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Sample records for analgesia initial experience

  1. The experience of labour with epidural analgesia

    DEFF Research Database (Denmark)

    Jepsen, Ingrid; Keller, Kurt Dauer

    2014-01-01

    of the epidural analgesia as high, in general, their satisfaction with labour is unchanged or even lower when epidural analgesia is used. Question: How do women experience being in labour with epidural analgesia, and what kind of midwifery care do they, consequently, need? Methods: A field study and semi......-structured interviews were conducted on a phenomenological basis. Nine nulliparous women were observed from initiation of epidural analgesia until birth of their baby. They were interviewed the day after the birth and again 2 months later. The involved midwives were interviewed 2–3 h after the birth. Findings......: Initiation of epidural analgesia can have considerable implications for women’s experience of labour. Two different types of emotional reactions towards epidural analgesia are distinguished, one of which is particularly marked by a subtle sense of worry and ambivalence. Another important finding refers...

  2. The experience of giving birth with epidural analgesia.

    Science.gov (United States)

    Jepsen, Ingrid; Keller, Kurt Dauer

    2014-06-01

    There is a lack of literature about what constitutes good midwifery care for women who have epidural analgesia during labour. It is known that an increasing number of women receive epidural analgesia for labour pain. We also know that while women rate the painkilling effect of the epidural analgesia as high, in general, their satisfaction with labour is unchanged or even lower when epidural analgesia is used. How do women experience being in labour with epidural analgesia, and what kind of midwifery care do they, consequently, need? A field study and semi-structured interviews were conducted on a phenomenological basis. Nine nulliparous women were observed from initiation of epidural analgesia until birth of their baby. They were interviewed the day after the birth and again 2 months later. The involved midwives were interviewed 2-3h after the birth. Initiation of epidural analgesia can have considerable implications for women's experience of labour. Two different types of emotional reactions towards epidural analgesia are distinguished, one of which is particularly marked by a subtle sense of worry and ambivalence. Another important finding refers to the labouring woman's relationship with the midwife, which represents an essential influencing factor on the woman' experience of labour. Within this relationship, some rather unnoticed matters of communication and recognition appear to be of decisive significance. After initiation of epidural analgesia the requirements of midwifery care seem to go beyond how women verbalise and define their own needs. The midwife should be attentive to the labouring woman's type of emotional reaction to epidural analgesia and her possible intricate worries. Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  3. Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection.

    Science.gov (United States)

    Van de Velde, M

    2009-11-01

    In the present review we outline the state-of-the-art of neuraxial analgesia. As neuraxial analgesia remains the gold standar of analgesia during labor, we review the most recent literature on this topic. The neuraxial analgesia techniques, types of administration, drugs, adjuvants, and adverse effects are investigated from the references. Most authors would agree that central neuraxial analgesia is the best form to manage labor pain. When neuraxial analgesia is administered to the parturient in labor, different management choices must be made by the anesthetist: how will we initiate analgesia, how will analgesia be maintained, which local anesthetic will we use for neuraxial analgesia and which adjuvant drugs will we combine? The present manuscript tries to review the literature to answer these questions.

  4. OUR EXPERIENCE WITH EPIDURAL LABOUR ANALGESIA

    Directory of Open Access Journals (Sweden)

    Uršula Reš Muravec

    2003-12-01

    Full Text Available Background. To evaluate the effects of regional labour analgesia used at the Hospital for Gynecology and Obstetrics in Postojna, Slovenia, in the year 2002.Patients and methods. In this retrospective study we enrolled 294 parturients who delivered in the year 2002 in the Postojna Maternity Hospital: in group 1 there were 147 parturients in whom three different regional analgesic techniques (study group were used at labour; in group 2 there were 147 parturients in whom regional analgesia was not used (control group. In the first step the two groups were compared in terms of maternal demographic data, duration and outcome of labour and 1' and 5' Apgar scores. In the second step the three regional analgesic groups were compared in terms of the course and outcome of labour, fetal condition, side and adverse effects of regional analgesic techniques, and patient satisfaction with a particular analgesic technique.Results. Regional labour analgesia was used in 147 (14% of the 1048 women who delivered in 2002: epidural analgesia (EPI was performed in 51.0%, combined spinal-epidural (CSE in 42.2% and spinal analgesia (SA in 6.8% of cases. The women in the regional analgesia group were significantly older, more educated, more often nulliparous and accompanied by their partner at labour than the women in the control group. Further, the duration of labour was significantly longer, oxytocin more frequently administered than in the control group. In terms of labour outcome there were no differences in the Cesarean section rates and 1- and 5-min Apgar scores minutes, but and the vacuum extraction rate was significantly higher in the regional analgesia group. Among the three regional analgesia techniques used, there were no statistically significant differences observed in terms of labour duration and outcome, and Apgar scores. The patient satisfaction was greatest with CSE. Adverse side effects such as weak muscles, reduced motion abilities, itching, nausea

  5. Epidural analgesia during labor and delivery: effects on the initiation and continuation of effective breastfeeding.

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    Chang, Zorina Marzan; Heaman, Maureen I

    2005-08-01

    This prospective cohort study examined the association between epidural analgesia during labor and delivery, infant neurobehavioral status, and the initiation and continuation of effective breastfeeding. Healthy, term infants delivered vaginally by mothers who received epidural analgesia (n = 52) or no analgesia (n = 63) during labor and delivery were assessed at 8 to 12 hours postpartum, followed by a telephone interview with the mothers at 4 weeks postpartum. There was no significant difference between the epidural analgesia and no-analgesia groups in breastfeeding effectiveness or infant neurobehavioral status at 8 to 12 hours or in the proportion of mothers continuing to breastfeed at 4 weeks. Therefore, epidural analgesia did not appear to inhibit effective breastfeeding. There was a positive correlation between infant neurobehavioral status and breastfeeding effectiveness (Spearman rho = 0.48, P = .01), suggesting that neurobehavioral assessment may prove beneficial in identifying infants at greater risk for breastfeeding difficulties.

  6. How first time mothers experience the use of epidural analgesia

    DEFF Research Database (Denmark)

    Jepsen, Ingrid

    2010-01-01

    How first time mothers experience the use of epidural analgesia during birth Ingrid Jepsen, Midwife, SD, MPH, Kurt Dauer Keller cand.psych, PhD Contact email irj@ucn.dk Aim: to investigate the experiences of epidural analgesia as to the choice of epidurals, the changes in pain, the period from th...... midwives handle the epidurals. Conclusion: In particular, the use of an epidural does not diminish the need for an individual approach. The woman’s level of consciousness and the entire situation makes her very sensitive to the midwives care....... factors influencing the relationship with the midwives were: the very choice of an epidural, the midwives accept of that choice, satisfaction with the presence of the midwifes, the continuity of the process, and a high level of information. Clearly, the establishment of an epidural implies important...

  7. Epidural analgesia during labour - maternal understanding and experience - informed consent.

    Science.gov (United States)

    Mahomed, K; Chin, D; Drew, A

    2015-01-01

    Women obtain information on epidural analgesia from various sources. For epidural for pain relief in labour this is provided by the anaesthetist as part of the consenting process. There is much discussion about the inadequacy of this consenting process; we report on women's knowledge, experience and recall of this process at a regional hospital with a 24-h epidural service. Fifty-four women were interviewed within 72 h of a vaginal birth. 91% of the women had acquired information from friends, relatives and antenatal classes. Lack of recall of benefits of epidural analgesia accounted for 26 (38%) and 25 (26%) of the responses, respectively. Similarly in terms of amount of pain relief they could expect, 13 (21%) could not remember and 13 (21%) thought that it may not work. We suggest use of varying methods of disseminating information and wider utilisation of anaesthetists in the antenatal educational programmes.

  8. Performance of the Angle Labor Pain Questionnaire During Initiation of Epidural Analgesia in Early Active Labor.

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    Angle, Pamela J; Kurtz Landy, Christine; Djordjevic, Jasmine; Barrett, Jon; Kibbe, Alanna; Sriparamananthan, Saiena; Lee, Yuna; Hamata, Lydia; Zaki, Pearl; Kiss, Alex

    2016-12-01

    The Angle Labor Pain Questionnaire (A-LPQ) is a new, 22-item multidimensional psychometric questionnaire that measures the 5 most important dimensions of women's childbirth pain experiences using 5 subscales: The Enormity of the Pain, Fear/Anxiety, Uterine Contraction Pain, Birthing Pain, and Back Pain/Long Haul. Previous work showed that the A-LPQ has overall good psychometric properties and performance during early active labor in women without pain relief. The current study assessed the tool's sensitivity to change during initiation of labor epidural analgesia with the standardized response mean (SRM, primary outcome). Two versions of the A-LPQ were administered once, in each of 2 test sessions, by the same trained interviewer during early active labor. The sequence of administration was randomized (ie, standard question order version [Test 1] followed by mixed version [Test 2] or vice versa). Test 1 was completed before epidural insertion; Test 2 commenced 20 to 30 minutes after the test dose. Providers assessed/treated pain independently of the study. Sensitivity to change was assessed using SRMs, Cohen's d, and paired t tests. Overall pain intensity was concurrently examined using Numeric Rating Scale and the Verbal Rating Scale (VRS); coping was assessed with the Pain Mastery Scale. Changes in pain were measured with the Patient Global Impression of Change Scale. Internal consistency was assessed with Cronbach's α. Concurrent validity with other tools was assessed using Spearman's rank correlation coefficient. A total of 51 complete datasets were analyzed. Most women reported moderate (63%, 32/51) or severe (18%, 9/51) baseline pain on VRS scores during Test 1; 29% (15/51) reported mild pain, and 6% (3/51) reported moderate pain during Test 2. Approximately 90% (46/51) of women reported much or very much improved pain at the end of testing. Cronbach's α for A-LPQ summary scores was excellent (0.94) and ranged from 0.78 (acceptable) to 0.92 (excellent) for

  9. Early versus late initiation of epidural analgesia in labor: does it increase the risk of cesarean section? A randomized trial.

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    Ohel, Gonen; Gonen, Roni; Vaida, Sonia; Barak, Shlomi; Gaitini, Luis

    2006-03-01

    To determine whether early initiation of epidural analgesia in nulliparous women affects the rate of cesarean sections and other obstetric outcome measures. A randomized trial in which 449 at term nulliparous women in early labor, at less than 3 cm of cervical dilatation, were assigned to either immediate initiation of epidural analgesia at first request (221 women), or delay of epidural until the cervix dilated to at least 4 cm (228 women). At initiation of the epidural the mean cervical dilatation was 2.4 cm in the early epidural group and 4.6 cm in the late group (P labor, the women indicated a preference for early epidural. Initiation of epidural analgesia in early labor, following the first request for epidural, did not result in increased cesarean deliveries, instrumental vaginal deliveries, and other adverse effects; furthermore, it was associated with shorter duration of the first stage of labor and was clearly preferred by the women.

  10. Initial Cooling Experiment (ICE)

    CERN Multimedia

    Photographic Service

    1978-01-01

    In 1977, in a record-time of 9 months, the magnets of the g-2 experiment were modified and used to build a proton/antiproton storage ring: the "Initial Cooling Experiment" (ICE). It served for the verification of the cooling methods to be used for the "Antiproton Project". Stochastic cooling was proven the same year, electron cooling followed later. Also, with ICE the experimental lower limit for the antiproton lifetime was raised by 9 orders of magnitude: from 2 microseconds to 32 hours. For its previous life as g-2 storage ring, see 7405430. More on ICE: 7711282, 7809081, 7908242.

  11. The effect of bupivacaine with fentanyl temperature on initiation and maintenance of labor epidural analgesia: a randomized controlled study.

    Science.gov (United States)

    Sviggum, H P; Yacoubian, S; Liu, X; Tsen, L C

    2015-02-01

    Labor epidural analgesia is highly effective, but can be limited by slow onset and incomplete blockade. The administration of warmed, compared to room temperature, bupivacaine has resulted in more rapid onset epidural anesthesia. We hypothesized that the administration of bupivacaine with fentanyl at 37°C versus 20°C would result in improved initial and ongoing labor epidural analgesia. In this prospective, randomized, doubled blinded study, 54 nulliparous, laboring women were randomized to receive epidural bupivacaine 0.125% with fentanyl 2 μg/mL (20 mL initial and 6 mL hourly boluses) at either 37°C or 20°C. Pain verbal rating scores (VRS), sensory level, oral temperature, and side effects were assessed after epidural loading (time 0), at 5, 10, 15, 20, 30, 60 min, and at hourly intervals. The primary outcome was the time to achieve initial satisfactory analgesia (VRS ⩽3). Secondary outcomes included ongoing quality of sensory blockade, body temperature and shivering. There were no differences between groups in patient demographics, initial pain scores, cervical dilatation, body temperature or mode of delivery. Epidural bupivacaine at 37°C resulted in shorter mean (±SD) analgesic onset time (9.2±4.7 vs. 16.0±10.5 min, P=0.005) and improved analgesia for the first 15 min after initial bolus (P=0.001-0.03). Although patient temperature increased during the study (Plabor analgesia for the first 15 min. There was no evidence of improved ongoing labor analgesia or differences in side effects between groups. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Effect of labor analgesia on labor outcome.

    Science.gov (United States)

    Halpern, Stephen H; Abdallah, Faraj W

    2010-06-01

    Labor is among the most painful experiences that humans encounter. Neuraxial analgesia is the most effective means of treating this pain. In this review, we discussed the effect of neuraxial analgesia on the progress of labor when compared with parenteral opioids. We then compared initiation of analgesia with a combined spinal-epidural technique (CSE) to conventional epidural analgesia. Finally we discussed the impact of neuraxial analgesia, given early in labor, compared with later administration. Compared with parenteral opioids, neuraxial analgesia does not increase the incidence of cesarean section, although it is associated with a longer (approximately 16 min) second stage of labor. The incidence of operative vaginal delivery is higher in the epidural group but this may be due to indirect reasons such as changes in physician behavior. There was no difference in labor outcome when CSE was compared with low-concentration epidural analgesia, but higher concentrations may prolong labor. Early administration of neuraxial analgesia does not increase the incidence of operative delivery or prolong labor. Neuraxial analgesia does not interfere with the progress or outcome of labor. There is no need to withhold neuraxial analgesia until the active stage of labor.

  13. Predicting early epidurals: association of maternal, labor, and neonatal characteristics with epidural analgesia initiation at a cervical dilation of 3 cm or less

    Directory of Open Access Journals (Sweden)

    Moore AR

    2013-08-01

    Full Text Available Albert R Moore, William Li Pi Shan, Roupen Hatzakorzian Department of Anaesthesia, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada Background: Retrospective studies have associated early epidural analgesia with cesarean delivery, but prospective studies do not demonstrate a causal relationship. This suggests that there are other variables associated with early epidural analgesia that increase the risk of cesarean delivery. This study was undertaken to determine the characteristics associated with early epidural analgesia initiation. Methods: Information about women delivering at 37 weeks or greater gestation with epidural analgesia, who were not scheduled for cesarean delivery, was extracted from the McGill Obstetric and Neonatal Database. Patients were grouped into those who received epidural analgesia at a cervical dilation of ≤3 cm and >3 cm. Univariable and multivariable logistic regression was used to determine the maternal, neonatal, and labor characteristics that increased the risk of inclusion in the early epidural group. Results: Of the 13,119 patients analyzed, multivariable regression demonstrated odds ratios (OR of 2.568, 5.915 and 10.410 for oxytocin augmentation, induction, and dinoprostone induction of labor (P < 0.001. Increasing parity decreased the odds of early epidural analgesia (OR 0.780, P < 0.001, while spontaneous rupture of membranes (OR 1.490 and rupture of membranes before labor commenced (OR 1.288 were also associated with early epidural analgesia (P < 0.001. Increasing maternal weight (OR 1.049, P = 0.002 and decreasing neonatal weight (OR 0.943, P < 0.001 were associated with increasing risk of early epidural analgesia. Conclusion: Labor augmentation and induction, nulliparity, rupture of membranes spontaneously and before labor starts, increasing maternal weight, and decreasing neonatal weight are associated with early epidural analgesia. Many of these variables are also

  14. Initial Egyptian ECMO experience

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    Akram Abdelbary

    2016-04-01

    Results: A total of twelve patients received ECMO between January 2014 and June 2015. The mean age was 35.9 years. (range 13–65 years, 8 males, with VV ECMO in 10 patients, and VA ECMO in 2 patients. Out of ten patients of VV ECMO, one had H1N1 pneumonia, one had advanced vasculitic lung, four had bacterial pneumonia, two traumatic lung contusions and one with organophosphorus poisoning, and one undiagnosed etiology leading to severe ARDS. Lung injury score range was 3–3.8, PaO2/FiO2 (20–76 mechanical ventilation duration before ECMO 1–14 days, Femoro-jugular cannulation in 7 patients and femoro-femoral in 2 patients and femoro-subclavian in 1 patient; all patients were initially sedated and paralyzed for (2–4 days and ventilated on pressure controlled ventilation with Pmax of 25 cm H2O and PEEP of 10 cm H2O. In VA ECMO patients were cannulated percutaneously using femoro-femoral approach. One patient showed no neurologic recovery and died after 24 h, the other had CABG on ECMO however the heart didn’t recover and died after 9 days. Heparin intravenous infusion was used initially in all patients and changed to Bivalirudin in 2 patients due to possible HIT. Pump flow ranged from 2.6 to 6.5 L/min. Average support time was 12 days (range 2–24 days. Seven patients (63.3% were successfully separated from ECMO and survived to hospital discharge. Hospital length of stay ranged from 3 to 42 days, tracheostomy was done percutaneously in 5 patients and surgically in 3. Gastrointestinal bleeding occurred in 6 patients, VAP in 7 patients, neurologic complications in 1 patient with complete recovery, cardiac arrhythmias in 3 patients, pneumothorax in 9 patients, and deep venous thrombosis in 2 patients.

  15. INITIAL COOLING EXPERIMENT (ICE)

    CERN Multimedia

    1979-01-01

    ICE was built in 1977, using the modified bending magnets of the g-2 muon storage ring (see 7405430). Its purpose was to verify the validity of stochastic and electron cooling for the antiproton project. Stochastic cooling proved a resounding success early in 1978 and the antiproton project could go ahead, now entirely based on stochastic cooling. Electron cooling was experimented with in 1979. The 26 kV equipment is housed in the cage to the left of the picture, adjacent to the "e-cooler" located in a straight section of the ring. With some modifications, the cooler was later transplanted into LEAR (Low Energy Antiproton Ring) and then, with further modifications, into the AD (Antiproton Decelerator), where it cools antiprotons to this day (2006). See also: 7711282, 7802099, 7809081.

  16. Predicting early epidurals: association of maternal, labor, and neonatal characteristics with epidural analgesia initiation at a cervical dilation of 3 cm or less.

    Science.gov (United States)

    Moore, Albert R; Shan, William Li Pi; Hatzakorzian, Roupen

    2013-01-01

    Retrospective studies have associated early epidural analgesia with cesarean delivery, but prospective studies do not demonstrate a causal relationship. This suggests that there are other variables associated with early epidural analgesia that increase the risk of cesarean delivery. This study was undertaken to determine the characteristics associated with early epidural analgesia initiation. Information about women delivering at 37 weeks or greater gestation with epidural analgesia, who were not scheduled for cesarean delivery, was extracted from the McGill Obstetric and Neonatal Database. Patients were grouped into those who received epidural analgesia at a cervical dilation of ≤3 cm and >3 cm. Univariable and multivariable logistic regression was used to determine the maternal, neonatal, and labor characteristics that increased the risk of inclusion in the early epidural group. Of the 13,119 patients analyzed, multivariable regression demonstrated odds ratios (OR) of 2.568, 5.915 and 10.410 for oxytocin augmentation, induction, and dinoprostone induction of labor (P labor commenced (OR 1.288) were also associated with early epidural analgesia (P Labor augmentation and induction, nulliparity, rupture of membranes spontaneously and before labor starts, increasing maternal weight, and decreasing neonatal weight are associated with early epidural analgesia. Many of these variables are also associated with cesarean delivery.

  17. Outpatient multimodal intravenous analgesia in patients undergoing day-case surgery: description of a three year experience.

    Science.gov (United States)

    Serra, Magdalena; Vives, Roser; Cañellas, Montserrat; Planell, Josep; Oliva, Joan Carles; Colilles, Carmen; Pontes, Caridad

    2016-09-13

    The use of elastomeric devices for ambulatory intravenous pain treatment in Major Ambulatory Surgery (MAS) has been described to improve postoperative pain management. The objective of the study was to describe the first 3 years experience of the use of elastomeric devices for ambulatory intravenous pain treatment in MAS implemented at our site since 2010. Data were retrieved from the medical records for all patients who, between January 2010 and March 2014, underwent surgical procedures at the ambulatory surgical centre at our hospital and were prescribed a home-based continuous intravenous analgesia. Data were retrieved from the medical records of 1128 patients. The most frequent surgical interventions included orthopedic and proctology surgeries. 80 % of patients were discharged home without pain; during the first 48 h after discharge roughly 40 % of subjects were completely free of pain, 50 % reported mild pain (VAS 1 to 3) and 9 % reported higher pain scores (4 and above). Peripheral nerve block was associated to better pain control in the immediate postoperative period. Vomiting in the first 24 h was 4.6 % before introducing haloperidol into the drug schemes, and 2.6 % thereafter. Complications related with the intravenous route required treatment withdrawal in 1.1 % cases. Only 3.5 % of patients returned to the hospital in the first 72 h, mainly for non-pain related reasons. Overall, 99.5 % of patients were satisfied with the treatment received at home. Our initial experience suggest that outpatient multimodal intravenous analgesia in patients undergoing day-case surgery is a feasible alternative in our setting, that allows an effective management of postoperative pain with a small rate of adverse events and complications requiring readmission.

  18. EXPERIENCES WITH IDEA PROMOTING INITIATIVES

    DEFF Research Database (Denmark)

    Gish, Liv

    2011-01-01

    In new product development a central activity is to provide new ideas. Over the last decades experiences with stimulating employee creativity and establishing idea promoting initiatives have been made in industrial practice. Such initiatives are often labeled Idea Management – a research field...... with a growing interest. In this paper I examine three different idea promoting initiatives carried out in Grundfos, a leading pump manufacturer. In the analysis I address what understandings of idea work are inscribed in the initiatives and what role these initiatives play in the organization with respect...... understandings of idea work are inscribed in the idea promoting initiatives as they to some degree have to fit with the understandings embedded in practice in order to work....

  19. EXPERIENCES WITH IDEA PROMOTING INITIATIVES

    DEFF Research Database (Denmark)

    Gish, Liv

    2011-01-01

    In new product development a central activity is to provide new ideas. Over the last decades experiences with stimulating employee creativity and establishing idea promoting initiatives have been made in industrial practice. Such initiatives are often labeled Idea Management – a research field...... with a growing interest. In this paper I examine three different idea promoting initiatives carried out in Grundfos, a leading pump manufacturer. In the analysis I address what understandings of idea work are inscribed in the initiatives and what role these initiatives play in the organization with respect...... understandings of idea work are inscribed in the idea promoting initiatives as they to some degree have to fit with the understandings embedded in practice in order to work....

  20. Reduction of empathy for pain by placebo analgesia suggests functional equivalence of empathy and first-hand emotion experience.

    Science.gov (United States)

    Rütgen, Markus; Seidel, Eva-Maria; Riečanský, Igor; Lamm, Claus

    2015-06-10

    Previous research in social neuroscience has consistently shown that empathy for pain recruits brain areas that are also activated during the first-hand experience of pain. This has been interpreted as evidence that empathy relies upon neural processes similar to those underpinning the first-hand experience of emotions. However, whether such overlapping neural activations imply that equivalent neural functions are engaged by empathy and direct emotion experiences remains to be demonstrated. We induced placebo analgesia, a phenomenon specifically modulating the first-hand experience of pain, to test whether this also reduces empathy for pain. Subjective and neural measures of pain and empathy for pain were collected using self-report and event-related potentials (ERPs) while participants underwent painful electrical stimulation or witnessed that another person was undergoing such stimulation. Self-report showed decreased empathy during placebo analgesia, and this was mirrored by reduced amplitudes of the pain-related P2, an ERP component indexing neural computations related to the affective-motivational component of pain. Moreover, these effects were specific for pain, as self-report and ERP measures of control conditions unrelated to pain were not affected by placebo analgesia. Together, the present results suggest that empathy seems to rely on neural processes that are (partially) functionally equivalent to those engaged by first-hand emotion experiences. Moreover, they imply that analgesics may have the unwanted side effect of reducing empathic resonance and concern for others. Copyright © 2015 the authors 0270-6474/15/358938-10$15.00/0.

  1. Energy efficiency initiatives: Indian experience

    Energy Technology Data Exchange (ETDEWEB)

    Dey, Dipankar [ICFAI Business School, Kolkata, (IBS-K) (India)

    2007-07-01

    India, with a population of over 1.10 billion is one of the fastest growing economies of the world. As domestic sources of different conventional commercial energy are drying up, dependence on foreign energy sources is increasing. There exists a huge potential for saving energy in India. After the first 'oil shock' (1973), the government of India realized the need for conservation of energy and a 'Petroleum Conservation Action Group' was formed in 1976. Since then many initiatives aiming at energy conservation and improving energy efficiency, have been undertaken (the establishment of Petroleum Conservation Research Association in 1978; the notification of Eco labelling scheme in 1991; the formation of Bureau of Energy Efficiency in 2002). But no such initiative was successful. In this paper an attempt has been made to analyze the changing importance of energy conservation/efficiency measures which have been initiated in India between 1970 and 2005.The present study tries to analyze the limitations and the reasons of failure of those initiatives. The probable reasons are: fuel pricing mechanism (including subsidies), political factors, corruption and unethical practices, influence of oil and related industry lobbies - both internal and external, the economic situation and the prolonged protection of domestic industries. Further, as India is opening its economy, the study explores the opportunities that the globally competitive market would offer to improve the overall energy efficiency of the economy. The study suggests that the Bureau of Energy Efficiency (BEE) - the newly formed nodal agency for improving energy efficiency of the economy may be made an autonomous institution where intervention from the politicians would be very low. For proper implementation of different initiatives to improve energy efficiency, BEE should involve more the civil societies (NGO) from the inception to the implementation stage of the programs. The paper also

  2. Robonaut Mobile Autonomy: Initial Experiments

    Science.gov (United States)

    Diftler, M. A.; Ambrose, R. O.; Goza, S. M.; Tyree, K. S.; Huber, E. L.

    2006-01-01

    A mobile version of the NASA/DARPA Robonaut humanoid recently completed initial autonomy trials working directly with humans in cluttered environments. This compact robot combines the upper body of the Robonaut system with a Segway Robotic Mobility Platform yielding a dexterous, maneuverable humanoid ideal for interacting with human co-workers in a range of environments. This system uses stereovision to locate human teammates and tools and a navigation system that uses laser range and vision data to follow humans while avoiding obstacles. Tactile sensors provide information to grasping algorithms for efficient tool exchanges. The autonomous architecture utilizes these pre-programmed skills to form complex behaviors. The initial behavior demonstrates a robust capability to assist a human by acquiring a tool from a remotely located individual and then following the human in a cluttered environment with the tool for future use.

  3. Epidural analgesia and anticoagulant therapy. Experience with one thousand cases of continuous epidurals.

    Science.gov (United States)

    Odoom, J A; Sih, I L

    1983-03-01

    One thousand lumbar epidural blocks in 950 patients undergoing vascular surgery are reported. All patients were receiving oral anticoagulants pre-operatively. Mean thrombotest (TT) was 19.3% (normal range 70-130%). During surgery intravascular heparin was administered. At the end of surgery, the kaolin cephalin clotting time (KCCT) was 68 (+/- 0.8) seconds (normal range 35-60 seconds), and partial thromboplastin time (PTT) was 536 (77.9%, normal control of 100%). Despite the anticoagulant therapy, no side effects were observed in any patient which could be related to haemorrhage or haematoma formation in the epidural space. It is concluded that, provided adequate precautions are taken, epidural analgesia can be safely used in patients receiving anticoagulant therapy.

  4. Preventive analgesia

    DEFF Research Database (Denmark)

    Dahl, Jørgen B; Kehlet, Henrik

    2011-01-01

    findings: The nature of central sensitization during acute and chronic postsurgical pain share common features, and there may be interactions between acute and persistent postoperative pain. The term ‘pre-emptive analgesia’ should be abandoned and replaced by the term ‘preventive analgesia’. Recent studies......This paper will discuss the concepts of pre-emptive and preventive analgesia in acute and persistent postsurgical pain, based on the most recent experimental and clinical literature, with a special focus on injury-induced central sensitization and the development from acute to chronic pain. Recent...... of preventive analgesia for persistent postoperative pain are promising. However, clinicians must be aware of the demands for improved design of their clinical studies in order to get more conclusive answers regarding the different avenues for intervention. Summary: The concept of preventive analgesia is still...

  5. Return to Experience and Initial Wage Level

    DEFF Research Database (Denmark)

    Sørensen, Kenneth Lykke; Vejlin, Rune Majlund

    This paper estimates the relationship between initial wage and return to experience. We use a Mincer-like wage model to nonparametrically estimate this relationship allowing for an unobservable individual permanent effect in wages and unobservable individual return to experience. The relationship...

  6. Return to experience and initial wage level

    DEFF Research Database (Denmark)

    Sørensen, K.L.; Vejlin, R.

    2014-01-01

    This paper estimates the relationship between initial wage and return to experience. We use a Mincer-like wage model to non-parametrically estimate this relationship allowing for an unobservable individual permanent effect in wages and unobservable individual return to experience. The relationshi...

  7. Initial conditions of radiative shock experiments

    Energy Technology Data Exchange (ETDEWEB)

    Kuranz, C. C.; Drake, R. P.; Krauland, C. M.; Marion, D. C.; Grosskopf, M. J.; Rutter, E.; Torralva, B.; Holloway, J. P. [Department of Atmospheric, Oceanic and Space Science, University of Michigan, Center for Radiative Shock Hydrodynamics, 2455 Hayward Dr., Ann Arbor, Michigan 48109 (United States); Bingham, D.; Goh, J. [Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada V5A 1S6 (Canada); Boehly, T. R.; Sorce, A. T. [Laboratory for Laser Energetics, University of Rochester, New York 14623 (United States)

    2013-05-15

    We performed experiments at the Omega Laser Facility to characterize the initial, laser-driven state of a radiative shock experiment. These experiments aimed to measure the shock breakout time from a thin, laser-irradiated Be disk. The data are then used to inform a range of valid model parameters, such as electron flux limiter and polytropic γ, used when simulating radiative shock experiments using radiation hydrodynamics codes. The characterization experiment and the radiative shock experiment use a laser irradiance of ∼7 × 10{sup 14} W cm{sup −2} to launch a shock in the Be disk. A velocity interferometer and a streaked optical pyrometer were used to infer the amount of time for the shock to move through the Be disk. The experimental results were compared with simulation results from the Hyades code, which can be used to model the initial conditions of a radiative shock system using the CRASH code.

  8. Análisis de la analgesia en la baja de combate: Experiencia de la Sanidad Militar española Analgesia in the management of the combat casualty: Experience of the Spanish Medical Service

    Directory of Open Access Journals (Sweden)

    R. Navarro Suay

    2012-03-01

    type of administration routes, as well as the type of anesthesia used in gunshot or explosive device casualties in the Spanish Role 2 in Herat (Afghanistan between 2005 and 2008, in accordance with an anatomical injury severity score (NISS of the injuries. Material and Methods: We carried out an observational, retrospective study with a sample of 256 patients. Results: The drugs most commonly used were the NSAIDs (73% followed by major morphine derivatives (44%, adjuvants (29%, minor morphine derivatives (21 %, and ketamine (12%. In 61 % of the cases the analgesia was administered in the prehospital setting and in 31 % in the hospital. The most common administration route was intravenous (79%. In 75% of the cases only one administration route was obtained for analgesia. General anesthesia was the most common anesthetic procedure (32%. Conclusions: Analgesic treatment of the combat casualties studied was homogeneous in terms of drugs used and number and types of administration routes. However it was heterogeneous in reference to the chosen type of NSAIDs and initiation of analgesic drug administration.

  9. Initial state radiation experiment at MAMI

    Directory of Open Access Journals (Sweden)

    Mihovilovič M.

    2014-05-01

    Full Text Available In an attempt to contribute further insight into the discrepancy between the Lamb shift and elastic scattering determinations of the proton charge radius, a new experiment at MAMI is underway, aimed at measuring proton form-factors at very low momentum transfers by using a new technique based on initial state radiation. This paper reports on the conclusions of the pilot measurement performed in 2010, whose main goal was to check the feasibility of the proposed experiment and to recognize and overcome any obstacles before running the full experiment. The modifications to the experimental apparatus are then explained which significantly improved the quality of data collected in the full scale experiment, which was successfully executed in August 2013. At the end first findings of the new experiment are discussed.

  10. Labor analgesia for the obese parturient.

    Science.gov (United States)

    Ellinas, Elizabeth H

    2012-10-01

    Obese parturients present obstetric anesthesia providers with multiple challenges, including increased incidence of maternal coexisting disease, labor complications, and potential for difficult initiation and failure of neuraxial labor analgesia. This focused review discusses these challenges, and suggests potential methods to increase labor analgesia success in this population.

  11. Initial Commissioning Experience With the LCLS Injector

    Energy Technology Data Exchange (ETDEWEB)

    Akre, R.; Castro, J.; Ding, Y.; Dowell, D.H.; Emma, P.; Frisch, J.; Gilevich, A.; Hays, G.; Hering, P.; Huang, Z.; Iverson, R.; Krejcik, P.; Limborg-Deprey, C.; Loos, H.; Miahnahri, A.; Rivetta, C.; Saleski, M.; Schmerge, J.F.; Schultz, D.; Turner, J.; Welch, J.; /SLAC /DESY

    2007-11-02

    The Linac Coherent Light Source (LCLS) is a SASE xray Free-Electron Laser (FEL) project presently under construction at SLAC [1]. The injector section, from drive-laser and RF photocathode gun through first bunch compressor chicane, was installed in fall 2006. Initial system commissioning with an electron beam is taking place during the spring and summer of 2007. The second phase of construction, including second bunch compressor and full linac, will begin later, in the fall of 2007. We report here on experience gained during the first phase of machine commissioning, including RF photocathode gun, linac booster section, S-band and X-band RF systems, first bunch compressor, and the various beam diagnostics.

  12. Barrier experiment: Shock initiation under complex loading

    Energy Technology Data Exchange (ETDEWEB)

    Menikoff, Ralph [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-01-12

    The barrier experiments are a variant of the gap test; a detonation wave in a donor HE impacts a barrier and drives a shock wave into an acceptor HE. The question we ask is: What is the trade-off between the barrier material and threshold barrier thickness to prevent the acceptor from detonating. This can be viewed from the perspective of shock initiation of the acceptor subject to a complex pressure drive condition. Here we consider key factors which affect whether or not the acceptor undergoes a shock-to-detonation transition. These include the following: shock impedance matches for the donor detonation wave into the barrier and then the barrier shock into the acceptor, the pressure gradient behind the donor detonation wave, and the curvature of detonation front in the donor. Numerical simulations are used to illustrate how these factors affect the reaction in the acceptor.

  13. Liver transplantations in Bulgaria--initial experience.

    Science.gov (United States)

    Vladov, N; Mihaylov, V; Takorov, I; Vasilevski, I; Lukanova, T; Odisseeva, E; Katzarov, K; Simonova, M; Tomova, D; Konakchieva, M; Petrov, N; Mladenov, N; Sergeev, S; Mutafchiiski, V

    2014-01-01

    The filed of liver transplantation (LT) continues to evolve and is highly effective therapy for many patients with acute and chronic liver failure resulting from a variety of causes. Improvement of perioperative care, surgical technique and immunosuppression in recent years has led to its transformation into a safe and routine procedure with steadily improving results. The aim of this paper is to present the initial experience of the transplant team at Military Medical Academy - Sofia, Bulgaria. For the period of April 2007 - August 2014 the team performed 38 liver transplants in 37 patients (one retransplantation). Patients were followed up prospectively and retrospectively. In 36 (95%) patients a graft from a cadaveric donor was used and in two cases--a right liver grafts from live donor. The mean MELD score of the transplanted patients was 17 (9-40). The preferred surgical technique was "piggyback" with preservation of inferior vena cava in 33 (86%) of the cases and classical technique in 3 (8%) patients. The overall complication rate was 48%. Early mortality rate was 13% (5 patients). The overall 1- and 5-year survival is 81% and 77% respectivelly. The setting of a new LT program is a complex process which requires the effort and effective colaboration of a wide range of speciacialists (hepatologists, surgeons, anesthesiologists, psychologists, therapists, coordinators, etc.) and institutions. The good results are function of a proper selection of the donors and the recipients. Living donation is an alternative in the shortage of cadaveric donors.

  14. Paediatric analgesia in an Emergency Department.

    LENUS (Irish Health Repository)

    Hawkes, C

    2012-02-03

    Timely management of pain in paediatric patients in the Emergency Department (ED) is a well-accepted performance indicator. We describe an audit of the provision of analgesia for children in an Irish ED and the introduction of a nurse-initiated analgesia protocol in an effort to improve performance. 95 children aged 1-16 presenting consecutively to the ED were included and time from triage to analgesia, and the rate of analgesia provision, were recorded. The results were circulated and a nurse initiated analgesia protocol was introduced. An audit including 145 patients followed this. 55.6% of patients with major fractures received analgesia after a median time of 54 minutes, which improved to 61.1% (p = 0.735) after 7 minutes (p = 0.004). Pain score documentation was very poor throughout, improving only slightly from 0% to 19.3%. No child had a documented pain score, which slightly improved to 19.3%. We recommend other Irish EDs to audit their provision of analgesia for children.

  15. [Factors justifying the choice of labor epidural analgesia by nulliparous women: experience at a maternity center in Antananarivo, Madagascar].

    Science.gov (United States)

    Ramorasata, J A C; Raveloson, N E; Randriamahavonjy, R; Tohaina, D; Keita, H

    2011-10-01

    Epidural analgesia is the most effective method for pain relief during labor. This 10-year exploratory descriptive study on factors underlying women's decisions to request or refuse labor epidural analgesia (LEA) was carried out at a level III maternity hospital in Antananarivo, Madagascar. All patients underwent a pre-anesthesia check-up (PAC) between 32 and 34 weeks of amenorrhea. During the PAC, a questionnaire was administered to determine socio-economic aspects, level of education, and knowledge about labor pain and LEA. In addition, LEA was proposed and patients were asked to explain their reasons for accepting or refusing the procedure. The purpose of this report was to describe the factors underlying acceptance or refusal of EA by nulliparous women. A total of 41 nulliparous women were included. Fourteen (34.14%) accepted LEA and 27 (63.86%) refused. Mean age was 27 years in the acceptance group and 25 years in the refusal group. No patient had good knowledge about LEA. Nulliparous women that accepted EA had a higher socio-economic level, expected stronger labor pain, were better informed about EA, and expressed greater confidence in medical care. In addition to economic aspects, the main reasons for refusing EA involved fear and family background.

  16. Partial reinforcement, extinction, and placebo analgesia.

    Science.gov (United States)

    Au Yeung, Siu Tsin; Colagiuri, Ben; Lovibond, Peter F; Colloca, Luana

    2014-06-01

    Numerous studies indicate that placebo analgesia can be established via conditioning procedures. However, these studies have exclusively involved conditioning under continuous reinforcement. Thus, it is currently unknown whether placebo analgesia can be established under partial reinforcement and how durable any such effect would be. We tested this possibility using electrocutaneous pain in healthy volunteers. Sixty undergraduates received placebo treatment (activation of a sham electrode) under the guise of an analgesic trial. The participants were randomly allocated to different conditioning schedules, namely continuous reinforcement (CRF), partial reinforcement (PRF), or control (no conditioning). Conditioning was achieved by surreptitiously reducing pain intensity during training when the placebo was activated compared with when it was inactive. For the CRF group, the placebo was always followed by a surreptitious reduction in pain during training. For the PRF group, the placebo was followed by a reduction in pain stimulation on 62.5% of trials only. In the test phase, pain stimulation was equivalent across placebo and no placebo trials. Both CRF and PRF produced placebo analgesia, with the magnitude of initial analgesia being larger after CRF. However, although the placebo analgesia established under CRF extinguished during test phase, the placebo analgesia established under PRF did not. These findings indicate that PRF can induce placebo analgesia and that these effects are more resistant to extinction than those established via CRF. PRF may therefore reflect a novel way of enhancing clinical outcomes via the placebo effect.

  17. Five-year experience of critical incidents associated with patient-controlled analgesia in an Irish University Hospital.

