.20 ml than head-up position (83.33 ΁ 21.18 ml, although, there was no statistical difference between two groups. However, there was no significant differences among two groups in different aspects of hemodynamic determinants and bleeding amount during and after rhinoplasty. Conclusions: Our results showed that patient bleeding is not increased because of positioning per se. In conclusion, perhaps in the future reverse trendelenburg will be given more often during rhinoplasry.

  6. EMMA model: an advanced operational mesoscale air quality model for urban and regional environments

    Mesoscale air quality models are an important tool to forecast and analyse the air quality in regional and urban areas. In recent years an increased interest has been shown by decision makers in these types of software tools. The complexity of such a model has grown exponentially with the increase of computer power. Nowadays, medium workstations can run operational versions of these modelling systems successfully. Presents a complex mesoscale air quality model which has been installed in the Environmental Office of the Madrid community (Spain) in order to forecast accurately the ozone, nitrogen dioxide and sulphur dioxide air concentrations in a 3D domain centred on Madrid city. Describes the challenging scientific matters to be solved in order to develop an operational version of the atmospheric mesoscale numerical pollution model for urban and regional areas (ANA). Some encouraging results have been achieved in the attempts to improve the accuracy of the predictions made by the version already installed. (Author)


    M. Yu Soloviev


    Full Text Available The article presents issues of radon accumulation in the air of dwellings and public buildings in the Rostov region. It is shown that radon concentration in the air of commissioned buildings does not depend on the season when the investigation was carried out, while equivalent equilibrium volumetric activity of radon in the operating buildings is approximately twice higher during the cold period, then during the hot period of a year.

  8. Asian regional co-operative project on food irradiation: Technology transfer

    These Proceedings include the final reports of work performed by different institutions under the scope of Phase II of the Asian Regional Co-operative Project on Food Irradiation. The topics covered include the disinfestation and decontamination of stored products; improvements in the hygiene of processed seafood; insect disinfestation of fruits; and sprout inhibition of root crops. The individual presentations are indexed separately. Refs, figs and tabs

  9. CLSM bleed water reduction test results

    Previous testing by BSRI/SRTC/Raytheon indicated that the CLSM specified for the Tank 20 closure generates about 6 gallons (23 liters) of bleed water per cubic yard of material (0.76 m3).1 This amount to about 10 percent of the total mixing water. HLWE requested that the CLSM mix be optimized to reduce bleed water while maintaining flow. Elimination of bleed water from the CLSM mix specified for High-Level Waste Tank Closure will result in waste minimization, time savings and cost savings. Over thirty mixes were formulated and evaluated at the on-site Raytheon Test Laboratory. Improved low bleed water CLSM mixes were identified. Results are documented in this report

  10. Management of radiation-induced rectal bleeding.

    Laterza, Liboria; Cecinato, Paolo; Guido, Alessandra; Mussetto, Alessandro; Fuccio, Lorenzo


    Pelvic radiation disease is one of the major complication after radiotherapy for pelvic cancers. The most commonly reported symptom is rectal bleeding which affects patients' quality of life. Therapeutic strategies for rectal bleeding are generally ignored and include medical, endoscopic, and hyperbaric oxygen treatments. Most cases of radiation-induced bleeding are mild and self-limiting, and treatment is normally not indicated. In cases of clinically significant bleeding (i.e. anaemia), medical therapies, including stool softeners, sucralfate enemas, and metronidazole, should be considered as first-line treatment options. In cases of failure, endoscopic therapy, mainly represented by argon plasma coagulation and hyperbaric oxygen treatments, are valid and complementary second-line treatment strategies. Although current treatment options are not always supported by high-quality studies, patients should be reassured that treatment options exist and success is achieved in most cases if the patient is referred to a dedicated centre. PMID:24101202

  11. Dysfunctional Uterine Bleeding (DUB) (For Teens)

    ... the body's hormones. Problems like compulsive exercise , not eating healthy foods, or too much stress can cause hormone changes. Some severe cases of AUB are caused by bleeding disorders such as von Willebrand disease . What Are the ...

  12. CO{sub 2}MPARE. CO2 Model for Operational Programme Assessment in EU Regions. Technical background and guidance for deployment in EU regions

    Hekkenberg, M. [ECN Policy Studies, Amsterdam (Netherlands); Le Pierres, S. [Energies Demain, Montreuil Sous Bois (France); Del Ciello, R. [Italian National Agency for New Technologies, Energy and Sustainable Economic Development ENEA, Rome (Italy); Keppo, I. [University College London UCL, London (United Kingdom); Papagianni, S. [Centre for Renewable Energy Sources and Saving CRES, Pikermi Attiki (Greece); Harnych, J. [ENVIROS, Prague (Czech Republic)


    The CO2MPARE model enables national and regional authorities to assess the carbon impacts of Operational Programmes co-financed through the European Regional Development Fund (ERDF). This document provides technical background information and guidance for deploying the model in additional EU regions.

  13. Modified Adaptive Control for Region 3 Operation in the Presence of Wind Turbine Structural Modes

    Frost, Susan Alane; Balas, Mark J.; Wright, Alan D.


    Many challenges exist for the operation of wind turbines in an efficient manner that is reliable and avoids component fatigue and failure. Turbines operate in highly turbulent environments resulting in aerodynamic loads that can easily excite turbine structural modes, possibly causing component fatigue and failure. Wind turbine manufacturers are highly motivated to reduce component fatigue and failure that can lead to loss of revenue due to turbine down time and maintenance costs. The trend in wind turbine design is toward larger, more flexible turbines that are ideally suited to adaptive control methods due to the complexity and expense required to create accurate models of their dynamic characteristics. In this paper, we design an adaptive collective pitch controller for a high-fidelity simulation of a utility-scale, variable-speed horizontal axis wind turbine operating in Region 3. The objective of the adaptive pitch controller is to regulate generator speed, accommodate wind gusts, and reduce the excitation of structural modes in the wind turbine. The control objective is accomplished by collectively pitching the turbine blades. The adaptive collective pitch controller for Region 3 was compared in simulations with a baseline classical Proportional Integrator (PI) collective pitch controller. The adaptive controller will demonstrate the ability to regulate generator speed in Region 3, while accommodating gusts, and reducing the excitation of certain structural modes in the wind turbine.

  14. Adaptive Control of a Utility-Scale Wind Turbine Operating in Region 3

    Frost, Susan A.; Balas, Mark J.; Wright, Alan D.


    Adaptive control techniques are well suited to nonlinear applications, such as wind turbines, which are difficult to accurately model and which have effects from poorly known operating environments. The turbulent and unpredictable conditions in which wind turbines operate create many challenges for their operation. In this paper, we design an adaptive collective pitch controller for a high-fidelity simulation of a utility scale, variable-speed horizontal axis wind turbine. The objective of the adaptive pitch controller in Region 3 is to regulate generator speed and reject step disturbances. The control objective is accomplished by collectively pitching the turbine blades. We use an extension of the Direct Model Reference Adaptive Control (DMRAC) approach to track a reference point and to reject persistent disturbances. The turbine simulation models the Controls Advanced Research Turbine (CART) of the National Renewable Energy Laboratory in Golden, Colorado. The CART is a utility-scale wind turbine which has a well-developed and extensively verified simulator. The adaptive collective pitch controller for Region 3 was compared in simulations with a bas celliansesical Proportional Integrator (PI) collective pitch controller. In the simulations, the adaptive pitch controller showed improved speed regulation in Region 3 when compared with the baseline PI pitch controller and it demonstrated robustness to modeling errors.

  15. Genetic analysis of bleeding disorders.

    Edison, E; Konkle, B A; Goodeve, A C


    Molecular genetic analysis of inherited bleeding disorders has been practised for over 30 years. Technological changes have enabled advances, from analyses using extragenic linked markers to next-generation DNA sequencing and microarray analysis. Two approaches for genetic analysis are described, each suiting their environment. The Christian Medical Centre in Vellore, India, uses conformation-sensitive gel electrophoresis mutation screening of multiplexed PCR products to identify candidate mutations, followed by Sanger sequencing confirmation of variants identified. Specific analyses for F8 intron 1 and 22 inversions are also undertaken. The MyLifeOurFuture US project between the American Thrombosis and Hemostasis Network, the National Hemophilia Foundation, Bloodworks Northwest and Biogen uses molecular inversion probes (MIP) to capture target exons, splice sites plus 5' and 3' sequences and to detect F8 intron 1 and 22 inversions. This allows screening for all F8 and F9 variants in one sequencing run of multiple samples (196 or 392). Sequence variants identified are subsequently confirmed by a diagnostic laboratory. After having identified variants in genes of interest through these processes, a systematic procedure determining their likely pathogenicity should be applied. Several scientific societies have prepared guidelines. Systematic analysis of the available evidence facilitates reproducible scoring of likely pathogenicity. Documentation of frequency in population databases of variant prevalence and in locus-specific mutation databases can provide initial information on likely pathogenicity. Whereas null mutations are often pathogenic, missense and splice site variants often require in silico analyses to predict likely pathogenicity and using an accepted suite of tools can help standardize their documentation. PMID:27405681

  16. Cough-induced Tracheobronchial Mucosal Bleeding.

    Hira, Harmanjit Singh


    A 56-year-old man presented with moderate hemoptysis. It was preceded by a severe bout of cough. Flexible bronchoscopy showed diffuse tracheobronchial mucosal petechiae and bleeding. The patient was not suffering with any coagulopathies. He did not receive antiplatelet drugs. Hemoptysis resolved with cough suppressant. Subsequent bronchoscopy revealed the complete resolution of petechiae. The mechanism of bleeding after the bout of coughing is discussed. PMID:23169019

  17. Abnormal uterine bleeding: a clinicohistopathological analysis

    Anupamasuresh Y; Suresh YV; Prachi Jain*,


    Background: Abnormal uterine bleeding (AUB) is one of the most common problem for the patients and the gynecologists. It adversely effects on the quality of life and psychology of women. It is of special concern in developing country as it adds to the causes of anemia. Management of Abnormal Uterine Bleeding (AUB) is not complete without tissue diagnosis especially in perimenopausal and post-menopausal women. Histological characteristics of endometrial biopsy material as assessed by light mic...

  18. Management of nonvariceal upper gastrointestinal bleeding

    E Wee


    Full Text Available Nonvariceal upper gastrointestinal bleeding is unique from variceal bleeding in terms of patient characteristics, management, rebleeding rates, and prognosis, and should be managed differently. The majority of nonvariceal upper gastrointestinal bleeds will not rebleed once treated successfully. The incidence is 80 to 90% of all upper gastrointestinal bleeds and the mortality is between 5 to 10%. The causes include nonacid-related ulceration from tumors, infections, inflammatory disease, Mallory-Weiss tears, erosions, esophagitis, dieulafoy lesions, angiodysplasias, gastric antral vascular ectasia, and portal hypertensive gastropathy. Rarer causes include hemobilia, hemosuccus pancreaticus, and aortoenteric fistulas. Hematemesis and melena are the key features of bleeding from the upper gastrointestinal tract, but fresh per rectal bleeding may be present in a rapidly bleeding lesion. Resuscitation and stabilization before endoscopy leads to improved outcomes. Fluid resuscitation is essential to avoid hypotension. Though widely practiced, there is currently insufficient evidence to show that routine red cell transfusion is beneficial. Coagulopathy requires correction, but the optimal international normalized ratio has not been determined yet. Risk stratification scores such as the Rockall and Glasgow-Blatchford scores are useful to predict rebleeding, mortality, and to determine the urgency of endoscopy. Evidence suggests that high-dose proton pump inhibitors (PPI should be given as an infusion before endoscopy. If patients are intolerant of PPIs, histamine-2 receptor antagonists can be given, although their acid suppression is inferior. Endoscopic therapy includes thermal methods such as coaptive coagulation, argon plasma coagulation, and hemostatic clips. Four quadrant epinephrine injections combined with either thermal therapy or clipping reduces mortality. In hypoxic patients, endoscopy masks allow high-flow oxygen during upper


    Hassan Mansouritorghabeh


    Full Text Available Introduction: Male circumcision practice is an invasive procedure that is using worldwide. It makes challenges to haemostatic system and its possible haemorrhagic side effects are more serious in bleeding individuals than normal subjects. In most cases, it can be complete controlled using infusion of appropriate amount of coagulation factors before and post circumcision.Aim: We aim to documentation type of coagulation therapy and post circumcision practice haemorrhagic presentation among 463 bleeder males of both common and rare bleeding disorders in north eastern part of country.Methods: We retrospectively gathered information using evaluation medical records in 3 major hospitals during last 15 years and list of patients with bleeding disorders that obtained from haemophilia center. Also a call phone established for each bleeder person to complete data and updating of them. The survey took time from Sep 2009- Mar 2011. The designed question form included data on doing circumcision or not? types of treatment before and post the procedure and occurrence of bleeding episodes after the surgery.Results: Overall among 424 cases with various common and rare bleeding disorders who had circumcised, 239 cases (56.3% had passed the procedure with bleeding experience, while 185 cases (43.7% had passed it successfully and without noticeable bleeding experience. The types of coagulation therapy in each group have been cited.Conclusion: The circumcision practice in unequipped medical center for bleeder ones may make challenges for them and medical services. Also it needed supervision of expert haematologist for adjusting treatment to ensure control of unwanted bleeding

  20. A Coupled Snow Operations-Skier Demand Model for the Ontario (Canada) Ski Region

    Pons, Marc; Scott, Daniel; Steiger, Robert; Rutty, Michelle; Johnson, Peter; Vilella, Marc


    The multi-billion dollar global ski industry is one of the tourism subsectors most directly impacted by climate variability and change. In the decades ahead, the scholarly literature consistently projects decreased reliability of natural snow cover, shortened and more variable ski seasons, as well as increased reliance on snowmaking with associated increases in operational costs. In order to develop the coupled snow, ski operations and demand model for the Ontario ski region (which represents approximately 18% of Canada's ski market), the research utilized multiple methods, including: a in situ survey of over 2400 skiers, daily operations data from ski resorts over the last 10 years, climate station data (1981-2013), climate change scenario ensemble (AR5 - RCP 8.5), an updated SkiSim model (building on Scott et al. 2003; Steiger 2010), and an agent-based model (building on Pons et al. 2014). Daily snow and ski operations for all ski areas in southern Ontario were modeled with the updated SkiSim model, which utilized current differential snowmaking capacity of individual resorts, as determined from daily ski area operations data. Snowmaking capacities and decision rules were informed by interviews with ski area managers and daily operations data. Model outputs were validated with local climate station and ski operations data. The coupled SkiSim-ABM model was run with historical weather data for seasons representative of an average winter for the 1981-2010 period, as well as an anomalously cold winter (2012-13) and the record warm winter in the region (2011-12). The impact on total skier visits and revenues, and the geographic and temporal distribution of skier visits were compared. The implications of further climate adaptation (i.e., improving the snowmaking capacity of all ski areas to the level of leading resorts in the region) were also explored. This research advances system modelling, especially improving the integration of snow and ski operations models with

  1. Wintertime Air Quality Impacts from Oil and Natural Gas Drilling Operations in the Bakken Formation Region

    Evanoski-Cole, Ashley; Sive, Barkley; Zhou, Yong; Prenni, Anthony; Schurman, Misha; Day, Derek; Sullivan, Amy; Li, Yi; Hand, Jenny; Gebhart, Kristi; Schichtel, Bret; Collett, Jeffrey


    Oil and natural gas extraction has dramatically increased in the last decade in the United States due to the increased use of unconventional drilling techniques which include horizontal drilling and hydraulic fracturing. The impact of these drilling activities on local and regional air quality in oil and gas basins across the country are still relatively unknown, especially in recently developed basins such as the Bakken shale formation. This study is the first to conduct a comprehensive characterization of the regional air quality in the Bakken region. The Bakken shale formation, part of the Williston basin, is located in North Dakota and Montana in the United States and Saskatchewan and Manitoba in Canada. Oil and gas drilling operations can impact air quality in a variety of ways, including the generation of atmospheric particulate matter (PM), hazardous air pollutants, ozone, and greenhouse gas emissions. During the winter especially, PM formation can be enhanced and meteorological conditions can favor increased concentrations of PM and other pollutants. In this study, ground-based measurements throughout the Bakken region in North Dakota and Montana were collected over two consecutive winters to gain regional trends of air quality impacts from the oil and gas drilling activities. Additionally, one field site had a comprehensive suite of instrumentation operating at high time resolution to gain detailed characterization of the atmospheric composition. Measurements included organic carbon and black carbon concentrations in PM, the characterization of inorganic PM, inorganic gases, volatile organic compounds (VOCs), precipitation and meteorology. These elevated PM episodes were further investigated using the local meteorological conditions and regional transport patterns. Episodes of elevated concentrations of nitrogen oxides and sulfur dioxide were also detected. The VOC concentrations were analyzed and specific VOCs that are known oil and gas tracers were used

  2. Transcatheter arterial embolization for traumatic bleeding control

    Ryu, Choon Wook; Lee, Sang Kwon; Suh, Kyung Jin; Kim, Tae Heon; Kim, Yong Joo; Kang, Duck Sik [Kyungpook National University College of Medicine, Taegu (Korea, Republic of)


    Angiography is essential for the detection of bleeding vessels in traumatic vascular injury. Immediately after the diagnosis, transcatheter embolization can be performed for the control of bleeding effectively and easily with proper use of embolic materials. Transcatheter embolization is believed to be the treatment of choice when emergency control is needed, where surgical approach is difficult and in those who are poor candidate for surgery. We have tried bleeding control in 18 cases of trauma over recent 4 years. The results were as follows; 1. Causes of bleeding(cases): Blunt or penetrating trauma (10), latrogenic trauma (8), (Postoperative (5), Needle biopsy (2), Percutaneous hepatic procedure (1)) 2. Embolized vessels: Renal artery branches (8), Hepatic artery branches (2), Arteries supplying chest wall (2), External carotid artery branches (3), Internal carotid artery (1), Circumflex humeral artery (1), Internal iliac artery branches (1). 3. Embolic agents: Gelfoam cubes (16), Stainless steel coils (3), Detachable latex balloon (1). 4. Successful bleeding control was achieved in 17 cases and reduction of the amount of bleeding in one case without significant complications.