    LENUS (Irish Health Repository)

    Ahmad, I

    2012-02-01

    BACKGROUND: Patient-controlled analgesia (PCA) is a common and effective means of managing post-operative pain. We sought to identify factors that may lead to critical incidents (CIs) in patient safety when using PCA in our institution. METHODS: An observational study of prospectively collected data of patients who received PCA from 2002 to 2006 was performed. All CIs were documented and analysed by staff members of the acute pain service (APS). Cause analysis of CIs was undertaken to determine if measures can be instituted to prevent recurrence of similar events. RESULTS: Over eight thousand patients (8,240) received PCA. Twenty-seven CIs were identified. Eighteen were due to programming errors. Other CIs included co-administration of opioids and oversedation. CONCLUSION: In our institution, the largest contributory factor to CIs with PCAs was programming error. Strategies to minimize this problem include better education and surveillance.

  18. Hypnotizability and Placebo Analgesia in Waking and Hypnosis as Modulators of Auditory Startle Responses in Healthy Women: An ERP Study

    Science.gov (United States)

    De Pascalis, Vilfredo; Scacchia, Paolo

    2016-01-01

    We evaluated the influence of hypnotizability, pain expectation, placebo analgesia in waking and hypnosis on tonic pain relief. We also investigated how placebo analgesia affects somatic responses (eye blink) and N100 and P200 waves of event-related potentials (ERPs) elicited by auditory startle probes. Although expectation plays an important role in placebo and hypnotic analgesia, the neural mechanisms underlying these treatments are still poorly understood. We used the cold cup test (CCT) to induce tonic pain in 53 healthy women. Placebo analgesia was initially produced by manipulation, in which the intensity of pain induced by the CCT was surreptitiously reduced after the administration of a sham analgesic cream. Participants were then tested in waking and hypnosis under three treatments: (1) resting (Baseline); (2) CCT-alone (Pain); and (3) CCT plus placebo cream for pain relief (Placebo). For each painful treatment, we assessed pain and distress ratings, eye blink responses, N100 and P200 amplitudes. We used LORETA analysis of N100 and P200 waves, as elicited by auditory startle, to identify cortical regions sensitive to pain reduction through placebo and hypnotic analgesia. Higher pain expectation was associated with higher pain reductions. In highly hypnotizable participants placebo treatment produced significant reductions of pain and distress perception in both waking and hypnosis condition. P200 wave, during placebo analgesia, was larger in the frontal left hemisphere while placebo analgesia, during hypnosis, involved the activity of the left hemisphere including the occipital region. These findings demonstrate that hypnosis and placebo analgesia are different processes of top-down regulation. Pain reduction was associated with larger EMG startle amplitudes, N100 and P200 responses, and enhanced activity within the frontal, parietal, and anterior and posterior cingulate gyres. LORETA results showed that placebo analgesia modulated pain-responsive areas

  19. Hypnotizability and Placebo Analgesia in Waking and Hypnosis as Modulators of Auditory Startle Responses in Healthy Women: An ERP Study.

    Science.gov (United States)

    De Pascalis, Vilfredo; Scacchia, Paolo

    2016-01-01

    We evaluated the influence of hypnotizability, pain expectation, placebo analgesia in waking and hypnosis on tonic pain relief. We also investigated how placebo analgesia affects somatic responses (eye blink) and N100 and P200 waves of event-related potentials (ERPs) elicited by auditory startle probes. Although expectation plays an important role in placebo and hypnotic analgesia, the neural mechanisms underlying these treatments are still poorly understood. We used the cold cup test (CCT) to induce tonic pain in 53 healthy women. Placebo analgesia was initially produced by manipulation, in which the intensity of pain induced by the CCT was surreptitiously reduced after the administration of a sham analgesic cream. Participants were then tested in waking and hypnosis under three treatments: (1) resting (Baseline); (2) CCT-alone (Pain); and (3) CCT plus placebo cream for pain relief (Placebo). For each painful treatment, we assessed pain and distress ratings, eye blink responses, N100 and P200 amplitudes. We used LORETA analysis of N100 and P200 waves, as elicited by auditory startle, to identify cortical regions sensitive to pain reduction through placebo and hypnotic analgesia. Higher pain expectation was associated with higher pain reductions. In highly hypnotizable participants placebo treatment produced significant reductions of pain and distress perception in both waking and hypnosis condition. P200 wave, during placebo analgesia, was larger in the frontal left hemisphere while placebo analgesia, during hypnosis, involved the activity of the left hemisphere including the occipital region. These findings demonstrate that hypnosis and placebo analgesia are different processes of top-down regulation. Pain reduction was associated with larger EMG startle amplitudes, N100 and P200 responses, and enhanced activity within the frontal, parietal, and anterior and posterior cingulate gyres. LORETA results showed that placebo analgesia modulated pain-responsive areas

  20. Experiences of Racism in Initial Teacher Education.

    Science.gov (United States)

    Garewal, Gurpreet

    1999-01-01

    Explores trainee teachers' perceptions and projections of racial discrimination while taking the postcompulsory teaching course in England. Experiences of four trainee teachers highlight the need for more support for teacher trainees, more cultural sensitivity among teacher educators, and the inclusion of cultural and racial issues in the course.…

  1. Initial experiments with Multiple Musical Gestures

    DEFF Research Database (Denmark)

    Jensen, Kristoffer; Graugaard, Lars

    2005-01-01

    The classic orchestra has a diminishing role in society, while hard-disc recorded music plays a predominant role today. A simple to use pointer interface in 2D for producing music is presented as a means for playing in a social situation. The sounds of the music are produced by a low......-level synthesizer, and the music is produced by simple gestures that are repeated easily. The gestures include left-to-right and right-to-left motion shapes for spectral envelope and temporal envelope of the sounds, with optional backwards motion for the addition of noise; downward motion for note onset and several...... other manipulation gestures. The initial position controls which parameter is being affected, the notes intensity is controlled by the downward gesture speed, and a sequence is finalized instantly with one upward gesture. The synthesis employs a novel interface structure, the multiple musical gesture...

  2. Women's initial experience of abnormal papanicolaou smear.

    Science.gov (United States)

    Mitchell, Susan; Hall, Vincent P

    2009-06-01

    To discover the early subjective experience of women affected by abnormal Papanicolaou smear, a qualitative study was undertaken with 8 North Carolina women, 4 to 12 months postnotification of their first abnormal result. Data were analyzed via grounded theory methodology to identify a core theory that could guide interventions to improve follow-up for cancer prevention. This theoretical process is described as a labyrinth journey-an imperative healing process undertaken by all participants, who undertook the following tasks: evaluating peril, seeking refuge, obtaining information, and reframing their self-image. Women who also learned they were infected with the human papillomavirus faced a prolonged sense of threat to their sense of sexual well-being. Their additional tasks related to reevaluating their sexual self-image, and they continued to work on these reframing tasks throughout their 1st year's journey. Progress through the labyrinth depended upon emotional or spiritual support, nonjudgmental acceptance and access to accurate information.

  3. SNS Target Systems initial operating experience

    Science.gov (United States)

    McManamy, T.; Forester, J.

    2009-02-01

    The SNS mercury target started operation with low beam power when commissioned on April 28, 2006. The beam power has been following a planned ramp up since then and has reached 340 kW as of February 2008. The target systems supporting neutron production include the target and mercury loop, the cryogenic and ambient moderator systems, reflector and vessel systems, bulk shielding and shutters systems, utility systems, remote handling systems and the associated instrumentation and controls. Availability for these systems has improved with time and reached 100% for the first 2000 hour neutron production run in fiscal year 2008. An overview of the operating experience and the planning to support continued power increases to 1.4 MW for these systems will be given in this paper.

  4. AMPAkines and morphine provide complementary analgesia.

    Science.gov (United States)

    Sun, Yongjun; Liu, Kevin; Martinez, Erik; Dale, Jahrane; Huang, Dong; Wang, Jing

    2017-09-15

    Glutamate signaling in the central nervous system is known to play a key role in pain regulation. AMPAkines can enhance glutamate signaling through α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors. previous studies have shown that AMPAkines are effective analgesic agents, and their site of action is likely in the brain. It is not known, however, if AMPAkines can provide complementary analgesia in combination with opioids, the most commonly used analgesics. Here, we show that the co-administration of an AMPAkine with morphine can provide additional analgesia, both in naïve rats and in rats that experience postoperative pain. Furthermore, we show that this AMPAkine can be administered directly into the prefrontal cortex to provide analgesia, and that prefrontal AMPAkine infusion, similar to systemic administration, can provide added pain relief to complement morphine analgesia. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  5. Initial experience with robot-assisted varicocelectomy

    Institute of Scientific and Technical Information of China (English)

    Tung Shu; Shaya Taghechian; Run Wang

    2008-01-01

    Aim: To determine if robot-assisted varicocelectomy can be safely and effectively performed when compared microscopic inguinal varicocelectomy. Methods: Eight patients aged 29.1 ± 12.5 years underwent microscopic subinguinal varicocelectomies: seven patients with left-sided repair, and one patient with bilateral repair. Eight patients aged 22.0 ± 8.0 years underwent robot-assisted varicocelectomies: seven patients with left-sided repair and one patient with bilateral repair. Results: The average operative time for microscopic inguinal varicocelectomy was 73.9 ± 12.2 min, whereas the robot-assisted technique took 71.1 ± 21.1 min. There were no difficulties in identifying and isolating vessels and the vas deferens with robot-assisted subinguinal varicocelectomy. Hand tremor was eliminated using the robotic procedure. Patients who underwent either microscopic or robot-assisted varicocelectomies were able to resume daily activities on the day of surgery and full activities within 2 weeks. There were complications or recurrences of varicocele. Conclusion: From our experience, compared to microscopic surgery,robot-assisted varicocelectomy can be safely and effectively performed, with the added benefit of eliminating hand tremor.

  6. Initial performance of the CUORE-0 experiment

    Energy Technology Data Exchange (ETDEWEB)

    Artusa, D.R. [University of South Carolina, Department of Physics and Astronomy, Columbia, SC (United States); INFN-Laboratori Nazionali del Gran Sasso, L' Aquila (Italy); Avignone, F.T.; Chott, N.; Creswick, R.J.; Farach, H.A.; Rosenfeld, C.; Wilson, J. [University of South Carolina, Department of Physics and Astronomy, Columbia, SC (United States); Azzolini, O.; Keppel, G.; Palmieri, V. [INFN-Laboratori Nazionali di Legnaro, Padua (Italy); Balata, M.; Bucci, C.; Canonica, L.; Casali, N.; Di Vacri, M.L.; Goett, J.; Gorla, P.; Nisi, S.; Orlandi, D.; Pattavina, L.; Pirro, S.; Zarra, C. [INFN-Laboratori Nazionali del Gran Sasso, L' Aquila (Italy); Banks, T.I. [INFN-Laboratori Nazionali del Gran Sasso, L' Aquila (Italy); University of California, Department of Physics, Berkeley, CA (United States); Lawrence Berkeley National Laboratory, Nuclear Science Division, Berkeley, CA (United States); Bari, G.; Deninno, M.M.; Moggi, N. [INFN-Sezione di Bologna, Bologna (Italy); Beeman, J. [Lawrence Berkeley National Laboratory, Materials Science Division, Berkeley, CA (United States); Bellini, F.; Cardani, L.; Cosmelli, C.; Ferroni, F.; Piperno, G. [Sapienza Universita di Roma, Dipartimento di Fisica, Rome (Italy); INFN-Sezione di Roma, Rome (Italy); Bersani, A. [INFN-Sezione di Genova, Genoa (Italy); Biassoni, M.; Brofferio, C.; Capelli, S.; Carrettoni, M.; Chiesa, D.; Clemenza, M.; Faverzani, M.; Ferri, E.; Fiorini, E.; Giachero, A.; Gironi, L.; Gotti, C.; Maiano, C.; Maino, M.; Nucciotti, A.; Pavan, M.; Sala, E.; Sisti, M.; Terranova, F.; Zanotti, L. [Universita di Milano-Bicocca, Dipartimento di Fisica, Milan (Italy); INFN-Sezione di Milano Bicocca, Milan (Italy); Cai, X.Z.; Cao, X.G.; Fang, D.Q.; Li, Y.L.; Ma, Y.G.; Tian, W.D.; Wang, H.W. [Shanghai Institute of Applied Physics (Chinese Academy of Sciences), Shanghai (China); Carbone, L.; Cremonesi, O.; Datskov, V.; Pessina, G.; Previtali, E.; Rusconi, C. [INFN-Sezione di Milano Bicocca, Milan (Italy); Dafinei, I.; Morganti, S.; Orio, F.; Pettinacci, V.; Tomei, C.; Vignati, M. [INFN-Sezione di Roma, Rome (Italy); Dally, A.; Ejzak, L.; Wielgus, L. [University of Wisconsin, Department of Physics, Madison, WI (United States); Di Domizio, S.; Fernandes, G.; Pallavicini, M. [INFN-Sezione di Genova, Genoa (Italy); Universita di Genova, Dipartimento di Fisica, Genoa (Italy); Freedman, S.J. [University of California, Department of Physics, Berkeley, CA (United States); Lawrence Berkeley National Laboratory, Nuclear Science Division, Berkeley, CA (United States); Fujikawa, B.K.; Han, K.; Mei, Y. [Lawrence Berkeley National Laboratory, Nuclear Science Division, Berkeley, CA (United States); Giuliani, A.; Tenconi, M. [Centre de Spectrometrie Nucleaire et de Spectrometrie de Masse, Orsay Campus (France); Gutierrez, T.D. [California Polytechnic State University, Physics Department, San Luis Obispo, CA (United States); Haller, E.E. [Lawrence Berkeley National Laboratory, Materials Science Division, Berkeley, CA (United States); University of California, Department of Materials Science and Engineering, Berkeley, CA (United States); Heeger, K.M.; Lim, K.E.; Maruyama, R.H. [Yale University, Department of Physics, New Haven, CT (United States); Hennings-Yeomans, R.; Ouellet, J.L. [University of California, Department of Physics, Berkeley, CA (United States); Lawrence Berkeley National Laboratory, Nuclear Science Division, Berkeley, CA (United States); Huang, H.Z.; Liu, X.; Trentalange, S.; Winslow, L.A.; Zhu, B.X. [University of California, Department of Physics and Astronomy, Los Angeles, CA (United States); Kadel, R. [Lawrence Berkeley National Laboratory, Physics Division, Berkeley, CA (United States); Kazkaz, K.; Pedretti, M.; Sangiorgio, S.; Scielzo, N.D. [Lawrence Livermore National Laboratory, Livermore, CA (United States); Kolomensky, Yu.G. [University of California, Department of Physics, Berkeley, CA (United States); Lawrence Berkeley National Laboratory, Physics Division, Berkeley, CA (United States); Martinez, M. [Universidad de Zaragoza, Laboratorio de Fisica Nuclear y Astroparticulas, Saragossa (Spain); Nones, C. [Service de Physique des Particules, CEA/Saclay, Gif-sur-Yvette (France); Norman, E.B.; Wang, B.S. [Lawrence Livermore National Laboratory, Livermore, CA (United States); University of California, Department of Nuclear Engineering, Berkeley, CA (United States); O' Donnell, T. [University of California, Department of Physics, Berkeley, CA (United States); Smith, A.R. [Lawrence Berkeley National Laboratory, EH and S Division, Berkeley, CA (United States); Taffarello, L. [INFN-Sezione di Padova, Padua (Italy); Ventura, G. [Universita di Firenze, Dipartimento di Fisica, Florence (Italy); INFN-Sezione di Firenze, Florence (Italy); Wise, T. [University of Wisconsin, Department of Physics, Madison, WI (United States); Yale University, Department of Physics, New Haven, CT (United States); Zucchelli, S. [INFN-Sezione di Bologna, Bologna (Italy); Universita di Bologna, Dipartimento di Fisica, Bologna (Italy)

    2014-08-15

    CUORE-0 is a cryogenic detector that uses an array of tellurium dioxide bolometers to search for neutrinoless double-beta decay of {sup 130}Te. We present the first data analysis with 7.1kg . y of total TeO{sub 2} exposure focusing on background measurements and energy resolution. The background rates in the neutrinoless double-beta decay region of interest (2.47 to 2.57MeV) and in the α backgrounddominated region (2.70 to 3.90 MeV) have been measured to be 0.071 ± 0.011 and 0.019 ± 0.002 counts/(keV . kg . y), respectively. The latter result represents a factor of 6 improvement from a predecessor experiment, Cuoricino. The results verify our understanding of the background sources in CUORE-0, which is the basis of extrapolations to the full CUORE detector. The obtained energy resolution (full width at half maximum) in the region of interest is 5.7 keV. Based on themeasured background rate and energy resolution in the region of interest, CUORE-0 half-life sensitivity is expected to surpass the observed lower bound of Cuoricino with one year of live time. (orig.)

  7. Initial performance of the CUORE-0 experiment

    CERN Document Server

    Aguirre, C P; Avignone, F T; Azzolini, O; Balata, M; Banks, T I; Bari, G; Beeman, J; Bellini, F; Bersani, A; Biassoni, M; Brofferio, C; Bucci, C; Cai, X Z; Canonica, L; Cao, X G; Capelli, S; Carbone, L; Cardani, L; Carrettoni, M; Casali, N; Chiesa, D; Chott, N; Clemenza, M; Cosmelli, C; Cremonesi, O; Creswick, R J; Dafinei, I; Dally, A; Datskov, V; Deninno, M M; Di Domizio, S; di Vacri, M L; Ejzak, L; Fang, D Q; Farach, H A; Faverzani, M; Fernandes, G; Ferri, E; Ferroni, F; Fiorini, E; Freedman, S J; Fujikawa, B K; Giachero, A; Gironi, L; Giuliani, A; Goett, J; Gorla, P; Gotti, C; Gutierrez, T D; Haller, E E; Han, K; Heeger, K M; Hennings-Yeomans, R; Huang, H Z; Kadel, R; Kazkaz, K; Keppel, G; Kolomensky, Yu G; Li, Y L; Lim, K E; Liu, X; Ma, Y G; Maiano, C; Maino, M; Martinez, M; Maruyama, R H; Mei, Y; Moggi, N; Morganti, S; Nisi, S; Nones, C; Norman, E B; Nucciotti, A; O'Donnell, T; Orio, F; Orlandi, D; Ouellet, J L; Pallavicini, M; Palmieri, V; Pattavina, L; Pavan, M; Pedretti, M; Pessina, G; Pettinacci, V; Piperno, G; Pirro, S; Previtali, E; Rosenfeld, C; Rusconi, C; Sala, E; Sangiorgio, S; Scielzo, N D; Sisti, M; Smith, A R; Taffarello, L; Tenconi, M; Terranova, F; Tian, W D; Tomei, C; Trentalange, S; Vignati, M; Wang, B S; Wang, H W; Wielgus, L; Wilson, J; Winslow, L A; Wise, T; Zanotti, L; Zarra, C; Zhu, B X; Zucchelli, S

    2014-01-01

    CUORE-0 is a cryogenic detector that uses an array of tellurium dioxide bolometers to search for neutrinoless double-beta decay of ^{130}Te. We present the first data analysis with 7.1 kg y of total TeO_2 exposure focusing on background measurements and energy resolution. The background rates in the neutrinoless double-beta decay region of interest (2.47 to 2.57 MeV) and in the {\\alpha} background-dominated region (2.70 to 3.90 MeV) have been measured to be 0.071 \\pm 0.011 and 0.019 \\pm 0.002 counts/keV/kg/y, respectively. The latter result represents a factor of 6 improvement from a predecessor experiment, Cuoricino. The results verify our understanding of the background sources in CUORE-0, which is the basis of extrapolations to the full CUORE detector. The obtained energy resolution (full width at half maximum) in the region of interest is 5.7 keV. Based on the measured background rate and energy resolution in the region of interest, CUORE-0 half-life sensitivity is expected to surpass the observed lower b...

  8. Laparoscopic nephrectomy: initial experience with 120 cases.

    LENUS (Irish Health Repository)

    Cheema, I A

    2012-02-01

    Laparoscopic nephrectomy for both benign and malignant diseases of kidney is increasingly being performed. We report our experience with the first 120 consecutive laparoscopic nephrectomy performed in our hospital. It is the retrospective analysis of a prospectively maintained database of 4 years period. The parameters examined included age, gender, indications, operative time, blood loss, intraoperative and post operative complications. Mean age of surgery was 59 years (rang 19-84years). The indications for surgery included solid renal masses (71 patients), non-functioning kidneys (43), and collecting system tumours (6). The mean operating time was 132 minutes (range 75-270), average blood loss was 209 ml (range 0-1090) and average hospital stay was 4.7days (range 2-20). Bleeding, bowel injury and poor progression of laparoscopic procedure were the reasons in 7 (5.8%) cases converted to open surgery. There was 1 (0.8%) perioperative mortality. Eight (6.6%) patients developed post operative complications. Laparoscopic nephrectomy has inherent benefits and may be considered an alternate therapeutic option for kidney diseases with acceptable morbidity

  9. Laparoscopic nephrectomy: initial experience with 120 cases.

    LENUS (Irish Health Repository)

    Cheema, I A

    2010-02-01

    Laparoscopic nephrectomy for both benign and malignant diseases of kidney is increasingly being performed. We report our experience with the first 120 consecutive laparoscopic nephrectomy performed in our hospital. It is the retrospective analysis of a prospectively maintained database of 4 years period. The parameters examined included age, gender, indications, operative time, blood loss, intraoperative and post operative complications. Mean age of surgery was 59 years (rang 19-84years). The indications for surgery included solid renal masses (71 patients), non-functioning kidneys (43), and collecting system tumours (6). The mean operating time was 132 minutes (range 75-270), average blood loss was 209 ml (range 0-1090) and average hospital stay was 4.7days (range 2-20). Bleeding, bowel injury and poor progression of laparoscopic procedure were the reasons in 7 (5.8%) cases converted to open surgery. There was 1 (0.8%) perioperative mortality. Eight (6.6%) patients developed post operative complications. Laparoscopic nephrectomy has inherent benefits and may be considered an alternate therapeutic option for kidney diseases with acceptable morbidity

  10. Remifentanil for labor analgesia: an evidence-based narrative review.

    Science.gov (United States)

    Van de Velde, M; Carvalho, B

    2016-02-01

    This manuscript reviews the available literature on remifentanil patient-controlled intravenous analgesia in labor focusing on efficacy and safety. Remifentanil compares favorably to other potent systemic opioids but with fewer opioid-related neonatal effects. However, remifentanil provides modest and short-lasting labor analgesia that is consistently inferior when compared to neuraxial analgesia. The initial analgesic effect provided with remifentanil also diminishes as labor progresses. In several studies, remifentanil induced significant respiratory depressant effects in laboring women with episodes of desaturation, hypoventilation and even apnea. Given the safety concerns, we recommend that remifentanil patient-controlled intravenous analgesia should not be a routine analgesia technique during labor. In cases where neuraxial analgesia is refused or contraindicated and the use of remifentanil justified, continuous and careful monitoring is required to detect respiratory depression to provide safe care of both the pregnant woman and unborn child.

  11. Intrathecal analgesia and palliative care: A case study

    Directory of Open Access Journals (Sweden)

    Naveen S Salins

    2010-01-01

    Full Text Available Intrathecal analgesia is an interventional form of pain relief with definite advantages and multiple complications. Administration of intrathecal analgesia needs a good resource setting and expertise. Early complications of intrathecal analgesia can be very distressing and managing these complications will need a high degree of knowledge, technical expertise and level of experience. Pain control alone cannot be the marker of quality in palliative care. A holistic approach may need to be employed that is more person and family oriented.

  12. Analgesia accompanying food consumption requires ingestion of hedonic foods.

    Science.gov (United States)

    Foo, H; Mason, Peggy

    2009-10-14

    Animals eat rather than react to moderate pain. Here, we examined the behavioral, hedonic, and neural requirements for ingestion analgesia in ad libitum fed rats. Noxious heat-evoked withdrawals were similarly suppressed during self-initiated chocolate eating and ingestion of intraorally infused water, sucrose, or saccharin, demonstrating that ingestion analgesia does not require feeding motivation, self-initiated food procurement, sucrose, or calories. Rather, food hedonics is important because neither salt ingestion nor quinine rejection elicited analgesia. During quinine-induced nausea and lipopolysaccharide (LPS)-induced illness, conditions when chocolate eating was presumably less pleasurable, analgesia accompanying chocolate consumption was attenuated, yet analgesia during water ingestion was preserved in LPS-injected rats who showed enhanced palatability for water within this context. The dependence of ingestion analgesia on the positive hedonics of an ingestate was confirmed in rats with a conditioned taste aversion to sucrose: after paired exposure to sucrose and LPS, rats no longer showed analgesia during sucrose ingestion but continued to show analgesia during chocolate consumption. Eating pauses tended to occur less often and for shorter durations in the presence of ingestion analgesia than in its absence. Therefore, we propose that ingestion analgesia functions to defend eating from ending. Muscimol inactivation of the medullary raphe magnus blocked the analgesia normally observed during water ingestion, showing the involvement of brainstem endogenous pain inhibitory mechanisms in ingestion analgesia. Brainstem-mediated defense of the consumption of palatable foods may explain, at least in part, why overeating tasty foods is so irresistible even in the face of opposing cognitive and motivational forces.

  13. Effects of subtle cognitive manipulations on placebo analgesia - An implicit priming study.

    Science.gov (United States)

    Rosén, A; Yi, J; Kirsch, I; Kaptchuk, T J; Ingvar, M; Jensen, K B

    2017-04-01

    Expectancy is widely accepted as a key contributor to placebo effects. However, it is not known whether non-conscious expectancies achieved through semantic priming may contribute to placebo analgesia. In this study, we investigated if an implicit priming procedure, where participants were unaware of the intended priming influence, affected placebo analgesia. In a double-blind experiment, healthy participants (n = 36) were randomized to different implicit priming types; one aimed at increasing positive expectations and one neutral control condition. First, pain calibration (thermal) and a credibility demonstration of the placebo analgesic device were performed. In a second step, an independent experimenter administered the priming task; Scrambled Sentence Test. Then, pain sensitivity was assessed while telling participants that the analgesic device was either turned on (placebo) or turned off (baseline). Pain responses were recorded on a 0-100 Numeric Response Scale. Overall, there was a significant placebo effect (p priming conditions (positive/neutral) did not lead to differences in placebo outcome. Prior experience of pain relief (during initial pain testing) correlated significantly with placebo analgesia (p Priming is one of many ways to influence behaviour, and non-conscious activation of positive expectations could theoretically affect placebo analgesia. Yet, we found no SST priming effect on placebo analgesia. Instead, our data point to the significance of prior experience of pain relief, trait neuroticism and social interaction with the treating clinician. Our findings challenge the role of semantic priming as a behavioural modifier that may shape expectations of pain relief, and affect placebo analgesia. © 2016 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC®.

  14. Mouse anesthesia and analgesia.

    Science.gov (United States)

    Adams, Sean; Pacharinsak, Cholawat

    2015-03-02

    Providing anesthesia and analgesia for mouse subjects is a common and critical practice in the laboratory setting. These practices are necessary for performing invasive procedures, achieving prolonged immobility for sensitive imaging modalities (magnetic resonance imaging for instance), and providing intra- and post-procedural pain relief. In addition to facilitating the procedures performed by the investigator, the provision of anesthesia and analgesia is crucial for the preservation of animal welfare and for humane treatment of animals used in research. Furthermore, anesthesia and analgesia are important components of animal use protocols reviewed by Institutional Animal Care and Use Committees, requiring careful consideration and planning for the particular animal model. In this article, we provide technical outlines for the investigator covering the provision of anesthesia by two routes (injectable and inhalant), guidelines for monitoring anesthesia, current techniques for recognition of pain, and considerations for administering preventative analgesia. Copyright © 2015 John Wiley & Sons, Inc.

  15. ANALGESIA IN SMALL CHILDREN

    African Journals Online (AJOL)

    Opioids provide effective analgesia, but also have known side ... significance of the study lies in the improvement in post-operative pain management in children after day-case .... have required intervention or delay in discharge from hospital.

  16. Initial predictions in learning-to-forecast experiment

    NARCIS (Netherlands)

    C. Diks; T. Makarewicz

    2012-01-01

    In this paper we estimate the distribution of the initial predictions of the Heemeijer et al. [5] Learning-to-Forecast experiment. By design, these initial predictions were uninformed. We show that in fact they have a non-continuous distribution and that they systematically under-evaluate the fundam

  17. Regional anaesthesia and analgesia on the front line.

    Science.gov (United States)

    Scott, D M

    2009-11-01

    Deployment to a combat zone with the military poses many challenges to the anaesthetist. One of these challenges is the safe, rapid and comfortable initial wound management and repatriation of wounded combat soldiers to their home country or tertiary treatment facility for definitive care and rehabilitation. The current conflict in Afghanistan is associated with injury patterns that differ from wars such as Vietnam or Korea. This report describes the experience of an Australian military anaesthetist and the value of regional anaesthesia and analgesia for the care of the wounded combat soldier

  18. Involvement of connexin 43 in acupuncture analgesia

    Institute of Scientific and Technical Information of China (English)

    HUANG Guang-ying; ZHENG Cui-hong; YU Wei-chang; TIAN Dai-shi; WANG Wei

    2009-01-01

    Background Connexin 43 (Cx43) is one of the major components of human keratinocyte gap junctions. To study whether gap junctional intercellular communication participates in the transfer of acupoint signals and acupuncture analgesia, the expression of Cx43 was studied in Zusanli (ST36) acupoints compared with control non-acupoint regions in rats after acupuncture. In addition, Cx43 heterozygous gene knockout mice were used to further explore the relationship between Cx43 and acupuncture analgesia. Methods The expression of Cx43 was detected by immunohistochemistry, immunoblotting, and RT-PCR for the Cx43 protein and mRNA. The influence of the Cx43 gene knockout on acupuncture analgesia was measured by a hot plate and observing the writhing response on Cx43 heterozygous gene knockout mice. Results Immunohistochemistry showed abundant Cx43 expression in some cells in the skin and subcutaneous tissue of rat ST36 acupoints. The mRNA and protein levels of Cx43 in acupoints were significantly higher than those in the control points in the non-acupuncture group, and even more so after acupuncture. The hot plate and writhing response experiments showed that partial knockout of the Cx43 gene decreased acupuncture analgesia. Conclusion Cx43 expression and acupuncture analgesia showed a positive correlation.

  19. The NIF Shear Experiment: Emergent Coherent Structures and Initial Conditions

    Science.gov (United States)

    Flippo, K. A.; Doss, F. W.; Merritt, E. C.; di Stefano, C. A.; Devolder, B. G.; Kurien, S.; Kot, L.; Loomis, E. N.; Murphy, T. J.; Perry, T. S.; Kline, J. L.; Huntington, C. M.; Nagel, S. R.; MacLaren, S. A.; Schmidt, D. W.

    2016-10-01

    The NIF Shear experiments are designed to stress turbulence models at high Atwood numbers, high convective Mach number, and in a highly compressible regime. The NIF laser system is used to drive two hohlraums on either end of the experiment, which convert the laser drive into a bath of soft x-rays, 250eV in temperature. The counter-propagating shocks and flow, pressure balance the shear layer, such that it can grow due to the KH instability in the center of the experiment for 20 ns. These experiments are the first High Energy Density (HED) hydro-instability studies to show emergent coherent Kelvin-Helmholtz (KH) structures arising from random broadband seeds, and the first to control the phenomenological evolution of the tracer layer by controlling the initial surface roughness conditions. The change in initial conditions forces the system evolution on a different path that does not appear to reach a universal nor self-similar state by the end of the experiment. The experiment was modeled using the multi-physics hydrodynamic code RAGE with the BHR turbulence model. The initial scale-length of the model is modified to match the data. When the model is turned off, the pure hydrodynamics do not capture the behavior of the mixing layer and cannot match the data.

  20. Ethanol-induced analgesia

    Energy Technology Data Exchange (ETDEWEB)

    Pohorecky, L.A.; Shah, P.

    1987-09-07

    The effect of ethanol (ET) on nociceptive sensitivity was evaluated using a new tail deflection response (TDR) method. The IP injection of ET (0.5 - 1.5 g/kg) produced raid dose-dependent analgesia. Near maximal effect (97% decrease in TDR) was produced with the 1.5 g/kg dose of ET ten minutes after injection. At ninety minutes post-injection there was still significant analgesia. Depression of ET-induced nociceptive sensitivity was partially reversed by a 1 mg/kg dose of naloxone. On the other hand, morphine (0.5 or 5.0 mg/kg IP) did not modify ET-induced analgesia, while 3.0 minutes of cold water swim (known to produce non-opioid mediated analgesia) potentiated ET-induced analgesic effect. The 0.5 g/kg dose of ET by itself did not depress motor activity in an open field test, but prevented partially the depression in motor activity produced by cold water swim (CWS). Thus, the potentiation by ET of the depression of the TDR produced by CWS cannot be ascribed to the depressant effects of ET on motor activity. 21 references, 4 figures, 1 table.

  1. Initial Homosexual Experiences of MSM in Surat City

    Directory of Open Access Journals (Sweden)

    Kumar Mukesh, Bansal RK

    2010-06-01

    Full Text Available This cross-sectional study among 200 Men having sex with men in Surat City explores their initial MSM experiences. Our findings reveal that MSM are sexually active with slightly more bisexual than homosexual. Over half had their first homosexual attraction and relationships before the age of 14 years commonly while playing with friends, though some were forced or raped into their first MSM experience by cousin, friend or elders and care takers. 94% the second homosexual encounter had occurred within 3 months of the first homosexual encounter. These two initial MSM experiences play an important role in future MSM inclinations and highlight the need to ensure that children do not enter into such early relationships before the age of consent. What merits special attention is that these experiences invariably occur during adolescence and their impression makes a lasting effect on their psyche and sexual inclination lifelong. Receptive anal sex emerges as the most common sexual act (89.5% and as the commonest reason for continuing with MSM relationships (26.5%. Friends are the main source (99.5% of entry into an MSM group.

  2. Knowledge, attitude and acceptance of antenatal women toward labor analgesia and caesarean section in a medical college hospital in India

    Directory of Open Access Journals (Sweden)

    Udita Naithani

    2011-01-01

    Full Text Available Background : The present audit was initiated to evaluate the knowledge, attitude, perception and acceptance of women toward labor analgesia and caesarean section, in a Medical College Hospital in Udaipur, India. Materials and Methods : A semi-structured interview of 200 antenatal women was conducted, to assess the knowledge, attitude and perception regarding labor analgesia and caesarean section (CS and to estimate the correlation of awareness and acceptability with demographic variables. The data were analyzed using Epi Info 6 and the Likert type scale (0 - 10, as also the chi square test, to calculate the statistical significance. Results : Most of the patients (n = 181, 90.50% were unaware of labor analgesia. When the option of labor analgesia was offered, only 23% (n = 46 accepted it and the most significant reason for refusal was to experience natural child birth (n = 114 / 154, 74.03%. An educational status of the graduate level had a positive impact on knowledge about labor analgesia (P = 0.0001. When the option for CS was offered, 73.50% women (n = 147; P = 0.008 refused and the most common reasons for refusal were fear of operation (53.06%, n = 78 and delay in resuming household work (46.26%, n = 68. Educational status up to the graduate level and previous surgical experience of CS had a positive correlation with preference for CS (P = 0.0092 and P = 0.0001, respectively. Conclusions : Awareness and acceptance for labor analgesia was relatively low among the prospective parturients. A higher level of education had a significant impact on their decisions regarding delivery.

  3. Dynamic crack initiation toughness : experiments and peridynamic modeling.

    Energy Technology Data Exchange (ETDEWEB)

    Foster, John T.

    2009-10-01

    This is a dissertation on research conducted studying the dynamic crack initiation toughness of a 4340 steel. Researchers have been conducting experimental testing of dynamic crack initiation toughness, K{sub Ic}, for many years, using many experimental techniques with vastly different trends in the results when reporting K{sub Ic} as a function of loading rate. The dissertation describes a novel experimental technique for measuring K{sub Ic} in metals using the Kolsky bar. The method borrows from improvements made in recent years in traditional Kolsky bar testing by using pulse shaping techniques to ensure a constant loading rate applied to the sample before crack initiation. Dynamic crack initiation measurements were reported on a 4340 steel at two different loading rates. The steel was shown to exhibit a rate dependence, with the recorded values of K{sub Ic} being much higher at the higher loading rate. Using the knowledge of this rate dependence as a motivation in attempting to model the fracture events, a viscoplastic constitutive model was implemented into a peridynamic computational mechanics code. Peridynamics is a newly developed theory in solid mechanics that replaces the classical partial differential equations of motion with integral-differential equations which do not require the existence of spatial derivatives in the displacement field. This allows for the straightforward modeling of unguided crack initiation and growth. To date, peridynamic implementations have used severely restricted constitutive models. This research represents the first implementation of a complex material model and its validation. After showing results comparing deformations to experimental Taylor anvil impact for the viscoplastic material model, a novel failure criterion is introduced to model the dynamic crack initiation toughness experiments. The failure model is based on an energy criterion and uses the K{sub Ic} values recorded experimentally as an input. The failure model

  4. Team learning in medical education: initial experiences at ten institutions.

    Science.gov (United States)

    Searle, Nancy S; Haidet, Paul; Kelly, P Adam; Schneider, Virginia F; Seidel, Charles L; Richards, Boyd F

    2003-10-01

    In the midst of curricular reforms that frequently call for reducing lectures and increasing small-group teaching, there is a crisis in faculty time for teaching. This paper describes the initial experiences of ten institutions with team learning (TL), a teaching method which fosters small-group learning in a large-class setting. After initial pilot studies at one institution, nine additional institutions implemented TL in one or more courses. Within 18 months, TL has been used in 40 courses (from.5% to 100% of the time) and all ten institutions will increase its use next year. We surmise that this relatively rapid spread of TL into the medical curriculum is due to the sound pedagogy and efficiency of TL as well as the modest financial resources and support we have provided to partner institutions.

  5. Initiating the development of multisensory integration by manipulating sensory experience.

    Science.gov (United States)

    Yu, Liping; Rowland, Benjamin A; Stein, Barry E

    2010-04-07

    The multisensory integration capabilities of superior colliculus neurons emerge gradually during early postnatal life as a consequence of experience with cross-modal stimuli. Without such experience neurons become responsive to multiple sensory modalities but are unable to integrate their inputs. The present study demonstrates that neurons retain sensitivity to cross-modal experience well past the normal developmental period for acquiring multisensory integration capabilities. Experience surprisingly late in life was found to rapidly initiate the development of multisensory integration, even more rapidly than expected based on its normal developmental time course. Furthermore, the requisite experience was acquired by the anesthetized brain and in the absence of any of the stimulus-response contingencies generally associated with learning. The key experiential factor was repeated exposure to the relevant stimuli, and this required that the multiple receptive fields of a multisensory neuron encompassed the cross-modal exposure site. Simple exposure to the individual components of a cross-modal stimulus was ineffective in this regard. Furthermore, once a neuron acquired multisensory integration capabilities at the exposure site, it generalized this experience to other locations, albeit with lowered effectiveness. These observations suggest that the prolonged period during which multisensory integration normally appears is due to developmental factors in neural circuitry in addition to those required for incorporating the statistics of cross-modal events; that neurons learn a multisensory principle based on the specifics of experience and can then apply it to other stimulus conditions; and that the incorporation of this multisensory information does not depend on an alert brain.

  6. Epidural analgesia during labor vs no analgesia: A comparative study

    Directory of Open Access Journals (Sweden)

    Wesam Farid Mousa

    2012-01-01

    Full Text Available Background: Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. This study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia. Methods: One hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 mL bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal Apgar score were recorded. Results: There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group. Conclusion: Epidural analgesia by lidocaine (0.5% and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration.

  7. Initial clinical experience with Dideco Kids D100 neonatal oxygenator.

    Science.gov (United States)

    Pace Napoleone, Carlo; Oppido, Guido; Angeli, Emanuela; Shekho, Nazar; De Toni, Erika; Bruzzi, Franco; Gargiulo, Gaetano

    2008-07-01

    We describe our initial clinical experience with the new hollow fibre membrane oxygenator Dideco Kids D100, used in five patients with a mean age of 21 +/- 28 days. The priming volume is 31 ml with a membrane surface area of 0.22 m2. Data were compared with those deriving from five patients treated with Dideco D901 Lilliput 1 oxygenator. Among patients treated by the new Dideco Kids D100 oxygenator, priming volume was significantly reduced and an easier blood gas delivery was evident.

  8. Initial NIF Shock Timing Experiments: Comparison with Simulation

    Science.gov (United States)

    Robey, H. F.; Celliers, P. M.; Boehly, T. R.; Datte, P. S.; Bowers, M. W.; Olson, R. E.; Munro, D. H.; Milovich, J. L.; Jones, O. S.; Nikroo, A.; Kroll, J. J.; Horner, J. B.; Hamza, A. V.; Bhandarkar, S. D.; Giraldez, E.; Castro, C.; Gibson, C. R.; Eggert, J. H.; Smith, R. F.; Park, H.-S.; Young, B. K.; Hsing, W. W.; Landen, O. L.; Meyerhofer, D. D.