  3. Reasons of bleeding complications and prevention methods in endovascular stenting for intracranial artery stenosis

    Objective: To summarize the reasons of bleeding complications and the prevention methods in stenting for intracranial arterial stenosis. Methods: The clinical data of 366 patients underwent stent-assistant angioplasty of intracranial artery stenosis from July 2006 to December 2011 were analyzed retrospectively. Among them, 14 patients with bleeding complications were found. The initial 100 patients were categorized as early stage group and the rest as mature stage group. The reasons of bleeding and the methods for preventing this complication were summarized. Results: The overall incidence of bleeding complication was 3.8% (14/366). In the early stage group and mature stage group,the rates was 10%(10/100) and 1.5% (4/266). Six cases were related to the operational manipulation and 8 cases secondary to hyperperfusion injury. Death was found in 6 patients,severe disability in 3, mild paralysis in 2, and no neurological deficits in 3. Conclusions: The bleeding complications in stent-assisted angioplasty of intracranial artery stenosis have a high disability and mortality. The improvement of operative techniques and the more strict indications decrease the bleeding complications rate effectively. (authors)

  4. 14 CFR 23.1111 - Turbine engine bleed air system.


    ... using maximum bleed air must be established. (c) Hazardous contamination of cabin air systems may not... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Turbine engine bleed air system. 23.1111... Induction System § 23.1111 Turbine engine bleed air system. For turbine engine bleed air systems,...

  5. Gas Bearing Control for Safe Operation in Critical Speed Regions - Experimental Verification

    Theisen, Lukas R. S.; Niemann, Hans H.; Galeazzi, Roberto; Santos, Ilmar F.


    Gas bearings are popular for their high speed capabilities, low friction and clean operation, but require low clearances and suffer from poor damping properties. The poor damping properties cause high disturbance amplification near the natural frequencies. These become critical when the rotation speed coincides with a natural frequency. In these regions, even low mass unbalances can cause rub and damage the machine. To prevent rubbing, the variation of the rotation speed of machines supported by gas bearings has to be carefully conducted during run-ups and run-downs, by acceleration and deceleration patterns and avoidance of operation near the critical speeds, which is a limiting factor during operation, specially during run-downs. An approach for reducing the vibrations is by feedback controlled lubrication. This paper addresses the challenge of reducing vibrations in rotating machines supported by gas bearings to extend their operating range. Using H∞-design methods, active lubrication techniques are proposed to enhance the damping, which in turn reduces the vibrations to a desired safe level. The control design is validated experimentally on a laboratory test rig, and shown to allow safe shaft rotation speeds up to, in and above the two first critical speeds, which significantly extends the operating range.

  6. Duration of increased bleeding tendency after cessation of aspirin therapy.

    Cahill, Ronan A


    BACKGROUND: Aspirin has a significant effect on hemostasis, so it is often recommended that patients taking aspirin discontinue treatment before elective surgery. While off aspirin, these patients may be at risk of thrombosis. The optimum period of time that aspirin should be withheld is controversial. The aim of this study was to establish the duration of the antihemostatic effect of prolonged aspirin therapy. STUDY DESIGN: In a prospective study, 51 healthy volunteers were randomly assigned into 3 groups, each receiving an identical tablet for 14 days. One group received a placebo tablet; individuals in the other two groups received either 75 mg or 300 mg of aspirin once a day. Template bleeding times and specific platelet function testing (using the PFA-100; Dade Behring) were carried out on subjects before therapy and again after its completion until they returned to baseline. RESULTS: Thirty-eight volunteers complied sufficiently with the protocol to provide useful results. All bleeding times normalized within 96 hours and all platelet function tests within 144 hours after stopping aspirin. There was no demonstrable hemostatic defect in any volunteer persisting by or beyond the sixth day after treatment cessation. There was no apparent difference in duration of effect between those taking either 75 mg or 300 mg of aspirin. CONCLUSIONS: This study uses sensitive measures of platelet function to demonstrate the duration of increased bleeding tendency after withdrawal of aspirin therapy. It supports discontinuation of aspirin therapy 5 days before elective surgery (with the operation being performed on the sixth day).

  7. Critical gastrointestinal bleed due to secondary aortoenteric fistula.

    Malik, Mohammad U; Ucbilek, Enver; Sherwal, Amanpreet S


    Secondary aortoenteric fistula (SAEF) is a rare yet lethal cause of gastrointestinal bleeding and occurs as a complication of an abdominal aortic aneurysm repair. Clinical presentation may vary from herald bleeding to overt sepsis and requires high index of suspicion and clinical judgment to establish diagnosis. Initial diagnostic tests may include computerized tomography scan and esophagogastroduodenoscopy. Each test has variable sensitivity and specificity. Maintaining the hemodynamic status, control of bleeding, removal of the infected graft, and infection control may improve clinical outcomes. This review entails the updated literature on diagnosis and management of SAEF. A literature search was conducted for articles published in English, on PubMed and Scopus using the following search terms: secondary, aortoenteric, aorto-enteric, aortoduodenal, aorto-duodenal, aortoesophageal, and aorto-esophageal. A combination of MeSH terms and Boolean operators were used to device search strategy. In addition, a bibliography of clinically relevant articles was searched to find additional articles (Appendix A). The aim of this review is to provide a comprehensive update on the diagnosis, management, and prognosis of SAEF. PMID:26653698

  8. Critical gastrointestinal bleed due to secondary aortoenteric fistula

    Mohammad U. Malik


    Full Text Available Secondary aortoenteric fistula (SAEF is a rare yet lethal cause of gastrointestinal bleeding and occurs as a complication of an abdominal aortic aneurysm repair. Clinical presentation may vary from herald bleeding to overt sepsis and requires high index of suspicion and clinical judgment to establish diagnosis. Initial diagnostic tests may include computerized tomography scan and esophagogastroduodenoscopy. Each test has variable sensitivity and specificity. Maintaining the hemodynamic status, control of bleeding, removal of the infected graft, and infection control may improve clinical outcomes. This review entails the updated literature on diagnosis and management of SAEF. A literature search was conducted for articles published in English, on PubMed and Scopus using the following search terms: secondary, aortoenteric, aorto-enteric, aortoduodenal, aorto-duodenal, aortoesophageal, and aorto-esophageal. A combination of MeSH terms and Boolean operators were used to device search strategy. In addition, a bibliography of clinically relevant articles was searched to find additional articles (Appendix A. The aim of this review is to provide a comprehensive update on the diagnosis, management, and prognosis of SAEF.

  9. Improving reservoir operations modeling for integration in a regional Earth system model

    Voisin, N.; Li, H.; Ward, D. L.; Huang, M.; Leung, L.; Wigmosta, M. S.


    In integrated Earth system models (EaSMs), accurate hydrologic information in all of its components including socio-economy, atmosphere, land, and energy infrastructure is needed to represent the interactions between human and Earth system processes. The hydrology processes regulate the water, energy and carbon fluxes in this integrated framework. Human influence on the hydrologic cycle includes regulation and storage, consumptive use and overall redistribution of water resources in space and time. Representing these processes is essential for applications of EaSMs in hydrologic and climate predictions, as well as impact studies such as integrated assessment activities at regional to global scales. Dynamic programming approaches to optimize operations of reservoir systems have been widely used for water resources management planning at local and regional scales and recently have emerged in global-scale applications; albeit they are performed offline from the EaSMs , and require accurate knowledge of future flow for the upcoming water year. Other emerging large-scale research reservoir models use generic operating rules that are more flexible for coupling with EaSMs. Those generic operating rules have been successful in reproducing overall regulated flow at large basin scales. Improved generic operating rules are presented and evaluated across multiple spatial scales and objectives (flow but also storage and supply) over the complex multi-objective Columbia River Regulation System, which is representative of large river systems with increasing competitive reservoir purposes in the future. Challenges due to the difference in time and spatial scales between the physical processes versus reservoir operations and targets (irrigation, flood control, hydropower, environmental flow, navigation) are then discussed in the context of improving hydrology and evapotranspiration fluxes within an integrated EaSM.

  10. LPV control for the full region operation of a wind turbine integrated with synchronous generator.

    Cao, Guoyan; Grigoriadis, Karolos M; Nyanteh, Yaw D


    Wind turbine conversion systems require feedback control to achieve reliable wind turbine operation and stable current supply. A robust linear parameter varying (LPV) controller is proposed to reduce the structural loads and improve the power extraction of a horizontal axis wind turbine operating in both the partial load and the full load regions. The LPV model is derived from the wind turbine state space models extracted by FAST (fatigue, aerodynamics, structural, and turbulence) code linearization at different operating points. In order to assure a smooth transition between the two regions, appropriate frequency-dependent varying scaling parametric weighting functions are designed in the LPV control structure. The solution of a set of linear matrix inequalities (LMIs) leads to the LPV controller. A synchronous generator model is connected with the closed LPV control loop for examining the electrical subsystem performance obtained by an inner speed control loop. Simulation results of a 1.5 MW horizontal axis wind turbine model on the FAST platform illustrates the benefit of the LPV control and demonstrates the advantages of this proposed LPV controller, when compared with a traditional gain scheduling PI control and prior LPV control configurations. Enhanced structural load mitigation, improved power extraction, and good current performance were obtained from the proposed LPV control. PMID:25884036

  11. LPV Control for the Full Region Operation of a Wind Turbine Integrated with Synchronous Generator

    Guoyan Cao


    Full Text Available Wind turbine conversion systems require feedback control to achieve reliable wind turbine operation and stable current supply. A robust linear parameter varying (LPV controller is proposed to reduce the structural loads and improve the power extraction of a horizontal axis wind turbine operating in both the partial load and the full load regions. The LPV model is derived from the wind turbine state space models extracted by FAST (fatigue, aerodynamics, structural, and turbulence code linearization at different operating points. In order to assure a smooth transition between the two regions, appropriate frequency-dependent varying scaling parametric weighting functions are designed in the LPV control structure. The solution of a set of linear matrix inequalities (LMIs leads to the LPV controller. A synchronous generator model is connected with the closed LPV control loop for examining the electrical subsystem performance obtained by an inner speed control loop. Simulation results of a 1.5 MW horizontal axis wind turbine model on the FAST platform illustrates the benefit of the LPV control and demonstrates the advantages of this proposed LPV controller, when compared with a traditional gain scheduling PI control and prior LPV control configurations. Enhanced structural load mitigation, improved power extraction, and good current performance were obtained from the proposed LPV control.

  12. Genomic region operation kit for flexible processing of deep sequencing data.

    Ovaska, Kristian; Lyly, Lauri; Sahu, Biswajyoti; Jänne, Olli A; Hautaniemi, Sampsa


    Computational analysis of data produced in deep sequencing (DS) experiments is challenging due to large data volumes and requirements for flexible analysis approaches. Here, we present a mathematical formalism based on set algebra for frequently performed operations in DS data analysis to facilitate translation of biomedical research questions to language amenable for computational analysis. With the help of this formalism, we implemented the Genomic Region Operation Kit (GROK), which supports various DS-related operations such as preprocessing, filtering, file conversion, and sample comparison. GROK provides high-level interfaces for R, Python, Lua, and command line, as well as an extension C++ API. It supports major genomic file formats and allows storing custom genomic regions in efficient data structures such as red-black trees and SQL databases. To demonstrate the utility of GROK, we have characterized the roles of two major transcription factors (TFs) in prostate cancer using data from 10 DS experiments. GROK is freely available with a user guide from > PMID:23702556

  13. Tennessee Valley region study: potential year 2000 radiological dose to population resulting from nuclear facility operations

    A companion report, DOE/ET-0064/1, presents a geographic, cultural, and demographic profile of the Tennessee Valley Region study area. This report describes the calculations of radionuclide release and transport and of the resultant dose to the regional population, assuming a projected installed capacity of 220,000 MW in the year 2000, of which 144,000 MW would be nuclear. All elements of the fuel cycle were assumed to be in operation. The radiological dose was calculated as a one-year dose based on ingestion of 35 different food types as well as for nine non-food pathways, and was reported as dose to the total body and for six specific organs for each of four age groups (infant, child, teen, and adult). Results indicate that the average individual would receive an incremental dose of 7 x 10-4 millirems in the year 2000 from the operation of nuclear facilities within and adjacent to the region, five orders of magnitude smaller than the dose from naturally occurring radiation in the area. The major contributor to dose was found to be tritium, and the most significant pathways were immersion in air, inhalation of air, transpiration of tritium (absorption through the skin), and exposure radionuclide-containing soil. 60 references

  14. Secondary electric power generation with minimum engine bleed

    Tagge, G. E.


    Secondary electric power generation with minimum engine bleed is discussed. Present and future jet engine systems are compared. The role of auxiliary power units is evaluated. Details of secondary electric power generation systems with and without auxiliary power units are given. Advanced bleed systems are compared with minimum bleed systems. A cost model of ownership is given. The difference in the cost of ownership between a minimum bleed system and an advanced bleed system is given.

  15. Immediate bleeding complications in dental implants: A systematic review

    Balaguer Martí, José Carlos; Peñarrocha Oltra, David; Balaguer Martínez, José; Peñarrocha Diago, Miguel


    Objective: A review is made of the immediate or immediate postoperative bleeding complications in dental implants, with a view to identifying the areas of greatest bleeding risk, the causes of bleeding, the length of the implants associated with bleeding, the most frequently implicated blood vessels, and the treatments used to resolve these complications. Material and Methods: A Medline (PubMed) and Embase search was made of articles on immediate bleeding complications in dental implants publ...