    2010-11-01

    Initial experiments are underway to demonstrate the techniques required to tune the shock timing of capsule implosions on the National Ignition Facility (NIF). These experiments use a modified cryogenic hohlraum geometry designed to precisely match the performance of ignition hohlraums. The targets employ a re-entrant Au cone to provide optical access to the shocks as they propagate in the liquid deuterium-filled capsule interior. The strength and timing of the shocks is diagnosed with VISAR (Velocity Interferometer System for Any Reflector) and DANTE. The results of these measurements will be used to set the precision pulse shape for ignition capsule implosions to follow. Experimental results and comparisons with numerical simulation are presented.

  9. Offset analgesia is reduced in older adults.

    Science.gov (United States)

    Naugle, Kelly M; Cruz-Almeida, Yenisel; Fillingim, Roger B; Riley, Joseph L

    2013-11-01

    Recent studies indicate that aging is associated with dysfunctional changes in pain modulatory capacity, potentially contributing to increased incidence of pain in older adults. However, age-related changes in offset analgesia (offset), a form of temporal pain inhibition, remain poorly characterized. The purpose of this study was to investigate age differences in offset analgesia of heat pain in healthy younger and older adults. To explore the peripheral mechanisms underlying offset, an additional aim of the study was to test offset at 2 anatomical sites with known differences in nociceptor innervation. A total of 25 younger adults and 20 older adults completed 6 offset trials in which the experimental heat stimulus was presented to the volar forearm and glabrous skin of the palm. Each trial consisted of 3 continuous phases: an initial 15-second painful stimulus (T1), a slight increase in temperature from T1 for 5 seconds (T2), and a slight decrease back to the initial testing temperature for 10 seconds (T3). During each trial, subjects rated pain intensity continuously using an electronic visual analogue scale (0-100). Older adults demonstrated reduced offset compared to younger adults when tested on the volar forearm. Interestingly, offset analgesia was nonexistent on the palm for all subjects. The reduced offset found in older adults may reflect an age-related decline in endogenous inhibitory systems. However, although the exact mechanisms underlying offset remain unknown, the absence of offset at the palm suggests that peripheral mechanisms may be involved in initiating this phenomenon.

  10. Scaffolding Students’ Initial Self-Access Language Centre Experiences

    Directory of Open Access Journals (Sweden)

    Robert Croker

    2012-09-01

    Full Text Available As the number of self-access language centres (SALCs in Japanese universities continues to grow, so too does the challenge of successfully introducing them to first-year university students, whose initial experiences of self-access language learning may otherwise be confusing and even unsettling. One approach is to carefully scaffold students’ first SALC encounters by connecting them with their classroom learning experiences. This paper discusses one such approach developed at a private university in central Japan, which was based upon a two-stage ‘push-pull’ ‘materials-light, people-focused’ strategy. Teachers initially ‘pushed’ their students to visit the SALC by giving them speaking ‘homework’ to be done there. The SALC then also offered interesting interactive events designed to ‘pull’ learners to continue to come. These push-pull activities could be done with few or no materials, and emphasized interaction with people rather than materials. This two-stage, push-pull strategy served as a bridge between the language classroom and a SALC, helping learners make the first steps in their transition from being a ‘classroom English learner’ to becoming a ‘SALC English user’.

  11. Effect of residents' previous laparoscopic surgery experience on initial robotic suturing experience.

    Science.gov (United States)

    Kilic, Gokhan Sami; Walsh, Teresa M; Borahay, Mostafa; Zeybek, Burak; Wen, Michael; Breitkopf, Daniel

    2012-01-01

    Objective. To assess the impact of gynecology residents' previous laparoscopic experience on the learning curve of robotic suturing techniques and the value of initial structured teaching in dry lab prior to surgery. Methods. Thirteen gynecology residents with no previous robotic surgery experience were divided into Group 1, consisting of residents with 2 or fewer laparoscopic experiences, and Group 2, consisting of residents with 3 or more laparoscopic experiences. Group 1 had a dry-laboratory training in suturing prior to their initial experience in the operating room. Results. For all residents, it took on average 382 ± 159 seconds for laparoscopic suturing and 326 ± 196 seconds for robotic suturing (P = 0.12). Residents in Group 1 had a lower mean suture time than residents in Group 2 for laparoscopic suturing (P = 0.009). The residents in Group 2, however, had a lower mean suture time on the robot compared to Group 1 (P = 0.5). Conclusion. Residents with previous laparoscopic suturing experience may gain more from a robotic surgery experience than those with limited laparoscopic surgery experience. In addition, dry lab training is more efficient than hands-on training in the initial phase of teaching for both laparoscopic and robotic suturing skills.

  12. From Peripheral to Central: The Role of ERK Signaling Pathway in Acupuncture Analgesia

    Science.gov (United States)

    Park, Ji-Yeun; Park, Jongbae J.; Jeon, Songhee; Doo, Ah-Reum; Kim, Seung-Nam; Lee, Hyangsook; Chae, Younbyoung; Maixner, William; Lee, Hyejung; Park, Hi-Joon

    2014-01-01

    Despite accumulating evidence of the clinical effectiveness of acupuncture, its mechanism remains largely unclear. We assume that molecular signaling around the acupuncture needled area is essential for initiating the effect of acupuncture. To determine possible bio-candidates involved in the mechanisms of acupuncture and investigate the role of such bio-candidates in the analgesic effects of acupuncture, we conducted 2 stepwise experiments. First, a genome-wide microarray of the isolated skin layer at the GB34-equivalent acupoint of C57BL/6 mice 1 hour after acupuncture found that a total of 236 genes had changed and that extracellular signal–regulated kinase (ERK) activation was the most prominent bio-candidate. Second, in mouse pain models using formalin and complete Freund adjuvant, we found that acupuncture attenuated the nociceptive behavior and the mechanical allodynia; these effects were blocked when ERK cascade was interrupted by the mitogen-activated protein kinase kinase (MEK)/mitogen-activated protein kinase (MAPK) inhibitor U0126 (.8 μg/μL). Based on these results, we suggest that ERK phosphorylation following acupuncture needling is a biochemical hallmark initiating the effect of acupuncture including analgesia. Perspective This article presents the novel evidence of the local molecular signaling in acupuncture analgesia by demonstrating that ERK activation in the skin layer contributes to the analgesic effect of acupuncture in a mouse pain model. This work improves our understanding of the scientific basis underlying acupuncture analgesia. PMID:24524846

  13. PET/MR imaging of atherosclerosis: initial experience and outlook.

    Science.gov (United States)

    Rischpler, Christoph; Nekolla, Stephan G; Beer, Ambros J

    2013-01-01

    Hybrid scanners such as PET/CT have in the past emerged as a valuable modality in clinical routine as well as an important research tool. Recently, the newly developed fully integrated PET/MR scanners were introduced to the market, raising high expectations especially due to the excellent soft tissue contrast and functional imaging capabilities of MRI. In this issue of the American Journal of Nuclear Medicine and Molecular Imaging, initial experiences using a hybrid PET/MR scanner for carotid artery imaging in a group of patients with increased risk for atherosclerosis are described. This represents a proof-of-principle study, which could stimulate future applications of this powerful modality in atherosclerotic plaque imaging.

  14. Debris-flow initiation experiments using diverse hydrologic triggers

    Science.gov (United States)

    Reid, Mark E.; LaHusen, Richard G.; Iverson, Richard M.

    1997-01-01

    Controlled debris-flow initiation experiments focused on three hydrologic conditions that can trigger slope failure: localized ground-water inflow; prolonged moderate-intensity rainfall; and high-intensity rainfall. Detailed monitoring of slope hydrology and deformation provided exceptionally complete data on conditions preceding and accompanying slope failure and debris-flow mobilization. Ground-water inflow and high-intensity sprinkling led to abrupt, complete failure whereas moderate-intensity sprinkling led to retrogressive, block-by-block failure. Failure during ground-water inflow and during moderate-intensity sprinkling occurred with a rising water table and positive pore pressures. Failure during high-intensity sprinkling occurred without widespread positive pore pressures. In all three cases, pore pressures in most locations increased dramatically (within 2-3 seconds) during failure. In some places, pressures in unsaturated materials rapidly 'flashed' from zero to elevated positive values. Transiently elevated pore pressures and partially liquefied soil enhanced debris-flow mobilization.

  15. Initiation of a thrust fault revealed by analog experiments

    Science.gov (United States)

    Dotare, Tatsuya; Yamada, Yasuhiro; Adam, Juergen; Hori, Takane; Sakaguchi, Hide

    2016-08-01

    To reveal in detail the process of initiation of a thrust fault, we conducted analog experiments with dry quartz sand using a high-resolution digital image correlation technique to identify minor shear-strain patterns for every 27 μm of shortening (with an absolute displacement accuracy of 0.5 μm). The experimental results identified a number of "weak shear bands" and minor uplift prior to the initiation of a thrust in cross-section view. The observations suggest that the process is closely linked to the activity of an adjacent existing thrust, and can be divided into three stages. Stage 1 is characterized by a series of abrupt and short-lived weak shear bands at the location where the thrust will subsequently be generated. The area that will eventually be the hanging wall starts to uplift before the fault forms. The shear strain along the existing thrust decreases linearly during this stage. Stage 2 is defined by the generation of the new thrust and active displacements along it, identified by the shear strain along the thrust. The location of the new thrust may be constrained by its back-thrust, generally produced at the foot of the surface slope. The activity of the existing thrust falls to zero once the new thrust is generated, although these two events are not synchronous. Stage 3 of the thrust is characterized by a constant displacement that corresponds to the shortening applied to the model. Similar minor shear bands have been reported in the toe area of the Nankai accretionary prism, SW Japan. By comparing several transects across this subduction margin, we can classify the lateral variations in the structural geometry into the same stages of deformation identified in our experiments. Our findings may also be applied to the evaluation of fracture distributions in thrust belts during unconventional hydrocarbon exploration and production.

  16. Symetis Acurate Neo transfemoral aortic bioprosthesis - initial Polish experience.

    Science.gov (United States)

    Zembala, Michał; Hawranek, Michał; Wacławski, Jacek; Niklewski, Tomasz; Nadziakiewicz, Paweł; Koba, Rafał; Przybylski, Roman; Walas, Ryszard; Głowacki, Jan; Jazwiec, Tomasz; Garbacz, Marcin; Gąsior, Mariusz; Zembala, Marian

    2016-01-01

    Transcatheter aortic valve implantation (TAVI) has proven to be a valuable alternative to conventional surgical aortic valve replacement in high-risk and surgically inoperable patients who suffer from severe symptomatic aortic stenosis. With the second generation of TAVI devices improvements in both handling and performance are highly demanded. This brief clinical communication reports the first Polish experience with the second generation of transfemoral TAVI device--Symetis Acurate Neo. From November 19th 2014 until February 18th 2015 nine (n = 9) patients with severe symptomatic aortic stenosis have been operated on using the Symetis Acurate Neo. Patients were subject to seven-day evaluation and 30-day phone follow-up. The procedure was safely and successfully performed in all patients. A SMALL (S) valve (21-23 mm equivalent) was used in two patients, MEDIUM valve (M; 23-25 mm equivalent) in five patients, and a LARGE valve (L; 25-26 mm equivalent) in two patients. In three cases post-release balloon dilatation was required. There were no intraoperative complications and no major adverse events (as per VARC classification) during initial hospitalisation, including conduction or rhythm disturbances. In all cases, the mean gradient on the prosthetic valves was 7.8 mm Hg (10.2 mm Hg on the "S" valves). Rapid improvement in patients' functional class was noted. Perivalvular leak was evaluated as "mild" in three cases, "trace" in one, and "not existing" in five. This initial experience with the Symetis Acurate Neo demonstrates its good safety profile and excellent haemodynamics. Low radial stress of the valve results in minimal incidence of atrioventricular rhythm disturbances, and a sealing crown for nearly non-existent paravalvular leak.

  17. CENTRAL MECHANISMS OF ACUPUNCTURE ANALGESIA

    Directory of Open Access Journals (Sweden)

    Eman S. Mansour

    2015-12-01

    Full Text Available Background: Acupuncture is an component of traditional Chinese medicine (TCM that has been used for three thousand years to treat diseases and relieve pain. Pain is found to be the most common reason for people to use acupuncture. Due to recent scientific findings, acupuncture treatment has been accepted worldwide. Numerous trials have been conducted especially in analgesia. The mechanisms of acupuncture analgesia has been widely investigated, however, the underlying mechanism still not clear. This article summarizes the central mechanisms of acupuncture analgesia and reviews recent studies on the topic. Method: We have focused on examining the recent literature on acupuncture analgesia. The central mechanisms of acupuncture analgesia and reviews recent studies on the topic. We focused on the studies related to central mechanisms of acupuncture analgesia from these aspects: (neurophysiology, neurochemistry and neuroanatomy. Result: The result revealed that acupuncture act on various parts of the central nervous system, including the spinal cord, brain stem, cerebral ganglia and cerebral cortex to alleviate pain. The central mechanisms underlying the effects of acupuncture include neurohumors and neurotransmitters, which are involved in analgesia. At spinal level, Spinal opioids, glutamate, norepinephrine and serotonin are the key elements acupuncture-induced analgesia. At brain level, Endogenous opioid peptides, limbic system play essential roles in mediating the analgesia. Conclusion: Acupuncture is an effective approach to pain management. There is good evidence in both experimental and clinical research that supports acupuncture efficacy in management of chronic pain through central nervous system. Acupuncture should be strongly used as a part of pain management plans. This work helps in improving our understanding of the scientific basis underlying acupuncture analgesia.

  18. Initial results from the DSPlanar experiments on OMEGA

    Science.gov (United States)

    Dodd, E. S.; Merritt, E. C.; Montgomery, D. S.; Daughton, W.; Schmidt, D. W.; Cardenas, T.; Wilson, D. C.; Batha, S. H.

    2016-10-01

    Recently, LANL has begun a project aimed ultimately at fielding a neutron-producing double-shell capsule at the National Ignition Facility (NIF). Initial experiments have begun at both the NIF and OMEGA laser facilities over the last year. At OMEGA, halfraum-driven planar targets will be used to study physics issues important to double shell implosions, but outside of a convergent geometry. In particular, side-on radiography through a tube has advantages over imaging through the hohlraum and double-shell capsule at NIF. We plan to study a number physics issues with this platform, including both 1-d and higher dimensional effects. In 1-d, momentum transfer from the ablator to the inner shell, and the effect of pre-heat on the inner shell can be studied. Higher dimensional effects, in the form of hydrodynamic instabilities, can also be studied. Pre-heat expansion of the inner shell can lead to an unstable interface, which can be mitigated by a tamper layer. Manufacturing tolerances can be used to mitigate against feature-driven instability growth, such as from a glue joint or fill tube. Initial results on the amount pre-heat from various ablator materials will be given, along with a discussion of future plans. Supported under the US DOE by the LANS, LLC under contract DE-AC52-06NA25396. LA-UR-16-25044.

  19. Initially curved microplates under electrostatic actuation: theory and experiment

    KAUST Repository

    Saghir, S.

    2016-07-01

    Microplates are the building blocks of many micro-electro-mechanical systems. It is common for them to experience initial curvature imperfection due to residual stresses caused by the micro fabrication process. Such plates are essentially different from perfectly flat ones and cannot be modeled using flat plate models. In this paper, we adopt a dynamic analog of the von Karman governing equations of imperfect plates. These equations are then used to develop a reduced order model based on the Galerkin procedure, to simulate the static and dynamic behavior of the microplate under electrostatic actuation. To validate the simulation results, an initially curved imperfect microplate made of silicon nitride is fabricated and tested. The static behaviour of the microplate is investigated when applying a DC voltage Vdc. Then, the dynamic behaviour of the microplate is examined under the application of a harmonic AC voltage, Vac, superimposed to Vdc. The simulation results show good agreement with the experimentally measured responses. © 2016 IOP Publishing Ltd.

  20. The influence of analgesia on labor--is it related to primary cesarean rates?

    Science.gov (United States)

    Wong, Cynthia A

    2012-10-01

    Multiple observational studies have reported an association between neuraxial (epidural, spinal, or combined spinal-epidural) labor analgesia and cesarean delivery. The purpose of this review is to summarize data from controlled trials addressing the question of whether neuraxial labor analgesia causes an increased risk of cesarean delivery. Additionally, the review will discuss whether the timing of initiation of analgesia or the specific type of neuraxial analgesia influences mode of delivery. Finally, the issue of external validity of published trials will be discussed. Copyright © 2012 Elsevier Inc. All rights reserved.

  1. Shock initiation experiments on ratchet grown PBX 9502

    Energy Technology Data Exchange (ETDEWEB)

    Gustavsen, Richard L [Los Alamos National Laboratory; Thompson, Darla G [Los Alamos National Laboratory; Olinger, Barton W [Los Alamos National Laboratory; Deluca, Racci [Los Alamos National Laboratory; Bartram, Brian D [Los Alamos National Laboratory; Pierce, Timothy H [Los Alamos National Laboratory; Sanchez, Nathaniel J [Los Alamos National Laboratory

    2010-01-01

    This study compares the shock initiation behavior of PBX 9502 pressed to less than nominal density (nominal density is 1.890 {+-} 0.005 g/cm{sup 3}) with PBX 9502 pressed to nominal density and then ''ratchet grown'' to low density. PBX 9502 is an insensitive plastic bonded explosive consisting of 95 weight % dry-aminated tri-amino-tri-nitro-benzene (TATB) and 5 weight % Kel-F 800 plastic binder. ''Ratchet growth'' - an irreversible increase in specific volume - occurs when an explosive based on TATB is temperature cycled. The design of our study is as follows: PBX 9502, all from the same lot, received the following four treatments. Samples in the first group were pressed to less than nominal density. These were not ratchet grown and used as a baseline. Samples in the second group were pressed to nominal density and then ratchet grown by temperature cycling 30 times between -54 C and +80 C. Samples in the final group were pressed to nominal density and cut into 100 mm by 25.4 mm diameter cylinders. During thermal cycling the cylinders were axially constrained by a 100 psi load. Samples for shock initiation experiments were cut perpendicular (disks) and parallel (slabs) to the axial load. The four sample groups can be summarized with the terms pressed low, ratchet grown/no load, axial load/disks, and axial load/slabs. All samples were shock initiated with nearly identical inputs in plate impact experiments carried out on a gas gun. Wave profiles were measured after propagation through 3, 4, 5, and 6 mm of explosive. Side by side comparison of wave profiles from different samples is used as a measure of relative sensitivity. All reduced density samples were more shock sensitive than nominal density PBX 9502. Differences in shock sensitivity between ratchet grown and pressed to low density PBX 9502 were small, but the low density pressings are slightly more sensitive than the ratchet grown samples.

  2. Initial Experience Using the Gore Embolic Filter in Carotid Interventions.

    Science.gov (United States)

    Hornung, Marius; Franke, Jennifer; Bertog, Stefan C; Gafoor, Sameer; Grunwald, Iris; Sievert, Horst

    2016-08-01

    This is the first clinical report on experience in the use of the Gore embolic filter in carotid interventions. It was designed as a guidewire and embolic protection system in carotid, peripheral, and coronary interventions. The ability to capture debris is driven by the frame of the filter, which is designed to improve vessel wall apposition and allows a short landing zone. We report the results of the first 20 consecutive patients undergoing carotid artery stenting using the Gore embolic filter in our institution. We analyzed technical success as well as the occurrence of transient ischemic attack (TIA), stroke, or death periprocedurally and through 30 days of follow-up. Mean patient age was 72 years and 12 patients (60%) were male. Seven patients were symptomatic and 4 patients suffered recurrent neurological events. Technical success was achieved in all procedures. In 1 patient, the retrieval catheter was caught between the proximal struts of the stent and required further retrieval maneuvers. Within 30 days of follow-up, 1 patient had a TIA. No stroke, death, or myocardial infarction occurred. This initial experience suggests that the Gore embolic filter device can be used safely for distal embolic protection during carotid stenting procedures with high technical success.

  3. Labor analgesia: An update on the effect of epidural analgesia on labor outcome

    Directory of Open Access Journals (Sweden)

    Samina Ismail

    2013-01-01

    Full Text Available Following the introduction of epidural for labor analgesia, debate has centered on the issue of its effect on outcome of labor; in terms of length of labor and increase in the rate of instrumental vaginal delivery and cesarean section (CS. There is no ideal study on the effect of epidural analgesia (EA on the outcome of labor due to logistic problems in randomization, blinding and getting a control group; as a result these queries are partly answered. Despite these problems, it has been established that labor epidural has minimal effect on progress of established labor and maternal request should be a sufficient indication to start an epidural. Although instrumental vaginal delivery is probably increased with epidural but obstetrician practice, pain free patient and teaching opportunity are likely factors increasing the incidence. Maternal-fetal factors and obstetric management and not the use of EA are the most important determinants of the CS rate. The purpose of this review is to summarize data from controlled trials addressing the question of whether neuraxial labor analgesia causes an increased risk of CS or rate of instrumental delivery. In addition, the review discusses whether the timing of initiation of analgesia infl uences the mode of delivery.

  4. [Initial experience in robot-assisted colorectal surgery in Mexico].

    Science.gov (United States)

    Villanueva-Sáenz, Eduardo; Ramírez-Ramírez, Moisés Marino; Zubieta-O'Farrill, Gregorio; García-Hernández, Luis

    Colorectal surgery has advanced notably since the introduction of the mechanical suture and the minimally invasive approach. Robotic surgery began in order to satisfy the needs of the patient-doctor relationship, and migrated to the area of colorectal surgery. An initial report is presented on the experience of managing colorectal disease using robot-assisted surgery, as well as an analysis of the current role of this platform. A retrospective study was conducted in order to review five patients with colorectal disease operated using a robot-assisted technique over one year in the initial phase of the learning curve. Gender, age, diagnosis and surgical indication, surgery performed, surgical time, conversion, bleeding, post-operative complications, and hospital stay, were analysed and described. A literature review was performed on the role of robotic assisted surgery in colorectal disease and cancer. The study included 5 patients, 3 men and 2 women, with a mean age of 62.2 years. Two of them were low anterior resections with colorectal primary anastomoses, one of them extended with a loop protection ileostomy, a Frykman-Goldberg procedure, and two left hemicolectomies with primary anastomoses. The mean operating time was 6hours and robot-assisted 4hours 20minutes. There were no conversions and the mean hospital stay was 5 days. This technology is currently being used worldwide in different surgical centres because of its advantages that have been clinically demonstrated by various studies. We report the first colorectal surgical cases in Mexico, with promising results. There is enough evidence to support and recommend the use of this technology as a viable and safe option. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  5. Left atrial appendage occlusion: initial experience with the Amplatzer™ Amulet™.

    Science.gov (United States)

    Freixa, Xavier; Abualsaud, Ali; Chan, Jason; Nosair, Mohamed; Tzikas, Apostolos; Garceau, Patrick; Basmadjian, Arsène; Ibrahim, Réda

    2014-07-01

    The Amplatzer™ Amulet™ (Amulet) is the evolution of the Amplatzer™ Cardiac Plug, a dedicated device for percutaneous left atrial appendage (LAA) occlusion. The new device has been designed to facilitate the implantation process, improve the sealing performance and further reduce the risk of complications. The objective of the study was to describe the initial experience with the Amplatzer Amulet for percutaneous LAA occlusion. This was a prospective single-center study of patients undergoing percutaneous LAA occlusion. The indication for LAA closure was a formal contraindication for oral anticoagulation or previous history of stroke due to INR lability. All procedures were done under general anesthesia and transesophageal echocardiography (TEE) guidance. Transthoracic echocardiography was performed 24h after the procedure in order to rule out procedural complications before discharge. Further follow-up was done with a clinical visit and TEE at 1-3 months. Between July-2012 and June-2013, 25 patients with a mean CHA2DS2-VASC of 4.3 ± 1.7 underwent LAA occlusion with the Amplatzer Amulet. The device was successfully implanted in 24 patients (96%) without any procedural stroke, pericardial effusion or device embolization. None of the patients presented any clinical event at follow-up. Follow-up TEE showed complete LAA sealing in all patients with no residual leaks >3mm and no device embolization. One patient (4.1%) presented a device thrombosis at follow-up without clinical expression. In this initial series of patients, the Amulet showed a remarkable acute and short-term performance in terms of feasibility and safety as depicted by the high successful implantation rate and the low incidence of complications. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  6. Hypno-analgesia and acupuncture analgesia: a neurophysiological reality?

    Science.gov (United States)

    Saletu, B; Saletu, M; Brown, M; Stern, J; Sletten, I; Ulett, G

    1975-01-01

    The effects of hypnosis, acupuncture and analgesic drugs on the subjective experience of pain and on objective neurophysiological parameters were investigated. Pain was produced by brief electric stimuli on the wrist. Pain challengers were: hypnosis (induced by two different video tapes), acupuncture (at specific and unspecific loci, with and without electrical stimulation of the needles), morphine and ketamine. Evaluation of clinical parameters included the subjective experience of pain intensity, blood pressure, puls, temperature, psychosomatic symptoms and side effects. Neurophysiological parameters consisted of the quantitatively analyzed EEG and somatosensory evlked potential (SEP). Pain was significantly reduced by hypnosis, morphine and ketamine, but not during the control seesion. Of the four acupuncture techniques, only electro-acupuncture at specific loci significantly decreased pain. The EEG changes during hypnosis were dependent on the wording of the suggestion and were characterized by an increase of slow and a decrease of fast waves. Acupuncture induced just the opposite changes, which were most significant when needles were inserted at traditional specific sites and stimulated electrically. The evoked potential findings suggested that ketamine attenuates pain in the thalamo-cortical pathways, while hypnosis, acupuncture and morphine induce analgesia at the later CNS stage of stimulus processing. Finally some clinical-neurophysiological correlations were explored.

  7. [Laparoscopic distal gastrectomy for gastric cancer: initial experience].

    Science.gov (United States)

    Berrospi, Francisco; Celis, Juan; Ruíz, Eloy; Payet, Eduardo; Chávez, Iván; Young, Frank

    2008-01-01

    To report the initial experience with the laparoscopy-assisted distal gastrectomy (LADG) with D2 lymphadenectomy for gastric cancer. Between May 2006 and May 2007, 29 consecutive GC patients with gastric cancer underwent LADG with D2 lymphadenectomy. The operation consisted in a laparoscopic time to perform lymphadenectomy and mobilization of the distal stomach, followed by a minilaparotomy for exteriorization of the specimen and construction of a hand sewn anastomosis. Twenty-nine patients underwent LADG with D2 lymphadenectomy for gastric cancer. Mean age was 58.2 years. Mean operative time was 287.4 min. Mean number of lymph nodes resected was 42.6. Twelve patients were early gastric cancer, and seventeen were advanced gastric cancer. Mean proximal and distal resection margin were 5.8 cm and 3.5 cm, respectively. Resection margins were negative in all cases. Mean number of lymph nodes resected was 42.6. Thirty-day morbidity rate was 10.3 %. There were no postoperative deaths.CONCLUSION. The short-term results of our LADG with D2 lymphadenectomy for the treatment of gastric cancer shows that a radical surgery, in terms of resection margins and lymphadenectomy, can be done with low morbidity.

  8. Supplemental vibrational force does not reduce pain experience during initial alignment with fixed orthodontic appliances: a multicenter randomized clinical trial.

    Science.gov (United States)

    Woodhouse, Neil R; DiBiase, Andrew T; Papageorgiou, Spyridon N; Johnson, Nicola; Slipper, Carmel; Grant, James; Alsaleh, Maryam; Cobourne, Martyn T

    2015-11-27

    This prospective randomized trial investigated the effect of supplemental vibrational force on orthodontic pain during alignment with fixed-appliances. Eighty-one subjects analgesics reported slightly higher maximum-pain although this was not significant (P = 0.170). The effect of intervention was independent of analgesia (P = 0.883). At T1 and T2, a statistically and clinically significant increase in mean pain was seen at 4 and 24-hours, declining at 72-hours and becoming insignificant at 1-week. For mean alignment-rate, pain-intensity and use of analgesics, no significant differences existed between groups (P > 0.003). The only significant predictor for mean pain was time. Use of an AcceleDent vibrational device had no significant effect on orthodontic pain or analgesia consumption during initial alignment with fixed appliances.

  9. Popularizing labor analgesia in China.

    Science.gov (United States)

    Fan, Zi Tian; Gao, Xue Lian; Yang, Hui Xia

    2007-09-01

    In China many women in labor are young primigravidas whose fear of labor pain leads them to request cesarean deliveries. While the rate of cesarean deliveries has reached 50% in many hospitals, less than 1% of women in labor are given neuraxial analgesia. The necessary equipment is seldom available in China and many physicians have misconceptions about the risks associated with neuraxial analgesia, which are low with the ultra-low-dosages used today. However, attitudes have begun to change. Meetings held in China have brought together Chinese physicians and world experts on the various epidural and combined spinal-epidural techniques. Thanks to the information and support provided at these meetings clinical trials were carried out, more than 5000 women benefited from labor analgesia, and publications appeared in Chinese journals. An effective, safe, and cost-effective way to provide analgesia to women in labor may slow the increase in cesarean delivery rates across China and improve women's health in general.

  10. [Intravenous remifentanyl for labor analgesia].

    Science.gov (United States)

    Arnal, D; Serrano, M L; Corral, E M; García del Valle, S

    2009-04-01

    Intravenous remifentanil may be the preferred analgesic when regional techniques are contraindicated. To perform a systematic review on the use of remifentanil for analgesia in labor. We searched MEDLINE (January 1995-August 2007) for studies on obstetric analgesia with remifentanil. We found 32 references representing the use of remifentanil in 257 women in labor. In most cases, patients reported relief of pain and a high level of satisfaction, with no severe side effects in mothers or neonates. When compared with meperidine and nitrous oxide in clinical trials, remifentanil provided better analgesia with fewer adverse effects. Analgesia with intravenous remifentanil is more effective and safer than other alternatives to regional analgesic techniques in obstetrics. Nevertheless, the optimum system for infusing the drug must b e established and further studies of maternal and fetal safety should be carried out.

  11. Survey of Sedation and Analgesia Practice Among Canadian Pediatric Critical Care Physicians.

    Science.gov (United States)

    Garcia Guerra, Gonzalo; Joffe, Ari R; Cave, Dominic; Duff, Jonathan; Duncan, Shannon; Sheppard, Cathy; Tawfik, Gerda; Hartling, Lisa; Jou, Hsing; Vohra, Sunita

    2016-09-01

    Despite the fact that almost all critically ill children experience some degree of pain or anxiety, there is a lack of high-quality evidence to inform preferred approaches to sedation, analgesia, and comfort measures in this environment. We conducted this survey to better understand current comfort and sedation practices among Canadian pediatric intensivists. The survey was conducted after a literature review and initial focus groups. The survey was then pretested and validated. The final survey was distributed by email to 134 intensivists from 17 PICUs across Canada using the Research Electronic Data Capture system. The response rate was 73% (98/134). The most commonly used sedation scores are Face, Legs, Activity, Cry, and Consolability (42%) and COMFORT (41%). Withdrawal scores are commonly used (65%). In contrast, delirium scores are used by only 16% of the respondents. Only 36% of respondents have routinely used sedation protocols. The majority (66%) do not use noise reduction methods, whereas only 23% of respondents have a protocol to promote day/night cycles. Comfort measures including music, swaddling, soother, television, and sucrose solutions are frequently used. The drugs most commonly used to provide analgesia are morphine and acetaminophen. Midazolam and chloral hydrate were the most frequent sedatives. Our survey demonstrates great variation in practice in the management of pain and anxiety in Canadian PICUs. Standardized strategies for sedation, delirium and withdrawal, and sleep promotion are lacking. There is a need for research in this field and the development of evidence-based, pediatric sedation and analgesia guidelines.

  12. Percutaneous MR-guided cryoablation of prostate cancer: initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Gangi, Afshin; Tsoumakidou, Georgia; Abdelli, Omar; Buy, Xavier [University Hospital of Strasbourg, Department of Interventional Radiology, Strasbourg (France); Mathelin, Michel de [University of Strasbourg, Lsiit, Strasbourg (France); Jacqmin, Didier; Lang, Herve [University Hospital of Strasbourg, Department of Urology, Strasbourg (France)

    2012-08-15

    We report our initial experience and the technical feasibility of transperineal prostate cryoablation under MR guidance. Percutaneous MR-guided cryoablation was performed in 11 patients with prostatic adenocarcinoma contraindicated for surgery (mean age: 72 years, mean Gleason score: 6.45, mean prostate-specific antigen (PSA): 6.21 ng/ml, T1-2c/N0/M0, mean: prostate volume 36.44 ml). Free-hand probe positioning was performed under real-time MR imaging. Four to seven cryoprobes were inserted into the prostate, depending on gland volume. The ice ball was monitored using real-time and high-resolution BLADE multi-planar imaging. Patients were followed at 1, 3, 6, 9 and 12 months after the procedure with serum PSA level and post-ablation MRI. Prostate cryoablation was technically feasible in 10/11 patients. The ice ball was clearly and sharply visualised in all cases as a signal-void area. Mean ice-ball volume was 53.3 ml. Mean follow-up was 15 months (range: 1-25). Mean PSA nadir was 0.33 ng/ml (range: 0.02-0.94 ng/ml). Mean hospitalisation was 5 days (range: 3-13). Complications included a urethro-rectal fistula, urinary infection, transient dysuria and scrotal pain. MR-guided prostate cryoablation is feasible and promising, with excellent monitoring of the ice ball. Future perspectives could include the use of MR guidance for focal prostate cancer cryotherapy. (orig.)

  13. [The transcatheter closure of patent ductus arteriosus. The initial experience].

    Science.gov (United States)

    Vázquez-Antona, C A; Rijlaarsdam, M; Gaspar, J; Gil Moreno, M; Buendía Hernández, A; Martínez Ríos, M A; Attie, F

    1993-01-01

    Percutaneous closure of the patent ductus arteriosus (PDA) has been recently reported to be an effective alternative in the treatment of patients with ductal shunting. We report the initial experience and results during follow-up of percutaneous ductal occlusion with the Rashkind occluder (USCI) in six patients with isolated PDA. Ages ranged from 3 to 23 years. Diagnosis was corroborated with two dimensional and Doppler echocardiography in all patients. During cardiac catheterization systolic pulmonary artery pressure oscillated between 22 and 64 mmHg and Qp/Qs ratio between 1.3 and 4.1. In two patients prosthesis of 12 mm were used and in the remaining prosthesis of 17 mm. Only one patient demonstrated total occlusion during immediate control aortography, the other patients presented central residual shunting over the occluder. In the three patients occlusion with balloon-catheter was added to the procedure, resulting in total occlusion in two and significant reduction of the shunt magnitude in one. Two technical problems were resolved satisfactorily. None of the cases presented device embolization. Mean follow-up was 23.8 months with control echocardiograms at 24 hours, 1, 4, 12 and 24 months. In all patients immediate reduction of the left atrial dimension was demonstrated. Three patients presented residual shunts in the first 24 hours. In two of them total occlusion had occurred after one month and the other patient persisted with a small residual shunt until one year after the procedure. In conclusion, in this small study group good results were obtained with percutaneous ductal closure.

  14. Our initial experience with percutaneous nephrolithotomy in children

    Directory of Open Access Journals (Sweden)

    Mehmet Hanifi Okur

    2014-03-01

    Full Text Available Objective: To present our initial experience on percutaneous nephrolithotomy (PCNL in children between March 2012 and November 2013. Methods: 13 renal units of 12 patients underwent PCNL. Patients were evaluated in terms of age, preoperatively in terms of urine, blood count, urine culture, serum biochemical, and routine coagulation tests and radiological examinations, stone location, stone burden (according to plain radiograph, preoperative use of nephrostomy and average fluoroscopic manipulation time. To facilitate access, prior mechanical dilatation was performed nephrostomy access tract. After the PCNL procedure, we placed nephrostomy in all patients postoperatively. They were evaluated with regard to residual stone, complications (according to the Clavien classification and outcomes. Results: Average age was 11 years (6-15. There was no abnormality in Laboratory Screening. Location of 11 stones was renal pelvis and 2 stones was pelvis + calyx. The average stone size was 260 mm². Preoperative acces were provided in 3 patients, others were intraoperatively. Average fluoroscopic manipulation time was 4,8 minutes (2-11. At the first postoperative day, 11 (85 % patients achieved a completely stone-free state. Complications were seen in 3 patients; failure of renal access in one patient (Grade 3b, urine leakage was observed after surgery in one (Grade 3a, postoperative blood transfusion required in one patient (Grade 2. The hospital stay duration was 5,5 days (5-7 days. Conclusions: Pediatric PCNL is a minimal invasive procedure which provides high rate of stone free and good cosmetics. İf there is adequate facilities and equipment with experienced persons, this procedure can easily be used in pediatric surgery clinics.

  15. COMPARISON OF PATIENT CONTROLLED EPIDURAL ANALGESIA WITH CONTINUOUS EPIDURAL INFUSION FOR LABOUR ANALGESIA

    Directory of Open Access Journals (Sweden)

    Sumaiah Tahseen

    2016-07-01

    Full Text Available We conducted a study to compare the efficacy and safety of Patient Controlled Epidural Analgesia (PCEA with that of Continuous Infusion of Epidural Analgesia (CIEA for maintenance of labour analgesia and evaluated the quality of analgesia and obstetric and safety outcomes. METHODS The study was a hospital-based prospective, randomised control trial on 80 parturients who had a normal antenatal period. Each parturient received 500-1000 mL lactated ringer solution Intravenously (IV prior to initiating epidural blockade. Epidural catheter placement was performed in a standard manner and all patients received an initial dose of 8-10 mL bupivacaine 0.25%. Parturients self-administered 0.125% bupivacaine with fentanyl 2.5 µg/mL using PCA pumps programmed as follows: 4 mL bolus with a 20 mins Lockout Interval (LI. Group B received CIEA of 8 mL 0.125% bupivacaine with fentanyl 2.5/mL. Hourly assessments included: VAS scores for pain and satisfaction, sensory and motor block, analgesic supplements, bupivacaine and fentanyl consumption. RESULTS Data from 80 patients showed no differences among groups in pain relief. Maternal satisfaction was greater in PCEA group. Anaesthetic interventions by way of supplemental doses of Bupivacaine and Fentanyl in the PCEA group were minimal (4 and 2 vs 25 and 12 P <0.001 compared to CEI group. PCEA group received less local anaesthetic (5.2 vs 9.4 p <0.001 and few patients in PCEA group had motor weakness compared to CEI group (6 vs 17 p <0.05. Both methods were safe for mother and newborn. CONCLUSION Patients who received PCEA required less anaesthetic interventions, required lower doses of local anaesthetic, fentanyl and have less motor weakness than those who received CEI.

  16. Hyperventilation-induced tetany associated with epidural analgesia for labor.

    Science.gov (United States)

    Ray, N; Camann, W

    2005-01-01

    We report a case of painful carpo-pedal spasm associated with the initiation of epidural analgesia for labor. The patient, an otherwise healthy primigravida in early labor at term, was experiencing severe hyperventilation as a result of inappropriate use of the Lamaze breathing technique. Bilateral carpo-pedal spasm occurred, and produced severe pain. Resolution of symptoms coincided with onset of effective epidural labor pain relief. A diagnostic challenge was presented to the anesthesiologist, as the symptoms could have been consistent with subdural block, local anesthetic toxicity, high sensory level of analgesia or eclamptic neuro-excitation activity.

  17. Informal Science: Family Education, Experiences, and Initial Interest in Science

    Science.gov (United States)

    Dabney, Katherine P.; Tai, Robert H.; Scott, Michael R.

    2016-01-01

    Recent research and public policy have indicated the need for increasing the physical science workforce through development of interest and engagement with informal and formal science, technology, engineering, and mathematics experiences. This study examines the association of family education and physical scientists' informal experiences in…

  18. Professional Experience as a Wicked Problem in Initial Teacher Education

    Science.gov (United States)

    Southgate, Erica; Reynolds, Ruth; Howley, Peter

    2013-01-01

    Professional experience in teacher education is explored through the conceptual lens of the wicked problem. Wicked problems are socially constructed and complex. This paper outlines what is at stake in the framing of the problem of professional experience and how constructions of the problem make it difficult to find enduring solutions. The…

  19. Informal Science: Family Education, Experiences, and Initial Interest in Science

    Science.gov (United States)

    Dabney, Katherine P.; Tai, Robert H.; Scott, Michael R.

    2016-01-01

    Recent research and public policy have indicated the need for increasing the physical science workforce through development of interest and engagement with informal and formal science, technology, engineering, and mathematics experiences. This study examines the association of family education and physical scientists' informal experiences in…

  20. Initial Experiences with Retrieving Similar Objects in Simulation Data

    Energy Technology Data Exchange (ETDEWEB)

    Cheung, S-C S; Kamath, C

    2003-02-21

    Comparing the output of a physics simulation with an experiment, referred to as 'code validation,' is often done by visually comparing the two outputs. In order to determine which simulation is a closer match to the experiment, more quantitative measures are needed. In this paper, we describe our early experiences with this problem by considering the slightly simpler problem of finding objects in a image that are similar to a given query object. Focusing on a dataset from a fluid mixing problem, we report on our experiments with different features that are used to represent the objects of interest in the data. These early results indicate that the features must be chosen carefully to correctly represent the query object and the goal of the similarity search.

  1. [Epidural analgesia in obstetrics: is there an effect on labor and delivery?].

    Science.gov (United States)

    Segado Jiménez, M I; Arias Delgado, J; Domínguez Hervella, F; Casas García, M L; López Pérez, A; Izquierdo Gutiérrez, C

    2011-01-01

    Epidural analgesia is routinely used in obstetrics but has been blamed for possible effects on labor that lead to greater use of instruments or conversion to cesarean delivery. We aimed to assess this possibility in a cohort of obstetric patients receiving or not receiving epidural analgesia. Prospectively enrolled full-term obstetric patients were distributed in 2 groups according to whether they received epidural analgesia or not. We compared maternal and fetal characteristics, obstetric variables, and type of delivery between groups to record the likely causes of difficult labor and delivery and detect a possible influence of epidural analgesia. Of a total of 602 patients, 462 received epidural analgesia and 140 did not. Epidural analgesia was related to a higher rate of use of instruments but not cesareans (P labor (6.4 [4.2] hours in the epidural group vs 4.7 [3.5] hours in the no-epidural group, P initiation of epidural analgesia after the fetus has reached Hodge's first plane decreased risk 2.7-fold and 3.03-fold, respectively. Although epidural analgesia has traditionally been associated with a higher incidence of difficult labor and delivery, this association was not unequivocally evident in this cohort of patients. The apparent increase seems to be attributable to such obstetric factors as longer duration of stages of labor, higher body mass index, and first delivery.

  2. Diffusion tensor imaging of periventricular leukomalacia – Initial experience

    Directory of Open Access Journals (Sweden)

    Eman M. Abdelsalam

    2014-12-01

    Conclusion: DTI proved to be a promising noninvasive method for assessing the severity of white matter tract injury in patients with PVL. This is owing to the capability of fiber-tracking techniques to provide more information for understanding the pathophysiologic features of sensorimotor and cognitive disability associated with PVL. This will allow for the early intervention and initiation of rehabilitation programs aiming for minimizing the associated neurological deficit.

  3. The Planeterrella experiment: from individual initiative to networking

    CERN Document Server

    Lilensten, Jean; Grimald, Sandrine; Brekke, Asgeir; Fluckiger, Erwin; Vanlommel, Petra; Wedlund, Cyril Simon; Barthélémy, Mathieu; Garnier, Philippe

    2013-01-01

    Space weather is a relatively new discipline which is generally unknown to the wider public, despite its increasing importance to all of our daily lives. Outreach activities can help in promoting the concept of space weather. In particular the visual beauty and excitement of the aurora make these lights a wonderful inspirational hook. A century ago Norwegian experimental physicist Kristian Birkeland, one of the founding fathers of modern space science, demonstrated with his Terrella experiment the formation of the aurora. Recently a modernised version of the Terrella has been designed. This Planeterrella experiment is very flexible, allowing the visualization of many phenomena occurring in our space environment. Although the Planeterrella was originally designed to be small to be demonstrated locally by a scientist, the Planeterrella has proved to be a very successful public outreach experiment. We believe that its success is due to two main factors (i) the Planeterrella is not patented and the plans are give...

  4. Side effects of pain and analgesia in animal experimentation.

    Science.gov (United States)

    Jirkof, Paulin

    2017-03-22

    This review highlights selected effects of untreated pain and of widely used analgesics such as opioids, non-steroid anti-inflammatory drugs and antipyretics, to illustrate the relevance of carefully planned, appropriate and controlled analgesia for greater reproducibility in animal experiments involving laboratory rodents.

  5. Opioid and nonopioid interactions in two forms of stress-induced analgesia.

    Science.gov (United States)

    Grisel, J E; Fleshner, M; Watkins, L R; Maier, S F

    1993-05-01

    Stressful environmental events activate endogenous mechanisms of pain inhibition. Under some circumstances the analgesia is blocked by naloxone/naltrexone ("opioid"), while under others it is not ("nonopioid"). The existence of these two categories of analgesia leads to the question of how they are related. In a collateral inhibition model proposed by Kirshgessner, Bodnar, and Pasternak (1982), opiate and nonopiate mechanisms were viewed as acting in a mutually inhibitory fashion. In the present experiments, rats were exposed to either of two environmental stressors that produce a nonopioid stress-induced analgesia (SIA) following injections of the opiate antagonist naltrexone or agonist morphine. In the presence of naltrexone, SIA produced by either cold water swim (CWS) or social defeat was enhanced. These same SIAs were found to attenuate the analgesic effect of morphine, demonstrating that an activation of opioid systems can inhibit nonopioid analgesias. These results support an inhibitory interaction of opioid and nonopioid mechanisms in some forms of stress-induced analgesia.

  6. Radiofrequency Ablation for Iatrogenic Thyroid Artery Pseudoaneurysm: Initial Experience.

    Science.gov (United States)

    Jun, Ye Kyeong; Jung, So Lyung; Byun, Ho Kyun; Baek, Jung Hwan; Sung, Jin Yong; Sim, Jung Suk

    2016-10-01

    Eight iatrogenic thyroid pseudoaneurysms (ITPAs) after thyroid biopsy are reported. The mean ITPA diameter was 7.2 mm (range 4 to 12 mm). Ultrasound (US)-guided compression was initially performed at the neck of the ITPA in all cases. Among them, 4 ITPAs persisted (50%) in which radiofrequency (RF) ablation was performed. Mean RF ablation time and power were 13.5 seconds (range 5 to 24 seconds) and 20 W (range 10 to 50 W), respectively. All 4 cases were treated with RF ablation without any complications.

  7. Initial operation with sodium in the Madison Dynamo Experiment.

    Science.gov (United States)

    Kendrick, R.; Spence, Ej; Forest, C. B.; O'Connell, R.; Nornberg, Md; Canary, Hw; Wright, A.; Robinson, K.

    1999-11-01

    A new liquid metal MHD experiment has been constructed at the University of Wisconsin to test several key predictions of dynamo theory: magnetic instabilities driven by sheared flow, the effects of turbulence on current generation, and the back-reaction of the self-generated magnetic field on the fluid motion which brings saturation. This presentation describes the engineering design of the experiment, which is a 0.5 m radius spherical vessel, filled with liquid sodium at 150 ^circC. The experiment is designed to achieve a magnetic Reynolds number in excess of 100, which requires approximately 80 Hp of mechanical drive, producing flow velocities in sodium of 15 m/s through impellers. Handling liquid sodium offers a number of technical challenges, but routine techniques have been developed over the past several decades for safely handling large quantities for the fast breeder reactor. The handling strategy is discussed, technical details concerning seals and pressurization are presented, and safety elements are highlighted.

  8. Initial experience with ocriplasmin in the treatment of vitreomacular traction

    Directory of Open Access Journals (Sweden)

    José Maurício Botto de Barros Garcia

    2016-04-01

    Full Text Available ABSTRACT This study aimed to report the clinical and structural outcomes of intravitreal ocriplasmin in the treatment of vitreomacular interface disorders in two tertiary centers in Brazil. A retrospective study was performed by reviewing medical records and spectral domain optical coherence tomography (SD-OCT findings of seven patients who were treated with a single ocriplasmin injection. A total of 57.14% of patients achieved resolution of vitreomacular traction as evidenced by SD-OCT. Regarding our functional results, 87.71% maintained or improved visual acuity after follow-up. To the best of our knowledge, this is the first study reporting initial results of ocriplasmin therapy in Brazil.

  9. Coherent fluctuations in the initial TFTR D-T experiments

    Energy Technology Data Exchange (ETDEWEB)

    Fredrickson, E.; Chang, Z.Y.; Budny, R.V.

    1995-03-01

    The initial operation of TFTR with approximately equal power in the tritium and deuterium neutral beam injectors has resulted in the production of fusion power in excess of 9MW and central {beta}{sub {alpha}} > 0.25%. This {beta}{sub {alpha}} is within a factor of 2--3 of the {beta}{sub {alpha}} in projections of ITER performance. Effects of this {alpha} population on TAE modes, sawteeth and fishbone activity are being searched for. The D-T plasmas are also being studied for evidence of changes in MHD activity which might be attributed to the fast {alpha} population. This paper reports on the activity in the Alfven range of frequencies in the D-T plasmas and on detailed measurements of the MHD activity preceding major disruptions in D-D and D-T.

  10. Cardiac biplane strain imaging: initial in vivo experience

    Energy Technology Data Exchange (ETDEWEB)

    Lopata, R G P; Nillesen, M M; Thijssen, J M; De Korte, C L [Clinical Physics Laboratory, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Verrijp, C N; Lammens, M M Y; Van der Laak, J A W M [Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Singh, S K; Van Wetten, H B [Department of Cardiothoracic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Kapusta, L [Pediatric Cardiology, Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)], E-mail: R.Lopata@cukz.umcn.nl

    2010-02-21

    In this study, first we propose a biplane strain imaging method using a commercial ultrasound system, yielding estimation of the strain in three orthogonal directions. Secondly, an animal model of a child's heart was introduced that is suitable to simulate congenital heart disease and was used to test the method in vivo. The proposed approach can serve as a framework to monitor the development of cardiac hypertrophy and fibrosis. A 2D strain estimation technique using radio frequency (RF) ultrasound data was applied. Biplane image acquisition was performed at a relatively low frame rate (<100 Hz) using a commercial platform with an RF interface. For testing the method in vivo, biplane image sequences of the heart were recorded during the cardiac cycle in four dogs with an aortic stenosis. Initial results reveal the feasibility of measuring large radial, circumferential and longitudinal cumulative strain (up to 70%) at a frame rate of 100 Hz. Mean radial strain curves of a manually segmented region-of-interest in the infero-lateral wall show excellent correlation between the measured strain curves acquired in two perpendicular planes. Furthermore, the results show the feasibility and reproducibility of assessing radial, circumferential and longitudinal strains simultaneously. In this preliminary study, three beagles developed an elevated pressure gradient over the aortic valve ({delta}p: 100-200 mmHg) and myocardial hypertrophy. One dog did not develop any sign of hypertrophy ({delta}p = 20 mmHg). Initial strain (rate) results showed that the maximum strain (rate) decreased with increasing valvular stenosis (-50%), which is in accordance with previous studies. Histological findings corroborated these results and showed an increase in fibrotic tissue for the hearts with larger pressure gradients (100, 200 mmHg), as well as lower strain and strain rate values.

  11. Cardiac biplane strain imaging: initial in vivo experience

    Science.gov (United States)

    Lopata, R. G. P.; Nillesen, M. M.; Verrijp, C. N.; Singh, S. K.; Lammens, M. M. Y.; van der Laak, J. A. W. M.; van Wetten, H. B.; Thijssen, J. M.; Kapusta, L.; de Korte, C. L.

    2010-02-01

    In this study, first we propose a biplane strain imaging method using a commercial ultrasound system, yielding estimation of the strain in three orthogonal directions. Secondly, an animal model of a child's heart was introduced that is suitable to simulate congenital heart disease and was used to test the method in vivo. The proposed approach can serve as a framework to monitor the development of cardiac hypertrophy and fibrosis. A 2D strain estimation technique using radio frequency (RF) ultrasound data was applied. Biplane image acquisition was performed at a relatively low frame rate (cardiac cycle in four dogs with an aortic stenosis. Initial results reveal the feasibility of measuring large radial, circumferential and longitudinal cumulative strain (up to 70%) at a frame rate of 100 Hz. Mean radial strain curves of a manually segmented region-of-interest in the infero-lateral wall show excellent correlation between the measured strain curves acquired in two perpendicular planes. Furthermore, the results show the feasibility and reproducibility of assessing radial, circumferential and longitudinal strains simultaneously. In this preliminary study, three beagles developed an elevated pressure gradient over the aortic valve (Δp: 100-200 mmHg) and myocardial hypertrophy. One dog did not develop any sign of hypertrophy (Δp = 20 mmHg). Initial strain (rate) results showed that the maximum strain (rate) decreased with increasing valvular stenosis (-50%), which is in accordance with previous studies. Histological findings corroborated these results and showed an increase in fibrotic tissue for the hearts with larger pressure gradients (100, 200 mmHg), as well as lower strain and strain rate values.

  12. Management support to e-business initiatives: The Croatian experience

    Directory of Open Access Journals (Sweden)

    Mario Spremić

    2003-01-01

    Full Text Available After defining e-business and explaining why an evolutionary aspect of moving to e-business is required, the dimensions of e-business is defined with respect to differences between traditional business, partial, or pure e-business. Also, a model for moving to e-business is illustrated. The e-business evolving model is divided into six stages and represents an evolutionary aspect of migrating to e-business. Finally, the results of the research study on current practices in evolving e-business in the most successful Croatian companies are given. In this research, some aspects of business process innovation and e-business usage have been investigated (general e-business issues with levels of e-business usage, key objectives of participating in e-business, alignment of business strategy with e-business initiatives, initiation of e-business projects and e-business planning issues, especially e-business funding. The questionnaire was sent to 400 CEOs or CIOs in Croatian companies selected from the Register of the ‘400 Biggest’ Croatian companies which were ranked according to their 2001 annual revenue and which were most likely to represent the structure of the Croatian economy. Although they represent less than 1% of the total number of registered companies in Croatia, the sampled companies hold 73% of the equity capital of the whole Croatian economy, they contribute with 65% in the total Croatian economy’s export balance and they employ 37% of the total number of people employed in Croatia.

  13. The Planeterrella experiment: from individual initiative to networking

    Directory of Open Access Journals (Sweden)

    Garnier Pierre

    2013-02-01

    Full Text Available Space weather is a relatively new discipline, which is still largely unknown amongst the wider public despite its increasing importance in all of our daily lives. Outreach activities can promote awareness of space weather. In particular the visual beauty and excitement of the aurora make these lights a wonderful inspirational hook to enhance understanding of space weather in a general audience. A century ago, the Norwegian experimental physicist Kristian Birkeland, one of the founding fathers of modern space science, demonstrated with his Terrella experiment the formation of the aurora. Recently, a modernized version of the Terrella has been designed. This “Planeterrella” experiment allows the visualization of many phenomena that occur in our space environment. Although the Planeterrella was originally a local project, it has developed to become a very successful international public outreach experiment. We believe that its success is due to mainly two factors (i the Planeterrella is not patented and the plans are free to any public institute and (ii the project is widely advertised using national and European scientific networks such as COST ES 0803, as well as press releases, books and web sites. Today, seven Planeterrellas are in operation, four more are under construction in four different countries and several more are being planned. During the last five years, about 50 000 people in Europe have attended live Planeterrella demonstration on the formation of auroral light, the space environment and space weather. Many more have seen the Planeterrella being demonstrated on TV. The Planeterrella received the first international prize for outreach activities from the Europlanet Framework 7 program in 2010 and the French Ministry of Science outreach prize “Le goût des sciences” in November 2012. This paper describes the process that led to the construction of the first Planeterrella and discusses how the Planeterrella project developed

  14. The Planeterrella experiment: from individual initiative to networking

    Science.gov (United States)

    Lilensten, J.; Provan, G.; Barthelemy, M.; Simon Wedlund, C.; Gronoff, G.; Vanlommel, P.; Brekke, A.; Garnier, P.; Grimald Rochel, S.

    2013-12-01

    Space weather is a relatively new discipline, which is still largely unknown amongst the wider public despite its increasing importance in all of our daily lives. Outreach activities can promote awareness of space weather. In particular the visual beauty and excitement of the aurora make these lights a wonderful inspirational hook to enhance understanding of space weather in a general audience. A century ago, the Norwegian experimental physicist Kristian Birkeland, one of the founding fathers of modern space science, demonstrated with his Terrella experiment the formation of the aurora. Recently, a modernized version of the Terrella has been designed in France. This ';';Planeterrella'' experiment allows the visualization of many phenomena that occur in our space environment. Although the Planeterrella was originally a local project, it has developed to become a very successful international public outreach experiment. We believe that its success is due to mainly two factors (i) the Planeterrella is not patented and the plans are free to any public institute and (ii) the project is widely advertised using national and scientific networks, as well as press releases, books and web sites. Today, nine Planeterrellas are in operation, six more are under construction in five different countries including in the US and several more are being planned. During the last five years, about 55 000 people in Europe have attended live Planeterrella demonstration on the formation of auroral light, the space environment and space weather. Many more have seen the Planeterrella being demonstrated on TV. It is now used for education, outreach, scientific, and artistic purposes. We will describes this process and discuss how the Planeterrella project developed to become an international public outreach phenomenon. We also examine some of the lessons learnt along the way such as patented or not, big or small, automatized or hand-operated, and the cost of the overall project. A star (close

  15. Operational experience during initial beam commissioning of the LHC

    CERN Document Server

    Fuchsberger, K; Arduini, G; Assmann, R; Bailey, R; Bruning, O; Goddard, B; Kain, V; Lamont, M; MacPherson, A; Meddahi, M; Papotti, G; Pojer, M; Ponce, L; Redaelli, S; Solfaroli Camillocci, M; Venturini Delsolaro, W; Wenninger, J

    2010-01-01

    After the incident on the 19th September 2008 and more than one year without beam the commissioning of the LHC started again on November 20, 2009. Progress was rapid and collisions under stable beam conditions were established at 1.2 TeV within 3 weeks. In 2010 after qualification of the new quench protection system the way to 3.5 TeV was open and collision were delivered at this energy after a month of additional commissioning. This paper describes the experiences and issues encountered during these first periods of commissioning with beam.

  16. Robotic-assisted partial Nephrectomy: initial experience in South America

    Directory of Open Access Journals (Sweden)

    Gustavo C. Lemos

    2011-08-01

    Full Text Available OBJECTIVE:To report the initial outcomes of robotic-assisted partial nephrectomy in a tertiary center in South America. MATERIAL AND METHODS: From 11/2008 to 12/2009, a total of 16 transperitoneal robotic-assisted partial nephrectomies were performed in 15 patients to treat 18 kidney tumors. One patient with bilateral tumor had two procedures, while two patients with two synchronous unilateral tumors had a single operation to remove them. Eleven (73% patients were male and the right kidney was affected in 7 (46% patients. The median patient age and tumor size were 57 years old and 30 mm, respectively. Five (28% tumors were hilar and/or centrally located. RESULTS: The median operative time, warm ischemia time and estimated blood loss was 140 min, 27 min and 120 mL, respectively. Blood transfusion was required in one patient with bilateral tumor, and one additional pyelolithotomy was performed due to a 15mm stone located in the renal pelvis. The histopathology analysis showed 15 (83% malignant tumors, which 10 (67% were clear cell carcinoma. The median hospital stay was 72 hrs and no major complication was observed. CONCLUSION: Robotic-assisted partial nephrectomy is safe and represents a valuable option to perform minimally invasive nephron-sparing surgery.

  17. Initial experience with tadalafil in pediatric pulmonary arterial hypertension.

    Science.gov (United States)

    Takatsuki, Shinichi; Calderbank, Michelle; Ivy, David Dunbar

    2012-06-01

    This study aimed to investigate the safety, tolerability, and effects of tadalafil on children with pulmonary arterial hypertension (PAH) after transition from sildenafil or after tadalafil received as initial therapy. A total of 33 pediatric patients with PAH were retrospectively evaluated. Of the 33 patients, 29 were switched from sildenafil to tadalafil. The main reason for the change from sildenafil was once-daily dosing. The average dose of sildenafil was 3.4 ± 1.1 mg/kg/day, and that of tadalafil was 1.0 ± 0.4 mg/kg/day. For 14 of the 29 patients undergoing repeat catheterization, statistically significant improvements were observed after transition from sildenafil to tadalafil in terms of mean pulmonary arterial pressure (53.2 ± 18.3 vs. 47.4 ± 13.7 mmHg; p sildenafil to tadalafil including headache, nausea, myalgia, nasal congestion, flushing, and allergic reaction. Two patients discontinued tadalafil due to migraine or allergic reaction. One patient receiving sildenafil had no breakthrough syncope after transition to tadalafil. Tadalafil can be safely used for pediatric patients with PAH and may prevent disease progression.

  18. Initial Active MHD Spectroscopy Experiments on Alcator C-MOD

    Science.gov (United States)

    Schmittdiel, D. A.; Snipes, J. A.; Granetz, R. S.; Parker, R. R.; Wolfe, S. M.; Fasoli, A.

    2002-11-01

    The Active MHD Spectroscopy system is a new diagnostic on C-MOD that will be used to study low frequency MHD modes and TAE's present at high B_tor, n_e, and Te ˜= T_i. The present system consists of two antennas, power amplifiers, and an impedance matching network. Each antenna is 15 × 25 cm with five turns, an inductance of ˜10 μH, and is covered by boron nitride tiles. The two antennas are placed at the same toroidal location, symmetrically above and below the midplane. Each antenna is driven by a ˜1 kW power amplifier in the range of 1 kHz - 1 MHz with an expected antenna current ˜10 A, which will produce a vacuum field of ˜0.5 G at the q = 1.5 surface. This diagnostic is designed to excite high n ( ˜20) stable TAE's and initial results regarding their frequency, mode structure, and damping rate will be presented. Evolution of these modes could also provide information on the q profile to compare with MSE measurements, which will be important for planned lower hybrid current drive operation in 2003.

  19. Initial Diagnostics for the National Spherical Torus Experiment

    Energy Technology Data Exchange (ETDEWEB)

    A.L. Roquemore; B. McCormack; D. Johnson; H. Kugel; R. Kaita; and the NSTX Team

    1999-06-01

    The spherical torus (ST) approach to magnetic confinement has many attractive features as both a fusion reactor concept and a volume neutron source. The National Spherical Torus Experiment (NSTX) is under construction at the Princeton Plasma Physics Laboratory (PPPL), and it is designed to achieve plasma parameters needed for a proof-of-principle test of the ST concept. Discharges with magnetic fields of 2.3 kG on axis and plasma currents of 1 MA will be heated with 6 MW of radio frequency (RF) power and 5 MW of neutral beams, and pulse lengths up to 5 seconds are planned. Central electron temperatures of about 4 keV are expected with RF heating, and theoretical studies show that high values of b and b{sub n} can be achieved.

  20. Placental abruption occurring soon after labor combined spinal-epidural analgesia.

    Science.gov (United States)

    Jaime, F; Degani, J; Lam, N; Allen, G

    2012-10-01

    We present a case of placental abruption necessitating emergency cesarean section in an otherwise uncomplicated patient soon after initiation of combined spinal-epidural analgesia in labor. Administration of spinal opioids has the potential to cause fetal bradycardia due to uterine hypertonicity following rapid onset of analgesia. In this case, a previously bloody show before placement of combined spinal-epidural analgesia may have been evidence of a small abruption. We hypothesize that uterine hypertonicity following administration of spinal opioids may have hastened the development of an existing placental abruption. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. PET/MRI in head and neck cancer: initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Platzek, Ivan; Laniado, Michael [Dresden University Hospital, Department of Radiology, Dresden (Germany); Beuthien-Baumann, Bettina [Dresden University Hospital, Department of Nuclear Medicine, Dresden (Germany); Schneider, Matthias [Dresden University Hospital, Oral and Maxillofacial Surgery, Dresden (Germany); Gudziol, Volker [Dresden University Hospital, Department of Otolaryngology, Dresden (Germany); Langner, Jens; Schramm, Georg; Hoff, Joerg van den [Institute of Bioinorganic and Radiopharmaceutical Chemistry, Helmholtz-Zentrum Dresden-Rossendorf, Dresden (Germany); Kotzerke, Joerg [Dresden University Hospital, Nuclear Medicine, Dresden (Germany)

    2013-01-15

    To evaluate the feasibility of PET/MRI (positron emission tomography/magnetic resonance imaging) with FDG ({sup 18}F-fluorodeoxyglucose) for initial staging of head and neck cancer. The study group comprised 20 patients (16 men, 4 women) aged between 52 and 81 years (median 64 years) with histologically proven squamous cell carcinoma of the head and neck region. The patients underwent a PET scan on a conventional scanner and a subsequent PET/MRI examination on a whole-body hybrid system. FDG was administered intravenously prior to the conventional PET scan (267-395 MBq FDG, 348 MBq on average). The maximum standardized uptake values (SUV{sub max}) of the tumour and of both cerebellar hemispheres were determined for both PET datasets. The numbers of lymph nodes with increased FDG uptake were compared between the two PET datasets. No MRI-induced artefacts where observed in the PET images. The tumour was detected by PET/MRI in 17 of the 20 patients, by PET in 16 and by MRI in 14. The PET/MRI examination yielded significantly higher SUV{sub max} than the conventional PET scanner for both the tumour (p < 0.0001) and the cerebellum (p = 0.0009). The number of lymph nodes with increased FDG uptake detected using the PET dataset from the PET/MRI system was significantly higher the number detected by the stand-alone PET system (64 vs. 39, p = 0.001). The current study demonstrated that PET/MRI of the whole head and neck region is feasible with a whole-body PET/MRI system without impairment of PET or MR image quality. (orig.)

  2. Application of robotics in general surgery: initial experience.

    Science.gov (United States)

    Nguyen, Ninh T; Hinojosa, Marcelo W; Finley, David; Stevens, Melinda; Paya, Mahbod

    2004-10-01

    Robotic surgery was recently approved for clinical use in general abdominal surgery. The aim of this study was to review our experience with the da Vinci surgical system during laparoscopic general surgical procedures. Eighteen patients underwent robotically assisted laparoscopic abdominal surgery between June 2002 and March 2003. Main outcome measures were operative time, room setup time, robotic arm-positioning and surgical time, blood loss, conversion to laparoscopy, length of stay, and morbidity. The types of robotically assisted laparoscopic procedures were excision of gastric leiomyoma (n = 1), Heller myotomy (n = 1), cholecystectomy (n = 2), gastric banding (n = 2), Nissen fundoplication (n = 4), and gastric bypass (n = 8). The mean room setup time was 63 +/- 14 minutes, and the mean robotic arm-positioning time was 16 +/- 7 minutes. Conversion to laparoscopy occurred in two (11%) of 18 cases because of equipment difficulty (n = 1) and technical difficulty (n = 1). Estimated blood loss was 91 +/- 71 mL. The mean operative time was 156 +/- 42 minutes, and the robotic operative time was 27% of the total operative time. The mean length of hospital stay was 2.2 +/- 1.5 days. There was one postoperative wound infection and one anastomotic stricture. Robotically assisted laparoscopic abdominal surgery is feasible and safe; however, the theoretical advantages of the da Vinci surgical system were not clinically apparent.

  3. The role of psychological support in cardiac surgery: initial experience

    Directory of Open Access Journals (Sweden)

    Fabrizio Sansone

    2011-11-01

    Full Text Available The scientific literature has pointed out several predictors of negative outcome after surgery such as pain and depression, negatively affecting the postoperative outcome in cardiac surgery. From January 2009 until June 2010, 15 patients scheduled for cardiac surgery were enrolled. The patients were assessed by psychological evaluation either in the hospital stay either in the rehabilitation period with the aim of identifying their emotional condition (sentiments about the onset of the disease, support received from family and friends even by means of preformed tests for anxiety and depression (tests of Stay and Back. Thus, in our preliminary experience, the psychological evaluation failed to detect the occurrence of postoperative complications. Conversely, the psychological evaluation is very effective in detecting a poor emotional state and the psychological support decreases the degree of anxiety and depression with positive effects on postoperative outcome. In conclusion, a standardize test for anxiety and depression should be used for patients at hospital admission to detect who may benefits by psychological support.

  4. Initial experience with a nuclear medicine viewing workstation

    Science.gov (United States)

    Witt, Robert M.; Burt, Robert W.

    1992-07-01

    Graphical User Interfaced (GUI) workstations are now available from commercial vendors. We recently installed a GUI workstation in our nuclear medicine reading room for exclusive use of staff and resident physicians. The system is built upon a Macintosh platform and has been available as a DELTAmanager from MedImage and more recently as an ICON V from Siemens Medical Systems. The workstation provides only display functions and connects to our existing nuclear medicine imaging system via ethernet. The system has some processing capabilities to create oblique, sagittal and coronal views from transverse tomographic views. Hard copy output is via a screen save device and a thermal color printer. The DELTAmanager replaced a MicroDELTA workstation which had both process and view functions. The mouse activated GUI has made remarkable changes to physicians'' use of the nuclear medicine viewing system. Training time to view and review studies has been reduced from hours to about 30-minutes. Generation of oblique views and display of brain and heart tomographic studies has been reduced from about 30-minutes of technician''s time to about 5-minutes of physician''s time. Overall operator functionality has been increased so that resident physicians with little prior computer experience can access all images on the image server and display pertinent patient images when consulting with other staff.

  5. Initial experience with a newly developed cementless hip endoprosthesis.

    Science.gov (United States)

    Hach, V; Delfs, G

    2009-01-01

    The HELICA-Endoprosthesis is a newly developed cementless hip prosthesis for dogs. It was implanted in 39 dogs that had severe hip osteoarthritis and a history of hip pain, as well as in one dog that had chronic hip luxation. One dog had a bilateral arthroplasty. The body weight of the patients ranged between 22 and 54 kg and their ages between nine months and 10 years. Both the femoral stem and acetabular component of the prosthesis were screwed into position following bony preparation. Additional fixation was not necessary as the components remain fixed in position until osteointegration is complete. There are currently five sizes of prosthesis available, and the various components such as the stem, cup and head are readily interchangeable. Although it appeared that good osseous anchorage of the prostheses in the bone on the surgery table had been obtained, three patients experienced both stem and cup loosening (one week, three weeks and six months after surgery). In one animal, stem loosening was observed six weeks after surgery, and another dog experienced a cup loosening two weeks postoperatively. Most of the complications were due to technical errors that occurred during the learning phase. Surgical revisions were successful in three out of five animals. In two animals we had to perform a femoral head and neck excision. Two other animals experienced radiographic bone resorption underneath the segmented collar of the femoral prosthesis but did not show any significant clinical signs of lameness. Another dog that showed signs of ischial neuropraxy after surgery, recovered completely within six weeks after surgery. All of the dogs were capable of weight bearing on the operated leg one day after surgery. The main advantage of the HELICA-Endoprosthesis is the relatively easy surgical technique and short surgery time. The initial clinical results in these 40 cases have been very encouraging. The aim of this study was to assess the early clinical results in these 39

  6. Laparoscopic colorectal surgery: what to expect from an initial experience

    Directory of Open Access Journals (Sweden)

    Fábio Ramos Teixeira

    2012-06-01

    Full Text Available Laparoscopic colorectal surgery is less traumatic when compared to traditional surgery techniques, with well-established advantages. The objective of this study was to report the experience in laparoscopic surgical treatment of colorectal diseases. METHOD: Catalog all patients submitted to laparoscopic colorectal surgery performed by one surgeon and perform a descriptive analysis of key data from these records. RESULTS: The study analyzed data from 43 patients who underwent laparoscopic colorectal surgery. Most were females (n=30; 69.77% in relation to males (n=13; 30.23%, mean age of 57.21 years old. Among the indications for surgery, diverticular disease was the most frequent (n=20; 46.51%, followed by malignancy (n=13; 30.23%. Most patients underwent rectosigmoidectomy (n=28; 65.12%, followed by right hemicolectomy (n=6; 13.95%, with conversions in five cases (11.63%. The study observed a tendency towards increased number of surgeries, reduced average operative time as well as decreased conversions to laparotomy along the studied period. CONCLUSION: Laparoscopic colorectal surgery is a safe procedure, and with the technical development of the team, the results have been increasingly good.A videolaparoscopia colorretal apresenta-se como uma tática operatória menos traumática com vantagens bem-estabelecidas. O objetivo deste trabalho foi apresentar a experiência no tratamento cirúrgico videolaparoscópico das afecções colorretais. MÉTODO: Catalogar todos os pacientes submetidos à cirurgia colorretal videolaparoscópica realizadas por um único cirurgião e realizar uma análise descritiva dos principais dados a partir dos prontuários destes. RESULTADOS: O estudo analisou dados de 43 pacientes que foram submetidos à cirurgia colorretal por videolaparoscopia. A maioria era do gênero feminino (n=30; 69,77% em relação ao masculino (n=13; 30,23% com média de idade de 57,21 anos. Dentre as indicações cirúrgicas, doença diverticular

  7. CORONARY ANGIOGRAPHY WITH DUAL SOURCE COMPUTED TOMOGRAPHY: INITIAL EXPERIENCE

    Institute of Scientific and Technical Information of China (English)

    Zhu-hua Zhang; Wen-min Zhao; Wen-bin Mou; Li-ren Zhang; Wen-ling Zhu; Qi Miao; Qi Fang; Zheng-yu Jin; Shu-yang Zhang; Song-bai Lin; Dong-jing Li; Ling-yan Kong; Yi-ning Wang; Lan Song; Yun Wang

    2007-01-01

    To explore the scan technique and image quality of coronary angiography with dual source computed tomography (CT) without oral metoprolol preparation.Methods Plain and enhanced dual source CT coronary angiography without oral metoprolol preparation was prospectively performed in 600 patients. Calcium scoring with plain scan images as well as multi-planar reconstruction( MPR ), maximum intensity projection (MIP), and volume rendering technique (VRT) reconstruction with enhanced scan images were performed in all cases. The scan technique and post-reconstruction experience was summarized. The image quality was classified as 1 to 4 points, and coronary segments classified according to the American Heart Association standards were evaluated.Results The average calcium score of the 600 cases was 213.6 ± 298.7 (0-3 216. 5). The average heart rate of the enhanced scan was 82.1 ± 16.2 (47-139) bpm. The post-reconstruction methods with which coronary segments could be shown as best as possible consisted of single phase reconstruction method, two or more phases supplemented method, and electrocardiogram editing method. Altogether 8 457 coronary segments were evaluated, among which 97.2% were evaluated as point 1, 1.7% point 2, 0.5% point 3, and0.6% point 4. The coronary segments in 261 cases were completely normal, while 360 segments were diagnosed with < 50% stenosis and 625 segments with ≥50%stenosis.Conclusions Excellent coronary artery image can be obtained with dual source CT in patients with any heart rate without oral metoprolol preparation. Heart rate is not a major source of the artifact, coronary segments can be well shown with single or multiple-phase reconstruction method.

  8. Ingestion analgesia occurs when a bad taste turns good.

    Science.gov (United States)

    Foo, Hayley; Mason, Peggy

    2011-12-01

    During ingestion of water, chocolate, sucrose, and saccharin, pain-related behaviors are suppressed. This ingestion analgesic effect is reversed when the hedonic valence of a food is switched from "good" to "bad" as occurs during conditioned taste aversion. Here, we tested the converse hedonic shift to determine if ingestion analgesia occurs when 0.3 M NaCl is made palatable by inducing a sodium appetite. In Experiment 1, sham- and sodium-depleted rats were tested for paw withdrawal and lick latencies to brief noxious heat during quiet wake and intraoral NaCl ingestion. Only sodium-depleted rats showed a suppression of heat-evoked reactions during NaCl ingestion. In Experiment 2, we tested whether this analgesic effect is mediated by the brainstem nucleus raphe magnus (NRM). Inactivation of NRM with muscimol blocked ingestion analgesia during NaCl ingestion by sodium-depleted rats. This attenuation was not due to a hyperalgesic effect of NRM inactivation. Muscimol microinjections into a nearby region, the nucleus raphe obscurus (NRO), were ineffective. The present findings demonstrate that the internal milieu of an animal can modify ingestion analgesia, and that the analgesia during NaCl ingestion by sodium hungry rats is mediated by NRM. PsycINFO Database Record (c) 2011 APA, all rights reserved.

  9. Sedations and analgesia in patients undergoing percutaneous transhepatic biliary drainage

    Energy Technology Data Exchange (ETDEWEB)

    Hatzidakis, A.A.; Charonitakis, E.; Athanasiou, A.; Tsetis, D.; Chlouverakis, G.; Papamastorakis, G.; Roussopoulou, G.; Gourtsoyiannis, N.C

    2003-02-01

    AIM: To present our experience using intravenous sedoanalgesia for percutaneous biliary drainage. MATERIALS AND METHODS: This study comprised 100 patients, all of whom were continuously monitored [electrocardiogram (ECG), blood pressure, pulse oxymetry] and received an initial dose of 2 mg midazolam followed by 0.02 mg fentanyl. Before every anticipated painful procedure, a maintenance dose of 0.01 mg fentanyl was administered. If the procedure continued and the patient became aware, another 1 mg midazolam was given. This was repeated if patients felt pain. A total dose of 0.08 mg fentanyl and 7 mg midazolam was never exceeded. Immediately after the procedure, the nurse was asked to evaluate patients' pain score. The patients were asked 3 h later to complete a visual 10-degree pain score scale. RESULTS: The average dose of fentanyl and midazolam was 0.042 mg (0.03-0.08 mg) and 4.28 mg (2-7 mg), respectively. Only one patient recorded the procedure as painful. The scores given by the attending nurse (1-7 points, mean 2.9) correlated well with those given by the patients (1-6 points, mean 2.72). No complications were noted. CONCLUSION: According to our experience, interventional radiologists practising biliary procedures can administer low doses of midazolam and minimize the doses of fentanyl, without loss of adequate sedation and analgesia. Hatzidakis, A. A. et al. (2003). Clinical Radiology58, 121-127.

  10. Digital breast tomosynthesis (DBT): initial experience in a clinical setting

    Energy Technology Data Exchange (ETDEWEB)

    Skaane, Per; Gullien, Randi; Eben, Ellen B.; Haakenaasen, Unni; Naess Jebsen, Ingvild; Krager, Mona [Dept of Radiology, Oslo Univ. Hospital Ullevaal, Univ. of Oslo, Oslo (Norway)], e-mail: PERSKA@ous-hf.no; Bjoerndal, Hilde [Dept of Radiology, Oslo Univ. Hospital The Norwegian Radium Hospital, Oslo (Norway); Ekseth, Ulrika [Curato Roentgen Institute, Oslo (Norway); Jahr, Gunnar [Dept. of Radiology, Oslo Univ. Hospital Rikshospitalet, Oslo (Norway)

    2012-06-15

    false-positive findings. The side-by-side feature analysis showed higher conspicuity scores for tomosynthesis compared to conventional 2D for cancers presenting as spiculated masses and distortions. Conclusion: Tomosynthesis is a promising new technique. Our preliminary clinical experience shows that there is a potential for increasing the sensitivity using this new technique, especially for cancers manifesting as spiculated masses and distortions.

  11. Placebo analgesia: understanding the mechanisms.

    Science.gov (United States)

    Medoff, Zev M; Colloca, Luana

    2015-01-01

    Expectations of pain relief drive placebo analgesia. Understanding how expectations of improvement trigger distinct biological systems to shape therapeutic analgesic outcomes has been the focus of recent pharmacologic and neuroimaging studies in the field of pain. Recent findings indicate that placebo effects can imitate the actions of real painkillers and promote the endogenous release of opioids and nonopioids in humans. Social support and observational learning also contribute to placebo analgesic effects. Distinct psychological traits can modulate expectations of analgesia, which facilitate brain pain control mechanisms involved in pain reduction. Many studies have highlighted the importance and clinical relevance of these responses. Gaining deeper understanding of these pain modulatory mechanisms has important implications for personalizing patient pain management.

  12. Patient controlled analgesia with remifentanil versus epidural analgesia in labour : randomised multicentre equivalence trial

    NARCIS (Netherlands)

    Freeman, Liv M; Bloemenkamp, Kitty W; Franssen, Maureen T; Papatsonis, Dimitri N; Hajenius, Petra J; Hollmann, Markus W; Woiski, Mallory D; Porath, Martina; van den Berg, Hans J; van Beek, Erik; Borchert, Odette W H M; Schuitemaker, Nico; Sikkema, J Marko; Kuipers, A H M; Logtenberg, Sabine L M; van der Salm, Paulien C M; Oude Rengerink, Katrien; Lopriore, Enrico; van den Akker-van Marle, M Elske; le Cessie, Saskia; van Lith, Jan M; Struys, Michel M; Mol, Ben Willem J; Dahan, Albert; Middeldorp, Johanna M; Oude Rengerink, K

    2015-01-01

    OBJECTIVE: To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. DESIGN: Multicentre randomised controlled equivalence trial. SETTING: 15 hospitals in the Netherlands. PARTICIPANTS: Women with an interm

  13. Labour pain with remifentanil patient-controlled analgesia versus epidural analgesia : a randomised equivalence trial

    NARCIS (Netherlands)

    Logtenberg, Slm; Oude Rengerink, K; Verhoeven, C J; Freeman, L M; van den Akker, Esa; Godfried, M B; van Beek, E; Borchert, Owhm; Schuitemaker, N; van Woerkens, Ecsm; Hostijn, I; Middeldorp, J M; van der Post, J A; Mol, B W

    OBJECTIVE: To distinguish satisfaction with pain relief using remifentanil patient-controlled analgesia (RPCA) compared with epidural analgesia (EA) in low-risk labouring women. DESIGN: Randomised controlled equivalence trial. SETTING: Eighteen midwifery practices and six hospitals in the

  14. Placebo analgesia: understanding the mechanisms

    OpenAIRE

    Medoff, Zev M; Colloca, Luana

    2015-01-01

    Expectations of pain relief drive placebo analgesia. Understanding how expectations of improvement trigger distinct biological systems to shape therapeutic analgesic outcomes has been the focus of recent pharmacologic and neuroimaging studies in the field of pain. Recent findings indicate that placebo effects can imitate the actions of real painkillers and promote the endogenous release of opioids and nonopioids in humans. Social support and observational learning also contribute to placebo a...