  16. Columbia River System Operation Review final environmental impact statement. Appendix Q: Regional forum

    The System Operation Review (SOR) is a study and environmental compliance process being used by the three Federal agencies to analyze future operations of the system and river use issues. The goal of the SOR is to achieve a coordinated system operation strategy for the river that better meets the needs of all river users. This technical appendix addresses only the effects of alternative system operating strategies for managing the Columbia River system. The SOR is currently developing a System Operating Strategy (SOS) that will guide the physical operations of the Columbia River system. The SOR is also addressing the institutional arrangements that must be in place to make needed changes to the SOS in the future, or make interpretations of the strategy in the light of changing water conditions or river needs. For convenience, this future institutional arrangement is referred to as ''The Columbia River Regional Forum,'' or simply ''the Forum,'' even though the nature of this institution is still to be determined. This appendix and the Final Environmental Impact Statement (EIS) identify the Forum as an administrative process that will not result in impacts to the environment and will not require analysis in a NEPA context. The composition of and procedures followed by a decision making body cannot--in and of themselves--be used to predict a particular decision with definable impacts on the environment. Nevertheless, because of the relationship to the other SOR actions, the SOR lead agencies have prepared this Technical Appendix to provide opportunities for review and comment on the Forum alternatives

  17. Facing operational problems in a biodigester in Yuvientsa - Amazonian region of Ecuador

    Aragundy, J.


    Yuvientsa is a Shuar indigenous community located in the Morona Santiago Province in the southwestern part of the Amazonian region of Ecuador. Two types of alternative energies have being implemented in Yuvientsa to satisfy people's needs. Solar panels provide electricity to the community. A biodigester to treat the school lavatories' brown-water (fecal water) and to provide gas for cooking to the communal kitchen was built as well. During the operational phase the biodigester faced some difficulties as: being perforated by people of the community as started inflating, being fumigated against malaria, and not having enough organic matter to produce biogas. As a result in this time the biodigester did not operate satisfactorily and the community did not believe that it could work and produce biogas. A biodigester should not be built without an awareness campaign or showing a direct benefit to the community that ensures its adequate operation and maintenance. Before constructing the reactor the organic matter source to operate the biodigester should be clearly identified and its amount should be enough. (orig.)


    V. Poroch


    Full Text Available Actual treatment of bleeding duodenal ulcer is most frequently medical but also surgical. The aim of this study is to assess the factors that influence the outcomes for a group of 67 patients suffering of bleeding duodenal ulcer. Out of 67 patients considered in this study, 53 were men (79.1% and 14 were women (20.9%. The average age was 52 years for men and 53 years for women (range 19-86 years. 59 (88% were patients with known medical history of peptic ulcer disease. Endoscopy has been performed for 64 patients (95.6%. Specific medical treatment was started immediately for all patients. For 47 patients (70.1% the hemorrhage stopped with conservative treatment, 8 patients (12% benefit by endoscopic treatment and 12 patients (17.9% underwent surgery. The postoperative morbidity rate was 16.7%. Comorbidities were present in 43 patients (64.2%. Failure of medical conservative treatment has been observed in 7 cases (13%, and failure of endoscopic procedures in 2 cases (20%. The risk factors involved in therapy outcomes of bleeding duodenal ulcer are: age, the severity of hemorrhage confirmed by endoscopy, the hemorrhagic episodes in medical history and the time of surgery. Conclusion: The prognosis of bleeding duodenal ulcer after bleeding is highly correlated with the time that the treatment starts, the severity of hemorrhage, comorbid conditions and age.

  19. Accuracy of rockall score for in hospital re bleeding among cirrhotic patients with variceal bleed

    To assess the diagnostic accuracy of Roc kall scoring system for predicting in-hospital re-ble- eding in cirrhotic patients presenting with variceal bleed. Material and Methods: This descriptive case series study was conducted at Department of Medicine Combined Military Hospital Lahore from December 2013 to May 2014. We included patients with liver cirrhosis who presented with upper GI bleeding and showed varices as the cause of bleeding on endoscopy. Clinical and endoscopic features were noted to calculate Rockall score. Patients with score < 2 and > 8 were included. After treating with appropriate pharmacological and endoscopic therapy, patients were followed for re-bleeding for 10 days. Diagnostic accuracy was assessed by calculating sensitivity, specificity, positive and negative predictive values using 2 x 2 tables. Results: In the study, 175 patients were included. Mean age was 51.5 ± 1.22 years. Male to female ratio was 1.5 to 1.0 out of 175 patients, 157 patients (89.7%) were of low risk group (score = 2) while 18 patients (10.3%) were in high risk group (score > 8). In low risk group, re-bleeding occurred only in 2 patients (1.2%) while in high risk group, re-bleeding occurred in 14 patients (78%). Rockall score was found to have good diagnostic accuracy with sensitivity of 87.5%, specificity of 97.48%, positive predictive value of 77.8% and negative predictive value of 98.7%. Conclusion: In cases of variceal bleed, frequency of re-bleed is less in patients who are in low risk category with lower Rockall score and high in high risk patients with higher rockall score. The Rockall score has a good diagnostic accuracy in prediction of re-bleed in variceal bleeding. (author)

  20. PRESSCA: A regional operative Early Warning System for landslides risk scenario assessment

    Ponziani, Francesco; Stelluti, Marco; Berni, Nicola; Brocca, Luca; Moramarco, Tommaso


    The Italian national alert system for the hydraulic and hydrogeological risk is ensured by the National Civil Protection Department, through the "Functional Centres" Network, together with scientific/technical Support Centres, named "Competence Centres". The role of the Functional Centres is to alert regional/national civil protection network, to manage the prediction and the monitoring phases, thus ensuring the flow of data for the management of the emergency. The Umbria regional alerting procedure is based on three increasing warning levels of criticality for 6 sub-areas (~1200 km²). Specifically, for each duration (from 1 to 48 hours), three criticality levels are assigned to the rainfall values corresponding to a recurrence interval of 2, 5, and 10 years. In order to improve confidence on the daily work for hydrogeological risk assessment and management, a simple and operational early warning system for the prediction of shallow landslide triggering on regional scale was implemented. The system is primarily based on rainfall thresholds, which represent the main element of evaluation for the early-warning procedures of the Italian Civil Protection system. Following previous studies highlighting that soil moisture conditions play a key role on landslide triggering, a continuous physically-based soil water balance model was implemented for the estimation of soil moisture conditions over the whole regional territory. In fact, a decreasing trend between the cumulated rainfall values over 24, 36 and 48 hours and the soil moisture conditions prior to past landslide events was observed. This trend provides an easy-to-use tool to dynamically adjust the operational rainfall thresholds with the soil moisture conditions simulated by the soil water balance model prior to rainfall events. The application of this procedure allowed decreasing the uncertainties tied to the application of the rainfall thresholds only. The system is actually operational in real-time and it was

  1. Per rectal portal scintigraphy as a useful tool for predicting esophageal variceal bleeding in cirrhotic patients

    Taned Chitapanarux; Ong-ard Praisontarangkul; Satawat Thongsawat; Pises Pisespongsa; Apinya Leerapun


    AIM: To investigate potential roles of per rectal portal scintigraphy in diagnosis of esophageal varices and predicting the risk of bleeding.METHODS: Fifteen normal subjects and fifty cirrhotic patients with endoscopically confirmed esophageal varices were included. Patients were categorized into bleeder and non-bleeder groups according to history of variceal bleeding. All had completed per rectal portal scintigraphy using 99mTechnetium pertechnetate.The shunt index was calculated from the ratio of 99mTechnetium pertechnetate in the heart and the liver.Data were analyzed using Student's t-test and receiver operating characteristics.RESULTS: Cirrhotic patients showed a higher shunt index than normal subjects (63.80 ± 25.21 vs 13.54 ± 6.46, P < 0.01). Patients with variceal bleeding showed a higher shunt index than those without bleeding (78.45 ± 9.40 vs 49.35 ± 27.72, P < 0.01). A shunt index of over 20% indicated the presence of varices and that of over 60% indicated the risk of variceal bleeding.CONCLUSION: In cirrhotic patients, per rectal portal scintigraphy is a clinically useful test for identifying esophageal varices and risk of variceal bleeding.

  2. Assessment of the Water Balance Over France Using Regionalized Turc-Pike Formula for Operational Hydrology

    LE Lay, M.; Garcon, R.; Gailhard, J.; Garavaglia, F.


    With extensive use of hydrological models over a wide range of hydro-climatic contexts, bias in hydro-climatic data may lead to unreliable models and thus hydrological forecasts and projections. This issue is particularly pregnant when considering mountainous areas with great uncertainties on precipitations, or when considering complex unconservative catchments (e.g. karstic systems). The Turc-Pike water balance formula, analogous to the classical Budyko formula, is a simple and efficient mathematical formulation relating long-term average streamflow to long-term average precipitation and potential evaporation. In this study, we propose to apply this framework to assess and eventually adjust the water-balance before calibrating an operational hydrologic model (MORDOR model). Considering a large set of 350 french catchments, the Turc-Pike formula is regionalized based on ecohydrologic criterions to handle various hydro-climatic contexts. This interannual regional model is then applied to assess the water-balance over numerous catchments and various conditions, such as karstic, snow-driven or glaciarized and even anthropized catchments. Results show that it is possible to obtain pretty realistic corrections of meteorological inputs (precipitations, temperature or potential evaporation) or hydrologic surface (or runoff). These corrections can often be confirmed a posteriori by exogenous information. Positive impacts on hydrologic model's calibration are also demonstrated. This methodology is now operational for hydrologic applications at EDF (Electricité de France, French electric utility company), and therefore applied on hundreds of catchments.

  3. The assessment of anticoagulant activity to predict bleeding outcome in atrial fibrillation patients receiving dabigatran etexilate.

    Chang, Yao-Ting; Hu, Yu-Feng; Liao, Jo-Nan; Chern, Chang-Ming; Lin, Yenn-Jiang; Chang, Shih-Lin; Wu, Cheng-Hsueh; Sung, Shih-Hsien; Wang, Kang-Ling; Lu, Tse-Min; Chao, Tze-Fan; Lo, Li-Wei; Hsu, Li-Chi; Chung, Chih-Ping; Chang, Peter M-H; Hsu, Wei-Hsuan; Chiou, Chuen-Wang; Chen, Shih-Ann


    Special circumstances may require the measurement of the anticoagulant effect of dabigatran etexilate. No data currently link any given coagulation test to bleeding outcomes in patients receiving dabigatran etexilate for atrial fibrillation. Nonvalvular atrial fibrillation patients receiving dabigatran etexilate of 110 mg (DE110) or 150 mg (DE150) were consecutively enrolled. The hemoclot thrombin inhibitor (HTI) assay, prothrombin time, and activated partial thromboplastin time (APTT) measurements were correlated with bleeding events during a prospective follow-up. There were 17 bleeding events (8.2%) in 208 patients (74.7 ± 10.3 years old, 67.9% male, median follow-up: 364 days), whereas 15 patients with bleeding events used DE110. Compared with DE110, the patients receiving DE150 were younger and more often male and had lower HAS-BLED and CHA2DS2VASc scores and better renal function. Patients' HTI levels were very variable (DE110, 10-90th percentile: 20.5-223.9 ng/ml). A receiver-operator characteristic curve gave a median cutoff HTI level of 117.7 ng/ml to predict bleeding events (C-statistics: 0.65; P = 0.036), but no cutoff could be determined for prothrombin time or APTT. Based on the Kaplan-Meier analysis, a dabigatran etexilate level greater than 117.7 ng/ml was associated with a higher bleeding rate (15.4% vs. 4.9%, P = 0.01). After multivariate Cox regression analysis, HTI levels, history of stroke, and male sex were independent risk factors for bleeding events. Dabigatran etexilate-HTI levels were independently associated with bleeding in patients receiving routine clinical care. Blood sampling at multiple time points might be needed to increase reliability because of high variation of dabigatran etexilate-HTI levels. PMID:26991859

  4. How I manage heavy menstrual bleeding.

    Pai, Menaka; Chan, Anthony; Barr, Ronald


    Heavy menstrual bleeding (HMB) is a common clinical problem; population-based studies estimate that approximately 10-35% of women report this symptom during their lifetime, while about 5% of women consult a physician for evaluation of HMB. Patients with HMB account for 15% of all referrals to gynaecologists and are frequently seen by haematologists in bleeding disorder clinics as well. Heavy menstrual bleeding can be caused by a wide variety of local and systemic factors, so a careful clinical and laboratory evaluation is often necessary to determine the aetiology and guide appropriate management. This review discusses the definition, causes and clinical outcomes of HMB. It outlines a diagnostic approach and focuses on medical (as opposed to surgical) treatments. Throughout, areas of controversy and opportunities for further research are highlighted. PMID:23829452

  5. Fibrinogen concentrate for bleeding - a systematic review

    Lunde, J; Stensballe, J; Wikkelsø, A;


    Fibrinogen concentrate as part of treatment protocols increasingly draws attention. Fibrinogen substitution in cases of hypofibrinogenaemia has the potential to reduce bleeding, transfusion requirement and subsequently reduce morbidity and mortality. A systematic search for randomised controlled...... trials (RCTs) and non-randomised studies investigating fibrinogen concentrate in bleeding patients was conducted up to November 2013. We included 30 studies of 3480 identified (7 RCTs and 23 non-randomised). Seven RCTs included a total of 268 patients (165 adults and 103 paediatric), and all were...... mortality were lacking. Weak evidence from RCTs supports the use of fibrinogen concentrate in bleeding patients, primarily in elective cardiac surgery, but a general use of fibrinogen across all settings is only supported by non-randomised studies with serious methodological shortcomings. It seems pre...

  6. Radionuclide detection of lower gastrointestinal bleeding sites

    A retrospective review of two years' experience with radionuclide screening to detect lower gastrointestinal bleeding sites was conducted at New York's Montefiore Medical Center. Of 82 studies performed in 63 patients, 13 identified active bleeding sites. Only three of eight angiograms obtained in these 13 patients were positive. Thirteen contrast angiograms were performed in the group of 50 patients with negative radionuclide studies of which ten were negative and one was equivocal. The results of this study suggest that the Tc-99m sulfur colloid study for active lower gastrointestinal (GI) bleeding is an effective screening procedure. Positive studies help determine which vessel to catheterize selectively if an angiogram is to be performed. If vascular ectasis is still suspected following a negative radionuclide study, contrast angiography can be more efficaciously performed on a nonemergent basis

  7. Radiotherapy in benign uterine bleeding disorders

    Radiotherapy was earlier a method of choice for treatment of benign bleeding disorders (metropathia), especially in woman of high surgical risk. During the period 1912 to 1977 933 women with benign bleeding disorders were treated at Radiumhemmet with intracavitary brachytherapy or external irradiation or a combination of both. The result with regard to cure of the uterine bleedings was good (48%). Hormonal withdrawal symptoms after treatment were noted in 45% of the patients. In the long term follow up an increased risk of cardiovascular death was found in women treated before menopause. Malignant tumours occurred in 107 cases versus 90.2 expected. The estimated ovarian dose of ionizing radiation varied from 3.5 Gy to 6.0 Gy for the three standard techniques. Two women gave birth to a healthy child 4 and 5 years after intracavitary radium treatment. The estimated absorbed dose to the ovaries in these two women were 1 Gy and 4 Gy, respectively

  8. Implementation and modeling of a Regional Hub Reception Center during mass evacuation operations.

    Wojtalewicz, Cliff; Kirby, Adam; Dietz, J Eric


    When developing response plans in the aftermath of a catastrophic incident, jurisdictions often fail to conduct the necessary interdisciplinary planning needed to fully address the needs across jurisdictional borders. The Purdue Homeland Security Institute (PHSI) was selected by the City of Chicago Office of Emergency Management and Communications (OEMC) in 2010 to lead an effort to address planning across jurisdictional borders during mass evacuations following a catastrophic incident. Specifically, PHSI was chosen to lead the effort in developing a planning and implementation guide for standing up a conceptual Regional Hub Reception Center (RHRC). A major component within the mass evacuation and sheltering continuum, the RHRC is designed to provide evacuees with quickresponse mass care and emergency assistance while their other needs are assessed and appropriate shelter locations are identified. The RHRC also provides a central location to leverage governmental, nongovernmental, and private sector resources and is the first point in the evacuation, mass care, and sheltering concept of operations where more comprehensive support (food, shelter, medical, psychological, household pet sheltering, reunification, etc) can be expected. PHSI undertook this lead role working within the Illinois-Indiana-Wisconsin (IL-IN-WI) Combined Statistical Area (CSA) as part of the US Department of Homeland Security Regional Catastrophic Planning Grant Program. Coordinating closely with the City of Chicago OEMC and IL-IN-WI CSA Regional Catastrophic Planning Team, PHSI lead the research effort using resource and capability data compiled from all 17 jurisdictions within the IL-IN-WI CSA and validated the RHRC concept using three tabletop exercises. Upon completion, the PHSI team published the RHRC planning guide complete with procedures and processes that define the roles and responsibilities of government, nongovernment organizations, and private sector for providing RHRC mass care

  9. [Jejunal GIST with obscure gastrointestinal bleeding].

    Nelly Manrique, María; Frisancho, Oscar; Rivas Wong, Luz; Palomino, Américo


    We report the case of a woman of 84 years with a history of cardiac arrhythmia and hemorrhoids. She had multiple hospitalizations and transfusions for symptomatic iron deficiency anemia, endoscopic studies showed only small diverticula and colon polyps. He was later hospitalized with bloody stools red wines, upper endoscopy and colonoscopy showed gastritis, small colonic ulcers, colonic polyp and multiple diverticula. Readmitted with bleeding of obscure origin, on that occasion showed gastritis, antral erosions, small ulcers, colon polyps and colon ulcers in the process of healing, capsule endoscopy showed angiodysplasia in jejunum, anterograde enteroscopy detected some erythematous lesions in proximal jejunum without evidence of bleeding. Again hospitalized for melena and abdominal. PMID:22086325

  10. Somatostatin analogues for acute bleeding oesophageal varices

    Gøtzsche, Peter C.; Hrobjartsson, A.


    BACKGROUND: Somatostatin and its derivatives are sometimes used for emergency treatment of bleeding oesophageal varices in patients with cirrhosis of the liver. OBJECTIVES: To study whether somatostatin or its analogues improve survival or reduce the need for blood transfusions in patients with...... bleeding oesophageal varices. SEARCH STRATEGY: PubMed and The Cochrane Library were searched (November 2007). Reference lists of publications, contacts with authors. SELECTION CRITERIA: All randomised trials comparing somatostatin or analogues with placebo or no treatment in patients suspected of acute or...


    LEE Kun Sang


    Coupled hydrogeological-thermal simulation of the Standing Column Well (SCW) system is essential to provide an optimized configuration and operation schedule for boreholes on the site.This paper presents numerical investigations and thermo-hydraulic evaluation of standing column well system operating under cyclic flow regime.A three-dimensional numerical model for groundwater flow and heat transport is used to analyze the heat exchange in the ground.The model includes the effects of convective and conductive heat transfer, heat loss to the adjacent confining strata, and hydraulic anisotropy.The operation scenario consists of cyclic injection and recovery and four periods per year to simulate the seasonal temperature conditions.For different parameters of the system, performances have been evaluated in terms of variations in recovery temperature.The calculated temperatures at the producing pipe are relatively constant within a certain range through the year and fluctuating quarterly a year.Pipe-to-pipe distance, injection/production rate, ground thickness, and permeability considered in the model are shown to impact the predicted temperature profiles at each stage and the recovery water temperature.The influence of pressure gradient, which determines the velocity of regional groundwater flow, is most substantial.

  12. CO{sub 2}MPARE. CO2 Model for Operational Programme Assessment in EU Regions. Improved carbon management with EU Regional Policy. Final Report

    Hekkenberg, M. [ECN Policy Studies, Amsterdam (Netherlands); Schram, J. [Energies Demain, Montreuil Sous Bois (France); Amerighi, O. [Italian National Agency for New Technologies, Energy and Sustainable Economic Development ENEA, Rome (Italy); Keppo, I. [University College London UCL, London (United Kingdom); Papagianni, S. [Centre for Renewable Energy Sources and Saving CRES, Pikermi Attiki (Greece); Ten Donkelaar, M. [ENVIROS, Prague (Czech Republic)


    The CO2MPARE model supports national and regional authorities in making balanced decisions for their investment portfolio under their regional development programmes, in particular under their Operational Programmes of EU Regional Policy. The EU's climate objectives require that investments across the EU are channeled towards low-carbon development. The carbon impacts of investments should therefore be seriously considered in the decision making process of regional development programmes. The CO2MPARE model informs national and regional authorities on the impacts that the investments under various Operational Programmes can have in terms of CO2 emissions. Knowing which investments lead either to additional emissions or rather to emission reductions, and what the overall impact of a programme is, represents the first step towards investment decisions that have decarbonisation co-benefits. CO2MPARE estimates the combined carbon impact of all activities that take place under a programme, and provides insights into the relative contributions of the different themes. Through its high aggregation level, it allows comparison of investment scenarios rather than individual projects. As such, it aims to support informed decisions on investment strategies rather than project investment decisions. In doing so, it also helps to build and develop a 'carbon culture' within the authorities directly or indirectly in charge of managing Regional Policy Operational Programmes. The model is primarily aimed at Operational Programmes co-financed by the European Regional Development Fund (ERDF)

  13. Radiation protection activities under a Regional Co-operative Agreement (RCA)

    The current status of a Regional Co-operative Agreement (RCA) project on 'strengthening of radiation protection' is described. All the RCA Member States, i.e. Australia, Bangladesh, China, India, Indonesia, Japan, the Republic of Korea, Malaysia, Pakistan, the Philippines, Singapore, Sri Lanka, Thailand and Viet Nam are participating in the project and providing the financial and human resources necessary for its implementation. The objective of the project is to strengthen radiation protection capabilities in the RCA region with emphasis on the establishment and development of the infrastructure, in particular, manpower development in dosimetry, dose and risk assessment, protection practices, emergency countermeasures, regulatory provisions, and educational and training systems. The activities include practical training, the acquisition of fundamental knowledge and techniques; workshop and study tours at an advanced level; a co-ordinated research programme to obtain data essential for radiation protection measures in the region; assignment of experts to address specific problems; provision of long term fellowships to supplement short term training; provision of instruments and equipment; participation in the radiation protection advisory team (RAPAT) programme of the IAEA; and periodic evaluation of the project. These activities are applied in a concerted way to industrial applications, including nuclear energy and medical and biological applications. In the field of industrial applications, two training courses and two workshops including study tours were implemented in 1988 and 1989, and one training course and two workshops are envisaged for 1990. In the medical and biological field, efforts have been concentrated on the co-ordinated research programme which aims at compiling essential data of the region for setting Reference Asian Man. 1 tab

  14. Diagnosis of gastrointestinal bleeding: A practical guide for clinicians

    Bong; Sik; Matthew; Kim; Bob; T; Li; Alexander; Engel; Jaswinder; S; Samra; Stephen; Clarke; Ian; D; Norton; Angela; E; Li


    Gastrointestinal bleeding is a common problem encountered in the emergency department and in the primary care setting. Acute or overt gastrointestinal bleeding is visible in the form of hematemesis, melena or hematochezia. Chronic or occult gastrointestinal bleeding is notapparent to the patient and usually presents as positive fecal occult blood or iron deficiency anemia. Obscure gastrointestinal bleeding is recurrent bleeding when the source remains unidentified after upper endoscopy and colonoscopic evaluation and is usually from the small intestine. Accurate clinical diagnosis is crucial and guides definitive investigations and interventions. This review summarizes the overall diagnostic approach to gastrointestinal bleeding and provides a practical guide for clinicians.


    Munteanu Nicolae-Eugen


    It is very important to be found methods to increase the competitiveness between the Romanian administrative-territorial units, under the current conditions of the economic crisis, by means of the existing economic levers successfully used within the European Union regions. The development regions of Romania do not have the statute of administrative units, but they represent territorial units large enough to constitute a good basis for the elaboration and implementation of regional developmen...


    Regis R, Regina; Bisso A, Aland; Rebaza, Segundo


    Pectic ulcer is the most frequent cause of gastrointestinal bleeding. The homeostatic mechanism of bleeding, and coagulation, does not happen with values of pH less than 5,0. Therefore neutralization of gastric acidity (pH more than 5,0) is a recourse of control, improve the evolution and healing of peptic ulcer and to avoid a new bleeding. The aim of this study was to compare the results of treatment with omeprazole and ranitidine, in 57 patients admitted at emergency room of the Hospital Central de la Polic a Nacional del Per with endoscopic diagnosis of peptic ulcer, using Forrest classification. Patients received omeprazole 40 mg in bolus IV, followed by continuos infusion of 8 mg/hour for 72 hours (group A) or ranitidine 50 mg IV each 8 hours for 72 hours (group B). A new endoscopy was made 72 hours after admission demostrated a succesful therapy in both group. Bleeding stopped in 26/27 patients in group A (96,2%) and in 23/30 patients in group B (76,6%) (pomeprazole IV is more effective than ranitidine IV in the control of UGB because of peptic ulcer and provides a faster healing. PMID:12181579

  17. Endometrial biopsy findings in postmenopausal bleeding

    To study endometrial histopathology in women presenting with postmenopausal bleeding. A two-year study from January 2003 to December 2004 of 100 cases of postmenopausal bleeding was conducted at Combined Military Hospital, Sialkot. The histopathology of endometrial biopsy specimens was done to find out the causes of postmenopausal bleeding in these ladies. All these 100 patients had confirmed menopause and the average age was 55 years and above. The most common histopathological diagnosis was senile endometrial atrophy (27%), followed by simple cystic hyperplasia in (17%). Three cases of simple cystic hyperplasia had coexistent ovarian tumors. Glandular hyperplasia without atypia was seen in 6% and with atypia in 4%. Other causes were endometritis (13%), endometrial polyps (8%), proliferative phase endometrium (6%) and secretary phase endometrium (5%). Endometrial carcinoma was seen in (6%) cases, (8%) biopsy specimens were non-representative. Although senile endometrial atrophy was most commonly found in these ladies but a significant percentage of endometrial hyperplasia and endometrial cancer implies the need for investigating all cases of postmenopausal bleeding. Bimanual examination and pelvic ultrasonography should be combined with endometrial sampling so that rare pelvic pathologies may not be missed. (author)

  18. Do statins protect against upper gastrointestinal bleeding?

    Gulmez, Sinem Ezgi; Lassen, Annmarie Touborg; Aalykke, Claus; Dall, Michael; Andries, Alin; Andersen, Birthe Søgaard; Hansen, Jane Møller; Andersen, Morten; Hallas, Jesper


    AIMS: Recently, an apparent protective effect of statins against upper gastrointestinal bleeding (UGB) was postulated in a post hoc analysis of a randomized trial. We aimed to evaluate the effect of statin use on acute nonvariceal UGB alone or in combinations with low-dose aspirin and other...

  19. Dysfunctional uterine bleedings of a climacteric period

    Climacteric period of some women is complicated by dysfunctional uterine bleedings (DUB). Bearing in mind the fact that DUBS are caused by disorder of estrin rhysmic secretion, the paper presents the methods of differential diagnostics for investigations into functional disorders in the hypothalamus -hypophysis - ovaries - uterus system. The preference is given to roentgenologic and radioimmunologic diagnostic methods

  20. Airport operations management- aplikace na regionální letiště

    Adamová, Eva


    Záverečná diplomová práca sa zaoberá problematikou Airport Operations Management a jej aplikáciou na regionálne letisko Brno – Tuřany. Rozoberá všeobecné prevádzkové procesy letísk a porovnáva ich so súčasnou situáciou v Tuřanoch. Na základe porovnania sú navrhnuté zlepšenia, alebo návrhy pre zefektívnenie prevádzky. Súčasťou práce je tiež priblíženie súčasnej problematiky ekologizácie letísk a leteckej dopravy.

  1. Impact of pellet injection on extension of operational region in LHD

    Pellet injection has been used as a primary fueling scheme in Large Helical Device (LHD). Pellet injection has extended an operational region of NBI plasmas to higher densities with maintaining preferable dependence of energy confinement on density, and achieved several important data, such as plasma stored energy (0.88 MJ), energy confinement time (0.3 s), β (2.4% at 1.3 T) and density (1.1x1020m-3). These parameters cannot be attained by gas puffing. Ablation and subsequent behavior of plasma has been investigated. Measured pellet penetration depth that is estimated by duration of the Hα emission is shallower than predicted penetration depth from the simple neutral gas shielding (NGS) model. The penetration depth can be explained by NGS model with fast ion effect on the ablation. Just after ablation, redistribution of ablated pellet mass was observed in short time (∼400ms). The redistribution causes shallow deposition and low fueling efficiency. (author)

  2. Environmental and economic assessment of discharges from Gulf of Mexico Region Oil and Gas Operations

    Task 3 (Environmental Field Sampling and Analysis of NORM, Heavy Metals, and Organics) and 4 (Monitoring of the Recovery of Impacted Wetland and Open Bay Produced Water Discharge Sites in Coastal Louisiana and Texas) activities involved continued data analysis and report writing. Task 5 (Assessment of Economic Impacts of Offshore and Coastal Discharge Requirements on Present and Future Operations in the Gulf of Mexico Region) was issued as a final report during the previous reporting period. Task 6 (Synthesis of Gulf of Mexico Seafood Consumption and Use Patterns) activities included the preparation of the final report. There were no Task 7 (Technology Transfer Plan) activities to report. Task 8 (Project Management and Deliverables) activities involved the submission of the necessary reports and routine management

  3. Endovascular Management of Acute Bleeding Arterioenteric Fistulas

    The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed over the 3-year period between December 2002 and December 2005 at our institution, were retrospectively reviewed. Five patients with severe enteric bleeding underwent angiography and endovascular repair. Four presented primary arterioenteric fistulas, and one presented a secondary aortoenteric fistula. All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed immediate further open surgery. There were no procedure-related major complications. Mean hospital stay after the initial endovascular intervention was 19 days. Rebleeding occurred in four patients (80%) after a free interval of 2 weeks or longer. During the follow-up period three patients needed reintervention. The in-hospital mortality was 20% and the 30-day mortality was 40%. The midterm outcome was poor, due to comorbidities or rebleeding, with a mortality of 80% within 6 months. In conclusion, endovascular repair is an efficient and safe method to stabilize patients with life-threatening bleeding arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered

  4. Outcomes from the regional Co-operation in the Area of the Safety Analysis Methodology

    International Atomic Energy Agency (IAEA) carried out the Co-ordinated Research Program (CRP) ON Validation of Accident and Safety Analysis Methodology'' in the period between 1995 and 1998. Three areas of interest identified by the participants referred to the pressurised water reactors of Western and Eastern type (PWR and WWER type). The specific areas of attention were: system behaviour of the primary and secondary loops (PS area), the containment response (CO area) and the severe accidents (SA area). During the CRP it became clear that the technology advancements, the available tools (i.e. codes) and the experimental databases in the above areas are quite different. At the conclusion of the CRP, all objectives of the program have been reached. This paper presents the summary of the regional co-operation in this framework. The CRP activities focused on the codes and expertise available at the participating organisations. This overview therefore summarises their experience related to the state-of-the-art in the field of computational accident analysis. In addition, the paper proposes the recommendations for future activities related to the code usage, the user effects and code development. In pursuing of these goals special attention is given to the importance of the international co-operation. (author)

  5. Impact of Water Availability on Regional Power System Operations - A Case Study of ERCOT

    Levin, T.; Zhou, Z.