  15. Pharmacogenomic considerations in opioid analgesia

    Directory of Open Access Journals (Sweden)

    Vuilleumier PH

    2012-08-01

    Full Text Available Pascal H Vuilleumier,1 Ulrike M Stamer,1 Ruth Landau21Klinik für Anästhesiologie und Schmerztherapie, Inselspital Universität Bern, Switzerland; 2Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USAAbstract: Translating pharmacogenetics to clinical practice has been particularly challenging in the context of pain, due to the complexity of this multifaceted phenotype and the overall subjective nature of pain perception and response to analgesia. Overall, numerous genes involved with the pharmacokinetics and dynamics of opioids response are candidate genes in the context of opioid analgesia. The clinical relevance of CYP2D6 genotyping to predict analgesic outcomes is still relatively unknown; the two extremes in CYP2D6 genotype (ultrarapid and poor metabolism seem to predict pain response and/or adverse effects. Overall, the level of evidence linking genetic variability (CYP2D6 and CYP3A4 to oxycodone response and phenotype (altered biotransformation of oxycodone into oxymorphone and overall clearance of oxycodone and oxymorphone is strong; however, there has been no randomized clinical trial on the benefits of genetic testing prior to oxycodone therapy. On the other hand, predicting the analgesic response to morphine based on pharmacogenetic testing is more complex; though there was hope that simple genetic testing would allow tailoring morphine doses to provide optimal analgesia, this is unlikely to occur. A variety of polymorphisms clearly influence pain perception and behavior in response to pain. However, the response to analgesics also differs depending on the pain modality and the potential for repeated noxious stimuli, the opioid prescribed, and even its route of administration.Keywords: pain perception, opioid analgesia, genetic variation, pharmacogenetics

  16. Analgesia for acute pain

    African Journals Online (AJOL)

    ailment known to man, and acute pain is an experience familiar to all. Pain is defined as ... standard drug or cocktail and a satisfactory patient response is based on .... it was found in a systematic review that music therapy reduces anxiety and ...

  17. Single dose spinal analgesia: Is it a good alternative to epidural analgesia in controlling labour pain?

    Directory of Open Access Journals (Sweden)

    Tarek AbdElBarr

    2014-07-01

    Conclusions: Based on the results of our study we concluded that single dose spinal analgesia is a good alternative to epidural analgesia in controlling labour pain i.e. spinal compared to epidural is more easy performed, faster, less expensive, and provide effective analgesia.

  18. Remifentanil em analgesia para o trabalho de parto Remifentanil en analgesia para el trabajo de parto Remifentanil as analgesia for labor

    Directory of Open Access Journals (Sweden)

    Eliane C S Soares

    2010-06-01

    para la analgesia del parto discutindo los aspectos farmacocinéticos, farmacodinamicos, eficacia analgésica, satisfacion materna y efectos colaterales maternos y fetales. CONCLUSIONES: Los datos iniciales nos indican al remifentanil como una opción promisoria que podemos usar en las situaciones en que la embarazada no quiere o no puede recibir la analgesia neuroaxial.BACKGROUND AND OBJECTIVES: The neuraxial techniques currently represent the most effective methods for pain control during labor and the epidural block using ultradiluted anesthetic solutions is considered the gold standard promoting adequate pain relief with minimum side effects. In some situations however the use of these techniques is limited by the existence of maternal contraindications, or structural or material obstacles. In these cases, the alternatives are still precarious and scarce offering little optimistic results and of dubious effectiveness. CONTENT: This article presents through a literature review the available information on the use of remifentanil as an alternative technique for analgesia during labor discussing aspects of pharmacokinetics, analgesia efficacy, maternal satisfaction and maternal/fetal side effects. CONCLUSIONS: The initial data show that remifentanil is a promising option to be employed in situations where the parturient cannot or does not want to receive the neuraxial analgesia.

  19. Postoperative pain and gastro-intestinal recovery after colonic resection with epidural analgesia and multimodal rehabilitation

    DEFF Research Database (Denmark)

    Werner, M U; Gaarn-Larsen, L; Basse, L;

    2005-01-01

    and ten consecutive patients scheduled for elective open colonic resection under general anaesthesia with combined thoracic epidural analgesia were prospectively studied. Postoperative epidural analgesia was maintained for 48 h with bupivacaine 2.5 mg/ml and morphine 50 µg/ml, 4 ml/h. Postoperative pain......The aim of the study was to evaluate initial postoperative pain intensity and the association with recovery of gastrointestinal function and length of stay (LOS) in a multimodal programme with epidural analgesia, early oral nutrition and mobilisation with a 48 h planned hospital stay. One hundred......, respectively. Gastrointestinal recovery and LOS did not differ between patients with high (3-6) versus low (0-2) dynamic pain scores (P > 0.4 and P > 0.1, respectively). It is concluded that a multimodal rehabilitation program including continuous thoracic epidural analgesia leads to early recovery...

  20. Posterior paramedian subrhomboidal analgesia versus thoracic epidural analgesia for pain control in patients with multiple rib fractures.

    Science.gov (United States)

    Shelley, Casey L; Berry, Stepheny; Howard, James; De Ruyter, Martin; Thepthepha, Melissa; Nazir, Niaman; McDonald, Tracy; Dalton, Annemarie; Moncure, Michael

    2016-09-01

    Rib fractures are common in trauma admissions and are associated with an increased risk of pulmonary complications, intensive care unit admissions, and mortality. Providing adequate pain control in patients with multiple rib fractures decreases the risk of adverse events. Thoracic epidural analgesia is currently the preferred method for pain control. This study compared outcomes in patients with multiple acute rib fractures treated with posterior paramedian subrhomboidal (PoPS) analgesia versus thoracic epidural analgesia (TEA). This prospective study included 30 patients with three or more acute rib fractures admitted to a Level I trauma center. Thoracic epidural analgesia or PoPS catheters were placed, and local anesthesia was infused. Data were collected including patients' pain level, adjunct morphine equivalent use, adverse events, length of stay, lung volumes, and discharge disposition. Nonparametric tests were used and two-sided p Pain rating was lower in the PoPS group (2.5 vs. 5; p = 0.03) after initial placement. Overall, there was no other statistically significant difference in pain control or use of oral morphine adjuncts between the groups. Hypotension occurred in eight patients, 75% with TEA and only 25% with PoPS. No difference was found in adverse events, length of stay, lung volumes, or discharge disposition. In patients with rib fractures, PoPS analgesia may provide pain control equivalent to TEA while being less invasive and more readily placed by a variety of hospital staff. This pilot study is limited by its small sample size, and therefore additional studies are needed to prove equivalence of PoPS compared to TEA. Therapeutic study, level IV.

  1. Analgesia adjuvante e alternativa Analgesia adyuvante y alternativa Adjuvant and alternative analgesia

    Directory of Open Access Journals (Sweden)

    Nilton Bezerra do Vale

    2006-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Embora a dor aguda e a crônica sejam habitualmente controladas com intervenções farmacológicas, 14 métodos complementares de analgesia adjuvante e alternativa (AAA podem reduzir o uso e abuso na prescrição de analgésicos e diminuir os efeitos colaterais que eventualmente comprometem o estado fisiológico do paciente. CONTEÚDO: Todos os mecanismos antiálgicos atuam através da via espinal de controle da comporta de Melzack e Wall e/ou através da transdução do sinal nos sistemas de neurotransmissão e neuromodulação central relacionados com analgesia, relaxamento e humor: peptidérgico, monaminérgico, gabaérgico, colinérgico e canabinóide. A analgesia adjuvante complementar é habitualmente utilizada nos tratamentos fisiátricos, ortopédicos, reumatológicos, obstétricos e com acupuntura. A analgesia alternativa complementar pode potencializar os métodos analgésicos convencionais, a exposição à luz do sol matutino, luz e cores sob luz artificial, o tempo (T - anestésicos gerais mais potentes à noite, opióides de manhã e anestésicos locais à tarde, dieta, bom humor e riso, espiritualidade, religião, meditação, musicoterapia, hipnose e efeito placebo. CONCLUSÕES: Se a dor aguda é um mecanismo de defesa, a dor crônica é um estado patológico desagradável relacionado com a depressão endógena e a uma baixa qualidade de vida. É importante estabelecer relações interdisciplinares entre a Medicina adjuvante e alternativa nas terapias analgésicas e antiinflamatórias clássicas.JUSTIFICACIÓN Y OBJETIVOS: Aunque el dolor agudo y el crónico sean habitualmente controlados con intervenciones farmacológicas, 14 métodos complementarios de analgesia adyuvante y alternativa (AAA pueden reducir el uso y el abuso en la prescripción de analgésicos y disminuir los efectos colaterales que eventualmente comprometen el estado fisiológico del paciente. CONTENIDO: Todos los mecanismos anti

  2. The WIND-HAARP Experiment: Initial Results of High Power Radiowave Interactions with Space Plasmas

    Science.gov (United States)

    1997-11-10

    Results from the first science experiment with the new HF Active Auroral Research Program ( HAARP ) facility in Alaska are reported. The initial...experiments involved transmission of high frequency waves from HAARP to the NASA/WIND satellite. The objective was to investigate the effects of space

  3. Multimodal analgesia and regional anaesthesia.

    Science.gov (United States)

    Tornero Tornero, C; Fernández Rodríguez, L E; Orduña Valls, J

    Multimodal analgesia provides quality analgesia, with fewer side effects due to the use of combined analgesics or analgesic techniques. Regional anaesthesia plays a fundamental role in achieving this goal. The different techniques of regional anaesthesia that include both peripheral and central blocks in either a single dose or in continuous infusion help to modulate the nociceptive stimuli that access the central level. The emergence of the ultrasound as an effective system to perform regional anaesthesia techniques has allowed the development of new regional anaesthesia techniques that formerly could not be carried out since only neurostimulation or skin references were used. It is essential to take into account that even with effective blocking it is advisable to associate other drugs by other routes, in this way we will be able to reduce the required doses individually and attempt to achieve a synergistic, not purely additive, effect. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Analgesia regional em cuidados intensivos

    Directory of Open Access Journals (Sweden)

    Luísa Guedes

    2012-10-01

    Full Text Available JUSTIFICATIVAS E OBJETIVOS: A analgesia regional desempenha um papel importante na abordagem multimodal da dor no doente crítico e permite amenizar o desconforto do doente e reduzir os estresses fisiológico e psicológico associados. Ao diminuir as doses de opioides sistêmicos, reduz alguns dos seus efeitos colaterais, como a síndrome de abstinência, possíveis alterações psicológicas e disfunção gastrintestinal. Apesar desses benefícios, seu uso é controverso, uma vez que os doentes em unidades de cuidados intensivos apresentam frequentemente contraindicações, como coagulopatia, instabilidade hemodinâmica e dificuldade na avaliação neurológica e na execução da técnica regional. CONTEÚDO: Os autores apresentam uma revisão sobre analgesia regional em cuidados intensivos, com foco nas principais vantagens e limitações de seu uso no doente crítico, e descrevem as técnicas regionais mais usadas e a sua aplicabilidade nesse contexto.

  5. Experience with irrigation analgesia after abdominal hysterectomy

    Directory of Open Access Journals (Sweden)

    R. V. Garyaev

    2012-01-01

    Full Text Available A prospective randomized clinical trial was performed in 100 patients who underwent abdominal hysterectomy under endotracheal anesthesia based on sevoflurane and fentanyl. Intraoperatively, ketorolac 30 mg was administered intramuscularly after induction of anesthesia and paracetamol 1 g was injected intravenously 30–40 minutes prior to surgical termination in a control group (n = 25. For postoperative anal- gesia, promedol, tramadol, and ketorolac were used intramuscularly and paracetamol was given intravenously. Three study groups (n = 2 in each differed from the control group in that during wound suturing a multiperforated catheter was placed above the peritoneum over a length of 15 cm, through which a 10-ml bolus of 0.75 % ropivacaine was first administered, followed by continuous infusion of 0.2 % ropivacaine at a rate of 8 ml/hour for 36 hours. In one irrigation group, ketorolac 30 mg was injected intramuscularly t.i.d. for 2 days; in another group, the agent was added to a ropivacaine solution calculated with reference to 180 mg for 2 days; in the third group, ketoprofen 100 mg instead of ketorolac was used b.i.d. for 2 days. Pain level (by digital rating scale, 0–10 and the need for analgesics were measured. There was no sta- tistical significant difference in the level of pain and the need for analgesics between the wound irrigation and control groups.

  6. [Pneumoencephalotomography under diaz-analgesia and narco-analgesia].

    Science.gov (United States)

    Bergeron, J L; Renou, A M; Boulard, G; Vernhiet, J; Nicod, J

    1978-01-01

    The authors reported 92 observations of anesthesia for gaseous encephalotomography interest the adult. The contrast produce is air. 49 under diazanalgesia and myoresolution. Diazepam, +Fentanyl, pancuronium bromide N2O to 60 p. 100. 25 under diazanalgesia and myoresolution. Diazepam, +Fentanyl, succinylcholine, N2O to 60 p. 100. 18 under narco-analgesia and myoresolution. +Fentyl, pancuronium bromide N2O to 60 p. 100. The conditions of the study are described in the first part. The results and their analysis permit the appreciation of: - the patient confort, the quality of the examination; -the respect of the hemodynamics for this examination, reputed to be "difficult"; -the immediatly noticeable diminution of side effects; -the absence of side effects; -the justification and interesting of the control ventilation; -the quality of waking up. In the conclusion the authors underline the interest of their different techniques and the possibility of using them in operations in sitting position in neurosurgery, and all important chirurgical intervention.

  7. Effect of epidural analgesia with 0.075% ropivacaine versus 0.1%ropivacaine on the maternal temperature during labor:a randomized controlled study

    Institute of Scientific and Technical Information of China (English)

    YUE Hong-li; SHAO Liu-jiazi; LI Jin; WANG Ya-nan; WANG Lei; HAN Ru-quan

    2013-01-01

    Background A wealth of evidence has indicated that labor epidural analgesia is associated with an increased risk of hyperthermia and overt clinical fever.Recently,evidence is emerging that the epidural analgesia-induced fever is associated with the types of the epidural analgesia and the variations in the epidural analgesia will affect the incidence of fever.The aim of the present study was to investigate the effects of epidural analgesia with 0.075% or 0.1%ropivacaine on the maternal temperature during labor.Methods Two hundred healthy term nulliparas were randomly assigned to receive epidural analgesia with either 0.1% ropivacaine or 0.075% ropivacaine.Epidural analgesia was initiated with 10 ml increment of the randomized solution and 0.5 μg/ml sufentanyl after a negative test dose of 5 ml of 1.5% lidocaine,and maintained with 7 ml bolus doses of the abovementioned mixed analgesics every 30 minutes by the patient-controlled epidural analgesia.The measurements included the maternal oral temperature,visual analog scale pain scores,labor events and neonatal outcomes.Results Epidural analgesia with 0.075% ropivacaine could significantly lower the mean maternal temperature at 4 hours after the initiation of analgesia and the oxytocin administration during labor compared with the one with 0.1%ropivacaine.Moreover,0.075% ropivacaine treatment could provide satisfactory pain relief during labor and had no significant adverse effects on the labor events and neonatal outcomes.Conclusion Epidural analgesia with 0.075% ropivacaine may be a good choice for the epidural analgesia during labor.

  8. Comparing overflow and wave-overtopping induced breach initiation mechanisms in an embankment breach experiment

    Directory of Open Access Journals (Sweden)

    van Damme Myron

    2016-01-01

    Full Text Available As part of the SAFElevee project Delft University of Technology collabored with Flanders Hydraulics Research, and Infram B.V. in the preperation and execution of a full scale embankment breach experiment in November 2015. This breach experiment was performed on an 3.5m high embankment with a sand core and clay outer layer situated along the tidal river Scheldt in Belgium near Schellebelle. During the experiment a wave overtopping simulator and overflow simulator were used to initiate a breach. Both simulators were placed near the top of the waterside slope. The use of the simulators facilitated comparison between the effects of continueous overflow and the effects of intermittent wave overtopping. This paper presents the data collected during the experiment, describe the development of hypotheses on the failure processes using the latest insights, and comment on the failure initiation process of a grass covered flood embankment with a clay outer layer and a sandy core.

  9. Clonidine as an adjuvant for propranolol enhances its effect on infiltrative cutaneous analgesia in rats.

    Science.gov (United States)

    Hung, Ching-Hsia; Chiu, Chong-Chi; Liu, Kuo-Sheng; Wang, Jhi-Joung; Chen, Yu-Wen

    2016-03-11

    Clonidine prolongs duration of analgesia when used as an adjunct to local anesthetics for infiltrative cutaneous analgesia, and propranolol produces local anesthesia. The purpose of the experiment was to evaluate clonidine as an adjuvant for propranolol on the quality and duration of cutaneous analgesia. A rat model of cutaneous trunci muscle reflex (CTMR) in response to local skin pinprick was employed to evaluate the cutaneous analgesic effect of propranolol combined with clonidine. The long-lasting local anesthetic bupivacaine was used as control. Cutaneous analgesia elicited by propranolol and bupivacaine was dose-dependent, and both propranolol (9.0μmol) and bupivacaine (1.8μmol) produced 100% nociceptive blockade. On an 50% effective dose (ED50) basis, the relative potency was bupivacaine [0.48 (0.42-0.55) μmol] greater than propranolol [2.27 (1.98-2.54) μmol] (ppropranolol or bupivacaine) at ED50 or ED95 increased the potency and extended the duration at producing cutaneous analgesia. The resulting data demonstrated that propranolol is less potent than bupivacaine as an infiltrative anesthetic. Clonidine as an adjuvant for propranolol or bupivacaine has a significant peripheral action in increasing the depth and duration of action on infiltrative cutaneous analgesia.

  10. Commissioning and initial experimental program of the BGO-OD experiment at ELSA

    Directory of Open Access Journals (Sweden)

    Alef S.

    2016-01-01

    Full Text Available BGO-OD is a new meson photoproduction experiment at the ELSA facility of Bonn University. It aims at the investigation of non strange and strange baryon excitations, and is especially designed to be able to detect weekly bound meson-baryon type structures. The setup for the BGO-OD experiment is presented, the characteristics of the photon beam and the detector performances are shown and the initial experimental program is discussed.

  11. Initiating Transdisciplinarity in Academic Case Study Teaching: Experiences from a Regional Development Project in Salzburg, Austria

    Science.gov (United States)

    Muhar, Andreas; Vilsmaier, Ulli; Glanzer, Michaela; Freyer, Bernhard

    2006-01-01

    Purpose: The purpose of this paper is to describe experiences with the initiation of transdisciplinarity in academic case study teaching with special reference to regional planning, based on the case study "Leben 2014 (Life 2014)--perspectives for regional development in the national park region Ober-pinz-gau, Salzburg".…

  12. "Elite" Career-Changers and Their Experience of Initial Teacher Education

    Science.gov (United States)

    Wilkins, Chris

    2017-01-01

    This study explores the motivation of "high-status" professionals to change career and enter teaching, and their experience of undertaking initial teacher education (ITE) programmes in England. The study builds on previous research which found that career-changers are disproportionately more likely to fail to complete their ITE studies,…

  13. Initial Experience with the Extracorporeal HIFU Knife with 49 Patients: Japanese Experience

    Science.gov (United States)

    Ganaha, F.; Okuno, T.; Lee, C. O.; Shimizu, T.; Osako, K.; Oka, S.; Lee, K. H.; Chen, W. Z.; Zhu, H.; Park, S. H.; Qi, Z.; Shi, D.; Song, H. S.

    2005-03-01

    Forty nine patients with 63 tumours were treated with the Chongqing Haifu knife, as an adjunct to intra-arterial chemoinfusion. Treatment targets included breast (20 lesions), liver (16), bone (8), lymph-node (6), soft tissue (4), lung and pleura (4), pancreas (2), kidney (2) and adrenal gland (1). Follow-up contrast MRI was performed at 3 weeks to assess the effects of HIFU ablation. All cases completed the planned treatment. Of 25 lesions treated with the intention of complete tumour ablation, complete necrosis was obtained in 19 lesions (76%) including 4 secondary success cases. Among 32 lesions having partial and palliative treatment, tumour size was decreased in 6 lesions (21%), and good pain control was obtained in 6 out of 7 patients (86%). Skin injury was the most common complication after HIFU (16%), and was mostly a superficial dermal burn that did not necessitate any treatment. However, there was one patient with deep skin injury at an operation scar which resulted in skin perforation. Other adverse events included soft tissue swelling, prolonged fever, anorexia, persistent pain, shortness of the breath, sacroiliac joint fracture and prolonged diarrhoea. In our limited experience, superficial lesions (e.g. breast cancer, bone, soft tissue, lymph-node and pleural metastasis) appear to be good candidates for HIFU treatment. There appears to be a role for the HIFU knife in pain control for patients with bone metastasis and pancreatic cancer.

  14. Effects of hypnotic analgesia and hypnotizability on experimental ischemic pain.

    Science.gov (United States)

    DeBenedittis, G; Panerai, A A; Villamira, M A

    1989-01-01

    Mechanisms of hypnotic analgesia are still poorly understood and conflicting data are reported regarding the underlying neurochemical correlates. The present study was designed to investigate the effects of hypnotically induced analgesia and hypnotizability on experimental ischemic pain, taking into account pain and distress tolerance as well as the neurochemical correlates. 11 high hypnotizable Ss and 10 low hypnotizable Ss, as determined by scores on the Stanford Hypnotic Susceptibility Scale, Form C (Weitzenhoffer & E. R. Hilgard, 1962), were administered an ischemic pain test in both waking and hypnotic conditions. The following variables were measured: (a) pain and distress tolerance, (b) anxiety levels, and (c) plasma concentrations of beta-endorphin and adrenocorticotropic hormone (ACTH). Results confirmed significant increases of pain and distress tolerance during hypnosis as compared to the waking state, with positive correlations between pain and distress relief and hypnotizability. Moreover, a hypnotically induced dissociation between the sensory-discriminative and the affective-motivational dimensions of pain experience was found, but only in high hypnotizable Ss. Hypnotic analgesia was unrelated to anxiety reduction and was not mediated either by endorphins or by ACTH.

  15. The elusive rat model of conditioned placebo analgesia.

    Science.gov (United States)

    McNabb, Christopher T; White, Michelle M; Harris, Amber L; Fuchs, Perry N

    2014-10-01

    Recent research on human placebo analgesia has suggested the need for rodent models to further elucidate the neural substrates of the placebo effect. This series of 3 experiments therefore was performed in an attempt to develop a model of placebo analgesia in rats. In each study, female Sprague-Dawley rats received an L5 spinal nerve ligation to induce a neuropathic pain condition. Each rat then underwent a 4-day conditioning procedure in which an active analgesic drug or its vehicle (unconditioned stimulus) was associated with the following cues (conditioned stimuli): novel testing room (environmental), vanilla scent cue (olfactory), dim incandescent lighting (visual), restraint procedure/injection (tactile), and time of day and injection-test latency (temporal). The analgesics for each experiment were as follows: Experiment 1 used 90 mg/kg gabapentin, experiment 2 used 3mg/kg loperamide hydrochloride, and experiment 3 used 6 mg/kg morphine sulfate. On the following test day, half of the animals received the opposite treatment, resulting in 4 conditioning manipulations: drug/drug, drug/vehicle, vehicle/drug, and vehicle/vehicle. Nociceptive thresholds were assessed with the mechanical paw withdrawal threshold test each day after the conditioning procedure. In all 3 experiments, no significant differences were detected on test day between control and placebo groups, indicating a lack of a conditioned placebo analgesic response. Our results contrast with prior research that implies the existence of a reliable and robust response to placebo treatment. We conclude that placebo analgesia in rats is not particularly robust and that it is difficult to achieve using conventional procedures and proper experimental design.

  16. Analgesia pós-operatória Postoperative analgesia

    Directory of Open Access Journals (Sweden)

    Betina Sílvia Beozzo Bassanezi

    2006-04-01

    Full Text Available JUSTIFICATIVAS E OBJETIVOS: A dor sempre foi uma das maiores preocupações do homem, entretanto, apesar dos progressos da ciência, ainda existem várias barreiras ao seu adequado tratamento, incluindo a falta de conhecimento por parte da equipe médica, sobre o mecanismo das diversas drogas e técnicas empregadas. O objetivo deste trabalho é abordar as principais drogas e técnicas empregadas no controle da dor pós-operatória, visando estimular o interesse sobre o assunto bem como aumentar a eficácia do tratamento dado aos pacientes. CONTEÚDO: Está ressaltada neste artigo, a importância da adequada analgesia pós-operatória, considerando as principais drogas e técnicas utilizadas no controle da dor, seus mecanismos de ação, posologias, vias de administração e efeitos colaterais, bem como a importância da integração de toda a equipe envolvida nos cuidados do paciente para o sucesso do tratamento. O tratamento inadequado da dor no pós-operatório não se justifica, pois há um arsenal considerável de drogas e técnicas analgésicas. O que se faz necessário, portanto, é que toda equipe, anestesistas, cirurgiões, e enfermeiros tenham conhecimento e estejam integrados na utilização deste arsenal.BACKGROUND AND OBJECTIVES: Pain has been one of the men's biggest worries. Despite of scientific progress there still exist many barriers in an adequate treatment of pain including the lack of knowledge of many drugs and pain management techniques. The objective of this study is to discuss the main drugs and analgesics process in an effort to stimulate our colleague interest about the subject and thus increasing treatment efficiency of our patients. CONTENTS: It is emphasized in this study the importance of an adequate postoperative analgesia discussing the main drugs and techniques used in pain management, their mechanism of action, dose, administration route and side effects of each drug. It is also pointed out the great importance

  17. Intranasal sufentanil/ketamine analgesia in children

    DEFF Research Database (Denmark)

    Nielsen, Bettina Nygaard; Friis, Susanne M; Rømsing, Janne

    2014-01-01

    The management of procedural pain in children ranges from physical restraint to pharmacological interventions. Pediatric formulations that permit accurate dosing, are accepted by children and a have a rapid onset of analgesia are lacking.......The management of procedural pain in children ranges from physical restraint to pharmacological interventions. Pediatric formulations that permit accurate dosing, are accepted by children and a have a rapid onset of analgesia are lacking....

  18. Influence of the initial soil water content on Beerkan water infiltration experiments

    Science.gov (United States)

    Lassabatere, L.; Loizeau, S.; Angulo-Jaramillo, R.; Winiarski, T.; Rossier, Y.; Delolme, C.; Gaudet, J. P.

    2012-04-01

    Understanding and modeling of water flow in the vadose zone are important with regards water management and infiltration devices design. Water infiltration process clearly depends on initial soil water content, in particular for sandy soils with high organic matter content. This study investigates the influence of initial water content on water infiltration in a hydrophobic sandy soil and on the related derivation of hydraulic parameters using the BEST algorithm (Lassabatere et al., 2006). The studied sandy soil has a high total organic content decreasing from 3.5% (w/w) at the surface to 0.5% (w/w) below 1cm depth. The highest TOC at surface was due to the presence of a dense biofilm and resulted in a high surface hydrophobicity under dry conditions (low initial water contents). The water infiltration experiments consisted in infiltrating known volumes of water through a simple ring at null pressure head (Beerkan method). The infiltrations were performed during three successive days after a dry period with a storm event between the first and the second day (5 mm) and another between the second and the third day (35 mm). These events resulted in an increase in initial water contents, from less than 5% for the first day to around 10% for the last day. Experiments were performed for appropriate conditions for Beerkan experiments: initial water contents below 1/4 of the saturated water content and uniform water profile resulting from water redistribution after each rainfall event. The analysis of the infiltration data clearly highlights the strong effect of hydrophobicity. For the driest initial conditions (first day), infiltration rates increased with time, whereas they decreased with time for wetter conditions. Such a decrease agreed with the principles of water infiltration without hydrophobicity. In addition, total cumulative infiltrations were far higher for the wettest conditions. Regarding hydraulic characterization, only the data obtained during the last

  19. Combined spinal epidural (CSE) analgesia: technique, management, and outcome of 300 mothers.

    Science.gov (United States)

    Collis, R E; Baxandall, M L; Srikantharajah, I D; Edge, G; Kadim, M Y; Morgan, B M

    1994-04-01

    Epidural analgesia in labour is commonly associated with some degree of lower limb weakness often severe enough to be described as paralysis by the mother. We aimed to produce rapid reliable analgesia with no motor block throughout labour. We report a pilot survey of 300 consecutive women requesting regional analgesia in labour who received a combined spinal epidural blockade (CSE). The initial dose was given into the subarachnoid space and analgesia maintained via an epidural catheter. A subarachnoid injection of 2.5 mg bupivacaine and 25 mug fentanyl was successfully given in 268 women (89.3%). Completely pain-free contractions within 3 min of this injection occurred in 195 women (65%) and in all 300 within 20 min and there was no associated motor block in 291 (97%). 141 women chose to stand, walk or sit in a rocking chair at some time during labour. Only 38 women (12.6%) were immobile during the first stage of labour. Analgesia was maintained via the epidural catheter with bolus doses of 10-15 ml of 0.1% bupivacaine and 0.0002% fentanyl. The mean bupivacaine requirement was 9.5 mg/h throughout the entire duration of analgesia. The incidence of post lumbar puncture headache was 2.3%. Transient hypotension occurred in 24 women (8%) and was treated with 6 mg intravenous boluses of ephedrine. Complete satisfaction with analgesia and mobility was reported 12-24 h post partum by 95% of mothers. The use of this analgesic technique caused no alteration in obstetric management or post partum care of the women.

  20. Experiments and simulations on the incompressible, Rayleigh-Taylor instability with small wavelength initial perturbations

    Science.gov (United States)

    Roberts, Michael Scott

    The Rayleigh-Taylor instability is a buoyancy driven instability that takes place in a stratified fluid system with a constant acceleration directed from the heavy fluid into the light fluid. In this study, both experimental data and numerical simulations are presented. Experiments are performed primarily using a lithium-tungstate aqueous solution as the heavy liquid, but sometimes a calcium nitrate aqueous solution is used for comparison purposes. Experimental data is obtained for both miscible and immiscible fluid combinations. For the miscible experiments the light liquid is either ethanol or isopropanol, and for the immiscible experiments either silicone oil or trans-anethole is used. The resulting Atwood number is either 0.5 when the lithium-tungstate solution is used or 0.2 when the calcium nitrate solution is used. These fluid combinations are either forced or left unforced. The forced experiments have an initial perturbation imposed by vertically oscillating the liquid containing tank to produce Faraday waves at the interface. The unforced experiments rely on random interfacial fluctuations, due to background noise, to seed the instability. The liquid combination is partially enclosed in a test section that is accelerated downward along a vertical rail system causing the Rayleigh-Taylor instability. Accelerations of approximately 1g (with a weight and pulley system) or 10g (with a linear induction motor system) are experienced by the liquids. The tank is backlit and digitally recorded with high speed video cameras. These experiments are then simulated with the incompressible, Navier-Stokes code Miranda. The main focus of this study is the growth parameter (α) of the mixing region produced by the instability after it has become apparently self-similar and turbulent. The measured growth parameters are compared to determine the effects of miscibility and initial perturbations (of the small wavelength, finite bandwidth type used here). It is found that while

  1. Migration experience and premarital sexual initiation in urban Kenya: an event history analysis.

    Science.gov (United States)

    Luke, Nancy; Xu, Hongwei; Mberu, Blessing U; Goldberg, Rachel E

    2012-06-01

    Migration during the formative adolescent years can affect important life-course transitions, including the initiation of sexual activity. In this study, we use life history calendar data to investigate the relationship between changes in residence and timing of premarital sexual debut among young people in urban Kenya. By age 18, 64 percent of respondents had initiated premarital sex, and 45 percent had moved at least once between the ages of 12 and 18. Results of the event history analysis show that girls and boys who move during early adolescence experience the earliest onset of sexual activity. For adolescent girls, however, other dimensions of migration provide protective effects, with greater numbers of residential changes and residential changes in the last one to three months associated with later sexual initiation. To support young people's ability to navigate the social, economic, and sexual environments that accompany residential change, researchers and policymakers should consider how various dimensions of migration affect sexual activity.

  2. Causes and outcomes of revisional bariatric surgery: initial experience at a single center

    OpenAIRE

    2014-01-01

    Purpose Bariatric surgery has become more prevalent owing to the worldwide obesity epidemic. With the growing number of bariatric procedures performed annually, the requirement for revisional and secondary operations is increasing accordingly. This study aimed to evaluate the initial experience of revisional bariatric surgery at a single specialized center. Methods A retrospective review of the prospectively established database identified all patients who underwent revisional bariatric surge...

  3. Initial experience with a first-to-market member accountability-based insurance product.

    Science.gov (United States)

    Woll, Douglas R; Nelson, David R

    2010-10-01

    We describe the initial experience with a first-to-market health insurance product design based on principles of both member and purchaser accountability. Two benefit levels were offered, enhanced and standard. Qualification for the enhanced benefit level was obtained through members' commitment to follow their physicians' recommended treatment plan. Employers were offered a discount of 10% in exchange for offering this new product and promoting a healthy work environment. Membership in the product grew beyond expectations, and several health improvements were noted.

  4. Resolving the Brainstem Contributions to Attentional Analgesia

    Science.gov (United States)

    Brooks, Jonathan C.W.; Davies, Wendy-Elizabeth

    2017-01-01

    Previous human imaging studies manipulating attention or expectancy have identified the periaqueductal gray (PAG) as a key brainstem structure implicated in endogenous analgesia. However, animal studies indicate that PAG analgesia is mediated largely via caudal brainstem structures, such as the rostral ventromedial medulla (RVM) and locus coeruleus (LC). To identify their involvement in endogenous analgesia, we used brainstem optimized, whole-brain imaging to record responses to concurrent thermal stimulation (left forearm) and visual attention tasks of titrated difficulty in 20 healthy subjects. The PAG, LC, and RVM were anatomically discriminated using a probabilistic atlas. Pain ratings disclosed the anticipated analgesic interaction between task difficulty and pain intensity (p pain intensity. Intersubject analgesia scores correlated to activity within a distinct region of the RVM alone. These results identify distinct roles for a brainstem triumvirate in attentional analgesia: with the PAG activated by attentional load; specific RVM regions showing pronociceptive and antinociceptive processes (in line with previous animal studies); and the LC showing lateralized activity during conflicting attentional demands. SIGNIFICANCE STATEMENT Attention modulates pain intensity, and human studies have identified roles for a network of forebrain structures plus the periaqueductal gray (PAG). Animal data indicate that the PAG acts via caudal brainstem structures to control nociception. We investigated this issue within an attentional analgesia paradigm with brainstem-optimized fMRI and analysis using a probabilistic brainstem atlas. We find pain intensity encoding in several forebrain structures, including the insula and attentional activation of the PAG. Discrete regions of the rostral ventromedial medulla bidirectionally influence pain perception, and locus coeruleus activity mirrors the interaction between attention and nociception. This approach has enabled the

  5. Postoperative pain and gastro-intestinal recovery after colonic resection with epidural analgesia and multimodal rehabilitation

    DEFF Research Database (Denmark)

    Werner, M U; Gaarn-Larsen, L; Basse, L

    2005-01-01

    The aim of the study was to evaluate initial postoperative pain intensity and the association with recovery of gastrointestinal function and length of stay (LOS) in a multimodal programme with epidural analgesia, early oral nutrition and mobilisation with a 48 h planned hospital stay. One hundred......, respectively. Gastrointestinal recovery and LOS did not differ between patients with high (3-6) versus low (0-2) dynamic pain scores (P > 0.4 and P > 0.1, respectively). It is concluded that a multimodal rehabilitation program including continuous thoracic epidural analgesia leads to early recovery...

  6. Postoperative analgesia with continuous epidural sufentanil and bupivacaine : A prospective study in 614 patients

    NARCIS (Netherlands)

    Broekema, AA; Gielen, MJM; Hennis, PJ

    1996-01-01

    To assess the efficacy and safety of postoperative analgesia with continuous epidural sufentanil and bupivacaine, we performed a prospective study in 614 patients undergoing major surgery. Before surgical incision, all patients received an initial dose of 50 mu g sufentanil in 6-10 mL bupivacaine 0.

  7. Postoperative analgesia with continuous epidural sufentanil and bupivacaine : A prospective study in 614 patients

    NARCIS (Netherlands)

    Broekema, AA; Gielen, MJM; Hennis, PJ

    To assess the efficacy and safety of postoperative analgesia with continuous epidural sufentanil and bupivacaine, we performed a prospective study in 614 patients undergoing major surgery. Before surgical incision, all patients received an initial dose of 50 mu g sufentanil in 6-10 mL bupivacaine

  8. Thermophysical Property Estimation by Transient Experiments: The Effect of a Biased Initial Temperature Distribution

    Directory of Open Access Journals (Sweden)

    Federico Scarpa

    2015-01-01

    Full Text Available The identification of thermophysical properties of materials in dynamic experiments can be conveniently performed by the inverse solution of the associated heat conduction problem (IHCP. The inverse technique demands the knowledge of the initial temperature distribution within the material. As only a limited number of temperature sensors (or no sensor at all are arranged inside the test specimen, the knowledge of the initial temperature distribution is affected by some uncertainty. This uncertainty, together with other possible sources of bias in the experimental procedure, will propagate in the estimation process and the accuracy of the reconstructed thermophysical property values could deteriorate. In this work the effect on the estimated thermophysical properties due to errors in the initial temperature distribution is investigated along with a practical method to quantify this effect. Furthermore, a technique for compensating this kind of bias is proposed. The method consists in including the initial temperature distribution among the unknown functions to be estimated. In this way the effect of the initial bias is removed and the accuracy of the identified thermophysical property values is highly improved.

  9. Progress in analgesia for labor: focus on neuraxial blocks

    Directory of Open Access Journals (Sweden)

    J Sudharma Ranasinghe

    2009-05-01

    Full Text Available J Sudharma Ranasinghe, David J BirnbachMiller School of Medicine, University of Miami, Florida, USAAbstract: Neuraxial analgesia is widely accepted as the most effective and the least depressant method of providing pain relief in labor. Over the last several decades neuraxial labor analgesia techniques and medications have progressed to the point now where they provide high quality pain relief with minimal side effects to both the mother and the fetus while maximizing the maternal autonomy possible for the parturient receiving neuraxial analgesia. The introduction of the combined spinal epidural technique for labor has allowed for the rapid onset of analgesia with minimal motor blockade, therefore allowing the comfortable parturient to ambulate. Patient-controlled epidural analgesia techniques have evolved to allow for more flexible analgesia that is tailored to the individual needs of the parturient and effective throughout the different phases of labor. Computer integrated systems have been studied to provide seamless analgesia from induction of neuraxial block to delivery. New adjuvant drugs that improve the effectiveness of neuraxial labor analgesia while decreasing the side effects that may occur due to high dose of a single drug are likely to be added to future labor analgesia practice. Bupivacaine still remains a popular choice of local anesthetic for labor analgesia. New local anesthetics with less cardiotoxicity have been introduced, but their cost effectiveness in the current labor analgesia practice has been questioned.Keywords: labor, neuraxial, analgesia, neuraxial labor analgesia

  10. Experience shapes our odor perception but depends on the initial perceptual processing of the stimulus.

    Science.gov (United States)

    Sinding, Charlotte; Coureaud, Gérard; Bervialle, Boris; Martin, Christophe; Schaal, Benoist; Thomas-Danguin, Thierry

    2015-07-01

    The questions of whether configural and elemental perceptions are competitive or exclusive perceptual processes and whether they rely on independent or dependent mechanisms are poorly understood. To examine these questions, we modified perceptual experience through preexposure to mixed or single odors and measured the resulting variation in the levels of configural and elemental perception of target odor mixtures. We used target mixtures that were spontaneously processed in a configural or an elemental manner. The AB binary mixture spontaneously involved the configural perception of a pineapple odor, whereas component A smelled like strawberry and component B smelled like caramel. The CD mixture produced the elemental perceptions of banana (C) and smoky (D) odors. Perceptual experience was manipulated through repeated exposure to either a mixture (AB or CD) or the components (A and B or C and D). The odor typicality rating data recorded after exposure revealed different influences of experience on odor mixtures and single-component perception, depending both on the type of exposure (components or mixture) and the mixture's initial perceptual property (configural or elemental). Although preexposure to A and B decreased the pineapple typicality of the configural AB mixture, preexposure to AB did not modify its odor quality. In contrast, preexposure to the CD elemental mixture induced a quality transfer between the components. These results emphasize the relative plasticity of odor mixture perception, which is prone to experience-induced modulations but depends on the stimulus's initial perceptual properties, suggesting that configural and elemental forms of odor mixture perception rely on rather independent processes.