    Impact of water availability on regional power system operations - A case study of ERCOT Thermal power plants are the largest single source of water withdrawals in the United States, mainly for cooling purposes. The amount of water that is required for cooling is highly dependent on a number of factors including the generation technologies being used, the temperature of the input water, and the total electricity load in the system. During summer months, many of these factors coincide to greatly increase the demand for water in a power system. Electricity demand typically reaches its annual peak when temperatures are high due to increased air conditioning loads. Ambient water temperatures also increase, meaning that greater quantities of water are required to provide the same amount of cooling at thermal generation plants. Finally, water availability is generally constrained due to seasonal effects and potential droughts. This raises concerns that water scarcity may lead to forced de-rating at some power plants during periods of peak demand, resulting in a more vulnerable and less reliable energy system. While increasing attention has recently been given to the inexorable link between water and energy, most commercial power models do not explicitly account for water use when optimizing system operation. We apply the AURORAxmp power modeling software to a case study analysis of the ERCOT power system to determine the water requirements of the system during periods of peak power demand. We then analyze water availability by location and time to identify potential supply shortages, which may reduce actual power generation availability. These data are fed back into the power systems model and specific generation units are de-rated as necessitated by water constraints. We then analyze these results to determine how the optimal generation mix, system reliability, and wholesale electricity prices may be affected by when the ERCOT power system is operated under water

  6. AROME-Arctic: New operational NWP model for the Arctic region

    Süld, Jakob; Dale, Knut S.; Myrland, Espen; Batrak, Yurii; Homleid, Mariken; Valkonen, Teresa; Seierstad, Ivar A.; Randriamampianina, Roger


    substitute our actual operational Arctic mesoscale HIRLAM (High Resolution Limited Area Model) NWP model. This presentation will discuss in detail the operational implementation of the AROME-Arctic model together with post-processing methods. Aimed services in the Arctic region covered by the model, such as online weather forecasting ( and tracking of polar lows (, is also included.

  7. Correlation of bleeding pattern with endometrial histopathologic results in perimenopausal women with abnormal uterine bleeding

    Zehra Yilmaz


    Full Text Available Background: Abnormal Uterine Bleeding (AUB is referred as bleeding outside of normal menstruation pattern and it is the most common gynecological problem for women of all ages. This study was evaluated the correlation of menstrual bleeding patterns and endometrial histopathological findings in perimenopausal women. Methods: This study was done on perimenopausal aged women presented with AUB for the last 6 months at a gynecology clinic of a tertiary medical center. Only the patients with isolated endometrial causes of AUB were selected for study. A total of 313 cases were included in the study. Abnormal bleeding patterns of the patients were recorded and endometrial sampling was performed to all women. AUB was classified as menorrhagia, metrorrhagia, menometrorrhagia, polymenorrhea, intermenstrual bleeding, and histopathological findings were classified as Proliferative Endometrium (PE, Secretory Endometrium (SE, Disordered Proliferative Pattern (DPP, Endometrial Polyp (EP, Chronic Endometritis (CE, Endometrial Hyperplasia (EH, and Endometrial Adenocarcinoma (CA. Results: The most common bleeding pattern was menorrhagia (45.0% and the most common histopathological finding was PE+SE (52.0% in our study. PE+SE and endometrial hyperplasia without atypia were found more common in menorrhagia group. The most histopathological findings were found PE+SE in menometrorrhagia and polymenorrhea group (P 0.05. Conclusions: We concluded that although menometrorrhagia and polymenorrhea were significantly more associated with PE+SE, intermenstrual bleeding was significantly more associated with EP and CE. It is noteworthy that endometrial hyperplasia without atypia is significantly higher in patients with menorrhagia which is the most common abnormal bleeding pattern in perimenopausal aged women. [Int J Reprod Contracept Obstet Gynecol 2015; 4(3.000: 547-550

  8. Whipple's operation for carcinoma of the pancreatic head and the ampullary region. Short-and long-term results

    Sørensen, M B; Banner, Jytte; Rokkjaer, M; Jacobsen, N O


    In this retrospective review short- and long-term perspectives have been evaluated for 108 patients who, during 1982 through 1992, had Whipple's operation performed for carcinoma of the pancreatic head (PC, n=63) or the ampullary region (AC, n=45). In 24 patients the operation was not radical (21...

  9. Bleeding from gums: Can it be a dengue

    Rajat Bansal; Purnita Goyel; Dinesh. C. Agarwal


    Introduction: Bleeding from gums is a common feature in periodontitis patient. But abnormal bleeding from the gingiva or other areas of the oral mucosa that is difficult to control is an important clinical sign suggesting a hematological disorder. Case Report: A-40-year old male patient reported to our clinic with the chief complaint of acute gingival bleeding. There was continuous bleeding, fever since 3-4 days with weakness, retro orbital pain, and severe backache. Patient gave a history of...

  10. Bleeding from the pancreas - a comparison of imaging methods

    Roedl, W.; Nebel, G.; Englehard, K.


    Four patients with spontaneous bleeding from the pancreas are described. Transpapillary bleeding is diagnosed endoscopically. Angiography can demonstrate the eroded vessel directly. Ultrasound, CT and ERCP demonstrate the underlying abnormality in the pancreas. Bleeding into a cyst produces characteristic echoes, or an increase in density. NMR is able to demonstrate pancreatitis and pancreatic pseudo-cysts. Early diagnosis is extremely important, since without appropriate surgery, pancreatic bleeding is frequently fatal. 7 figs.

  11. Assessment of a water hydraulics joint for RH operations in the divertor region

    Due to the high level of radiations, all the nominal maintenance in the divertor region of ITER will be carried out with help of robotic means. In reduced volumes, hydraulic applications can provide powerful actuators. They become an interesting technology to build a heavy duty manipulator for operations in space constrained areas. Oil hydraulics can not ensure the cleanliness level required for all maintenance operations in the vacuum vessel. Therefore, pure water hydraulics proposes a good alternative to oil and developments are today focusing on that direction. Although basic hydraulic elements like pumps, on-off valves, filters running with pure water are already available on the market, actuators are not so many and generally limited to linear motions. Fine control of the joint is achieved with help of servovalves. Today's off the shelf products are only adaptations from standard oil servovalves and are not specifically designed for water use. Operational experience for these products shows short lifetime expectancy and could not last a complete shutdown. Starting from the oil hydraulic version CEA with help of Cybernetix redesigned for water applications the elbow vane actuator of a Maestro arm, a six-degrees-of-freedom hydraulic manipulator used in decommissioning activities. In parallel with help of In-LHC, CEA developed a servovalve for water hydraulic applications that fits the space constraints of a Maestro manipulator. This prototype is a pressure-control valve. To a current input this servovalve supplies a very accurate pressure difference output instead of a flow rate in the case of flow control servovalve that are generally used in that kind of applications. The advantage is the improvement of the performances and stability of the force control loop. This paper presents the performances of the modified vane actuator and its servovalve. Both static and dynamic responses of the servovalve prototype with and without actuator are presented. Position and

  12. CO{sub 2}MPARE. CO2 Model for Operational Programme Assessment in EU Regions. User Tutorial

    Hekkenberg, M. [ECN Policy Studies, Amsterdam (Netherlands); Vincent-Genod, C. [Energies Demain, Montreuil Sous Bois (France); Regina, P. [Italian National Agency for New Technologies, Energy and Sustainable Economic Development ENEA, Rome (Italy); Keppo, I. [University College London UCL, London (United Kingdom); Papagianni, S. [Centre for Renewable Energy Sources and Saving CRES, Pikermi Attiki (Greece); Harnych, J. [ENVIROS, Prague (Czech Republic)


    The CO2MPARE model supports national and regional authorities in making balanced decisions for their investment portfolio under their regional development programmes, in particular under their Operational Programmes of EU Regional Policy. This document is a tutorial for users of the CO2MPARE model and provides step by step guidance on the different functionalities of the model for both basic and expert users.

  13. Ultrasonographic evaluation of abnormal uterine bleeding in postmenopausal women

    Bindushree Kadakola


    Full Text Available Background: Objectives of current study were to diagnose causes of Abnormal Uterine Bleeding (AUB in postmenopausal women (PMW and to correlate it with curettage and histopathological findings, hysteroscopy and thereby minimizing unnecessary interventions in the form of operations and hysteroscopy where sonography depicts normal findings. Methods: After obtaining ethical clearance present prospective observational study was conducted from November 2010 to November 2012, to evaluate the endometrium in 50 postmenopausal women (PMW with bleeding per vagina referred to the department of Radio diagnosis by the department of gynaecology in Bangalore medical college and research institute. After applying inclusion and exclusion criterias the cases were evaluated with ultrasonography both transabdominal (TAS and transvaginal scan (TVS where ever necessary. Histopathological and hysteroscopic correlation was done in all cases. Results: 58% of the PMW with bleed were in the age group of 51-60 years. Most common cause of PMB was atrophic endometrium (44%, endometrial polyp (22%, followed by malignancy (14%, and hyperplastic endometrium (6%. At Endometrium thickness less than 4 mm there were nil chances of carcinoma. Conclusions: In women with AUB in postmenopausal age ultrasonography (USG can be considered as an initial imaging modality for diagnosing endometrial diseases. The sensitivity and specificity of USG for Atrophic endometrium is 100% and 84% respectively with accuracy of 100%, endometrial polyp the specificity is 100% with accuracy of 88%. For malignancy USG showed 100% specificity and accuracy of 100%. Hence USG is highly accurate for evaluating endometrial pathologies. Being noninvasive, less costly and good patient compliance USG should be considered as an initial imaging modality over invasive investigations like D and C, hysteroscopy in evaluating endometrial disorders. [Int J Reprod Contracept Obstet Gynecol 2015; 4(1.000: 229-234

  14. Experience with WASP and MAED among IAEA Member States participating in the Regional Co-operative Agreement (RCA) in Asia and the Pacific Region

    The report includes the proceedings and papers presented during the workshop on the experience with WASP/MAED computer programs among IAEA Member States participating in the regional co-operative agreement (RCA) in Asia and the Pacific Region, organized by the IAEA and held in Kuala Lumpur (Malaysia) between 5-9 December 1988. A separate abstract was prepared for each of the 14 papers presented. Refs, figs and tabs

  15. Effect of Desmopressin in Reducing Bleeding after Cardiac Surgery in Patients Receiving Anti-Platelet Agents

    Kamran Shadvar


    Full Text Available Background: Severe bleeding is an important cause of morbidity and mortality in cardiac surgery using the cardiopulmonary bypass (CPB pump. Desmopressin, a synthetic analogue of vasopressin, is used to prevent postoperative bleeding in patients with renal insufficiency. The aim of the present study was to evaluate the effect of desmopressin in reducing blood loss after cardiac surgery in patients receiving antiplatelet drugs. Methods: In this prospective clinical trial, 40 patients undergoing coronary artery bypass grafting (CABG surgery with CPB, aged over 18 years, and on antiplatelet therapy for a week before surgery were divided in two groups. Case and control groups received nasal desmopressin spray and nasal normal saline spray, respectively. Patient vital signs, blood loss, administration of blood products, prescription drugs to improve the coagulation status, serum and whole intake and output of patients, need for a second surgery to control the bleeding, remaining sternum open, mortality due to bleeding, duration of intensive care unit (ICU stay and mechanical ventilation were recorded. Results: In the case and control groups there were no differences in duration of operation, mechanical ventilation and length of ICU stay. There was no significant difference in terms of postoperative bleeding and intake of blood products between two groups (P>0.05. Reoperation due to bleeding in the case and control groups was observed in 3 (15%, and 1 (5% patient(s, respectively (P=0.3. Conclusion: Desmopressin has no significant effect on reducing the amount of bleeding after cardiac surgery in patients receiving anti-platelet agents. Keywords: CABG; cardio pulmonary bypass pump; hemorrhage; desmopressin 

  16. Scintigraphic detection and localization of gastrointestinal bleeding sites

    Successful management of acute gastrointestinal (GI) bleeding usually depends on accurate localization of the bleeding site. History and clinical findings are often misleading in determination of the site of hemorrhage. The widespread application of flexible endoscopy and selective arteriography now provide accurate diagnoses for the majority of patients bleeding from the upper GI tract, but lower GI bleeding still poses a serious diagnostic challenge. Endoscopy and barium studies are of limited value in examining the small bowel and colon in the face of active hemorrhage. Arteriography, although successful in many cases (3-5), has limitations. The angiographic demonstration of bleeding is possible only when the injection of contrast material coincides with active bleeding at a rate greater than 0.5 ml/min, and since lower GI bleeding is commonly intermittent rather than continuous, a high rate of negative angiographic examinations has been reported. The diagnosis of lower GI bleeding is usually easy to make. In contrast, localizing the site of bleeding may be extremely difficult. Using the techniques described the nuclear physician may be able to detect the bleeding site precisely. However, if the cautions detailed are not observed, the tracer studies will show GI bleeding, but not at the true bleeding site. This must be carefully understood and avoided. Done correctly, these tests can have a major impact on patient care

  17. Evaluation and outcomes of patients with obscure gastrointestinal bleeding

    Santhakumar, Cositha; Liu, Ken


    Obscure gastrointestinal bleeding (OGIB) is defined as recurrent or persistent bleeding or presence of iron deficiency anaemia after evaluation with a negative bidirectional endoscopy. OGIB accounts for 5% of gastrointestinal bleeding and presents a diagnostic challenge. Current modalities available for the investigation of OGIB include capsule endoscopy, balloon assisted enteroscopy, spiral enteroscopy and computed tomography enterography. These modalities overcome the limitations of previou...

  18. 14 CFR 23.1109 - Turbocharger bleed air system.


    ... Induction System § 23.1109 Turbocharger bleed air system. The following applies to turbocharged bleed air systems used for cabin pressurization: (a) The cabin air system may not be subject to hazardous... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Turbocharger bleed air system....

  19. Methods of Nuclear Medicine in gastrointestinal bleeding detection

    Several methods used in the diagnostic of gastrointestinal bleeding are presented. Two radioisotopic methods are considered the main ones: coloidal sulphur labeled with technetium-99m, more useful for low and acute bleeding and red blood cells labeled with technetium-99m, adequate for high and intermitent bleeding. (Author)

  20. Obesity and risk of bleeding : The SMART study

    Braekkan, S. K.; van der Graaf, Y.; Visseren, F. L J; Algra, A.


    Essentials: Whether obesity protects against clinically relevant bleeding is unclear. We investigated the risk of bleeding according to various measures of obesity in a cohort of 9736 patients. Obesity was not associated with a lower risk of bleeding. The procoagulant profile in obese subjects may n

  1. Endoscopic Management of Bleeding Ectopic Varices With Histoacryl


    Bleeding from antral and duodenal varices is an uncommon feature in patients with portal hypertension. We report a patient with cirrhosis and portal vein thrombosis, who had a massive bleed from antral and duodenal varices. Bleeding was controlled with endoscopic injection of varices using histoacryl. Endoscopic treatment and the relatively uncommon occurrence of antral and duodenal varices are highlighted.

  2. Fatiguing effect of multiple take-offs and landings in regional airline operations.

    Honn, Kimberly A; Satterfield, Brieann C; McCauley, Peter; Caldwell, J Lynn; Van Dongen, Hans P A


    Fatigue is a risk factor for flight performance and safety in commercial aviation. In US commercial aviation, to help to curb fatigue, the maximum duration of flight duty periods is regulated based on the scheduled start time and the number of flight segments to be flown. There is scientific support for regulating maximum duty duration based on scheduled start time; fatigue is well established to be modulated by circadian rhythms. However, it has not been established scientifically whether the number of flight segments, per se, affects fatigue. To address this science gap, we conducted a randomized, counterbalanced, cross-over study with 24 active-duty regional airline pilots. Objective and subjective fatigue was compared between a 9-hour duty day with multiple take-offs and landings versus a duty day of equal duration with a single take-off and landing. To standardize experimental conditions and isolate the fatiguing effect of the number of segments flown, the entire duty schedules were carried out in a high-fidelity, moving-base, full-flight, regional jet flight simulator. Steps were taken to maintain operational realism, including simulated airplane inspections and acceptance checks, use of realistic dispatch releases and airport charts, real-world air traffic control interactions, etc. During each of the two duty days, 10 fatigue test bouts were administered, which included a 10-minute Psychomotor Vigilance Test (PVT) assessment of objective fatigue and Samn-Perelli (SP) and Karolinska Sleepiness Scale (KSS) assessments of subjective sleepiness/fatigue. Results showed a greater build-up of objective and subjective fatigue in the multi-segment duty day than in the single-segment duty day. With duty start time and duration and other variables that could impact fatigue levels held constant, the greater build-up of fatigue in the multi-segment duty day was attributable specifically to the difference in the number of flight segments flown. Compared to findings in

  3. The achievements of the IAEA's regional programmes of technical co-operation in the applications of radiation and radioisotopes

    The IAEA's regional technical co-operation programmes are rapidly expanding because of (i) the desire of Member States to increase the degree of regional self-sufficiency in a number of nuclear technologies which cannot currently be sustained nationally; (ii) the efficiency of co-ordinating the approach to problems in the agricultural, health, industrial and resources fields which are inherently regional because of similarities of climate, demographic factors and macro-economic conditions; (iii) the desirability of increasing intra-regional trade which may require a unified approach to the qualification and certification of key technical personnel; and (iv) the expressed desire of a number of countries to use technical co-operation to encourage wider interaction within the region. The approach to regional technical co-operation varies from region to region. Within Asia and the Pacific, virtually all the regional projects are administered within the framework of the intergovernmental Regional Co-operative Agreement (RCA). In Latin America, the corresponding arrangement ARCAL is based on guidelines agreed between the IAEA and the National Atomic Energy authorities. The future arrangements for Africa, Eastern Europe and the Middle East are under active consideration. As major achievements of the programme reference may be made to the rapidly increasing investment in industrial radiation and radiation technology in Asia; to the improvements in liver diagnosis and cancer therapy in Asia; to the extensive NDT training programme in Latin America, to the successful programme of water resources evaluation in Africa and the introduction of reactor safety analysis methodology in the Middle East and Europe. These and other examples will be analysed and conclusions drawn concerning the likely trends within the regional programmes. (author)

  4. The Korean Peninsula Energy Development Organization : implications for Northeast Asian regional security co-operation?

    This paper identifies opportunities for co-operation on regional development and security in the North Pacific region. The Korean Peninsula Energy Development Organization (KEDO) was created in 1993 during bilateral negotiations between the United States and the Democratic People's Republic of Korea (US-DPRK) over North Korea's alleged nuclear weapons program. The negotiations resulted in an agreement to freeze North Korea's known nuclear weapons program in return for the construction of two proliferation-resistant 100 MWe light water reactors (LWR) in North Korea, and the provision of 500,000 tons of heavy fuel oil per year until the completion of the LWR construction as compensation for lost energy production capacity resulting from the shutting down of North Korea's nuclear reactors. The author described the activities of KEDO and examined its internal dynamics. The unique circumstances that produced the Agreed Framework and KEDO in response to a major international crisis of the nuclear program in the DPRK were also highlighted along with the US-DPRK bilateral agreement and the multilateral institution involving the United States, South Korea, Japan and the European Union. Financial support from Australia and Canada was discussed along with the mechanism for engaging North Korea in regularized interaction and technical cooperation. It was concluded that KEDO's record of successes and failures is mixed. The energy security issue has been identified as an area that could result in conflict among Northeast Asian countries which are increasingly dependent on oil supplies from the Middle East. In response, numerous multilateral financing mechanisms have been developed to promote joint business opportunities that exploit natural gas resources in the Russian Far East to address Japanese, Korean and Chinese energy needs. 35 refs

  5. Applying micro scales of horizontal axis wind turbines for operation in low wind speed regions

    Highlights: • Three micro-turbines with output power less than 1 kW were designed for operation in low wind speed regions. • In addition to the output power, starting time was considered as a key parameter during the design. • The effects of generator resistive torque and number of blades on the performance of the turbines were investigated. - Abstract: Utilizing the micro scales of wind turbines could noticeably supply the demand for the electricity in low wind speed regions. Aerodynamic design and optimization of the blade, as a main part of a wind turbine, were addressed in the study. Three micro scales of horizontal axis wind turbines with output power of 0.5, 0.75 and 1 kW were considered and the geometric optimization of the blades in terms of the two involved parameters, chord and twist, was undertaken. In order to improve the performance of the turbines at low wind speeds, starting time was included in an objective function in addition to the output power – the main and desirable goal of the wind turbine blade design. A purpose-built genetic algorithm was employed to maximize both the output power and the starting performance which were calculated by the blade-element momentum theory. The results emphasize that the larger values of the chord and twist at the root part of the blades are indispensable for the better performance when the wind speed is low. However, the noticeable value of the generator resistive torque could largely delay the starting of the micro-turbines especially for the considered smaller size, 0.5 kW, where the starting aerodynamic torque could not overcome the generator resistive torque. For that size, an increase in the number of blades improved both the starting performance and also output power

  6. Investigation of Tractor Base Bleeding for Heavy Vehicle Aerodynamic Drag Reduction

    Ortega, J; Salari, K; Storms, B


    One of the main contributors to the aerodynamic drag of a heavy vehicle is tractor-trailer gap drag, which arises when the vehicle operates within a crosswind. Under this operating condition, freestream flow is entrained into the tractor-trailer gap, imparting a momentum exchange to the vehicle and subsequently increasing the aerodynamic drag. While a number of add-on devices, including side extenders, splitter plates, vortex stabilizers, and gap sealers, have been previously tested to alleviate this source of drag, side extenders remain the primary add-on device of choice for reducing tractor-trailer gap drag. However, side extenders are not without maintenance and operational issues. When a heavy vehicle pivots sharply with respect to the trailer, as can occur during loading or unloading operations, the side extenders can become crushed against the trailer. Consequently, fleet operators are forced to incur additional costs to cover the repair or replacement of the damaged side extenders. This issue can be overcome by either shortening the side extenders or by devising an alternative drag reduction concept that can perform just as effectively as side extenders. To explore such a concept, we investigate tractor base bleeding as a means of reducing gap drag. Wind tunnel measurements are made on a 1:20 scale heavy vehicle model at a vehicle width-based Reynolds number of 420,000. The tractor bleeding flow, which is delivered through a porous material embedded within the tractor base, is introduced into the tractor-trailer gap at bleeding coefficients ranging from 0.0-0.018. To determine the performance of tractor base bleeding under more realistic operating conditions, computational fluid dynamics simulations are performed on a full-scale heavy vehicle within a crosswind for bleeding coefficients ranging from 0.0-0.13.

  7. Management of disseminated bleeding in a patient with multiple malignomas using rotation thromboleastometry

    Kolbenschlag, Jonas


    Full Text Available [english] We report on a case of Klippel-Trenaunay syndrome with a histologically diagnosed dedifferentiated angiosarcoma. During operative tumor debulking, a disseminated bleeding developed which required a massive transfusion of red blood cell concentrates and therapeutic plasma. While plasmatic coagulation was within normal range, thromboelastometry showed a distinct hyperfibrinolysis. The bleeding was controlled by prolonged cauterisation and the substitution of tranexam acid as well as fresh frozen plasma. As a result of this treatment, hyperfibrinolysis showed complete restitution within a few hours. Histologically, a malignant peripheral nerve sheat tumor, a dedifferentiated angiosarcoma, a spindle cell sarcoma and an osteosarcoma were diagnosed within the tissue samples.

  8. Polyclonal gammopathy related to renal bleeding in a peritoneal dialysis patient

    Eun-Mi Cho


    Full Text Available Polyclonal gammopathy represents the diffuse activation of B cells and is usually related to inflammation or immune-related diseases. However, the mechanisms leading to polyclonal gammopathy are essentially speculative. Generally, infectious, inflammatory, or various other reactive processes may be indicated by the presence of a broad-based peak or band in the gamma region on serum protein electrophoresis results. A 15-year-old girl, who had been receiving peritoneal dialysis, presented with polyclonal gammopathy and massive gross hematuria. Renal artery embolization was performed, after which the continuous bleeding subsided and albumin-globulin dissociation resolved. This is a rare case of polyclonal gammopathy related to renal bleeding.

  9. Tranexamic acid for upper gastrointestinal bleeding

    Bennett, Cathy; Klingenberg, Sarah Louise; Langholz, Ebbe;


    2011. The number of participants randomly assigned ranged from 47 to 216 (median 204). All trials reported mortality. In total, 42 of 851 participants randomly assigned to tranexamic acid and 71 of 850 in the control group died (RR 0.60, 95% CI 0.42 to 0.87; P value 0.007; I² = 0%). The analysis was...... review will be much more informative in a few years. Further examination of tranexamic acid would require inclusion of high-quality randomised controlled trials. Timing of randomisation is essential to avoid attrition bias and to limit the number of withdrawals. Future trials may use a pragmatic design...... and should include all participants with suspected bleeding or with endoscopically verified bleeding, as well as a tranexamic placebo arm and co-administration of pump inhibitors and endoscopic therapy. Assessment of outcome measures in such studies should be clearly defined. Endoscopic examination...

  10. Reoperation for bleeding in cardiac surgery

    Kristensen, Katrine Lawaetz; Rauer, Line Juul; Mortensen, Poul Erik; Kjeldsen, Bo Juel


    At Odense University Hospital (OUH), 5-9% of all unselected cardiac surgical patients undergo reoperation due to excessive bleeding. The reoperated patients have an approximately three times greater mortality than non-reoperated. To reduce the rate of reoperations and mortality due to postoperative...... bleeding, we aim to identify risk factors that predict reoperation. A total of 1452 consecutive patients undergoing cardiac surgery using extracorporeal circulation (ECC) between November 2005 and December 2008 at OUH were analysed. Statistical tests were used to identify risk factors for reoperation. We...... after cardiac surgery was low ejection fraction, high EuroSCORE, procedures other than isolated CABG, elongated time on ECC, low body mass index, diabetes mellitus and preoperatively elevated s-creatinine. Reoperated patients significantly had a greater increase in postoperative s-creatinine and higher...

  11. Bleeding risk in 'real world' patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort

    Olesen, J B; Lip, G Y H; Hansen, P R;


    Oral anticoagulation (OAC) in patients with atrial fibrillation (AF) is a double-edged sword, because it decreases the risk of stroke at the cost of an increased risk of bleeding. We compared the performance of a new bleeding prediction scheme, HAS-BLED, with an older bleeding prediction scheme, ......, HEMORR(2)HAGES, in a cohort of 'real-world' AF patients....

  12. Clinical application of Hawkeye VG SPECT/CT imaging in the bleeding position of lower gastrointestinal

    Objective: To evaluate the clinical application of Hawkeye VG SPECT/CT imaging on diagnosing and locating lower gastrointestinal bleeding using in vivo labeling 99Tcm-RBC. Methods: Fifty-six patients (42 males, 14 females, age ranging from 10 to 76 years) who had definite lower gastrointestinal bleeding were studied retrospectively. All patients had intravenous injection with 370 MBq 99Tcm-RBC and then underwent planar, SPECT, and CT imaging respectively in the abdomen before exploratory laparotomy. Images from SPECT and CT were fused thereafter to locate the active bleeder, if any. χ2 test was performed to show the differences of diagnostic sensitivity and accuracy between planar and SPECT/CT imaging. Results: In 56 patients with lower gastrointestinal bleeding, 50 patients showed abnormally concentrated radionuclide activity with planar images and 52 patients showed the similar imaging pattern with SPECT/CT. Among these patients, concordant bleeding with operation findings was found in 31 patients with planar images and 48 patients with SPECT/CT images. The sensitivity and accuracy were 89.3% (50/56) and 73.8% (31/42) in planar images, and 92.9% (52/56) and 92.3% (48/52) in SPECT/CT images (χ2=0.11, P>0.05; χ2=4.63, P<0.05). Conclusion: Hawkeye VG SPECT/CT imaging shows an effective, simple and accurate method and could be used for diagnosing and locating lower gastrointestinal bleeding. (authors)


    Popescu (Stîngaciu Ana-Maria


    Full Text Available The analysis of the administrative capacity of institutions in the regional development starts from the analysis of the existing framework for the implementation of regional politics in Romania and studies the extent to what the structures and competencies were regionally enlarged as to contribute in the regional development. The basic hypothesis considered for such analysis had in view the fact that the differences recorded with respect to the implementation capacity of the regional development policy are caused by the various levels of the administrative capacity of the national, regional and local institutions existent in Romania. Although the regional development activity is, both centrally and regionally, dominated by the Regional Operational Programmme 2007-2013 (ROP implementation, significant activity also exists outside the ROP, but only regionally. The regional strategies incorporate to a great extent the strategic objectives established nationally, being coordinated with the national financing instruments for economic, social and territorial development. The undertaking degree of responsibilities regarding the objectives fulfillment of the regional development policy is relatively low both regionally and locally, and the main indicator which contributes in sustaining this conclusion is the absence of an adequate level regarding the property holding on certain strategies and also the methodological lack of strategies. Nationally, the current activity of Ministry of Regional Development and Tourism in the field of regional development totally overlaps the management activity of ROP. The management of structural funds 2007-2013 granted through ROP deals with various situations in which, due to the fact that the Law of regional development remained behind the legislation for the structural instruments implementation in Romania, additional resources are necessary to be granted in order to be found solutions through other types of

  14. Sedimentation and Bleeding of Cement Paste

    Peng, Ya


    The lower viscosity and high matrix volume of Self-Compacting Concrete (SCC) compared to ordinary concrete can lead to instability in the form of particle segregation, sedimentation and bleeding. This is a problem for the exploitation of all the benefits from the use of SCC for the ready mix industry and contractors. This research started from the investigation on the main factors influencing the stability of the paste as well as the applicability of generally used theories on particle sedime...

  15. Otorrhagia bleeding due to leech bite

    Narges Askari; Afrooz Eshaghian


    Leeches are blood-sucking hermaphroditic parasites that attach to vertebrate hosts, bite through the skin, and suck out blood. When leeches feed, they secrete an anticoagulant (hirudin), which helps them get a full meal of blood. This is the first report of leech removal from external auditory canal. Previous leech involvement cases were explained in nasopharynx, larynx, pharynx, eye, and gastrointestinal tract. Prominent sign of all cases was active bleeding from the leech attachment site; t...

  16. Experience with WASP among IAEA Member States participating in the Regional Co-operative Agreement (RCA) in Asia and the Pacific Region

    The document contains the proceedings and the 15 papers presented during the Regional Co-operative Agreement (RCA) Workshop on the WASP Computer Program held in Jakarta, Indonesia, 7-11 December 1987. A separate abstract was prepared for each paper. Refs, figs and tabs

  17. Jejunal angiodysplasia causing recurrent gastrointestinal bleeding presenting as severe anaemia and melena.

    Tiwary, Satyendra K; Hakim, Md Zeeshan; Kumar, Puneet; Khanna, Ajay Kumar


    Angiodysplasia of the gastrointestinal (GI) tract consists of ectasia of the submucosal vessels of the bowel. The evaluation of such patients needs proctoscopy, colonoscopy, small bowel enema, enteroscopy, capsule enteroscopy and angiography. Capsule enteroscopy has come up as an alternative to GI enteroscopy and colonoscopy in patients with occult GI bleeding; up to 52% cases of small bowel angiodysplasia in patients with occult GI bleed with negative upper GI and colonoscopy have been reported. The use of capsule enteroscopy potentially limits the hazard of radiation exposure from angiography and is less invasive than double balloon endoscopy. The treatment options for angiodysplasias include intra-arterial vasopressin injection, selective gel foam embolisation, endoscopic electrocoagulation and injection of sclerosants, with each of these being technically demanding, and requiring centres with good access to enteroscopy technology and trained gastroenterologists. Operative intervention has been indicated for refractory bleeding or lesions in sites not accessible to endoscopic interventions. PMID:26567241

  18. Treatment of bleeding gastroesophageal varices: a report of forty-four cases.

    Tay, S K; Leong, Y P; Meah, F A; Abdullah, T; Zain, A R


    Bleeding gastroesophageal varices is associated with a high morbidity and mortality. Forty-four cases of bleeding gastroesophageal varices were treated at the Department of Surgery, Universiti Kebangsaan Malaysia, General Hospital, Kuala Lumpur over four and a half years. Thirty-two of them had liver cirrhosis. Hepatitis B infection was noted in 13 and alcoholic abuse was present in 14 patients. Five patients had associated hepatoma. Thirty-four percent had gastric fundal varices and a third of these bled from them. A total of 179 endoscopic injection sclerotherapy sessions were performed averaging 4 per person. Rebleeding rate was 4% and mortality was high (50%) in these cases. It was concluded that injection sclerotherapy is a safe and effective means of controlling bleeding oesophageal varices. Operative surgery was employed in those who rebled after injection and would be considered in those in Child's A. PMID:1303478

  19. Traumatic intercostal arterial bleeding controlled with a novel surgical technique: a case report

    Miettinen Simo


    Full Text Available Abstract Introduction A blunt thoracic trauma may cause arterial bleeding requiring operative treatment or endovascular embolization or endovascular aortic stenting. A novel damage control technique to stop such bleeding is presented. Case presentation We present the case of an 82-year-old Caucasian man who experienced rib fractures I-VII on the left side and bleeding from damaged intercostal arteries after a blunt thoracic trauma. Emergency thoracotomy was performed. Conclusions Effective hemostasis was achieved by using a rolled surgical swab and inserting it against the chest wall next to the aorta with sutures pulled through the intercostal muscles and then sutured to the back side of the patient. The patient died four days after the surgery due to a head injury sustained in the car crash.