  11. Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Freeman Liv M

    2012-07-01

    Full Text Available Abstract Background Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a result of non-availability due to logistic problems. Remifentanil, a synthetic opioid, is very suitable for patient controlled analgesia. Recent studies show that epidural analgesia is superior to remifentanil patient controlled analgesia in terms of pain intensity score; however there was no difference in satisfaction with pain relief between both treatments. Methods/design The proposed study is a multicentre randomized controlled study that assesses the cost-effectiveness of remifentanil patient controlled analgesia compared to epidural analgesia. We hypothesize that remifentanil patient controlled analgesia is as effective in improving pain appreciation scores as epidural analgesia, with lower costs and easier achievement of 24 hours availability of pain relief for women in labour and efficient pain relief for those with a contraindication for epidural analgesia. Eligible women will be informed about the study and randomized before active labour has started. Women will be randomly allocated to a strategy based on epidural analgesia or on remifentanil patient controlled analgesia when they request pain relief during labour. Primary outcome is the pain appreciation score, i.e. satisfaction with pain relief. Secondary outcome parameters are costs, patient satisfaction, pain scores (pain-intensity, mode of delivery and maternal and neonatal side effects. The economic analysis will be performed from a short-term healthcare perspective. For both strategies the cost of perinatal care for mother and child, starting at the onset of labour and ending ten days after delivery, will be registered and compared. Discussion This study, considering cost

  12. Magnetohydrodynamic simulation of solid-deuterium-initiated Z-pinch experiments

    Energy Technology Data Exchange (ETDEWEB)

    Sheehey, Peter Trogdon [Univ. of California, Los Angeles, CA (United States)

    1994-02-01

    Solid-deuterium-initiated Z-pinch experiments are numerically simulated using a two-dimensional resistive magnetohydrodynamic model, which includes many important experimental details, such as ``cold-start`` initial conditions, thermal conduction, radiative energy loss, actual discharge current vs. time, and grids of sufficient size and resolution to allow realistic development of the plasma. The alternating-direction-implicit numerical technique used meets the substantial demands presented by such a computational task. Simulations of fiber-initiated experiments show that when the fiber becomes fully ionized rapidly developing m=0 instabilities, which originated in the coronal plasma generated from the ablating fiber, drive intense non-uniform heating and rapid expansion of the plasma column. The possibility that inclusion of additional physical effects would improve stability is explored. Finite-Larmor-radius-ordered Hall and diamagnetic pressure terms in the magnetic field evolution equation, corresponding energy equation terms, and separate ion and electron energy equations are included; these do not change the basic results. Model diagnostics, such as shadowgrams and interferograms, generated from simulation results, are in good agreement with experiment. Two alternative experimental approaches are explored: high-current magnetic implosion of hollow cylindrical deuterium shells, and ``plasma-on-wire`` (POW) implosion of low-density plasma onto a central deuterium fiber. By minimizing instability problems, these techniques may allow attainment of higher temperatures and densities than possible with bare fiber-initiated Z-pinches. Conditions for significant D-D or D-T fusion neutron production may be realizable with these implosion-based approaches.

  13. Initial experience with stapled hemorrhoidopexy for treatment of hemorrhoids Experiência inicial com o tratamento da doença hemorroidária pela técnica de grampeamento circular

    Directory of Open Access Journals (Sweden)

    Carlos Walter Sobrado

    2006-09-01

    Full Text Available BACKGROUND: Introduction of stapled hemorrhoidopexy by Longo in 1998 represented a radical change in the treatment of hemorrhoids. By avoiding multiple excisions and suture lines in the perianal region, stapled hemorrhoidopexy is intended to offer less postoperative pain than with conventional techniques. OBJECTIVE: To report and analyze the intra and postoperative results gained during initial experience with stapled hemorrhoidopexy. METHODS: One hundred and fifty five patients (67 males with average age of 39.5 years (21-67 years underwent stapled hemorrhoidopexy between June 2000 and December 2003 with symptomatic third-degree (n = 74 and fourth-degree (n = 81 hemorrhoids. Mean follow-up period was 20 months (14-60 months. RESULTS: Preoperative symptoms were prolapse (96.7% and anal bleeding (96.1%. Overall mean operative time was 23 minutes (16-48 minutes. We observed one case of stapler failure and one case of failure to introduce the stapler occurred in a patient with previous anal surgery. Additional sutures for hemostasis were required in 103 patients (66.5%. Resection of skin tags was performed in 45 cases (29%. Postoperatively scheduled analgesia with oral dipyrone and celecoxib was enough for pain control in 131 patients (84.5%. Rescue analgesia was necessary in 24 cases (15.5%. Five patients needed opiates for pain control. Hospital discharge took place on the first postoperative day in 140 patients (90.3%. First defecation without pain was reported by 118 patients (76.1%. Postoperative complications were anal bleeding (10.3%, severe pain (3.2%, urinary retention (3.9%, fever without any signs of perianal infection (1.9%, incontinence for flatus (1.9%, hemorrhoidal thrombosis (1.3%. Two patients presented symptoms of recurrent hemorrhoidal disease and were successfully treated by conventional hemorrhoidectomy. They were no cases of anal stenosis, permanent incontinence, chronic pain or deaths in this series. CONCLUSIONS

  14. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity is controv......Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity...... is controversial. We therefore update the effects of postoperative analgesia on surgical outcome. After major abdominal surgery, postoperative epidural analgesia with local anesthetics significantly reduces postoperative ileus and pulmonary complications while effects on cardiac morbidity are debatable. Continuous...... regimen does not contain a sufficient amount of local anesthetics. Future evaluation of the effects of epidural analgesia on postoperative outcome also requires integration of epidural analgesia within a multimodal rehabilitation programme....

  15. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity is controv...

  16. Procedural sedation and analgesia for gastrointestinal endoscopy in infants and children: how, with what, and by whom?

    Science.gov (United States)

    Bartkowska-Śniatkowska, Alicja; Rosada-Kurasińska, Jowita; Zielińska, Marzena; Grześkowiak, Małgorzata; Bienert, Agnieszka; Jenkins, Ian A; Ignyś, Iwona

    2014-01-01

    Endoscopic procedures involving the gastrointestinal tract have been successfully developed in paediatric practice over the last two decades, improving both diagnosis and treatment in many children's gastrointestinal diseases. In this group of patients, experience and co-operation between paediatricians/endoscopists and paediatric anaesthesiologists should help to guarantee the quality and safety of a procedure and should additionally help to minimise the risk of adverse events which are greater the smaller the child is. This principle is more and more important especially since the announcement of the Helsinki Declaration on Patient Safety in Anaesthesiology in 2010, emphasising the role of anaesthesiology in promoting safe perioperative care. The Helsinki Declaration has been endorsed by all European anaesthesiology institutions as well as the World Health Organisation's 'Safe Surgery Saves Lives' initiative including the 'Surgical Safety Checklist'. Although most of these procedures could be performed by paediatricians under procedural sedation and analgesia, children with congenital defects and serious coexisting diseases (ASA ≥ III) as well as the usage of anaesthetics (e.g. propofol) must be managed by paediatric anaesthesiologists. We have reviewed the specific principles employed during qualification and performance of procedural sedation and analgesia for gastrointestinal endoscopy in paediatrics. We have also tried to answer the questions as to how, with what, and by whom, procedural sedation for gastrointestinal endoscopy in children should be performed.

  17. Initial Scaling Studies and Conceptual Thermal Fluids Experiments for the Prismatic NGNP Point Design

    Energy Technology Data Exchange (ETDEWEB)

    D. M. McEligot; G. E. McCreery

    2004-09-01

    The objective of this report is to document the initial high temperature gas reactor scaling studies and conceptual experiment design for gas flow and heat transfer. The general approach of the project is to develop new benchmark experiments for assessment in parallel with CFD and coupled CFD/ATHENA/RELAP5-3D calculations for the same geometry. Two aspects of the complex flow in an NGNP are being addressed: (1) flow and thermal mixing in the lower plenum ("hot streaking" issue) and (2) turbulence and resulting temperature distributions in reactor cooling channels ("hot channel" issue). Current prismatic NGNP concepts are being examined to identify their proposed flow conditions and geometries over the range from normal operation to decay heat removal in a pressurized cooldown. Approximate analyses are being applied to determine key non-dimensional parameters and their magnitudes over this operating range. For normal operation, the flow in the coolant channels can be considered to be dominant forced convection with slight transverse property variation. The flow in the lower plenum can locally be considered to be a situation of multiple buoyant jets into a confined density-stratified crossflow -- with obstructions. Experiments are needed for the combined features of the lower plenum flows. Missing from the typical jet experiments are interactions with nearby circular posts and with vertical posts in the vicinity of vertical walls - with near stagnant surroundings at one extreme and significant crossflow at the other. Two heat transfer experiments are being considered. One addresses the "hot channel" problem, if necessary. The second experiment will treat heated jets entering a model plenum. Unheated MIR (Matched-Index-of-Refraction) experiments are first steps when the geometry is complicated. One does not want to use a computational technique which will not even handle constant properties properly. The MIR experiment will simulate flow features of the paths of jets

  18. Effects of Initial Conditions on Compressible Mixing in Supernova-Relevant Laboratory Experiments

    Energy Technology Data Exchange (ETDEWEB)

    Miles, A R; Edwards, M; Greenough, J

    2004-04-30

    In core-collapse supernovae, strong blast waves drive interfaces susceptible to Rayleigh-Taylor (RT), Richtmyer-Meshkov (RM), and Kelvin-Helmholtz (KH) instabilities. In addition, perturbation growth can result from material expansion in large-scale velocity gradients behind the shock front. Laser-driven experiments are designed to produce a strongly shocked interface whose evolution is a scaled version of the unstable hydrogen-helium interface in core-collapse supernovae such as SN 1987A. The ultimate goal of this research is to develop an understanding of the effect of hydrodynamic instabilities and the resulting transition to turbulence on supernovae observables that remain as yet unexplained. In this paper, we summarize recent results from our computational study of unstable systems driven by high Mach number shock and blast waves. For planar multimode systems, compressibility effects preclude the emergence of a regime of self-similar instability growth independent of the initial conditions (IC's) by allowing for memory of the initial conditions to be retained in the mix-width at all times. With higher-dimensional blast waves, divergence restores the properties necessary for establishment of the self-similar state, but achieving it requires very high initial characteristic mode number and high Mach number for the incident blast wave. Initial conditions predicted by some recent stellar calculations are incompatible with self-similarity.

  19. Epidural anaesthesia and analgesia for liver resection.

    Science.gov (United States)

    Tzimas, P; Prout, J; Papadopoulos, G; Mallett, S V

    2013-06-01

    Although epidural analgesia is routinely used in many institutions for patients undergoing hepatic resection, there are unresolved issues regarding its safety and efficacy in this setting. We performed a review of papers published in the area of anaesthesia and analgesia for liver resection surgery and selected four areas of current controversy for the focus of this review: the safety of epidural catheters with respect to postoperative coagulopathy, a common feature of this type of surgery; analgesic efficacy; associated peri-operative fluid administration; and the role of epidural analgesia in enhanced recovery protocols. In all four areas, issues are raised that question whether epidural anaesthesia is always the best choice for these patients. Unfortunately, the evidence available is insufficient to provide definitive answers, and it is clear that there are a number of areas of controversy that would benefit from high-quality clinical trials.

  20. Bupivacaine versus lidocaine analgesia for neonatal circumcision

    Directory of Open Access Journals (Sweden)

    Stolik-Dollberg Orit C

    2005-05-01

    Full Text Available Abstract Background Analgesia for neonatal circumcision was recently advocated for every male infant, and its use is considered essential by the American Academy of Pediatrics. We compared the post-operative analgesic quality of bupivacaine to that of lidocaine for achieving dorsal penile nerve block (DPNB when performing neonatal circumcision. Methods Data were obtained from 38 neonates following neonatal circumcision. The infants had received DPNB analgesia with either lidocaine or bupivacaine. The outcome variable was the administration by the parents of acetaminophen during the ensuing 24 hours. Results Seventeen infants received lidocaine and 19 received bupivacaine DPNB. Ten infants in the lidocaine group (59% were given acetaminophen following circumcision compared to only 3 (16% in the bupivacaine group (P 2 = 20.6; P = 0.006. Conclusion DPNB with bupivacaine for neonatal circumcision apparently confers better analgesia than lidocaine as judged by the requirement of acetaminophen over the ensuing 24-hour period.

  1. Initial utility experience with cluster of three Mod-2 wind turbine systems

    Science.gov (United States)

    Seely, D. B.; Warchol, E. J.; Butler, N. G.; Ciranny, S.

    1982-01-01

    This paper describes the initial utility experiences of operating three MOD-2s during the Engineering Acceptance Testing. Electrical quantities of bus voltage, phase currents and power are initially being recorded to evaluate impacts to customers on the 69-kV subtransmission line during synchronization and operation of one or more WTSs. To date, effects on the system have been essentially undetectable. Measurements of television signal strengths were taken at an existing television remote pickup and relay station at the WTS site. Potential TV signal interference problems from the WTSs have been avoided by replacing the remote pickups with microwave repeater links for the four TV channels received from Portland, Oregon. Preliminary measurements of audible and sub-audible noise levels indicate that the upwind rotor, tubular tower design of the MOD-2 does not have the pulsing high intensity infrasound problems experienced by the MOD-1 machine at Boone, North Carolina.

  2. [The dispute and prospect of sedation and analgesia treatments in outpatient dental procedures].

    Science.gov (United States)

    Cong, Yu

    2015-12-01

    The topic of eliminating the fear or pain of patients during dental therapy is gaining increasing attention from dentists across the country. The field of painless dental therapeutics involves a wide range of subjects, including stomatology, anesthesiology, and hospital management. We summarized the characteristics of sedation and analgesia technology in outpatient oral therapy, reviewed the common sedative and analgesic treatments, and discussed the disputes on the use of sedation and analgesia in dental procedures. We also reviewed the trends and breakthroughs in this area on the basis of our own clinica experiences.

  3. [Effect of met- and leu-enkephalins and their synthetic analog on stimulation and acupunture analgesia].

    Science.gov (United States)

    Ignatov, Iu D; Vasil'ev, Iu N; Kovalenko, V S; Titov, M I

    1981-08-01

    Experiments on unrestrained rats were carried out to study the effect of intraventricularly injected met- and leu-enkephalins and their synthetic analog Tyr-dAla-Cly-Phe-NH2 on analgesia induced by electrical stimulation of the central gray. It was shown that subanalgesic doses of enkephalins and their synthetic analog facilitated the appearance of analgesic action on subthreshold antinociceptive-brain stimulation and potentiated the analgesic effect of threshold central gray stimulation. Subanalgesic and low analgesic doses of the peptides increased antinociceptive effect of electroacupuncture. The data obtained are discussed from the standpoint of the implication of the peptidergic mechanisms in the realization of acupuncture and stimulation analgesia.

  4. Experience of initiating collaboration of traditional healers in managing HIV and AIDS in Tanzania

    Directory of Open Access Journals (Sweden)

    Moshi Mainen J

    2007-01-01

    Full Text Available Abstract Collaboration between traditional healers and biomedical practitioners is now being accepted by many African countries south of the Sahara because of the increasing problem of HIV/AIDS. The key problem, however, is how to initiate collaboration between two health systems which differ in theory of disease causation and management. This paper presents findings on experience learned by initiation of collaboration between traditional healers and the Institute of Traditional Medicine in Arusha and Dar-es-Salaam Municipalities, Tanzania where 132 and 60 traditional healers respectively were interviewed. Of these 110 traditional healers claimed to be treating HIV/AIDS. The objective of the study was to initiate sustainable collaboration with traditional healers in managing HIV/AIDS. Consultative meetings with leaders of traditional healers' associations and government officials were held, followed by surveys at respective traditional healers' "vilinge" (traditional clinics. The findings were analysed using both qualitative and quantitative methods. The findings showed that influential people and leaders of traditional healers' association appeared to be gatekeepers to access potential good healers in the two study areas. After consultative meetings these leaders showed to be willing to collaborate; and opened doors to other traditional healers, who too were willing to collaborate with the Institute of Traditional Medicine in managing HIV/AIDS patients. Seventy five percent of traditional healers who claimed to be treating HIV/AIDS knew some HIV/AIDS symptoms; and some traditional healers attempted to manage these symptoms. Even though, they were willing to collaborate with the Institute of Traditional Medicine there were nevertheless some reservations based on questions surrounding sharing from collaboration. The reality of past experiences of mistreatment of traditional healers in the colonial period informed these reservations. General

  5. Maximizing the Workshop Experience: An Example from the PTRA Rural Initiatives Program

    Science.gov (United States)

    Burns, Teresa

    2003-11-01

    Since the summer of 2001, the Rural Initiative of the Physics Teaching Resource Agents have led summer workshops for high school and middle school physics teachers at several universities nationwide. From the site at Coastal Carolina University where teachers learned about radioactivity and nuclear physics, assistant professor Teresa Burns describes how high school teacher Lucas Mullen was able to build a curriculum tied to South Carolina State Science Standards around the content he learned at the workshop. This is one example of how a workshop experience can lead to better teaching practices through exposure to content material and current accepted practices in physics education research.

  6. Reactivity Initiated Accident Test Series RIA Scoping Test Experiment Operating Specification

    Energy Technology Data Exchange (ETDEWEB)

    N/A

    1978-06-01

    This document describes the experiment operating specifications for the Reactivity Initiated Accident (RIA) Scoping Test to be conducted in the Power Burst Facility (PBF) at the Idaho National Engineering Laboratory. The primary objectives of the RIA research are to determine fuel failure thresholds, modes, and consequences as functions of (a) enthalpy insertion, (b) irradiation history, and (c) fuel design. Coolant conditions of pressure, temperature, and flow rate that are typical of hot-startup conditions in commercial boiling water reactors (BWRs) will be used in the first six RIA tests, termed Series I.

  7. Initial experience with the Codman Certas adjustable valve in the management of patients with hydrocephalus

    DEFF Research Database (Denmark)

    Watt, Sara; Agerlin, Niels; Romner, Bertil

    2012-01-01

    A new adjustable valve, the Codman CertasTM valve for treatment of hydrocephalus was introduced into clinical practice in January 2011. It has 8 different settings with an opening pressure varying from 36 to over 400 mm H2O at a flow rate of 20 mL/h. The 8th setting is designed to provide...... a "virtual off" function. The objective of this report is to describe the initial clinical experience with the CertasTM valve and evaluate clinical usage with the main focus on the portable adjustment device - Therapeutic Management System (TMS), the "virtual off" setting and compatibility with magnetic...

  8. Sex reassignment surgery for male to female transsexuals: initial experience in Okayama university hospital.

    Directory of Open Access Journals (Sweden)

    Nagai,Atsushi

    2005-10-01

    Full Text Available

    The first case of sex reassignment surgery (SRS in our hospital was performed in January 2001; as of February, 2005, 4 cases of MTF-SRS had been performed. In the 2 most recent cases, we used penile and scrotal skin flaps to avoid complications. The depth and width of the new vagina was made to be adequate for sexual intercourse. Future attention should be focused on devising a surgical technique that will help prevent the complications of partial necrosis of the epidermal skin and wound dehiscence. Although ours is only an initial experience, we describe our surgical technique herein.

  9. Initial experience with stereoscopic visualization of three-dimensional ultrasound data in surgery.

    Science.gov (United States)

    Gronningsaeter, A; Lie, T; Kleven, A; Mørland, T; Langø, T; Unsgård, G; Myhre, H O; Mårvik, R

    2000-11-01

    Initial in vivo and in vitro experiments were performed to evaluate the feasibility of stereoscopically displaying three-dimensional (3D) ultrasound data from neurosurgery, laparoscopic surgery, and vascular surgery. Stereoscopic visualization was illustrated by four video sequences, which can be downloaded from http://www.us.unimed. sintef.no/. These sequences show a brain tumor, hepatic arteries in relation to the gallbladder, a model that mimics a neuroendoscope in a cyst, and a "flight" into model of an artery with an intima flap. The experiments indicate that stereoscopic display of ultrasound data is feasible when there is sufficient contrast between the objects of interest and the surrounding tissue. True 3D vision improves perception, thus enhancing the ability to understand complex anatomic structures such as irregular lesions and tortuous vessels.

  10. Comparison between initial Magnetized Liner Inertial Fusion experiments and integrated simulations

    Science.gov (United States)

    Sefkow, A. B.; Gomez, M. R.; Geissel, M.; Hahn, K. D.; Hansen, S. B.; Harding, E. C.; Peterson, K. J.; Slutz, S. A.; Koning, J. M.; Marinak, M. M.

    2014-10-01

    The Magnetized Liner Inertial Fusion (MagLIF) approach to ICF has obtained thermonuclear fusion yields using the Z facility. Integrated magnetohydrodynamic simulations provided the design for the first neutron-producing experiments using capabilities that presently exist, and the initial experiments measured stagnation radii rstag < 75 μm, temperatures around 3 keV, and isotropic neutron yields up to YnDD = 2 ×1012 from imploded liners reaching peak velocities around 70 km/s over an implosion time of about 60 ns. We present comparisons between the experimental observables and post-shot degraded integrated simulations. Sandia is a multiprogram laboratory operated by Sandia Corporation, a Lockheed Martin Company, for the National Nuclear Security Administration under Contract DE-AC04-94AL85000.

  11. [Epidural anesthesia and analgesia in the perioperative treatment of a patient with Kartagener syndrome].

    Science.gov (United States)

    Errando, C L; Sifre, C; López-Alarcón, D

    1998-12-01

    Kartagener's syndrome is an inherited disease characterized by a triad of symptoms--bronchiectasis, situs inversus and sinusitis--and is classified as an immotile cilia syndrome. Patients may experience specific airway problems when undergoing anesthesia for surgical procedures. We report the case of a woman with Kartagener's syndrome who underwent surgery under epidural anesthesia with postoperative epidural analgesia, both techniques proving successful.

  12. Initial Off-Axis Neutral Beam Checkout and Physics Experiments on DIII-D

    Science.gov (United States)

    van Zeeland, M. A.; Ferron, J. R.; Hyatt, A. W.; Murphy, C. J.; Petty, C. C.; Prater, R.; Scoville, J. T.; Heidbrink, W. W.; Muscatello, C. M.; Park, J. M.; Murakami, M.; Pace, D. C.; Holcomb, C. T.; Grierson, B. A.; Tobias, B. J.; Solomon, W. M.; Moyer, R. A.

    2011-10-01

    Two of the eight neutral beam sources on DIII-D have been modified to allow vertical steering, with the injection angle varying from horizontal to downward at an angle of 16.5 degrees for off-axis deposition. Initial experiments to assess the basic beam functionality, geometry, and confinement were carried out. Dα images of beam into gas and plasma yield beam neutral profiles and are key in assessing beam shape and clipping. Neutron and fast-ion Dα (FIDA) diagnostics verify classical behavior of the off-axis beam ions in MHD-quiescent conditions. An initial physics experiment takes advantage of the downward steered beams to vary the fast-ion gradient ∇βf from centrally peaked to hollow. Systematic scans determine the stability and impact of reversed shear Alfvén eigenmodes and toroidal Alfvén eigenmodes as a function of ∇βf . Supported by US DOE under DE-FC02-04ER54698, SC-G903402, DE-AC05-00OR22725, DE-AC05-06OR23100, DE-AC52-07NA27344, DE-AC02-09CH11466, & DE-FG02-07ER54917.

  13. Initial Experience with a Cone-beam Breast Computed Tomography-guided Biopsy System

    Science.gov (United States)

    Seifert, Posy J; Morgan, Renee C; Conover, David L; Arieno, Andrea L

    2017-01-01

    Objective: To evaluate our initial experience with a cone-beam breast computed tomography (BCT)-guided breast biopsy system for lesion retrieval in phantom studies for use with a cone-beam BCT imaging system. Materials and Methods: Under the Institutional Review Board approval, a phantom biopsy study was performed using a dedicated BCT-guided biopsy system. Fifteen biopsies were performed on each of the small, medium, and large anthropomorphic breast phantoms with both BCT and stereotactic guidance for comparison. Each set of the 45 phantoms contained masses and calcification clusters of varying sizes. Data included mass/calcium retrieval rate and dose and length of procedure time for phantom studies. Results: Phantom mass and calcium retrieval rate were 100% for BCT and stereotactic biopsy. BCT dose for small and medium breast phantoms was found to be equivalent to or less than the corresponding stereotactic approach. Stereotactic-guided biopsy dose was 34.2 and 62.5 mGy for small and medium breast phantoms, respectively. BCT-guided biopsy dose was 15.4 and 30.0 mGy for small and medium breast phantoms, respectively. Both computed tomography biopsy and stereotactic biopsy study time ranged from 10 to 20 min. Conclusion: Initial experience with a BCT-guided biopsy system has shown to be comparable to stereotactic biopsy in phantom studies with equivalent or decreased dose. PMID:28217404

  14. Intraoperative 3-tesla MRI in the management of paediatric cranial tumours - initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Avula, Shivaram; Garlick, Deborah; Abernethy, Laurence J. [Alder Hey Children' s NHS Foundation Trust, Department of Radiology, Liverpool (United Kingdom); Mallucci, Connor L. [Alder Hey Children' s Hospital, Department of Neurosurgery, Liverpool (United Kingdom); Pizer, Barry [Alder Hey Children' s Hospital, Department of Oncology, Liverpool (United Kingdom); Crooks, Daniel [Walton Centre for Neurology and Neurosurgery, Department of Pathology, Liverpool (United Kingdom)

    2012-02-15

    Intraoperative MRI (ioMRI) has been gaining recognition because of its value in the neurosurgical management of cranial tumours. There is limited documentation of its value in children. To review the initial experience of a paediatric 3-Tesla ioMRI unit in the management of cranial tumours. Thirty-eight children underwent ioMRI during 40 cranial tumour resections using a 3-Tesla MR scanner co-located with the neurosurgical operating theatre. IoMRI was performed to assess the extent of tumour resection and/or to update neuronavigation. The intraoperative and follow-up scans, and the clinical records were reviewed. In 27/40 operations, complete resection was intended. IoMRI confirmed complete resection in 15/27 (56%). As a consequence, surgical resection was extended in 5/27 (19%). In 6/27 (22%), ioMRI was equivocal for residual tumour. In 13/40 (33%) operations, the surgical aim was to partially resect the tumour. In 7 of the 13 (54%), surgical resection was extended following ioMRI. In our initial experience, ioMRI has increased the rate of complete resection, with intraoperative surgical strategy being modified in 30% of procedures. Collaborative analysis of ioMRI by the radiologist and neurosurgeon is vital to avoid errors in interpretation. (orig.)

  15. The Model Parameter Estimation Experiment (MOPEX): Its structure, connection to other international initiatives and future directions

    Energy Technology Data Exchange (ETDEWEB)

    Wagener, T; Hogue, T; Schaake, J; Duan, Q; Gupta, H; Andreassian, V; Hall, A; Leavesley, G

    2006-05-08

    The Model Parameter Estimation Experiment (MOPEX) is an international project aimed at developing enhanced techniques for the a priori estimation of parameters in hydrologic models and in land surface parameterization schemes connected to atmospheric models. The MOPEX science strategy involves: database creation, a priori parameter estimation methodology development, parameter refinement or calibration, and the demonstration of parameter transferability. A comprehensive MOPEX database has been developed that contains historical hydrometeorological data and land surface characteristics data for many hydrologic basins in the United States (US) and in other countries. This database is being continuously expanded to include basins from various hydroclimatic regimes throughout the world. MOPEX research has largely been driven by a series of international workshops that have brought interested hydrologists and land surface modelers together to exchange knowledge and experience in developing and applying parameter estimation techniques. With its focus on parameter estimation, MOPEX plays an important role in the international context of other initiatives such as GEWEX, PUB and PILPS. This paper outlines the MOPEX initiative, discusses its role in the scientific community and briefly states future directions.

  16. Initial Experiences of Simultaneous Laparoscopic Resection of Colorectal Cancer and Liver Metastases

    Directory of Open Access Journals (Sweden)

    L. T. Hoekstra

    2012-01-01

    Full Text Available Introduction. Simultaneous resection of primary colorectal carcinoma (CRC and synchronous liver metastases (SLMs is subject of debate with respect to morbidity in comparison to staged resection. The aim of this study was to evaluate our initial experience with this approach. Methods. Five patients with primary CRC and a clinical diagnosis of SLM underwent combined laparoscopic colorectal and liver surgery. Patient and tumor characteristics, operative variables, and postoperative outcomes were evaluated retrospectively. Results. The primary tumor was located in the colon in two patients and in the rectum in three patients. The SLM was solitary in four patients and multiple in the remaining patient. Surgical approach was total laparoscopic (2 patients or hand-assisted laparoscopic (3 patients. The midline umbilical or transverse suprapubic incision created for the hand port and/or extraction of the specimen varied between 5 and 10 cm. Median operation time was 303 (range 151–384 minutes with a total blood loss of 700 (range 200–850 mL. Postoperative hospital stay was 5, 5, 9, 14, and 30 days. An R0 resection was achieved in all patients. Conclusions. From this initial single-center experience, simultaneous laparoscopic colorectal and liver resection appears to be feasible in selected patients with CRC and SLM, with satisfying short-term results.

  17. New perspectives on sea use management: initial findings from European experience with marine spatial planning.

    Science.gov (United States)

    Douvere, Fanny; Ehler, Charles N

    2009-01-01

    Increased development pressures on the marine environment and the potential for multiple use conflicts, arising as a result of the current expansion of offshore wind energy, fishing and aquaculture, dredging, mineral extraction, shipping, and the need to meet international and national commitments to biodiversity conservation, have led to increased interest in sea use planning with particular emphasis on marine spatial planning. Several European countries, on their own initiative or driven by the European Union's Marine Strategy and Maritime Policy, the Bergen Declaration of the North Sea Conference, and the EU Recommendation on Integrated Coastal Zone Management, have taken global leadership in implementing marine spatial planning. Belgium, The Netherlands, and Germany in the North Sea, and the United Kingdom in the Irish Sea, have already completed preliminary sea use plans and zoning proposals for marine areas within their national jurisdictions. This paper discusses the nature and context of marine spatial planning, the international legal and policy framework, and the increasing need for marine spatial planning in Europe. In addition, the authors review briefly three marine spatial planning initiatives in the North Sea and conclude with some initial lessons learned from these experiences.

  18. The Lusi seismic experiment: An initial study to understand the effect of seismic activity to Lusi

    Energy Technology Data Exchange (ETDEWEB)

    Karyono, E-mail: karyonosu@gmail.com [Agency for Meteorology, Climatology and Geophysics (BMKG), Jakarta (Indonesia); OSLO University (Norway); Padjadjaran University (UNPAD), Bandung (Indonesia); Mazzini, Adriano; Sugiharto, Anton [OSLO University (Norway); Lupi, Matteo [ETH Zurich (Switzerland); Syafri, Ildrem [Padjadjaran University (UNPAD), Bandung (Indonesia); Masturyono,; Rudiyanto, Ariska; Pranata, Bayu; Muzli,; Widodo, Handi Sulistyo; Sudrajat, Ajat [Agency for Meteorology, Climatology and Geophysics (BMKG), Jakarta (Indonesia)

    2015-04-24

    The spectacular Lumpur Sidoarjo (Lusi) eruption started in northeast Java on the 29 of May 2006 following a M6.3 earthquake striking the island [1,2]. Initially, several gas and mud eruption sites appeared along the reactivated strike-slip Watukosek fault system [3] and within weeks several villages were submerged by boiling mud. The most prominent eruption site was named Lusi. The Lusi seismic experiment is a project aims to begin a detailed study of seismicity around the Lusi area. In this initial phase we deploy 30 seismometers strategically distributed in the area around Lusi and along the Watukosek fault zone that stretches between Lusi and the Arjuno Welirang (AW) complex. The purpose of the initial monitoring is to conduct a preliminary seismic campaign aiming to identify the occurrence and the location of local seismic events in east Java particularly beneath Lusi.This network will locate small event that may not be captured by the existing BMKG network. It will be crucial to design the second phase of the seismic experiment that will consist of a local earthquake tomography of the Lusi-AW region and spatial and temporal variations of vp/vs ratios. The goal of this study is to understand how the seismicity occurring along the Sunda subduction zone affects to the behavior of the Lusi eruption. Our study will also provide a large dataset for a qualitative analysis of earthquake triggering studies, earthquake-volcano and earthquake-earthquake interactions. In this study, we will extract Green’s functions from ambient seismic noise data in order to image the shallow subsurface structure beneath LUSI area. The waveform cross-correlation technique will be apply to all of recordings of ambient seismic noise at 30 seismographic stations around the LUSI area. We use the dispersive behaviour of the retrieved Rayleigh waves to infer velocity structures in the shallow subsurface.

  19. The Lusi seismic experiment: An initial study to understand the effect of seismic activity to Lusi

    Science.gov (United States)

    Karyono, Mazzini, Adriano; Lupi, Matteo; Syafri, Ildrem; Masturyono, Rudiyanto, Ariska; Pranata, Bayu; Muzli, Widodo, Handi Sulistyo; Sudrajat, Ajat; Sugiharto, Anton

    2015-04-01

    The spectacular Lumpur Sidoarjo (Lusi) eruption started in northeast Java on the 29 of May 2006 following a M6.3 earthquake striking the island [1,2]. Initially, several gas and mud eruption sites appeared along the reactivated strike-slip Watukosek fault system [3] and within weeks several villages were submerged by boiling mud. The most prominent eruption site was named Lusi. The Lusi seismic experiment is a project aims to begin a detailed study of seismicity around the Lusi area. In this initial phase we deploy 30 seismometers strategically distributed in the area around Lusi and along the Watukosek fault zone that stretches between Lusi and the Arjuno Welirang (AW) complex. The purpose of the initial monitoring is to conduct a preliminary seismic campaign aiming to identify the occurrence and the location of local seismic events in east Java particularly beneath Lusi.This network will locate small event that may not be captured by the existing BMKG network. It will be crucial to design the second phase of the seismic experiment that will consist of a local earthquake tomography of the Lusi-AW region and spatial and temporal variations of vp/vs ratios. The goal of this study is to understand how the seismicity occurring along the Sunda subduction zone affects to the behavior of the Lusi eruption. Our study will also provide a large dataset for a qualitative analysis of earthquake triggering studies, earthquake-volcano and earthquake-earthquake interactions. In this study, we will extract Green's functions from ambient seismic noise data in order to image the shallow subsurface structure beneath LUSI area. The waveform cross-correlation technique will be apply to all of recordings of ambient seismic noise at 30 seismographic stations around the LUSI area. We use the dispersive behaviour of the retrieved Rayleigh waves to infer velocity structures in the shallow subsurface.

  20. Neuraxial block and postoperative epidural analgesia

    DEFF Research Database (Denmark)

    Leslie, K; McIlroy, D; Kasza, J

    2016-01-01

    BACKGROUND: We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects. METHODS: 10 010 high-risk noncardiac surgical pat...

  1. Analgesia and sedation after pediatric cardiac surgery.

    Science.gov (United States)

    Wolf, Andrew R; Jackman, Lara

    2011-05-01

    In recent years, the importance of appropriate intra-operative anesthesia and analgesia during cardiac surgery has become recognized as a factor in postoperative recovery. This includes the early perioperative management of the neonate undergoing radical surgery and more recently the care surrounding fast-track and ultra fast-track surgery. However, outside these areas, relatively little attention has focused on postoperative sedation and analgesia within the pediatric intensive care unit (PICU). This reflects perceived priorities of the primary disease process over the supporting structure of PICU, with a generic approach to sedation and analgesia that can result in additional morbidities and delayed recovery. Management of the marginal patient requires optimisation of not only cardiac and other attendant pathophysiology, but also every aspect of supportive care. Individualized sedation and analgesia strategies, starting in the operating theater and continuing through to hospital discharge, need to be regarded as an important aspect of perioperative care, to speed the process of recovery. © 2010 Blackwell Publishing Ltd.

  2. Postoperative opioid analgesia: time for a reconsideration?

    DEFF Research Database (Denmark)

    Kehlet, H; Rung, G W; Callesen, T

    1996-01-01

    limit their future use in some situations. Thus, the recent emphasis on ambulatory surgery and accelerated surgical stay programs, both with a focus on early recovery of organ function and provision of functional analgesia [i.e., pain relief that allows normal function (Kehlet H: Postoperative pain...

  3. Nerve injury caused by mandibular block analgesia

    DEFF Research Database (Denmark)

    Hillerup, S; Jensen, Rigmor H

    2006-01-01

    : feather light touch, pinprick, sharp/dull discrimination, warm, cold, point location, brush stroke direction, 2-point discrimination and pain perception. Gustation was tested for recognition of sweet, salt, sour and bitter. Mandibular block analgesia causes lingual nerve injury more frequently than...

  4. The effects of maternal labour analgesia on the fetus.

    Science.gov (United States)

    Reynolds, Felicity

    2010-06-01

    Maternal labour pain and stress are associated with progressive fetal metabolic acidosis. Systemic opioid analgesia does little to mitigate this stress, but opioids readily cross the placenta and cause fetal-neonatal depression and impair breast feeding. Pethidine remains the most widely used, but alternatives, with the possible exception of remifentanil, have little more to offer. Inhalational analgesia using Entonox is more effective and, being rapidly exhaled by the newborn, is less likely to produce lasting depression. Neuraxial analgesia has maternal physiological and biochemical effects, some of which are potentially detrimental and some favourable to the fetus. Actual neonatal outcome, however, suggests that benefits outweigh detrimental influences. Meta-analysis demonstrates that Apgar score is better after epidural than systemic opioid analgesia, while neonatal acid-base balance is improved by epidural compared to systemic analgesia and even compared to no analgesia. Successful breast feeding is dependent on many factors, therefore randomized trials are required to elucidate the effect of labour analgesia.

  5. Age-dependency of analgesia elicited by intraoral sucrose in acute and persistent pain models.

    Science.gov (United States)

    Anseloni, Vanessa C Z; Weng, H-R; Terayama, R; Letizia, David; Davis, Barry J; Ren, Ke; Dubner, Ronald; Ennis, Matthew

    2002-05-01

    Treatment of pain in newborns is associated with problematic drug side effects. Previous studies demonstrate that an intraoral infusion of sucrose and other sweet components of mother's milk are effective in alleviating pain in infant rats and humans. These findings are of considerable significance, as sweet tastants are used in pain and stress management in a number of clinical procedures performed in human infants. The ability of sweet stimuli to induce analgesia is absent in adult rats, suggesting that this is a developmentally transient phenomenon. However, the age range over which intraoral sucrose is capable of producing analgesia is not known. We investigated the effects of intraoral sucrose (7.5%) on nocifensive withdrawal responses to thermal and mechanical stimuli in naive and inflamed rats at postnatal days (P) P0-21. In some rats, Complete Freund's adjuvant (CFA) was injected in a fore- or hindpaw to produce inflammation. In non-inflamed animals, for noxious thermal stimuli, sucrose-induced analgesia emerged at P3, peaked at P7-10, then progressively declined and was absent at P17. For mechanical forepaw stimuli, sucrose-induced analgesia emerged, and was maximal at approximately P10, then declined and was absent at P17. By contrast, maximal sucrose-induced analgesia for mechanical hindpaw stimuli was delayed (P13) compared to that for the forepaw, although it was also absent at P17. In inflamed animals, sucrose reduced hyperesthesia and hyperalgesia assessed with mechanical stimuli. Sucrose-induced analgesia in inflamed animals was initially present at P3 for the forepaw and P13 for the hindpaw, and was absent by P17 for both limbs. Intraoral sucrose produced significantly greater effects on responses in fore- and hindpaws in inflamed rats than in naive rats indicating that it reduces hyperalgesia and allodynia beyond its effects on responses in naive animals. These findings support the hypothesis that sucrose has a selective influence on analgesic

  6. Comparison of continuous epidural infusion and programmed intermittent epidural bolus in labor analgesia

    Directory of Open Access Journals (Sweden)

    Lin Y

    2016-07-01

    Full Text Available Yunan Lin, Qiang Li, Jinlu Liu, Ruimin Yang, Jingchen Liu Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China Background: This study aims to investigate differences between continuous epidural infusion (CEI and programmed intermittent epidural bolus (IEB analgesia for the Chinese parturients undergoing spontaneous delivery and to approach their safety to parturients and neonates.Methods: Two hundred healthy American Society of Anesthesiologists class I or II, term (≥37 weeks’ gestation, nulliparous women who requested analgesia for labor were recruited. Epidural analgesia was initiated with a solution of 0.15% ropivacaine 10 mL and maintained with 0.1% ropivacaine mixed with sufentanil 0.3 µg/mL by CEI at a rate of 5 mL/h combined with a patient-controlled epidural analgesia (PCEA bolus of 5 mL of ropivacaine sufentanil mixture or IEB of 5 mL of ropivacaine sufentanil mixture combined with a PCEA bolus of 5 mL of ropivacaine sufentanil mixture. The lockout interval was 20 minutes in each arm between the CEI and the IEB group. After 20 minutes of first dosage, visual analog scale (VAS score was obtained every 60 minutes. The maternal and fetal outcome and total consumption of analgesic solution were compared.Results: There was no difference in demographic characteristics, duration of first and second stages, delivery methods, sensory block, fetal Apgar scores, and the maternal outcomes between the CEI and IEB groups. There was a significant difference in VAS scores and epidural ropivacaine total consumption between the two groups (IEB vs CEI: 51.27±9.61 vs 70.44±12.78 mg, P<0.01. Conclusion: The use of programmed IEB mixed with PCEA improved labor analgesia compared to CEI mixed with PCEA, which could act as maintenance mode for epidural labor analgesia. Keywords: intermittent epidural bolus, continuous epidural infusion, labor analgesia, patient

  7. Post-game analysis: An initial experiment for heuristic-based resource management in concurrent systems

    Science.gov (United States)

    Yan, Jerry C.

    1987-01-01

    In concurrent systems, a major responsibility of the resource management system is to decide how the application program is to be mapped onto the multi-processor. Instead of using abstract program and machine models, a generate-and-test framework known as 'post-game analysis' that is based on data gathered during program execution is proposed. Each iteration consists of (1) (a simulation of) an execution of the program; (2) analysis of the data gathered; and (3) the proposal of a new mapping that would have a smaller execution time. These heuristics are applied to predict execution time changes in response to small perturbations applied to the current mapping. An initial experiment was carried out using simple strategies on 'pipeline-like' applications. The results obtained from four simple strategies demonstrated that for this kind of application, even simple strategies can produce acceptable speed-up with a small number of iterations.

  8. Use of indocyanine green angiography in microsurgical subinguinal varicocelectomy - lessons learned from our initial experience.

    Science.gov (United States)

    Cho, Chak-Lam; Ho, Kwan-Lun; Chan, Wayne Kwun-Wai; Chu, Ringo Wing-Hong; Law, In-Chak

    2017-07-20

    Microsurgical subinguinal varicocelectomy (MSV) is generally considered the gold standard nowadays in view of the lower risk of complications and recurrence. To achieve complete ligation of veins while preserving testicular artery (TA) during the procedure remains challenging despite the application of high power optical magnification and micro-Doppler ultrasonography. The use of intraoperative indocyanine green angiography (ICGA) with infrared fluorescence operative micro-scope in MSV potentially lowers the incidence of TA injury and shortens the learning curve of nov-ice surgeons. We present our initial experience in the application of the technique in nine patients and explore the potential of the new adjunct. Copyright® by the International Brazilian Journal of Urology.

  9. The Case For Reporting Pro-Active Environmental Initiatives: A Malaysian Experiment On Stakeholder Influence Strategies

    Directory of Open Access Journals (Sweden)

    Evangeline Elijido-Ten

    2008-06-01

    Full Text Available The purpose of this research is to gain insights on the preferred strategies chosen by various stakeholder representatives to influence management to either provide/not provide environmental disclosures in an experimental setting. A typology of resource relationships and influence strategies is adapted as a framework to make sense of the views presented by various stakeholder representative groups. To facilitate a Malaysian experiment, qualitative interviews with the aid of a hypothetical vignette are conducted to understand how different stakeholder groups go about seeking what they want from the management. The findings in this exploratory study indicate that although the model is useful to understand the influence strategies taken by each stakeholder group, its effectiveness is tempered by the level of significance placed by these groups on the environmental initiative and their perception of how the event will affect their stake on the firm.

  10. Highlight report local initiatives. Experiences with electric transport; Highlight report lokale initiatieven. Ervaringen met elektrisch vervoer

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-06-15

    In March 2013 Linkingreen and XTNT started a survey on local electric transportation initiatives. The aim is to learn from the experiences, problems and obstacles of business users of electric vehicles: cars, vans or trucks, scooters, boats and special vehicles (e.g. garbage trucks) that are all-electric or plug-in (with plug). In this brief report, the main results are presented [Dutch] In maart 2013 is door Linkingreen en XTNT in opdracht van Agentschap NL een enquete uitgezet naar lokale initiatieven elektrisch vervoer. Doel is te leren wat de ervaringen, knelpunten en belemmeringen zijn van zakelijke gebruikers van elektrisch vervoer: personenauto's, bestel- of vrachtauto's, scooters, vaartuigen en bijzondere voertuigen (vuilniswagens etc.) die volledig elektrische of plug in (met stekker) zijn. In dit korte verslag zijn de belangrijkste resultaten opgenomen.

  11. LOW AMPLITUDE SINGLE AND MULTIPLE SHOCK INITIATION EXPERIMENTS AND MODELING OF LX-04

    Energy Technology Data Exchange (ETDEWEB)

    Vandersall, K S; Tarver, C M; Garcia, F; Chidester, S; Urtiew, P A; Forbes, J W

    2006-06-27

    Shock initiation experiments were performed on the plastic bonded explosive (PBX) LX-04 (85% HMX, 15% Viton binder) using single and multiple low amplitude shocks to obtain pressure history data for use in Ignition and Growth reactive flow modeling parameterization. A 100 mm diameter propellant driven gas gun was utilized to initiate the LX-04 explosive charges containing manganin piezoresistive pressure gauge packages placed between explosive discs. In the single shock experiments, the run distances to detonation at three shock pressures showed agreement with previously published data above 3 GPa. Even longer run distances to detonation were measured using 80 mm long by 145 mm diameter LX-04 charges impacted by low velocity projectiles from a 155 mm diameter gun. The minimum shock pressure required to cause low levels of exothermic reaction were determined for these large LX-04 charge dimensions. Multiple shocks were generated as double shocks by using a flyer plate with two materials and as reflected shocks by placing a high impedance material at the rear of the explosive charge. In both cases, the first shock pressure was not high enough to cause detonation of LX-04, and the second shock pressure, which would have been sufficient to cause detonation if generated by a single shock, failed to cause detonation. Thus LX-04 exhibited shock desensitization over a range of 0.6 to 1.4 GPa. The higher shock pressure LX-04 model was extended to accurately simulate these lower pressure and multiple shock gauge records. The shock desensitization effects observed with multiple shock compressions were partially accounted for in the model by using a critical compression corresponding to a shock pressure of 1.2 GPa. This shock desensitization effect occurs at higher pressures than those of other HMX-based PBX's containing higher HMX percentages.

  12. Initial experience of using the filter protection device during carotid artery stenting in Japan.

    Science.gov (United States)

    Takayama, Katsutoshi; Nakagawa, Hiroyuki; Iwasaki, Satoru; Taoka, Toshiaki; Miyasaka, Toshiteru; Myouchin, Kaoru; Wada, Takeshi; Sakamoto, Masahiko; Fukusumi, Akio; Nakagawa, Ichiro; Kurokawa, Shinichiro; Kichikawa, Kimihiko

    2008-07-01

    No filter protection devices for carotid artery stenting (CAS) have been formally approved for use in Japan; however, as of April 2008, the Angioguard XP (AGXP) was approved. This article describes our initial results using the AGXP during CAS for the treatment of carotid artery stenosis. A group of 15 patients (14 men) with a mean age of 72.3 years (range 53-81 years) were treated by CAS using the AGXP. Among them, 10 were symptomatic with >50% stenosis of the common or internal carotid artery (ICA), and 5 were asymptomatic with >70% stenosis. The rates of technical success, periprocedural stroke, ICA flow impairment, filter movement, and development of new ischemic lesions on diffusion-weighted imaging (DWI) were assessed. CAS using the AGXP was successful in all cases. There was one minor stroke, and flow impairment occurred in six patients. Filter movement averaged 1.9 vertebral bodies. DWI showed new ipsilateral ischemic lesions in eight of the patients. Initial clinical experience using the AGXP for CAS has been generally sufficient. However, attention must be paid to three problems when using the AGXP: the filter may move after placement; the filter may disturb blood flow in the ICA; and debris may pass around the filter.

  13. Endobronchial Ultrasound-directed Transbronchial Needle Aspiration in Diagnosis of Mediastinal Lesions: Initial Egyptian Experience.

    Science.gov (United States)

    Safwat, Tarek; Khattab, Adel; Haddad, Salwa El; Mostafa, Yasser; Korraa, Emad; Madkour, Ashraf; Fattah, Wael Abd El

    2009-01-01

    Mediastinal lesions represent a diagnostic challenge and often require invasive approaches. We evaluated the role of radial probe endobronchial ultrasound-directed transbronchial needle aspiration (EBUS-TBNA) in the evaluation of mediastinal lesions. Between March 2005 to February 2006, 30 consecutive patients with enlarged mediastinal lymph nodes from unknown etiologies or suspicious for metastatic bronchogenic carcinoma and mediastinal masses underwent EBUS-TBNA and were clinically followed up. EBUS-TBNA was applied under topical anesthesia, midazolam sedation with a mean dose of 4.6+1.7 mg and prolonged the examination by 14.7 minutes on average. EBUS-directed TBNA was performed in 17 lymph nodes and 13 mediastinal masses, achieving specific diagnosis in 82.3% (14/17) and 84.6% (11/13) of examined lesions, respectively, with an overall yield of 83%. The sensitivity, specificity, and accuracy of EBUS-TBNA in distinguishing benign from malignant mediastinal lesions were 89.4%, 100%, and 93.3%, respectively. EBUS was well tolerated by most of the patients with no TBNA-related complications. In conclusion, EBUS-TBNA of mediastinal lesions is a minimally invasive safe diagnostic technique with high yield, even in the hands of those with initial experience. This initial study is convincing and stimulating for widespread application of EBUS-TBNA in Egyptian bronchoscopy practice.

  14. Academics and Learners’ Perceptions on Blended Learning as a Strategic Initiative to Improve Student Learning Experience

    Directory of Open Access Journals (Sweden)

    Ying Adeline Ng Ling

    2017-01-01

    Full Text Available The increasingly tighter shift of socio-economic constraints on higher education sectors in the recent years has called for greater flexibilities in student learning experience both locally and abroad. To this end, we have recently implemented a Blended Learning Initiative in an attempt to provide better learning support and greater flexibility to our students. This initiative is also in line with the University’s aim of having 50% of our learning and teaching delivered on-line by 2020. In this report, we present our findings on academics and learners’ perceptions on the approach which were obtained through surveys. Results showed that blended learning approach was new to the academics and the factors for successful blended learning implementation were identified. Results also showed that learners appreciated the approach as it made learning more accessible and flexible. Furthermore, they also enjoyed the interesting online activities incorporated into their units. In addition, learners were also able to review and pace their own learning. They also perceived that they have the access to the resources and technical ability to cope with online learning materials and activities. Nonetheless, the survey also revealed that learners still prefer to have academics delivering information to them directly rather than a flipped classroom model. In conclusion, findings from this study provide insights that blended learning could be effective to supplement courses offered by the faculty.

  15. Implementation of electronic checklists in an oncology medical record: initial clinical experience.

    Science.gov (United States)

    Albuquerque, Kevin V; Miller, Alexis A; Roeske, John C

    2011-07-01

    The quality of any medical treatment depends on the accurate processing of multiple complex components of information, with proper delivery to the patient. This is true for radiation oncology, in which treatment delivery is as complex as a surgical procedure but more dependent on hardware and software technology. Uncorrected errors, even if small or infrequent, can result in catastrophic consequences for the patient. We developed electronic checklists (ECLs) within the oncology electronic medical record (EMR) and evaluated their use and report on our initial clinical experience. Using the Mosaiq EMR, we developed checklists within the clinical assessment section. These checklists are based on the process flow of information from one group to another within the clinic and enable the processing, confirmation, and documentation of relevant patient information before the delivery of radiation therapy. The clinical use of the ECL was documented by means of a customized report. Use of ECL has reduced the number of times that physicians were called to the treatment unit. In particular, the ECL has ensured that therapists have a better understanding of the treatment plan before the initiation of treatment. An evaluation of ECL compliance showed that, with additional staff training, > 94% of the records were completed. The ECL can be used to ensure standardization of procedures and documentation that the pretreatment checks have been performed before patient treatment. We believe that the implementation of ECLs will improve patient safety and reduce the likelihood of treatment errors.

  16. Microcosm experiments to study the interaction of solid and solute phases during initial soil development

    Science.gov (United States)

    Zimmermann, C.; Chabbi, S.; Schaaf, W.

    2009-04-01

    During the initial phase of soil formation mineral weathering, interactions between the solid and liquid phases as well as accumulation of organic matter play an important role for the development of soil properties and for the establishment of vegetation and the colonization of soil biota. Our study is part of the Transregional Collaborative Research Centre (SFB/TRR 38) ‘Patterns and processes of initial ecosystem development in an artificial catchment' funded by the Deutsche Forschungsgemeinschaft (DFG). The catchment ´Chicken Creeḱ close to Cottbus (Germany) has a size of 6 ha and is composed of a 3-4 m layer of Quaternary loamy to sandy sediments overlying a 1-2 m clay layer. To connect interactions between the soil solid phase and soil solution at the micro-scale with observed processes at the catchment scale we perform microcosm experiments with soil samples from the catchment under controlled laboratory conditions. The microcosm experiments are carried out in a climate chamber at constant 10 °C corresponding to the mean annual temperature of the region. In total 48 soil columns with a diameter of 14.4 cm and height of 30 cm were filled with substrates of two textural compositions reflecting the gradients observed at the catchment and a bulk density of 1.4-1.5 g*cm3. Within the microcosms it is possible to control the gaseous phase and the water fluxes by artificial irrigation. The irrigation runs automated and quasi-continuously four times a day with 6.6 ml each (in total 600 mm*yr-1). Irrigation amount and chemical composition of the artificial rainwater are based on the annual mean at the field site. Litter of two different plant species occurring at the catchment site (Lotus corniculatus, Calamagrostis epigejos) labelled with stable isotopes (δ13C; δ15N) is used for the experiments. All treatments including a control run with four replicates. The gaseous phase in the headspace of the microcosms is analysed continuously for CO2 and N2O contents

  17. Epidural Analgesia and Fever at Labor

    Directory of Open Access Journals (Sweden)

    Ye. M. Shifman

    2008-01-01

    Full Text Available Objective: to study the incidence of labor fever under epidural analgesia (EA and to evaluate its impact on the courses of puerperium and early neonatality. Subjects and methods. The paper presents the data of a prospective study of the course of labor, puerperium, and early neonatality in 397 women in whom labors occurred at the Republican Peritoneal Center in 2006. A study group included 324 parturients in whom labor pain was relieved by EA. A comparison group comprised 55 parturients in whom no analgesics were used at labor. Results. There were no significant statistical differences between the groups in the incidence of labor fever and complicated puerperium and in that of neonatal pyoseptic diseases. Key words: labor hyperthermia, epidural analgesia, labor pain relief.

  18. [Epidural analgesia in combination with general anesthesia].

    Science.gov (United States)

    Gottschalk, Antje; Poepping, Daniel M

    2015-07-01

    Epidural anaesthesia is a widely used and accepted technique for perioperative analgesia in different kinds of surgery. Apart from analgetic effect and due to wide positve effects on patients outcome epidural analgesia is often used with general anaesthesia. It represents a reliable and reversible neural deafferentation technique that effectively contributes to a reduction of the surgical stress response with subsequent positive effects on cardiopulmonary, gastrointestinal, and immune function. Animal studies suggest that the use of epidural anaesthesia may be beneficial for cancer surgery because of less tumour recurrence. Further, a benefit is expected in patient's mortality. This article summarizes and critically discusses the current knowledge on the effects of epidural anaesthesia on pain management, cardiopulmonary as well as gastrointestinal functions and patient's outcome.

  19. Acupuncture for analgesia in veterinary medicine.

    Science.gov (United States)

    Fry, Lindsey M; Neary, Susan M; Sharrock, Joseph; Rychel, Jessica K

    2014-06-01

    Acupuncture for analgesia is growing rapidly in popularity with veterinarians and pet owners. This article summarizes the mechanisms of analgesia derived from acupuncture and reviews current literature on the topic. Areas covered include the local effects at area of needle insertion, systemic effects secondary to circulating neurotransmitters and changes in cell signaling, central nervous system effects including the brain and spinal cord, and myofascial trigger point and pathology treatment. Clinical applications are discussed and suggested in each section. When used by appropriately trained professionals, acupuncture offers a compelling and safe method for pain management in our veterinary patients and should be strongly considered as a part of multimodal pain management plans. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Analgesia PCA por catéter interesternocleidomastoideo frente analgesia PCA intravenosa tras cirugía proximal de húmero Continuous Intersternocleidomastoid PCA analgesia Vs intravenous PCA analgesia after proximal shoulder surgery

    Directory of Open Access Journals (Sweden)

    R. Ortiz de la Tabla

    2008-10-01

    Full Text Available Introducción: Comparar la eficacia analgésica e incidencia de efectos adversos entre el bloqueo interesternocleidomastoideo continuo y una pauta analgésica intravenosa tras cirugía proximal de húmero. Material y Métodos: Estudio prospectivo descriptivo no aleatorizado de pacientes intervenidos de cirugía de hombro bajo anestesia general con fentanilo intravenoso como analgesia intraoperatoria. Al grupo 1 se realizó bloqueo interesternocleidomastoideo con ropivacaína 0,5% 0,4 mL Kg-1 y en URPA se comenzó una perfusión de ropivacaína 0,2% 5mL h-1, con bolos PCA 5 mL y tiempo de cierre de 30 minutos. Al grupo 2, a su llegada a la URPA se administró una dosis carga de metamizol 2 gr, tramadol 100 mgr y ondansetrón 4 mgr, seguido por una perfusión de metamizol 0,16%, tramadol 0,04% y ondansetrón 0,0016% a 1,5 mL h-1 bolos PCA 1 mL y tiempo de cierre 20 minutos. La variable principal fue la valoración del dolor postoperatorio, en reposo y movimiento, mediante escala verbal numérica de 0 (no dolor a 10 (máximo dolor y la aparición de efectos indeseables. Resultados: Se incluyeron 38 pacientes en el grupo 1 y 39 en el 2. La valoración del dolor postoperatorio puso de manifiesto valores más elevados en las primeras 24 horas al movimiento y a las 48 horas, tanto en reposo como al movimiento, en el grupo 2 (pObjectives: We have compared results in postoperative analgesia and incidence of side effects between a continuous intersternocleidotnastoid blockade and intravenous analgesia after proximal shoulder surgery. Methods: In a prospective no randomized study on patients scheduled for unilateral shoulder surgery under general anaesthesia with intravenous fentanil as intraoperative analgesia. In group 1, a continuous intersternocleidomastoid blockade was performed with a bolus of ropivacaine 0,5% 0,4 mL/kg before surgery and a postoperative patient-controlled analgesia (PCA infusión pump of 0,2% ropivacaine (5ml/h, PCA bolus 5 mi / 30

  1. Effect of Microgravity on Sinorhizobium meliloti: Initial Results from the SyNRGE Experiment

    Science.gov (United States)

    Roberts, Michael S.; Stutte, Gary W.

    2011-01-01

    SyNRGE (Symbiotic Nodulation in a Reduced Gravity Environment) was a sortie mission on STS-135 in the Biological Research in Canisters (BRIe) hardware to study the effect of microgravity on a plant-microbe symbiosis resulting in biological nitrogen fixation. Medicago truncatula, a model species of the legume family, was innoculated with its bacterial symbiont, Sinorhizobium meliloti, to observe early events associated with infection and nodulation in Petri Dish Fixation Units (PDFUs). Two sets of experiments were conducted in orbit and in 24-hour delayed ground controls. Experiment one was designed to determine if S. meliloti infect M. truncatula and initiate physiological changes associated with nodule formation. Roots of five-day-old M. truncatula cultivar Jemalong A17 (Enodll::gus) were innoculated 24 hr before launch with either S. meliloti strain 1021 or strain ABS7 and integrated into BRIC-PDFU hardware placed in a 4 C Cold Bag for launch on Atlantis. Innoculated plants and uninoculated controls were maintained in the dark at ambient temperature in the middeck of STS-135 for 11 days before fixation in RNA/ate/M by crew activation of the PDFU. Experiment two was designed to determine if microgravity altered the process of bacterial infection and host plant nodule formation. Seeds of two M. truncatula cultivar Jemalong A17 lines, the Enodll::gus used in experiment 1, and SUNN, a super-nodulating mutant of A17, were germinated on orbit for 11 days in the middeck cabin and returned to Earth alive inside of BRIC-PDFU's at 4 C S. meliloti strains 1021 and ABS7 were cultivated separately in broth culture on orbit and also returned to Earth alive. After landing, flight- and ground-grown plants and bacteria were transferred from BRIC-PDFU's into Nunc(TradeMark) 4-well plates for reciprocity crosses. Rates of plant growth and nodule development on Buffered Nodulation Medium (lacking nitrogen) were measured for 14 days. Bacteria cultivated in microgravity in the

  2. Heidelberg Ion Therapy Center (HIT): Initial clinical experience in the first 80 patients

    Energy Technology Data Exchange (ETDEWEB)

    Combs, Stephanie E. (Univ. Hospital of Heidelberg, Dept. of Radiation Oncology, Heidelberg (Germany)), E-mail: Stephanie.Combs@med.uni-heidelberg.de; Ellerbrock, Malte; Haberer, Thomas (Heidelberger Ionenstrahl Therapiezentrum (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg (Germany)) (and others)

    2010-10-15

    The Heidelberg Ion Therapy Center (HIT) started clinical operation in November 2009. In this report we present the first 80 patients treated with proton and carbon ion radiotherapy and describe patient selection, treatment planning and daily treatment for different indications. Patients and methods. Between November 15, 2009 and April 15, 2010, 80 patients were treated at the Heidelberg Ion Therapy Center (HIT) with carbon ion and proton radiotherapy. Main treated indications consisted of skull base chordoma (n = 9) and chondrosarcoma (n = 18), malignant salivary gland tumors (n=29), chordomas of the sacrum (n = 5), low grade glioma (n=3), primary and recurrent malignant astrocytoma and glioblastoma (n=7) and well as osteosarcoma (n = 3). Of these patients, four pediatric patients aged under 18 years were treated. Results. All patients were treated using the intensity-modulated rasterscanning technique. Seventy-six patients were treated with carbon ions (95%), and four patients were treated with protons. In all patients x-ray imaging was performed prior to each fraction. Treatment concepts were based on the initial experiences with carbon ion therapy at the Gesellschaft fuer Schwerionenforschung (GSI) including carbon-only treatments and carbon-boost treatments with photon-IMRT. The average time per fraction in the treatment room per patient was 29 minutes; for irradiation only, the mean time including all patients was 16 minutes. Position verification was performed prior to every treatment fraction with orthogonal x-ray imaging. Conclusion. Particle therapy could be included successfully into the clinical routine at the Dept. of Radiation Oncology in Heidelberg. Numerous clinical trials will subsequently be initiated to precisely define the role of proton and carbon ion radiotherapy in radiation oncology.

  3. [Initial experiences with propofol (Disoprivan) for anesthesia induction in pediatric anesthesia].

    Science.gov (United States)

    Motsch, J; Must, W; Hutschenreuter, K

    1988-09-01

    Propofol is a new intravenous anesthetic agent that provides smooth and rapid induction of anesthesia. A short elimination half-life guarantees rapid recovery. Since it has been reformulated as an emulsion in soya bean oil, anaphylactoid reactions are unlikely to occur. As compared to adults, there is very little experience with propofol in pediatric anesthesia. The aim of this study was to evaluate propofol as an induction agent in children with respect to cardiovascular and respiratory effects and to investigate the incidence of other side-effects. METHOD. In 25 ASA I children aged 3-12 years (6.4 +/- 2.7 SD) anesthesia was induced with a single dose of propofol, after standard premedication with atropine 0.01 mg/kg and Thalamonal 0.04 ml/kg. Anesthesia was maintained with halothane, nitrous oxide, and oxygen. Blood pressure (BP), heart rate (HR), and arterial oxygen saturation (SaO2) were measured before and each minute for 6 min after propofol administration. The incidence of side-effects during induction of anesthesia as well as during recovery and the postoperative period were recorded. RESULTS. Propofol 2.5 mg/kg produced rapid and smooth induction of anesthesia. Mean arterial pressure decreased after 1 min by 14.3% with a maximum of 16.8% after 3 min. HR was influenced differently by propofol; children with initially high HR had a decrease in HR, whereas in children with a low initial rate, HR increased transiently. After 1 min, no further changes occurred. Although no apnea was observed, respiration was shallow and depressed, as indicated by a decrease in SaO2. Two children complained of pain and 4 of discomfort at the site of the injection; 1 of these developed transient phlebitis.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. The Workplace Experiences of Beginning Teachers in Three Countries: A Message for Initial Teacher Education from the Field

    Science.gov (United States)

    du Plessis, Anna Elizabeth; Sunde, Eva

    2017-01-01

    Previous research indicates that beginning teachers are not fully prepared for what awaits them in the workforce. This study highlights the value of partnerships among higher education providers, schools and employers and links the experiences of beginning teachers to initial teacher education (ITE). Real-life experiences from the field provide…

  5. Epidural Analgesia in the Postoperative Period

    Science.gov (United States)

    2001-10-01

    epidurally. They are opiods and local anesthetics. The pharmacokinetics and pharmacodynamics of each class are different, and they may act...overall pharmacodynamics of the drug. Epidural Opioids Brown (2000) states that opioids are one class of drug that may be used for epidural analgesia...morphine with lidocaine or bupivacaine with the effects of these medications when administered alone in mice. They used various tests to measure

  6. NUMERICAL EXPERIMENTS AND ANALYSIS OF DIGITAL FILTER INITIALIZATION FOR WRF MODEL

    Institute of Scientific and Technical Information of China (English)

    WANG Shu-chang; HUANG Si-xun; ZHANG Wei-min; ZHU Xiao-qian; CAO Xiao-qun; LI Yi

    2008-01-01

    Initialization and initial imbalance problem were discussed in the context of a three-dimensional variational data assimilation system of the new generation "Weather Research and Forecasting Model". Severaloptions of digital filter initialization have been tested with a rain storm case. It is shown that digital filter initialization, especially diabatic digital filter initialization and twice digital filter initialization, have effectively removed spurious high frequency noise from initial data for numerical weather prediction and produced balanced initial conditions. For six consecutive intermittent data assimilation cycles covering a 3-day period, mean initialization increments and impact on forecast variables are studied. DFI has been demonstrated to provide better adjustment of the hydrometeors and vertical velocity, reduced spin-up time, and improved forecast variables quantity.

  7. Nicotine Increases Codeine Analgesia Through the Induction of Brain CYP2D and Central Activation of Codeine to Morphine.

    Science.gov (United States)

    McMillan, Douglas M; Tyndale, Rachel F

    2015-06-01

    CYP2D metabolically activates codeine to morphine, which is required for codeine analgesia. Permeability across the blood-brain barrier, and active efflux, suggests that initial morphine in the brain after codeine is due to brain CYP2D metabolism. Human CYP2D is higher in the brains, but not in the livers, of smokers and 7-day nicotine treatment induces rat brain, but not hepatic, CYP2D. The role of nicotine-induced rat brain CYP2D in the central metabolic activation of peripherally administered codeine and resulting analgesia was investigated. Rats received 7-day nicotine (1 mg/kg subcutaneously) and/or a single propranolol (CYP2D mechanism-based inhibitor; 20 μg intracerebroventricularly) pretreatment, and then were tested for analgesia and drug levels following codeine (20 mg/kg intraperitoneally) or morphine (3.5 mg/kg intraperitoneally), matched for peak analgesia. Nicotine increased codeine analgesia (1.59X AUC(0-30 min) vs vehicle; p0.1). Nicotine increased, while propranolol decreased, brain, but not plasma, morphine levels, and analgesia correlated with brain (p0.4), morphine levels after codeine. Pretreatments did not alter baseline or morphine analgesia. Here we show that brain CYP2D alters drug response despite the presence of substantial first-pass metabolism of codeine and further that nicotine induction of brain CYP2D increases codeine response in vivo. Thus variation in brain CYP2D activity, due to genetics or environment, may contribute to individual differences in response to centrally acting substrates. Exposure to nicotine may increase central drug metabolism, not detected peripherally, contributing to altered drug efficacy, onset time, and/or abuse liability.

  8. Balloon-augmented Onyx endovascular ligation: initial human experience and comparison with coil ligation.

    Science.gov (United States)

    Osanai, Toshiya; Bain, Mark D; Toth, Gabor; Hussain, M Shazam; Hui, Ferdinand K

    2015-08-01

    Carotid artery sacrifice remains an important procedure for cerebral vascular disorders despite the development of new endovascular devices. Conventional carotid artery sacrifice with detachable coils alone often requires numerous coils to complete occlusion. To describe the initial human experience with balloon-augmented Onyx and coil vessel sacrifice based on our previous experience with animals. We performed a retrospective review of patients who underwent carotid artery sacrifice between 2008 and 2012 in accordance with local investigational review board approval. Two methods were used to occlude carotid arteries-namely, combined Onyx and coil embolization and traditional coil embolization. We compared the two methods for the cost of embolizate, time to occlude the vessels, and the number of coils. Eight consecutive patients (combined group n=3, traditional group n=5) were assessed. The median cost of embolic material was $6321 in the combined Onyx and coil embolization group and $29 996 in the traditional coil embolization group. The median time from first coil placement to achievement of vessel occlusion was 52 min in the Onyx group and 113 min in the coil embolization group. The median number of coils used was 4 in the Onyx group and 35 in the coil embolization group (p<0.05). No symptomatic complications or recurrences were seen in the combined group. Balloon-augmented Onyx endovascular ligation may reduce costs and fluoroscopy times during vessel sacrifice. Further studies in a larger number of patients are needed to confirm these findings. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. Initial Results from the STEM Student Experiences Aboard Ships (STEMSEAS) Program

    Science.gov (United States)

    Lewis, J. C.; Cooper, S. K.; Thomson, K.; Rabin, B.; Alberts, J.

    2016-12-01

    The Science Technology Engineering and Math Student Experiences Aboard Ships (STEMSEAS) program was created as a response to NSF's call (through GEOPATHS) for improving undergraduate STEM education and enhancing diversity in the geosciences. It takes advantage of unused berths on UNOLS ships during transits between expeditions. During its 2016 pilot year - which consisted of three transits on three different research vessels in different parts of the country, each with a slightly different focus - the program has gained significant insights into how best to create and structure these opportunities and create impact on individual students. A call for applications resulted in nearly 900 applicants for 30 available spots. Of these applicants, 32% are from minority groups underrepresented in the geosciences (Black, Hispanic, or American Indian) and 20% attend community colleges. The program was able to sail socioeconomically diverse cohorts and include women, veterans, and students with disabilities and from two- and four-year colleges. Twenty-three are underrepresented minorities, 6 attend community colleges, 5 attend an HBCU or tribal college, and many are at HSIs or other MSIs. While longer term impact assessment will have to wait, initial results and 6-month tracking for the first cohort indicate that these kinds of relatively short but intense experiences can indeed achieve significant impacts on students' perception of the geosciences, in their understanding of STEM career opportunities, their desire to work in a geoscience lab setting, and to incorporate geosciences into non-STEM careers. Insights were also gained into the successful makeup of mentor/leader groups, factors to consider in student selection, necessary pre- and post-cruise logistics management, follow-up activities, structure of activities during daily life at sea, increasing student networks and access to mentorships, and leveraging of pre-existing resources and ship-based opportunities

  10. Colorectal neoplasm: Magnetic resonance colonography with fat enema-initial clinical experience

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To assess Magnetic resonance colonography with fat enema as a method for detection of colorectal neoplasm. METHODS: Consecutive twenty-two patients underwent MR colonography with fat enema before colonoscopy. T1-weighted three-dimensional fast spoiled gradientecho with inversion recovery sequence was acquired with the patient in the supine position before and 75 s after Gadopentetate Dimelumine administration. Where by, pre and post MR coronal images were obtained with a single breath hold for about 20 s to cover the entire colon. The quality of MR colonographs and patients' tolerance to fat contrast medium was investigated. Colorectal neoplasms identified by MR colonography were compared with those identified on colonoscopy and sensitivity of detecting the lesions was calculated accordingly. RESULTS: MR colonography with fat enema was well tolerated without sedation and analgesia. 120 out of 132 (90.9%) colonic segments were well distended and only 1 (0.8%) colonic segment was poor distension. After contrast enhancement scan, mean contrast-to-noise ratio (CNR) value between the normal colonic wall and lumen was 18.5 ± 2.9 while mean CNR value between colorectal neoplasm and lumen was 20.2 ± 3.1. By Magnetic resonance colonography, 26 of 35 neoplasms (sensitivity 74.3%) were detected. However, sensitivity of MRC was 95.5% (21 of 22) for neoplasm larger than 10 mm and 55.6% (5 of 9) for 5-10 mm neoplasm. CONCLUSION: MR colonography with fat enema and T1-weighted three-dimensional fast spoiled gradientecho with inversion recovery sequence is feasible in detecting colorectal neoplasm larger than 10 mm.

  11. Hands-and-knees positioning during labor with epidural analgesia.

    Science.gov (United States)

    Stremler, Robyn; Halpern, Stephen; Weston, Julie; Yee, Jennifer; Hodnett, Ellen

    2009-01-01

    Hands-and-knees position has shown promise as an intervention to improve labor and birth outcomes, but no reports exist that examine its use with women laboring with epidural analgesia. Concerns of safety, effects on analgesia, and acceptability of use may limit use of active positioning during labor with regional analgesia. This article presents a case study series of 13 women who used hands-and-knees position in the first stage of labor.

  12. Sedation and analgesia in gastrointestinal endoscopy: What’s new?

    OpenAIRE

    Fanti, Lorella; Testoni, Pier Alberto

    2010-01-01

    Various types of sedation and analgesia technique have been used during gastrointestinal endoscopy procedures. The best methods for analgesia and sedation during gastrointestinal endoscopy are still debated. Providing an adequate regimen of sedation/analgesia might be considered an art, influencing several aspects of endoscopic procedures: the quality of the examination, the patient’s cooperation and the patient’s and physician’s satisfaction with the sedation. The properties of a model sedat...

  13. Sedation and analgesia in gastrointestinal endoscopy: What’s new?

    Institute of Scientific and Technical Information of China (English)

    Lorella; Fanti; Pier; Alberto; Testoni

    2010-01-01

    Various types of sedation and analgesia technique have been used during gastrointestinal endoscopy procedures.The best methods for analgesia and sedation during gastrointestinal endoscopy are still debated.Providing an adequate regimen of sedation/analgesia might be considered an art,influencing several aspects of endoscopic procedures: the quality of the examination,the patient’s cooperation and the patient’s and physician’s satisfaction with the sedation.The properties of a model sedative agent for endosc...

  14. Pancreas Preservation With Viaspan, Celsior, and Custodiol Solutions: An Initial Experience.

    Science.gov (United States)

    Montiel-Casado, M C; Pérez-Daga, J A; Blanco-Elena, J A; Aranda-Narváez, J M; Sánchez-Pérez, B; Cabello-Díaz, M; Ruiz-Esteban, P; León-Díaz, F J; Gutiérrez-de la Fuente, C; Santoyo-Santoyo, J

    2016-11-01

    There is still controversy about which preservation solution in pancreas transplantation could be the best. The aim of this study was to analyze our initial experience with Custodiol solution (CuS) compared with Viaspan solution (VS) and Celsior solution (CS) in pancreas transplantation. A retrospective study included 94 consecutive pancreatic transplants, from 2007 until 2015. We compared 3 groups, depending on preservation solution: Viaspan (n = 41), Celsior (n = 40), or Custodiol (n = 13). The primary end point was patient and pancreas survival at 1 year after pancreas transplantation. The recipient and donor characteristics were similar except in cold ischemia time; it was higher with Celsior. No differences were found in postoperative complications and pancreas graft function at 3 months, 6 months, and 1 year (glucose, HbA1c, C-peptide, creatinine). The pancreas and patient survival at 1 year was comparable (pancreas survival: VS, 80%; CS, 90%; CuS, 92%; log-rank, 0.875; and patient survival: VS, 92%; CS, 97%; CuS, 100%; log-rank, 0.9). In our institution, the Custodiol solution in pancreas transplantation presented similar outcomes in terms of postoperative complications, pancreas graft function, and 1-year survival. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Implementing a robotics curriculum at an academic general surgery training program: our initial experience.

    Science.gov (United States)

    Winder, Joshua S; Juza, Ryan M; Sasaki, Jennifer; Rogers, Ann M; Pauli, Eric M; Haluck, Randy S; Estes, Stephanie J; Lyn-Sue, Jerome R

    2016-09-01

    The robotic surgical platform is being utilized by a growing number of hospitals across the country, including academic medical centers. Training programs are tasked with teaching their residents how to utilize this technology. To this end, we have developed and implemented a robotic surgical curriculum, and share our initial experience here. Our curriculum was implemented for all General Surgical residents for the academic year 2014-2015. The curriculum consisted of online training, readings, bedside training, console simulation, participating in ten cases as bedside first assistant, and operating at the console. 20 surgical residents were included. Residents were provided the curriculum and notified the department upon completion. Bedside assistance and operative console training were completed in the operating room through a mix of biliary, foregut, and colorectal cases. During the fiscal years of 2014 and 2015, there were 164 and 263 robot-assisted surgeries performed within the General Surgery Department, respectively. All 20 residents completed the online and bedside instruction portions of the curriculum. Of the 20 residents trained, 13/20 (65 %) sat at the Surgeon console during at least one case. Utilizing this curriculum, we have trained and incorporated residents into robot-assisted cases in an efficient manner. A successful curriculum must be based on didactic learning, reading, bedside training, simulation, and training in the operating room. Each program must examine their caseload and resident class to ensure proper exposure to this platform.

  16. CT-guided spinal injection: initial experience with Sprotte tip needles

    Energy Technology Data Exchange (ETDEWEB)

    Pua, Uei [Tan Tock Seng Hospital, Department of Diagnostic Radiology, Singapore (Singapore)

    2010-09-15

    The purpose of this paper is to describe our initial experience and to illustrate the potential benefits of using small caliber (25 and 27 G), noncutting pencil point needles (Sprotte) with single puncture coaxial technique in CT-guided spinal intervention (CTSI). From January 2009 to June 2009, Sprotte needles with single puncture coaxial technique were used in a total of ten patients for selective nerve root block (SNRB), facet joint block, and pars block under CT fluoroscopy (total of 16 target structures). All procedures were performed without conscious sedation, and visual analog scale (VAS) scores were recorded to determine pain related to needle placement. Total CT fluoroscopy time and out-of-plane needle deviation were obtained. Final needle position was documented by contrast injection for SNRBs and image capture for joint space cannulation. Sixteen out of the 16 structures were successfully targeted. No increase in VAS scores associated with needle placement was recorded, after infiltration of local anesthesia. Optimal peri-neurograms were obtained in all cases of SNRB, despite the side-hole opening in the Sprotte needles. Mean CT fluoroscopy time was 2 s (range 2-8 s per structure), and there was no case of out-of-plane needle deviation that required adjustment of the CT gantry. The use of small caliber Sprotte needles in CTSI is technically feasible and represents a potential refinement to current techniques in the management of chronic spinal pain. (orig.)