  20. Single session treatment for bleeding hemorrhoids

    Weinstein, S.J.; Rypins, E.B.; Houck, J.; Thrower, S.


    Fifty consecutive outpatients with bleeding internal hemorrhoids were prospectively treated with a single application of rubber band ligation or infrared coagulation. Complete follow-up observation was obtained in 48 patients (23 underwent rubber band ligation and 25 underwent infrared coagulation). At one month after treatment, 22 patients who underwent rubber band ligation and 16 who underwent infrared coagulation, were symptomatically improved (p less than 0.05). At six months, 15 patients who had undergone rubber band ligation and ten who had infrared coagulation treatment, remained improved (p less than 0.05). There was no statistical difference in the discomfort experienced by either group during or after the procedure as determined by a self-assessment scale. Two patients who underwent rubber band ligation experienced complications--a thrombosed external hemorrhoid developed in one patient and another had delayed rectal bleeding. Although associated with occasional complications after treatment, rubber band ligation is more effective than in infrared coagulation for single session treatment of bleeding internal hemorrhoids.

  1. Endoscopic hemoclip treatment for bleeding peptic ulcer

    Yung Chih Lai; Sien Sing Yang; Chi Hwa Wu; Tzen Kwan Chen


    AIM To evaluate the efficacy of endoscopic hemoclip in the treatment of bleeding peptic ulcer.METHODS Totally, 40 patients with F1a and F1b hemorrhagic activity of peptic ulcers were enrolled in this uncontrolled prospective study for endoscopic hemoclip treatment. We used a newly developed rotatable clip-device for the application of hemoclip (MD850) to stop bleeding. Endoscopy was repeated if there was any sign or suspicion of rebleeding, and reclipping was performed if necessary and feasible.RESULTS Initial hemostatic rate by clipping was 95%, and rebleeding rate was only 8%.Ultimate hemostatic rates were 87%, 96%, and 93% in the F1a and F1b subgroups, and total cases, respectively. In patients with shock on admission, hemoclipping achieved ultimate hemostasis of 71% and 83% in F1a and F1b subgroups, respectively. Hemostasis reached 100% in patients without shock regardless of hemorrhagic activity being F1a or F1b. The average number of clips used per case was 3.0 (range 2- 5). Spurting bleeders required more clips on average than did oozing bleeders (3.4 versus 2.8 ). We observed no obvious complications, no tissue injury, or impairment of ulcer healing related to hemoclipping.CONCLUSION Endoscopic hemoclip placement is an effective and safe method. With the improvement of the clip and application device,the procedure has become easier and much more efficient. Endoscopic hemoclipping deserves further study in the treatment of bleeding peptic ulcers.

  2. [Obscure digestive bleeding by ileal carcinoid tumor].

    Nelly Manrique, María; Frisancho, Oscar; Zumaeta, Eduardo; Palomino, Américo; Rodriguez, César


    The patient is an 82 year-old female with a history of osteoarthritis, hypothyroidism and anemia for 14 years (receiving blood transfusions). She was admited to our hospital with a nine months history of malaise, anorexia, fatigue and weakness, associated with intermitten episodes of abdominal pain. She was diagnosed anemia and occult blood positive stools. Physical examination revealed a patient in generally fair condition, obese, with mild edema of lower limbs, no changes in the evaluation of chest, cardiovascular, abdomen, etc. Laboratory data was unremarkable, except for iron deficiency anemia. The upper endoscopy showed duodenal ulcer scar, fundic polyposis and chronic gastritis. Colonoscopy revealed some diverticula, a small sessile polyp and internal hemorrhoids. The diagnosis of obscure gastrointestinal bleeding was made. The CT scan of the abdomen showed gallstones and fatty liver; a radiograph of intestinal transit detected a lesion apparently protruded intestinal loop for distal jejunum; enteroscopy was performed (with one team ball) anterograde and retrograde achieving assess distal jejunum and distal ileum without observing any injuries. The study of capsule endoscopy showed a polypoid tumor intestinal with evidence of having bleeding. Surgery detected the tumor in proximal ileum. The surgical specimen findings showed three tumors 0.7 mm, 10 mm and 15 mm on the proximal ileum. The microscopic examination revealed that these lesions were neuroendocrine tumors (carcinoid). The Ileal carcinoid tumor may rarely presented with obscure gastrointestinal bleeding. PMID:21544161

  3. Absence of Helicobacter pylori is not protective against peptic ulcer bleeding in elderly on offending agents: lessons from an exceptionally low prevalence population

    Yeong Yeh Lee


    Full Text Available Aim. Helicobacter pylori (H. pylori infection is exceptionally rare in population from the north-eastern region of Peninsular Malaysia. This provides us an opportunity to contemplate the future without H. pylori in acute non-variceal upper gastrointestinal (GI bleeding. Methods. All cases in the GI registry with GI bleeding between 2003 and 2006 were reviewed. Cases with confirmed non-variceal aetiology were analysed. Rockall score > 5 was considered high risk for bleeding and primary outcomes studied were in-hospital mortality, recurrent bleeding and need for surgery. Results. The incidence of non-variceal upper GI bleeding was 2.2/100,000 person-years. Peptic ulcer bleeding was the most common aetiology (1.8/100,000 person-years. In-hospital mortality (3.6%, recurrent bleeding (9.6% and need for surgery (4.0% were uncommon in this population with a largely low risk score (85.2% with score ≤5. Elderly were at greater risk for bleeding (mean 68.5 years, P = 0.01 especially in the presence of duodenal ulcers (P = 0.04 despite gastric ulcers being more common. NSAIDs, aspirin and co-morbidities were the main risk factors. Conclusions. The absence of H. pylori infection may not reduce the risk of peptic ulcer bleeding in the presence of risk factors especially offending drugs in the elderly.

  4. Australia's co-operation under the framework of the Asian Regional Co-operative Project on Food Irradiation

    The second phase of the Asian Regional Project on Food Irradiation (RPFI) became effective on 11 April 1985, and will last for three years, with Australia as the funding country. The first major activity was a two-week Workshop on the Commercialization of Ionising Energy Treatments of Food, held at the Australian School of Nuclear Technology from 29 April to 10 May, 1985, attended by representatives from eight RPFI countries and two observers from New Zealand. Studies of the transportation irradiated foods under commercial conditions are an integral part of the Project. Results of shipping/airfreight trials between Thailand and Australia of Nan Klang Won mangoes and frozen shrimps are presented. These trials were successful as irradiated produce shipped under commercial conditions reached its destination in good, marketable condition. (author). 3 refs

  5. Plate Boundary Observatory Southwest Region Network Operations, Expansion and Communications Hardening

    Mann, D.; Walls, C. P.; Basset, A.; Turner, R.; Lawrence, S.; Feaux, K.; Mattioli, G. S.


    The Southwest Region of the Plate Boundary Observatory manages 480 continuously operating GPS stations located principally along the transform system of the San Andreas fault, Eastern California Shear Zone and the northern Baja peninsula. In the past year, network uptime averaged 98% with greater than 99% data acquisition. In an effort to modernize the network, we have started to replace Trimble NETRS receivers with GNSS capable NETR9 receivers. Currently, we have 431 NetRS receivers deployed in the region, and 48 NetR9 receivers. In addition, 82 stations (17%) stream 1 Hz data over the VRS3Net typically with 92%. Based on their typical data download rates, approximately 252 (53%) of all stations are capable of streaming 1 Hz, but have not yet been added to the real time network because of lack of resources. In the immediate aftermath of the M8.2 Chile earthquake in April 2014, high rate data downloads from the entire SW network had a success rate of 95% and 71% for 1 Hz and 5 Hz data downloads respectively. We have continued to upgrade critical radio networks, including the San Francisco Bay Area, Anza Borrego, and Santa Barbara networks. These efforts are ongoing, but they have already significantly improved data download rates and dependability. We are also converting cell modem to radio communications whenever possible for increased reliability and cost savings. In December 2013 the 13-station Edison network expansion was completed through cost recovery contracts. These stations span coastal southern California in Orange, San Diego and Los Angeles counties including a hybrid site on the Elly oil platform. The primary purpose of the stations is to aid in the seismic source characterization of the San Onofre Nuclear Generating Station and assess the strain field associated with the Oceanside Blind Thrust and Newport Inglewood fault. The new stations fill a gap between SCIGN and PBO. Three sites have WXT520 Vaisala metpacks and twelve stations stream 1Hz data via

  6. Co-operation and Competition in Regional Economic Development Associated with Radioactive Waste Management

    Competition and co-operation appear in many different social venues. The author gives a variety of examples of co-operative behaviour in economics, politics, research, and everyday life activities such as sports. These four diverse examples illustrate the variety of forms that co-operation may take such as tacit co-operation, incremental co-operation, deep co-operation, etc. The links with the form of democracy (adversary democracy or consensual democracy) are also pointed. However, as with so many other things in life, the key is to the question of co-operation or competition is balance. Co-operation and competition are dialectical opposites. They create and maintain and define each other; they each are incomplete without the other

  7. Demographic Characteristics of 796 Patients Operated for Lumbar Disc Herniation in Thrace Region, Turkey

    Emre Delen


    Full Text Available Aim: This study was designed was to determine the demographic characteristics of patients operated for lumbar disc herniation in Thrace Region, Turkey. Material and Method: We retrospectively searched our data to find out patients who had one sided, one level and only one spinal surgical intervention for herniated lumbar disc. Results: Among 796 cases, 336 (42% were men and 460 (58% were women. The level of the pathology is determined as L1 - 2 for 4 cases (0.5%, L2 - 3 for 15 cases (1.9%, L3 - 4 for 51 cases (6.4%, L4 - 5 for 412 cases (51.8% and as L5 - S1 on 314 cases (39.4%. While a total of 70 cases (8.9% were identified on upper-levels ( L1 %u2013 2, L2 %u2013 3, L3 %u2013 4; 726 cases (91.1% were found to be on lower-levels ( L4 %u2013 5, L5 - S1. A mild positive correlation between the pathology level and physical activity intensity (P < 0.05, P = 0.103 has been demonstrated; as well as a strong negative correlation between pathology level and mean age (P < 0.05, P = -0.404. Discussion: The demographic characteristics are consistent with the literature. Physical activity intensity influence on lower-level herniations might have significance due to the large sample size. The strong negative correlation between pathology level and mean age suggests that the degeneration raises the frequency of upper-level herniations.

  8. Comparison of detectable bleeding rates of radiopharmaceuticals for localization of gastrointestinal bleeding in sheep using a closed system

    Owunwanne, A.; Sadek, S.; Yacoub, T.; Awdeh, M.; Abdel-Dayem, H.M. (Kuwait Univ. (Kuwait). Dept. of Nuclear Medicine); Al-Wafai, I.; Vallgren, S. (Kuwait Univ. (Kuwait). Dept. of Surgery)


    The closed experimental animal model system was used to compare the detectable gastrointestinal (GI) bleeding rates of {sup 99m}Tc-DTPA, {sup 99m}Tc-RBCs and {sup 99m}Tc tin colloid in sheep. The three radiopharmaceuticals were used to detect the upper GI bleeding sites at rates of 0.57 and 0.25 ml/min. At the lower bleeding rate of 0.1 ml/min, both {sup 99m}Tc-DTPA and {sup 99m}Tc-RBCs were successful in detecting the bleeding site. At the lowest rate of 0.07 ml/min only {sup 99m}Tc-DTPA was successful in detecting the bleeding site. The results indicate that {sup 99m}Tc-DTPA is the most useful {sup 99m}Tc radiopharmaceutical for detecting the upper GI bleeding site at the slowest bleeding rate studied. (orig.).

  9. Life threatening bleeding from duodenal ulcer after Roux-en-Y gastric bypass: Case report and review of the literature

    Arpad; Ivanecz; Marko; Sremec; Davorin; ?erani?; Stojan; Potr?; Pavel; Skok


    Acute upper gastrointestinal bleeding is a rare, but serious complication of gastric bypass surgery. The inaccessibility of the excluded stomach restrains postoperative examination and treatment of the gastric remnant and duodenum, and represents a major challenge, especially in the emergency setting. A 59-year-old patient with previous history of peptic ulcer disease had an upper gastrointestinal bleeding from a duodenal ulcer two years after having a gastric bypass procedure for morbid obesity. After negative upper endoscopy finding, he was urgently evaluated for gastrointestinal bleeding. At emergency laparotomy, the bleeding duodenal ulcer was identified by intraoperative endoscopy through gastrotomy. The patient recovered well after surgical hemostasis, excision of the duodenal ulcer and completion of the remnant gastrectomy. Every general practitioner, gastroenterologist and general surgeon should be aware of growing incidenceof bariatric operations and coherently possible complications after such procedures, which modify patient’s anatomy and physiology.

  10. Bleeding risk assessment and management in atrial fibrillation patients: a position document from the European Heart Rhythm Association, endorsed by the European Society of Cardiology Working Group on Thrombosis.

    Lip, Gregory Y H; Andreotti, Felicita; Fauchier, Laurent; Huber, Kurt; Hylek, Elaine; Knight, Eve; Lane, Deirdre A; Levi, Marcel; Marin, Francisco; Palareti, Gualtiero; Kirchhof, Paulus; Collet, Jean-Philippe; Rubboli, Andrea; Poli, Daniela; Camm, John


    Despite the clear net clinical benefit of oral anticoagulation (OAC) in atrial fibrillation (AF) patients at risk for stroke, major bleeding events (especially intra-cranial bleeds) may be devastating events when they do occur. The decision for OAC is often based on a careful assessment of both stroke risk and bleeding risk, but clinical scores for bleeding risk estimation are much less well validated than stroke risk scales. Also, the estimation of bleeding risk is rendered difficult since many of the known factors that increase bleeding risk overlap with stroke risk factors. As well as this, many factors that increase bleeding risk are transient, such as variable international normalized ratio values, operations, vascular procedures, or drug-drug and food-drug interactions. In this Position Document, we comprehensively review the published evidence and propose a consensus on bleeding risk assessments in AF patients, with a view to summarizing 'best practice' when approaching antithrombotic therapy in AF patients. We address the epidemiology and size of the problem of bleeding risk in AF and review established bleeding risk factors. We also summarize definitions of bleeding in the published literature. Patient values and preferences balancing the risk of bleeding against thrombo-embolism is reviewed, and the prognostic implications of bleeding are discussed. We also review bleeding risk stratification and currently published bleeding risk schema. A brief discussion of special situations [e.g. peri-ablation, peri-devices (implantable cardioverter-defibrillator, pacemakers) and presentation with acute coronary syndromes and/or requiring percutaneous coronary interventions/stents and bridging therapy], as well as a discussion of prevention of bleeds and managing bleeding complications, is made. Finally, this document also puts forwards consensus statements that may help to define evidence gaps and assist in everyday clinical practice. Bleeding risk is almost

  11. Regional lung function impairment following post-operative radiotherapy for breast cancer using direct of tangential field techniques

    The effect of tangential and direct irradiation on regional lung function in 22 consecutive patients with breast cancer, treated by post-operative irradiation 3 months prior to examination. The tangential technique (total dose 32-36 Gy, 99Tcsup(m)-DTPA. Results were inconclusive, due to variable smoking habits. It is concluded that regional lung function was not significantly affected by the tangential technique, contrasting with a pronounced and harmful effect of the direct technique. (U.K.)

  12. Regional energy markets and the cost of natural flow dam operation

    Sparrow, F.T.; Preckel, P.V.; Gotham, D.J. [Purdue University, Energy Center at Discovery Park, West Lafayette, IN (United States); Bowen, B.H. [American University in Kosovo, Pristina (RS); Yu, Z. [EmberClear, Inc., Houston, TX (United States)


    With the proliferation of electricity markets for the purchase and sale of firm and non-firm power and capacity, the possibility exists for using trade in these commodities to minimize the cost impact of operating dams to restore downstream flows to pre-dam patterns - so called Run of River (ROR) dam operation. We examine the impact of such markets on the incremental costs of ROR operation relative to least cost operation via a stochastic, dynamic optimization model. We identify features of the dam structure and of the economic environment that are critical to achieving ROR operation at modest incremental cost. (orig.)

  13. Endoscopic hemostasis state of the art - Nonvariceal bleeding.

    Goelder, Stefan Karl; Brueckner, Juliane; Messmann, Helmut


    New endoscopic techniques for hemostasis in nonvariceal bleeding were introduced and known methods further improved. Hemospray and Endoclot are two new compounds for topical treatment of bleeding. Initial studies in this area have shown a good hemostatic effect, especially in active large scale oozing bleeding, e.g., tumor bleedings. For further evaluation larger prospective studies comparing the substanced with other methods of endoscopic hemostasis are needed. For localized active arterial bleeding primary injection therapy in the area of ​​bleeding as well as in the four adjacent quadrants offers a good method to reduce bleeding activity. The injection is technically easy to learn and practicable. After bleeding activity is reduced the bleeding source can be localized more clearly for clip application. Today many different through-the-scope (TTS) clips are available. The ability to close and reopen a clip can aid towards good positioning at the bleeding site. Even more important is the rotatability of a clip before application. Often multiple TTS clips are required for secure closure of a bleeding vessel. One model has the ability to use three clips in series without changing the applicator. Severe arterial bleeding from vessels larger than 2 mm is often unmanageable with these conventional methods. Here is the over-the-scope-clip system another newly available method. It is similar to the ligation of esophageal varices and involves aspiration of tissue into a transparent cap before closure of the clip. Thus a greater vascular occlusion pressure can be achieved and larger vessels can be treated endoscopically. Patients with severe arterial bleeding from the upper gastrointestinal tract have a very high rate of recurrence after initial endoscopic treatment. These patients should always be managed in an interdisciplinary team of interventional radiologist and surgeons. PMID:26962402

  14. Spectrum of histopathological findings in postmenopausal bleeding

    To determine the frequencies of histopathological findings in endometrial and endocervical biopsy samples with clinical history of Postmenopausal Bleeding (PMB). Study Design: Descriptive cross-sectional study. Place and Duration of Study: Section of Histopathology, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from February 2012 to January 2013. Methodology: A total of 157 consecutive endometrial and endocervical biopsy specimens with history of postmenopausal bleeding were included. After microscopic examination, frequencies of histological findings in different age groups were generated. Chi-square and independent sample t-tests were applied to see whether the difference was significant which was set at p < 0.05. Results: One hundred and twenty-one (77.1%) specimens showed benign pathologies while 36 (22.9%) were malignant. Endometrial polyp was seen in 67 (42.7%) cases followed by endometrial carcinomas in 25 (15.9%), endometrial hyperplasia in 21 (13.4%), cervical carcinoma in 12 (7.6%) and cervical polyps in 9 (5.7%) cases. Ahighly significant increase in the percentage of malignant and pre-malignant lesions was seen with increasing age group (p < 0.001). Mean age of patients with type-2 endometrial carcinoma was higher than type-1 endometrial carcinoma but statistical significance was not observed (70.2 ± 6.5 vs. 61.8 ± 9.1 years respectively, p=0.069). Conclusion: Although benign pathologies were more common in postmenopausal bleeding but the collective proportion of endometrial and cervical malignancies and pre-malignant conditions was quite high. Therefore, PMB should be urgently evaluated for cause and early commencement of treatment. (author)

  15. African regional co-operative agreement for research, development and training related to nuclear science and technology

    The document informs that the second extension of the 'African regional co-operative agreement for research, development and training related to nuclear science and technology' entered into force on 4 April 2000. In also includes the status list of the Agreement as of 29 April 2000

  16. The Text of a Regional Co-operative Agreement for Research, Development and Training related to Nuclear Science and Technology

    The text of the Agreement to Extend the Regional Co-operative Agreement for Research, Development and Training Related to Nuclear Science and Technology of 1972 (the RCA Agreement for a further period of five years with effect from 12 June 1977 is reproduced herein for the information of all Members

  17. From cities and towns to urban networks in Germany – intra regional competition versus regional co-operation and inter regional competitiveness

    Bernhard Mueller


    Full Text Available For many decades of the 20th century particular cities and towns were understood as integral parts of national and international urban systems. For many years the theory on central places and hierarchy of central places, first developed by Christaller and amended by Loesch, had a decisive influence on spatial research and regional development policies with guiding principles for urbanisation and the development of settlement patterns. However it is becoming ever more evident, that the planned effects of concepts for harmonising intra- and inter-regional differences were not reached. Moreover, inter-regional competition between neighbouring municipalities, as well as modern life styles and residential choices have caused the emergence of new settlement structures with dispersed spatial patterns and string functional ties. It is also true, that urban networking isn’t an easy task and that it inherently carries numerous obstacles.

  18. Porcine survival model to simulate acute upper gastrointestinal bleedings.

    Prosst, Ruediger L; Schurr, Marc O; Schostek, Sebastian; Krautwald, Martina; Gottwald, Thomas


    The existing animal models used for the simulation of acute gastrointestinal bleedings are usually non-survival models. We developed and evaluated a new porcine model (domestic pig, German Landrace) in which the animal remains alive and survives the artificial bleeding without any cardiovascular impairment. This consists of a bleeding catheter which is implanted into the stomach, then subcutaneously tunnelled from the abdomen to the neck where it is exteriorized and fixed with sutures. Using the injection of porcine blood, controllable and reproducible acute upper gastrointestinal bleeding can be simulated while maintaining normal gastrointestinal motility and physiology. Depending on the volume of blood applied through the gastric catheter, the bleeding intensity can be varied from traces of blood to a massive haemorrhage. This porcine model could be valuable, e.g. for testing the efficacy of new bleeding diagnostics in large animals before human use. PMID:26306615

  19. Emergent Bleeding in Patients Receiving Direct Oral Anticoagulants.

    Summers, Richard L; Sterling, Sarah A


    Direct oral anticoagulants (DOACs) offer clinical advantages over warfarin, such as minimal medication and food interactions and fixed dosing without the need for routine monitoring of coagulation status. As with all anticoagulants, bleeding, either spontaneous or provoked, is the most common complication. The long-term use of these drugs is increasing, and there is a crucial need for emergency medicine service professionals to understand the optimal management of associated bleeding. This review aims to describe the indications and pharmacokinetics of available DOACs; to discuss the risk of bleeding; to provide a treatment algorithm to manage DOAC-associated emergency bleeding; and to discuss future directions in bleeding management, including the role of specific reversal agents, such as the recently approved idarucizumab for reversal of the direct thrombin inhibitor dabigatran. Because air medical personnel are increasingly likely to encounter patients receiving DOACs, it is important that they have an understanding of how to manage patients with emergent bleeding. PMID:27255877

  20. Obscure bleeding colonic duplication responds to proton pump inhibitor therapy


    We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding. Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5 and 2 years previously. An emergency abdominal computed tomography scan, gastroscopy and colonoscopy, performed after hemodynamic stabilization, were considered normal. High-dose intravenous proton pump inhibitor (PPI) therapy was initiated and bleeding stopped spontaneously. Two othe...

  1. Bleeding and Filtration of Cement-Based Grout

    Draganovic, Almir


    Grouting is a common method of sealing rock around tunnels to reduce or stop water inflow. Successful grouting significantly minimizes the maintenance cost and safety of the tunnel. Some questions about bleeding and penetrability of the grouts have to be examined more closely to carry out a successful grouting. Bleeding of cement-based grout is a complex problem. Measuring methods used today originate from the measuring of the bleeding of cement pastes used in ordinary building industry. Whet...

  2. Performance analysis of bleed condenser used in Indian PHWR

    Condensation of hot two phase bleed from the Primary Heat Transport (PHT) system is carried out by two different cooling modes in the bleed condenser of Indian PHWRs. These are the reflux and spray cooling modes. A computer code has been developed to predict the performance of bleed condensers used in Indian PHWRs for the above two cooling modes. Using the computer code the performance analysis was carried out for the reflux cooling and spray cooling modes separately. (author). 19 refs., 8 figs

  3. ABO-incompatible kidney transplant recipients have a higher bleeding risk after antigen-specific immunoadsorption.

    de Weerd, Annelies E; van Agteren, Madelon; Leebeek, Frank W; Ijzermans, Jan N M; Weimar, Willem; Betjes, Michiel G H


    Pretransplant removal of antiblood group ABO antibodies is the cornerstone of all current ABO-incompatible (ABOi) transplantation programmes. In our protocol, plasmapheresis (PP) is performed with a plasmafilter followed by immunoadsorption (IA) of anti-ABO antibodies. The bleeding complications of this technique are not known. We analysed the data of all 65 consecutive ABOi kidney transplantations between March 2006 and October 2013 and compared these with matched 130 ABO-compatible (ABOc) kidney transplantations. Cases differed from controls in the pre-operative regimen, which included IA-PP and rituximab, tacrolimus, mycophenolate mofetil, prednisone and immunoglobulines. Data on platelet count, blood loss and red blood cell (EC) transfusions during 48 h postoperatively were collected. ABOi patients received EC transfusions more frequently than controls (29% vs. 12%, P = 0.005). Intra-operative blood loss was higher (544 vs. 355 ml, P < 0.005) and they experienced more major bleeding (≥3 EC within 24 h, 15% vs. 2%, P < 0.0005). Platelet count decreased by 28% after the pre-operative IA. In a multivariate model, only the number of pre-operative IAs was associated with the number of ECs given (OR per IA 1.9, P < 0.05). ABOi kidney transplant recipients have a high postoperative bleeding risk, correlating with the number of pre-operative IA sessions performed. PMID:25070762

  4. Recent Update of Embolization of Upper Gastrointestinal Tract Bleeding

    Shin, Ji Hoon [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)


    Nonvariceal upper gastrointestinal (UGI) bleeding is a frequent complication with significant morbidity and mortality. Although endoscopic hemostasis remains the initial treatment modality, severe bleeding despite endoscopic management occurs in 5-10% of patients, necessitating surgery or interventional embolotherapy. Endovascular embolotherapy is now considered the first-line therapy for massive UGI bleeding that is refractory to endoscopic management. Interventional radiologists need to be familiar with the choice of embolic materials, technical aspects of embolotherapy, and the factors affecting the favorable or unfavorable outcomes after embolotherapy for UGI bleeding.

  5. Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

    Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo [Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)


    Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.

  6. Typhoid ulcer causing life-threatening bleeding from Dieulafoy's lesion of the ileum in a seven-year-old child: a case report

    Rashid Abbas


    Full Text Available Abstract Introduction We describe a case of rare complication of typhoid fever in a seven-year-old child and review the literature with regard to other rare causes of bleeding per rectum. Dieulafoy's lesion is an uncommon but important cause of recurrent gastrointestinal bleeding. Dieulafoy's lesion located extragastrically is rare. We report a case of typhoid ulcer with Dieulafoy's lesion of the ileum causing severe life-threatening bleeding and discuss the management of this extremely uncommon entity. Case presentation As a complication of typhoid fever, a seven-year-old Kurdish girl from Northern Iraq developed massive fresh bleeding per rectum. During colonoscopy and laparotomy, she was discovered to have multiple bleeding ulcers within the Dieulafoy's lesion in the terminal ileum and ileocecal region. Conclusion Although there is no practical way of predicting the occurrence of such rare complications, we emphasize in this case report the wide array of pathologies that can result from typhoid fever.

  7. Integration Strategies and Barriers to Co-Operation in Cross-Border Regions

    Hansen, Povl Adler; Serin, Göran Folke


    Abstract: The purpose of the article is to analyze strategies for cross-border integration in the Øresund Region. The point of departure is that the development of strategies for cross-border integration is dependent on the development on both the general level in the EU and deregulation of economy...... and business on the global level. In this respect, the article points out the importance of market forces and their influence on institutional change. Recent economic crises have put growth center stage at both the national and regional level, and have called for regional development programs on both...... markets and institutions....

  8. The assessment of intracranial bleeding with virtual unenhanced imaging by means of dual-energy CT angiography

    Ferda, Jiri; Novak, Milan; Mirka, Hynek; Baxa, Jan; Ferdova, Eva; Bednarova, Alena; Kreuzberg, Boris [Charles University Teaching Hospital Plzen, Radiodiagnostic Clinic (Czech Republic); Flohr, Thomas; Schmidt, Bernhard; Klotz, Ernst [Siemens Healthcare, Computed Tomography (Germany)


    The purpose of this study was to assess virtual unenhanced brain computed tomography (CT) images obtained by dual-energy CT angiography (CTA) for the detection of intracranial bleeding. In total, 25 patients were included in the study (average age 53.2 years, range 25-75 years, 14 male, 11 female), all with intracranial bleeding on unenhanced brain CT and who underwent additional CTA performed on a dual-source CT in a dual-energy acquisition mode. The two X-ray tubes were operated at 140 and 80 kV, respectively. Data were analyzed using dual-energy evaluation software. Virtual unenhanced images were calculated by removing the relative iodine content from each voxel. The virtual unenhanced images were evaluated by a radiologist blinded to the findings of the conventional images related to the presence of intracranial bleeding. The image quality and contrast-to-noise ratio (CNR) between bleeding and brain tissue were assessed. The virtual image quality was found to be sufficient in 96%. The agreement in detection of intracranial bleeding on virtual and conventional unenhanced images reached 96% in per-lesion analysis and 100% in per-patient analysis. The averaged CNR reached 2.63 in virtual unenhanced images and 3.27 in conventional. Virtual unenhanced images are sufficient for the detection of intracranial bleeding. (orig.)

  9. New Mexico Southwest Regional Geothermal Development Operations Research Project. Appendix 9 of regional operations research program for development of geothermal energy in the Southwest United States. Final technical report, June 1977--August 1978

    Ortiz, Thomas A.; Fedor, Dennis


    This final report describes the findings and conclusions of the New Mexico Team during the first project year of the Southwest Regional Geothermal Development Operations Research Project. The purpose of this project is to help realize a goal of the USDOE , Division of Geothermal Energy (DOE/DGE), to accelerate the actual commercial utilization of geothermal energy. This was done by: (1) identifying the potential for development of geothermal energy in the five-state regions of Arizona, Colorado, New Mexico, Nevada and Utah; and (2) identifying the actions needed to accomplish that development.

  10. The Texts of the Agency's Co-operation Agreements with Regional Intergovernmental Organizations

    The text of the Agency's agreement for co-operation with the Organization of African Unity (OAU) is reproduced in this document for the information of all Members. The agreement entered into force on 26 March 1969