  17. A nonsurgical endodontics relational research database: the initial six years of experience.

    Science.gov (United States)

    Iqbal, Mian K; Shukovsky, Deborah Gortler; Wong, Steven; Vohra, Gayatri

    2008-09-01

    The purpose of this study was to report results of the initial six years of experience utilizing a nonsurgical root canal treatment (NSRCT) database; to compare patient characteristics, operative procedures, and patient outcomes observed in the database to those observed in other studies; and to discuss the potential benefits of a clinical endodontic database. A total of 7,372 NSRCT cases performed by endodontic residents at the University of Pennsylvania from 2000 to 2006 were evaluated. The odds ratio (OR) for caries and trauma being causative agents for NSRCT in

  18. Contrast-enhanced ultrasound in ovarian tumors – diagnostic parameters: method presentation and initial experience

    Science.gov (United States)

    MAXIM, ANITA-ROXANA; BADEA, RADU; TAMAS, ATILLA; TRAILA, ALEXANDRU

    2013-01-01

    The aim of this paper is to discuss and illustrate the use of contrast-enhanced ultrasound in evaluating ovarian tumors compared to conventional ultrasound, Doppler ultrasound and the histopathological analysis and suggest how this technique may best be used to distinguish benign from malignant ovarian masses. We present the method and initial experience of our center by analyzing the parameters used in contrast-enhanced ultrasound in 6 patients with ovarian tumors of uncertain etiology. For examination we used a Siemens ultrasound machine with dedicated contrast software and the contrast agent SonoVue, Bracco. The patients underwent conventional ultrasound, Doppler ultrasound and i.v. administration of the contrast agent. The parameters studied were: inflow of contrast (rise time), time to peak enhancement, mean transit time. The series of patients is part of an extensive prospective PhD study aimed at elaborating a differential diagnosis protocol for benign versus malignant ovarian tumors, by validating specific parameters for contrast-enhanced ultrasound. Although the method is currently used with great success in gastroenterology, urology and senology, its validation in gynecology is still in the early phases. Taking into consideration that the method is minimally invasive and much less costly that CT/MRI imaging, demonstrating its utility in oncologic gynecology would be a big step in preoperative evaluation of these cases. PMID:26527912

  19. Robotic liver resection: initial experience with three-arm robotic and single-port robotic technique.

    Science.gov (United States)

    Kandil, Emad; Noureldine, Salem I; Saggi, Bob; Buell, Joseph F

    2013-01-01

    Robotic-assisted surgery offers a solution to fundamental limitations of conventional laparoscopic surgery, and its use is gaining wide popularity. However, the application of this technology has yet to be established in hepatic surgery. A retrospective analysis of our prospectively collected liver surgery database was performed. Over a 6-month period, all consecutive patients who underwent robotic-assisted hepatic resection for a liver neoplasm were included. Demographics, operative time, and morbidity encountered were evaluated. A total of 7 robotic-assisted liver resections were performed, including 2 robotic-assisted single-port access liver resections with the da Vinci-Si Surgical System (Intuitive Surgical Sunnyvalle, Calif.) USA. The mean age was 44.6 years (range, 21-68 years); there were 5 male and 2 female patients. The mean operative time (± SD) was 61.4 ± 26.7 minutes; the mean operative console time (± SD) was 38.2 ± 23 minutes. No conversions were required. The mean blood loss was 100.7 mL (range, 10-200 mL). The mean hospital stay (± SD) was 2 ± 0.4 days. No postoperative morbidity related to the procedure or death was encountered. Our initial experience with robotic liver resection confirms that this technique is both feasible and safe. Robotic-assisted technology appears to improve the precision and ergonomics of single-access surgery while preserving the known benefits of laparoscopic surgery, including cosmesis, minimal morbidity, and faster recovery.

  20. Preparing beginning reading teachers: An experimental comparison of initial early literacy field experiences.

    Science.gov (United States)

    Al Otaiba, Stephanie; Lake, Vickie E; Greulich, Luana; Folsom, Jessica S; Guidry, Lisa

    2012-01-01

    This randomized-control trial examined the learning of preservice teachers taking an initial Early Literacy course in an early childhood education program and of the kindergarten or first grade students they tutored in their field experience. Preservice teachers were randomly assigned to one of two tutoring programs: Book Buddies and Tutor Assisted Intensive Learning Strategies (TAILS), which provided identical meaning-focused instruction (shared book reading), but differed in the presentation of code-focused skills. TAILS used explicit, scripted lessons, and the Book Buddies required that code-focused instruction take place during shared book reading. Our research goal was to understand which tutoring program would be most effective in improving knowledge about reading, lead to broad and deep language and preparedness of the novice preservice teachers, and yield the most successful student reading outcomes. Findings indicate that all pre-service teachers demonstrated similar gains in knowledge, but preservice teachers in the TAILS program demonstrated broader and deeper application of knowledge and higher self-ratings of preparedness to teach reading. Students in both conditions made similar comprehension gains, but students tutored with TAILS showed significantly stronger decoding gains.

  1. Single-port laparoscopic approach of the left liver: initial experience.

    Science.gov (United States)

    Camps Lasa, Judith; Cugat Andorrà, Esteban; Herrero Fonollosa, Eric; García Domingo, María Isabel; Sánchez Martínez, Raquel; Vargas Pierola, Harold; Rodríguez Campos, Aurora

    2014-11-01

    New technological advances have enabled the development of single-port laparoscopic surgery. This approach began with cholecystectomy and subsequently with other abdominal surgeries. However, few publications on laparoscopic liver surgery have described the use of complete single-port access. We present our initial experience of a single-port laparoscopic hepatectomy. Between May 2012 and December 2013, 5 single-port laparoscopic hepatectomies were performed: one for benign disease and four for colorectal liver metastases. The lesions were approached through a 3-5 cm right supraumbilical incision using a single-port access device. All the lesions were located in hepatic segments II or III. Four left lateral sectorectomies and one left hepatectomy were performed. Median operative time was 135 min. No cases were converted to conventional laparoscopic or open surgery. The oral intake began at 18 h. There were no postoperative complications and no patients required blood transfusion. The median hospital stay was 3 days. The degree of satisfaction was very good in 4 cases and good in one. Patients resumed their normal daily activities at 8 days. Single-port laparoscopic hepatectomy is safe and feasible in selected cases and may reduce surgical aggression and offer better cosmetic results. Comparative studies are needed to determine the real advantages of this approach. Copyright © 2014 AEC. Published by Elsevier Espana. All rights reserved.

  2. An initial experience with a digital drainage system during the postoperative period of pediatric thoracic surgery

    Science.gov (United States)

    Costa, Altair da Silva; Bachichi, Thiago; Holanda, Caio; Rizzo, Luiz Augusto Lucas Martins De

    2016-01-01

    ABSTRACT Objective: To report an initial experience with a digital drainage system during the postoperative period of pediatric thoracic surgery. Methods: This was a prospective observational study involving consecutive patients, ≤ 14 years of age, treated at a pediatric thoracic surgery outpatient clinic, for whom pulmonary resection (lobectomy or segmentectomy via muscle-sparing thoracotomy) was indicated. The parameters evaluated were air leak (as quantified with the digital system), biosafety, duration of drainage, length of hospital stay, and complications. The digital system was used in 11 children (mean age, 5.9 ± 3.3 years). The mean length of hospital stay was 4.9 ± 2.6 days, the mean duration of drainage was 2.5 ± 0.7 days, and the mean drainage volume was 270.4 ± 166.7 mL. The mean maximum air leak flow was 92.78 ± 95.83 mL/min (range, 18-338 mL/min). Two patients developed postoperative complications (atelectasis and pneumonia, respectively). The use of this digital system facilitated the decision-making process during the postoperative period, reducing the risk of errors in the interpretation and management of air leaks. PMID:28117476

  3. Initial clinical experience using the Echo Navigator~-system during structural heart disease interventions

    Institute of Scientific and Technical Information of China (English)

    Jan; Balzer; Tobias; Zeus; Katharina; Hellhammer; Verena; Veulemans; Silke; Eschenhagen; Eva; Kehmeier; Christian; Meyer; Tienush; Rassaf; Malte; Kelm

    2015-01-01

    AIM: To present our initial clinical experience using this innovative software solution for guidance of percutaneous structural heart disease interventions.METHODS: Left atrial appendage, atrial septal defect and paravalvular leak closure, transaortic valve repair and Mitra Clip procedures were performed in the catheter laboratory under fluoroscopic and echocardiographic guidance. The two-dimensional and three-dimensional images generated by the transesophageal echocardiography probe were interfaced with the fluoroscopic images in real-time using the Echo Navigator-system.RESULTS:The application of the novel image fusion technology was safe and led to a better appreciation of multimodality imaging guidance due to improved visualization of the complex relationship between catheter devices and anatomical structures.CONCLUSION:The Echo Navigator-system is a feasible and safe tool for guidance of interventional procedures in structural heart disease.This innovative technology may improve confidence of interventional cardiologists in targeting and positioning interventional devices in order to increase safety,accuracy,and efficacy of percutaneous interventions in the catheter laboratory.

  4. Initial experience with personal digital assistant-based reflectance photoplethysmograph for free tissue transfer monitoring.

    Science.gov (United States)

    Stack, Brendan C; Futran, Neal D; Zang, Billy; Scharf, John E

    2003-08-01

    Improved microsurgical technique has resulted in a high percentage of successful free tissue transfers. When a tissue transfer fails in the head and neck, however, the results are orocutaneous fistulas, carotid artery exposure, and deformity that adds morbidity, expense, and may delay adjuvant therapy. Postoperative monitoring of tissue perfusion can detect early problems in free tissue transfer that may allow for early intervention and salvage. The authors have demonstrated that reflectance photoplethysmography can detect perfusion changes in free tissue transfer within 5 minutes of a pedicle "insult" intraoperatively. Normative data for viable flaps from various donor sites have been established. The authors now report their initial experience with a newly developed reflectance photoplethysmograph based on a hand-held computer for routine clinical use. Their results are compared with a conventional surveillance protocol that included observation, bleeding to pin prick, and bedside duplex scanning of the vascular pedicle. In a series of 30 free tissue transfers (29 patients), there was one ischemic event (skin paddle loss only), which was detected by the monitor. The monitor was able to predict correctly (one flap) survival of a free tissue transfer even when duplex ultrasonic data were indicative of an absence of perfusion. Personal digital assistant-based photoplethysmography appears to be a promising device for bedside diagnosis of free tissue transfer viability or ischemia.

  5. Comparison of efficacy of bupivacaine and fentanyl with bupivacaine and sufentanil for epidural labor analgesia

    Directory of Open Access Journals (Sweden)

    Kalra Sumit

    2010-01-01

    Full Text Available Objectives: A study to compare the efficacy between fentanyl and sufentanil combined with low concentration (0.0625% of bupivacaine for epidural labor analgesia in laboring women. Materials and Methods: Fifty full term parturients received an initial bolus dose of a 10 ml solution containing 0.125% bupivacaine. The patients were randomly divided into two: group F received 0.0625% bupivacaine with 2.5 mcg/ml fentanyl and group S received 0.0625% bupivacaine with 0.25 mcg/ml sufentanil. Verbal analogue pain scores, need of supplementary/rescue boluses dose of bupivacaine consumed, mode of delivery, maternal satisfaction, and neonatal Apgar scores were recorded. No significant difference was observed between both groups. Results: Both the groups provided equivalent labor analgesia and maternal satisfaction. The chances of cesarean delivery were also not increased in any group. No difference in the cephalad extent of sensory analgesia, motor block or neonatal Apgar score were observed. Although mean pain scores throughout the labor and delivery were similar in both groups, more patients in fentanyl group required supplementary boluses though not statistically significant. Conclusion: We conclude that both 0.0625% bupivacaine-fentanyl (2.5 μg/ml and 0.0625% bupivacaine-sufentanil (0.25 μg/ml were equally effective by continuous epidural infusion in providing labor analgesia with hemodynamic stability achieving equivalent maternal satisfaction without serious maternal or fetal side effects. We found that sufentanil was 10 times more potent than fentanyl as an analgesic for continuous epidural labor analgesia.

  6. LABOUR ANALGESIA: EPIDURAL DEXMEDITOMIDINE WITH EITHER BUPIVACAINE OR ROPIVACAINE

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    Varaprasad

    2015-07-01

    Full Text Available BACKGROUND: Pain relief in labour is associated with myths and controversies. Providing effective and safe analgesia has remained a challenge. AIM: The purpose of the study was to compare the effect of analgesia with epidural bupivacain or ropivacain along with dexme ditomidine. METHODS AND MATERIAL: Sixty parturients of ASA grade I and II were randomly selected for the study. Each group consisted of thirty patients. The analgesia, motor loss and level of sedation were studied. RESULTS: There was no significant differ ence between the two groups in maternal satisfaction, analgesia and neonatal outcome .

  7. Selective REM Sleep Deprivation Improves Expectation-Related Placebo Analgesia.

    Science.gov (United States)

    Chouchou, Florian; Chauny, Jean-Marc; Rainville, Pierre; Lavigne, Gilles J

    2015-01-01

    The placebo effect is a neurobiological and psychophysiological process known to influence perceived pain relief. Optimization of placebo analgesia may contribute to the clinical efficacy and effectiveness of medication for acute and chronic pain management. We know that the placebo effect operates through two main mechanisms, expectations and learning, which is also influenced by sleep. Moreover, a recent study suggested that rapid eye movement (REM) sleep is associated with modulation of expectation-mediated placebo analgesia. We examined placebo analgesia following pharmacological REM sleep deprivation and we tested the hypothesis that relief expectations and placebo analgesia would be improved by experimental REM sleep deprivation in healthy volunteers. Following an adaptive night in a sleep laboratory, 26 healthy volunteers underwent classical experimental placebo analgesic conditioning in the evening combined with pharmacological REM sleep deprivation (clonidine: 13 volunteers or inert control pill: 13 volunteers). Medication was administered in a double-blind manner at bedtime, and placebo analgesia was tested in the morning. Results revealed that 1) placebo analgesia improved with REM sleep deprivation; 2) pain relief expectations did not differ between REM sleep deprivation and control groups; and 3) REM sleep moderated the relationship between pain relief expectations and placebo analgesia. These results support the putative role of REM sleep in modulating placebo analgesia. The mechanisms involved in these improvements in placebo analgesia and pain relief following selective REM sleep deprivation should be further investigated.

  8. Selective REM Sleep Deprivation Improves Expectation-Related Placebo Analgesia.

    Directory of Open Access Journals (Sweden)

    Florian Chouchou

    Full Text Available The placebo effect is a neurobiological and psychophysiological process known to influence perceived pain relief. Optimization of placebo analgesia may contribute to the clinical efficacy and effectiveness of medication for acute and chronic pain management. We know that the placebo effect operates through two main mechanisms, expectations and learning, which is also influenced by sleep. Moreover, a recent study suggested that rapid eye movement (REM sleep is associated with modulation of expectation-mediated placebo analgesia. We examined placebo analgesia following pharmacological REM sleep deprivation and we tested the hypothesis that relief expectations and placebo analgesia would be improved by experimental REM sleep deprivation in healthy volunteers. Following an adaptive night in a sleep laboratory, 26 healthy volunteers underwent classical experimental placebo analgesic conditioning in the evening combined with pharmacological REM sleep deprivation (clonidine: 13 volunteers or inert control pill: 13 volunteers. Medication was administered in a double-blind manner at bedtime, and placebo analgesia was tested in the morning. Results revealed that 1 placebo analgesia improved with REM sleep deprivation; 2 pain relief expectations did not differ between REM sleep deprivation and control groups; and 3 REM sleep moderated the relationship between pain relief expectations and placebo analgesia. These results support the putative role of REM sleep in modulating placebo analgesia. The mechanisms involved in these improvements in placebo analgesia and pain relief following selective REM sleep deprivation should be further investigated.

  9. Rising from failure and learning from success: The role of past experience in radical initiative taking

    NARCIS (Netherlands)

    D. Deichmann (Dirk); J.C.M. van den Ende (Jan)

    2014-01-01

    markdownabstract__Abstract__ We investigate how the successes and failures of people who initiate radical ideas influence (a) the inclination to take new personal initiatives and (b) the outcome of those initiatives. Using the data of 1,792 radical ideas suggested by 908 employees in a multinationa

  10. 78 FR 73518 - Notice Inviting Suggestions for New Experiments for the Experimental Sites Initiative; Federal...

    Science.gov (United States)

    2013-12-06

    ... based experiments designed to test alternative ways of administering the student financial assistance... the suggestions submitted in response to this notice the Secretary will design experiments and... the Congress. ] We are particularly interested in experiments that are designed to improve...

  11. [Comparison of clinical effectiveness of thoracic epidural and intravenous patient-controlled analgesia for the treatment of rib fractures pain in intensive care unit].

    Science.gov (United States)

    Topçu, Ismet; Ekici, Zeynep; Sakarya, Melek

    2007-07-01

    The results of thoracic epidural and systemic patient controlled analgesia practice were evaluated retrospectively in patients with thoracic trauma. Patients who were admitted to the intensive care unit between 1997 and 2003, with a diagnosis of multiple rib fractures related to thoracic trauma were evaluated retrospectively. Data were recorded from 49 patients who met the following criteria; three or more rib fractures, initiation of PCA with I.V. phentanyl or thoracic epidural analgesia with phentanyl and bupivacaine. There were no significant differences between the groups concerning injury severity score. APACHE II score (8.1+/-1.6 and 9.2+/-1.7) and the number of rib fractures (4+/-1.1 and 6.8+/-2.7) were higher in thoracic epidural analgesia group (pPain scores of patients who received thoracic epidural analgesia were significantly lower as from 6th hour during whole therapy (prib fractures who require intensive care.

  12. Challenges conducting comparative effectiveness research: the Clinical and Health Outcomes Initiative in Comparative Effectiveness (CHOICE experience

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    Friedly JL

    2014-05-01

    Full Text Available Janna L Friedly,1,4 Zoya Bauer,2,4 Bryan A Comstock,3,4 Emily DiMango,5 Assiamira Ferrara,6 Susan S Huang,7 Elliot Israel,8 Jeffrey G Jarvik,2,4 Andrew A Nierenberg,9 Michael K Ong,10 David F Penson,11 Rebecca Smith-Bindman,12 Arthur E Stillman,13 William M Vollmer,6 Stephen M Warren,14 Chunliu Zhan,15 David Chu-Wen Hsia,15 Anne Trontell15 1Department of Rehabilitation Medicine, 2Department of Radiology, 3Department of Biostatistics, 4Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, WA, 5Columbia University Medical Center, New York, NY, 6Kaiser Foundation Research Institute, Oakland, 7Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA, 8Harvard Medical School, Pulmonary and Critical Care, Allergy and Immunology, Brigham and Women's Hospital, 9Massachusetts General Hospital, Boston, MA, 10Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 11Vanderbilt University and Tennessee Valley VAHCC, Nashville, TN, 12Departments of Radiology and Biomedical Imaging, Health Policy, Epidemiology and Biostatistics, University of California, San Francisco, SF, 13Emory University, Atlanta, GA, 14Department of Plastic Surgery, Division of Clinical and Translational Research, NYU Langone Medical Center, New York, NY, 15Agency for Healthcare Research and Quality, Rockville, MD, USA Abstract: The Clinical and Health Outcomes Initiative in Comparative Effectiveness (CHOICE program, which includes 12 ongoing comparative effectiveness research (CER trials funded by the Agency for Healthcare Research and Quality under the American Recovery and Reinvestment Act of 2009, has had firsthand experience in dealing with the unique challenges of conducting CER since the trials started in the fall of 2010. This paper will explore the collective experience

  13. Initial experience of occluding special type patent ductus arterioses using the Amplatzer vascular plug

    Institute of Scientific and Technical Information of China (English)

    ZHANG Po; ZHU Xian-yang; WANG Qi-guang; ZHANG Duan-zhen; HAN Xiu-min

    2013-01-01

    Background Occluders licensed for clinical use are not fit for some special Krichenko E patent ductus arterioses.The Amplatzer vascular plug I (AVP1) has not been licensed for use for closure of patent ductus arteriose.We report our initial experience to occluding special type patent ductus arterioses with the AVP1-a single lobe device of single layer Nitinol mesh for short vessel landing zones.Methods Patients referred with small and long Krichenko E patent ductus arterioses 1 mm to 3 mm in diameter underwent occlusion using AVP1.All cases underwent pre-,intra-and post-procedural echocardiography and chest X-ray at the completion of the procedure,the next day and at a 30-day,3-month and 6-month follow-up visits.Device sizing for device waist diameter and length was based on aortography.Results From April 2008 to June 2012,26 patients with a mean age of (7.6±8.0) years (range 6 months-32 years)and a mean weight of (23.8±14.8) kg (range 7-67 kg) underwent successful patent ductus arteriose closure.The mean ductus diameter was (2.1±0.7) mm (range 1-3 mm).Transpulmonary (22/26) and transaortic approaches (4/26) were used.No persistent patency was observed after 24 hours and after one month.No device displacement,residual flow and iatrogenic coarctation of the aorta were observed after three months and six months.Conclusions The AVP1 makes it easy to close some Krichenko E patent ductus arterioses.Smaller delivery catheter profile and symmetric cylindrical device shape allow for use for small and long Krichenko E patent ductus arterioses 1 mm to 3 mm in diameter and small patients through transaortic approaches.Broader experience is required to further delineate device and patient selection as well as to document its long-term efficacy and safety.

  14. Social and Psychological Predictors of Initial Cigarette Smoking Experience: A Survey in Male College Students.

    Science.gov (United States)

    Menati, Walieh; Nazarzadeh, Milad; Bidel, Zeinab; Würtz, Morten; Menati, Rostam; Hemati, Rohollah; Yaghoubi, Maryam; Zareimanesh, Elham; Mohammadi, Mohammad Sabour; Akhlaghi Ardekani, Farzad; Tazval, Jafar; Delpisheh, Ali

    2016-01-01

    Knowledge about social and psychological risk factors for initial cigarette smoking experience (ICSE) is sparse. The present study aimed to estimate the prevalence of ICSE and to examine the psychological and social factors related to ICSE. In a cross-sectional survey, 1,511 male college students were recruited using multistage sampling techniques from four universities located within the city of Ilam, Iran. Self-administered multiple-choice questionnaires were distributed to students from March to June 2013. Risk factors for ICSE were evaluated using logistic regression models. Participants were 22.3 ± 2.4 years of age. ICSE prevalence was 30.6%. In multivariable adjusted analysis, risk taking behavior (odds ratio [OR] = 1.61; 95% confidence interval [CI] = 1.11-2.33), perceived peer smoking prevalence (OR = 2.48; 95% CI = 1.03-5.97), positive thoughts about smoking (OR = 1.06; 95% CI = 1.02-1.10), high self-efficacy (OR = 0.95, 95% CI [0.93, 0.98]), presence in smokers' gathering (OR = 4.45; 95% CI = 2.88-6.81), comity of smokers (OR = 2.56; 95% CI = 1.66, 3.92), very hard access to cigarettes (OR = 2.20; 95% CI = 1.16-4.16), close friends' medium reaction toward smoking (OR = 1.38; 95% CI = 1.02-1.88), and sporting activity (OR = 0.74; 95% CI = 0.56-0.98) were significantly associated with ICSE. This study identified that a combination of psychological and social variables account for up to 78% of the probability of ICSE. The most important protective factor against ICSE was physical activity, whereas the most important risk factor for ICSE was frequent gathering in the presence of smokers.

  15. SU-E-J-181: Magnetic Resonance Image-Guided Radiation Therapy Workflow: Initial Clinical Experience

    Energy Technology Data Exchange (ETDEWEB)

    Green, O; Kashani, R; Santanam, L; Wooten, H; Li, H; Rodriguez, V; Hu, Y; Mutic, S [Washington University School of Medicine, St. Louis, MO (United States); Hand, T; Victoria, J [ViewRay, Inc., Oakwood Village, OH (United States); Steele, C [Barnes Jewish Hospital, St Louis, MO (United States)

    2014-06-01

    Purpose: The aims of this work are to describe the workflow and initial clinical experience treating patients with an MRI-guided radiotherapy (MRIGRT) system. Methods: Patient treatments with a novel MR-IGRT system started at our institution in mid-January. The system consists of an on-board 0.35-T MRI, with IMRT-capable delivery via doubly-focused MLCs on three {sup 60} Co heads. In addition to volumetric MR-imaging, real-time planar imaging is performed during treatment. So far, eleven patients started treatment (six finished), ranging from bladder to lung SBRT. While the system is capable of online adaptive radiotherapy and gating, a conventional workflow was used to start, consisting of volumetric imaging for patient setup using visible tumor, evaluation of tumor motion outside of PTV on cine images, and real-time imaging. Workflow times were collected and evaluated to increase efficiency and evaluate feasibility of adding the adaptive and gating features while maintaining a reasonable patient throughput. Results: For the first month, physicians attended every fraction to provide guidance on identifying the tumor and an acceptable level of positioning and anatomical deviation. Average total treatment times (including setup) were reduced from 55 to 45 min after physician presence was no longer required and the therapists had learned to align patients based on soft-tissue imaging. Presently, the source strengths were at half maximum (7.7K Ci each), therefore beam-on times will be reduced after source replacement. Current patient load is 10 per day, with increase to 25 anticipated in the near future. Conclusion: On-board, real-time MRI-guided RT has been incorporated into clinical use. Treatment times were kept to reasonable lengths while including volumetric imaging, previews of tumor movement, and physician evaluation. Workflow and timing is being continuously evaluated to increase efficiency. In near future, adaptive and gating capabilities of the system will

  16. MRI-guided percutaneous laser ablation of small renal cell carcinoma: Initial clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    Kariniemi, Juho; Ojala, Risto; Hellstroem, Pekka; Sequeiros, Roberto Blanco (Dept. of Radiology, Dept. of Surgery, Oulu Univ. Hospital, Oulu (Finland)), e-mail: juho.kariniemi@oulu.fi

    2010-05-15

    Background: The number of detected small renal cell carcinomas (RCCs) has been rising, largely due to advances in imaging. Open surgical resection is the standard management of small RCCs; however, imaging-guided percutaneous ablative therapies have emerged as a minimally invasive treatment alternative, especially for patients who are poor candidates for surgery. Purpose: To evaluate the initial clinical experience of magnetic resonance imaging (MRI)-guided percutaneous laser ablation of small RCCs. Material and Methods: Eight patients with 10 tumors were treated with percutaneous MRI-guided laser ablation. All tumors (diameter range 1.5-3.8 cm, mean 2.7 cm) were biopsy-proven RCCs. By using a 0.23 T open MRI system and general anesthesia in patients, one to four (mean 2.6) laser fibers were placed and the tumors were ablated under near real-time MRI control by observing the signal void caused by the temperature change in the heated tissue. The treatment was considered successful if the tumor showed no contrast enhancement at follow-up imaging. Results: All except one tumor were successfully ablated in one session. The first patient treated showed enhancing residual tumor in post-procedural MRI; she has thus far declined retreatment. One complication, a myocardial infarction, occurred; all other patients tolerated the procedure well. No local recurrence was discovered during the follow-up (range 12-30 months, mean 20 months). Conclusion: In this small group of patients with relatively short follow-up period, MRI-guided percutaneous laser ablation proved to be a promising treatment option for small RCCs

  17. Initial experience of percutaneous treatment of mitral regurgitation with MitraClip® therapy in Spain.

    Science.gov (United States)

    Carrasco-Chinchilla, Fernando; Arzamendi, Dabit; Romero, Miguel; Gimeno de Carlos, Federico; Alonso-Briales, Juan Horacio; Li, Chi-Hion; Mesa, Maria Dolores; Arnold, Roman; Serrador Frutos, Ana María; Pan, Manuel; Roig, Eulalia; Rodríguez-Bailón, Isabel; de la Fuente Galán, Luis; Hernández, José María; Serra, Antonio; Suárez de Lezo, José

    2014-12-01

    Symptomatic mitral regurgitation has an unfavorable prognosis unless treated by surgery. However, the European registry of valvular heart disease reports that 49% of patients with this condition do not undergo surgery. Percutaneous treatment of mitral regurgitation with MitraClip® has been proved a safe, efficient adjunct to medical treatment in patients with this profile. The objective of the present study is to describe initial experience of MitraClip® therapy in Spain. Retrospective observational study including all patients treated between November 2011 and July 2013 at the 4 Spanish hospitals recording the highest numbers of implantations. A total of 62 patients (77.4% men) were treated, mainly for restrictive functional mitral regurgitation (85.4%) of grade III (37%) or grade IV (63%), mean (standard deviation) ejection fraction 36% (14%), and New York Heart Association functional class III (37%) or IV (63%). Device implantation was successful in 98% of the patients. At 1 year, 81.2% had mitral regurgitation ≤ 2 and 90.9% were in New York Heart Association functional class ≤ II. One periprocedural death occurred (sepsis at 20 days post-implantation) and another 3 patients died during follow-up (mean, 9.1 months). Two patients needed a second implantation due to partial dehiscence of the first device and 2 others underwent heart transplantation. In Spain, MitraClip® therapy has principally been aimed at patients with functional mitral regurgitation, significant systolic ventricular dysfunction, and high surgical risk. It is considered a safe alternative treatment, which can reduce mitral regurgitation and improve functional capacity. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  18. Transperineal prostate biopsy with ECHO-MRI fusion. Biopsee system. Initial experience.

    Science.gov (United States)

    Romero-Selas, E; Cuadros, V; Montáns, J; Sánchez, E; López-Alcorocho, J M; Gómez-Sancha, F

    2016-06-01

    The aim of this study is to present our initial experience with the stereotactic echo-MRI fusion system for diagnosing prostate cancer. Between September 2014 and January 2015, we performed 50 prostate biopsies using the stereotactic echo-MRI fusion system. The 3-Tesla multiparameter MR images were superimposed using this image fusion system on 3D echo images obtained with the Biopsee system for the exact locating of areas suspected of prostate cancer. The lesions were classified using the Prostate Imaging Report and Date System. We assessed a total of 50 patients, with a mean age of 63 years (range, 45-79), a mean prostate-specific antigen level of 8 ng/mL (range, 1.9-20) and a mean prostate volume of 52mL (range, 12-118). Prostate cancer was diagnosed in 69% of the patients and intraepithelial neoplasia in 6%. The results of the biopsy were negative for 24% of the patients. The results of the biopsy and MRI were in agreement for 62% of the patients; however, 46% also had a tumour outside of the suspicious lesion. We diagnosed 46% anterior tumours and 33% apical tumours. One patient had a haematuria, another had a haematoma and a third had acute urine retention. Multiparametric prostatic MRI helps identify prostate lesions suggestive of cancer. The Biopsee echo-MRI fusion system provides for guided biopsy and increases the diagnostic performance, reducing the false negatives of classical biopsies and increasing the diagnosis of anterior tumours. Transperineal access minimises the risk of prostatic infection and sepsis. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Initial Australian experience with high dose indium-111 pentreotide therapy in progressive, symptomatic neuroendocrine tumours

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    Hicks, R.J.; Keady, M.A.; Johnson, V. [The Peter McCallum Cancer Institute, Melbourne, VIC (Australia). Department of Nuclear Medicine and PET

    1998-06-01

    Full text: Neuroendocrine tumours variably express somatostatin receptors enabling imaging using somatostatin analogues, including In-111 pentreotide. Due to the emission of Auger electrons in the decay of In-1 11, there is the potential to use this agent for therapy. Based on favourable experience with high dose In-111 pentreotide therapy a the University of Rotterdam, a prospective trial of this treatment was performed in 6 patients with progressive, symptomatic neuroendocrine tumours (carcinoid in 4 patients and glucagonoma in 2 patients). Patients were selected based on the presence of uptake at multiple sites on In-1 11 pentreotide scanning with intensity equal to or greater than splenic activity. Follow-up of haematology, endocrine and renal function was performed and serial imaging correlation of index lesions was performed. Three treatments of approximately 6.5 GBq of In-111 pentreotide were administered to each patient over 3-5 months. One pt with bone metastases from carcinoid had an initial flare in symptoms 1 week following treatment but subsequent palliation which lasted 6 months before requiring local radiotherapy. The three remaining carcinoid patients had symptomatic improvement and reduced 5-HIAA levels when abnormal at baseline. Both patients with glucagonoma had symptomatic improvement and reduction in glucagon levels. No patients had evidence of disease progression up to 6 months post-treatment in index lesions with high In-1 11 pentreotide uptake. One lesion with low uptake progressed despite regression in other lesions with high uptake in the same patient Minor transient lymphopaenia was seen following treatment but no clinically significant toxicity was noted. These preliminary results complement European data suggesting good palliation from high dose In-111 pentreotide therapy in patients with high somatostatin receptor expression

  20. Initial experience in Brazil with the Helex septal occluder for percutaneous occlusion of atrial septal defects

    Directory of Open Access Journals (Sweden)

    Pedra Carlos A.C.

    2003-01-01

    Full Text Available OBJECTIVE: To evaluate the initial clinical experience with the Helex septal occluder for percutaneous closure of atrial septal defects. METHODS: Ten patients underwent the procedure, 7 patients with ostium secundum atrial septal defects (ASD with hemodynamic repercussions and 3 patients with pervious foramen ovale (PFO and a history of stroke. Mean age was 33.8 years and mean weight was 55.4 kg. Mean diameter by transesophageal echocardiography and mean stretched ASD diameter were 11.33 ± 3.3mm, and 15.2 ± 3.8mm, respectively. The Qp/Qs ratio was 1.9 ± 0.3 in patients with ASD. RESULTS: Eleven occluders were placed because a patient with 2 holes needed 2 devices. It was necessary to retrieve and replace 4 devices in 3 patients. We observed immediate residual shunt (< 2mm in 4 patients with ASD, and in those with patent foramen ovale total occlusion of the defect occurred. No complications were noted, and all patients were discharged on the following day. After 1 month, 2 patients with ASD experienced trivial residual shunts (1mm. In 1 patient, we observed mild prolapse in the proximal disk in the right atrium, without consequences. CONCLUSION: The Helex septal occluder was safe and effective for occluding small to moderate atrial septal defects. Because the implantation technique is demanding, it requires specific training of the operator. Even so, small technical failures may occur in the beginning of the learning curve, but they do not involve patient safety.

  1. Initial experience with the Codman Certas adjustable valve in the management of patients with hydrocephalus

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    Watt Sara

    2012-09-01

    Full Text Available Abstract Background A new adjustable valve, the Codman CertasTM valve for treatment of hydrocephalus was introduced into clinical practice in January 2011. It has 8 different settings with an opening pressure varying from 36 to over 400 mm H2O at a flow rate of 20 mL/h. The 8th setting is designed to provide a "virtual off" function. The objective of this report is to describe the initial clinical experience with the CertasTM valve and evaluate clinical usage with the main focus on the portable adjustment device - Therapeutic Management System (TMS, the “virtual off” setting and compatibility with magnetic resonance imaging (MRI. Findings Forty-two patients with hydrocephalus from different etiologies were treated with the CertasTM adjustable shunt system. Data regarding implantation procedures, the use of the TMS system, x-ray imaging, and MRI procedures were recorded prospectively. All patients had clinical follow-up at four weeks after implantation and every three months until a stable clinical condition was obtained. The mean time for follow-up was 8.6 months (1–16.6. Seventy-one adjustments were performed with the TMS, 12 were problematic. Twenty-nine MRI procedures were performed and did not cause accidental resetting. Five patients were treated with the "virtual off" function for a period. Conclusions We found the CertasTM valve valuable in the treatment of hydrocephalus, usability of the TMS was high because it is small and portable, but in some cases we experienced adjustment problems with the first procedures performed by a surgeon, indicating that there is a learning curve. The "virtual off" function provided a possibility of treating over-drainage without the need for shunt ligation or other invasive procedures.

  2. Augmented Reality Guidance for the Resection of Missing Colorectal Liver Metastases: An Initial Experience.

    Science.gov (United States)

    Ntourakis, Dimitrios; Memeo, Ricardo; Soler, Luc; Marescaux, Jacques; Mutter, Didier; Pessaux, Patrick

    2016-02-01

    Modern chemotherapy achieves the shrinking of colorectal cancer liver metastases (CRLM) to such extent that they may disappear from radiological imaging. Disappearing CRLM rarely represents a complete pathological remission and have an important risk of recurrence. Augmented reality (AR) consists in the fusion of real-time patient images with a computer-generated 3D virtual patient model created from pre-operative medical imaging. The aim of this prospective pilot study is to investigate the potential of AR navigation as a tool to help locate and surgically resect missing CRLM. A 3D virtual anatomical model was created from thoracoabdominal CT-scans using customary software (VR RENDER(®), IRCAD). The virtual model was superimposed to the operative field using an Exoscope (VITOM(®), Karl Storz, Tüttlingen, Germany). Virtual and real images were manually registered in real-time using a video mixer, based on external anatomical landmarks with an estimated accuracy of 5 mm. This modality was tested in three patients, with four missing CRLM that had sizes from 12 to 24 mm, undergoing laparotomy after receiving pre-operative oxaliplatin-based chemotherapy. AR display and fine registration was performed within 6 min. AR helped detect all four missing CRLM, and guided their resection. In all cases the planned security margin of 1 cm was clear and resections were confirmed to be R0 by pathology. There was no postoperative major morbidity or mortality. No local recurrence occurred in the follow-up period of 6-22 months. This initial experience suggests that AR may be a helpful navigation tool for the resection of missing CRLM.

  3. Single-incision laparoscopic colectomy without using special articulating instruments: an initial experience

    Directory of Open Access Journals (Sweden)

    Trakarnsanga Atthaphorn

    2011-12-01

    Full Text Available Abstract Background Single-incision laparoscopic colectomy (SILC was introduced as a novel minimally invasive technique. The benefits of this technique include reducing number of the incision and cosmetic improvement. Unlike the conventional laparoscopic colectomy, majority of previously reported SILC need to be performed using special curved or articulated instruments. The purpose of this study is to demonstrate our initial experience of SILC, which could be performed using the standard laparoscopic instruments. Material and methods Retrospective review of 14 patients who underwent SILC at Siriraj Hospital from May to December 2010, patient's demographic data, perioperative outcomes, early postoperative complications and pathological data were collected and analyzed. Results The mean age of all patients was 60 years. The most common operation with SILC was sigmoidectomy (n = 9, followed by right hemicolectomy (n = 2, left hemicolectomy (n = 1, anterior resection (n = 1, and total colectomy (n = 1. The trocar insertion techniques were multi-fascial incision using regular port (n = 11 and GelPOINT® (n = 3. The mean operative time was 155 minutes (range 90-280 and the mean estimate blood loss was 32.1 mL (range 10-100. All patients were successfully operated without conversion. The mean length of hospital stay was 9 days (range 5-20. There was no mortality. The pathological results revealed colorectal cancer (n = 12, neoplastic polyp (n = 1 and Familial adenomatous polyposis (FAP (n = 1. The mean number of lymph nodes retrieval was 16.6 (range 3-34. Conclusion SILC can successfully and safely be performed with standard laparoscopic instruments. This technique might be an alternative procedure to conventional laparoscopic colectomy with better cosmetic result.

  4. Initial experience with extreme angle cervical screw for treatment of trauma and cervical spondylosis.

    Science.gov (United States)

    Mehta, Ankit I; Babu, Ranjith; Bagley, Carlos A; Grossi, Peter M; Gottfried, Oren N

    2014-03-01

    In this study, we have described our initial experience and surgical technique of extreme angle screw placement in the cervical and upper thoracic spine of a cohort of patients undergoing posterior fusion. This extreme angle screw facilitates rod placement without need for any coronal contouring of the rod or offset connectors despite the varied entry site locations for posterior instrumentation and the different trajectories and pathways of these screws. From ruary 2011 to July 2011, extreme angle screws were placed in twenty consecutive adult patients who underwent posterior cervical, occipital-cervical or cervical-thoracic fusions. The primary diagnosis was cervical spondylotic myelopathy (13), trauma (4), and pseudoarthrosis with stenosis (3). Eight patients had gross instability. A total of 196 screws were placed; half of the cases involved instrumentation at or within the C3-7 segments (10) and the others included constructs extending to occipital bone, C2, T1, or T2 (10). Of all twenty cases, there were no perioperative hardware complications. At long-term follow-up, two patients required reoperation, one for hardware failure and the other for single level symptomatic pseudoarthrosis. We conclude that extreme angle screw use in the posterior cervical spine provides an evolution in posterior instrumentation that maximizes the biomechanical strength of a construct, allows for easy rod placement, and may improve the restoration of sagittal alignment. Overall, extreme angle screws facilitate rod placement even for screws offset from the natural plane of the rod, thereby avoiding the need for coronal contouring or placement of offset connectors.

  5. Pneumatic reduction of intussusception in children at Korle Bu Teaching Hospital: An initial experience

    Directory of Open Access Journals (Sweden)

    Yaw Boateng Mensah

    2011-01-01

    Full Text Available Background: Intussusception is a common abdominal emergency in children which necessitates prompt diagnosis and management. Nonsurgical methods of managing this condition are rapidly gaining popularity with fluoroscopic-guided pneumatic reduction being one of such methods that has been used with great success in many countries. We present our initial experience with fluoroscopic-guided pneumatic reduction of intussusception at Korle Bu Teaching Hospital which is also the first time the technique has been used in Ghana. Materials and Methods: A total of 18 children were enrolled in the study between August 2007 and February 2008 at Korle Bu Teaching Hospital, Accra, Ghana. Patients were given air enema under fluoroscopic-guidance using locally assembled equipment. The intraluminal pressure was monitored with a pressure gauge and was not permitted to go above 120 mmHg. A total of three attempts of 3 min each were allowed. Results: There were 12 males and 6 females. The average age of the patients was 8.3 months (SD= 3 months. Twelve (67% of the cases were reduced successfully while 6 (33% failed to reduce. A majority of those that did not reduced had symptoms for at least 2 days. Bowel perforation occurred in three (16.7% cases. Conclusion: Pneumatic reduction of intussusception is a cost-effective and rapid method of management of intussusception. It however has limitations like high reported rate of bowel perforation and limited ability to identify lead points. The benefits however seem to outweigh these challenges, such as fluoroscopic-guided pneumatic reduction has a very high success rate. Fluoroscopic guided pneumatic reduction should be considered as one of the primary modes of reduction in Ghana and other neighbouring countries that are yet to practice it.

  6. Robotic-assisted laparoscopic partial nephrectomy: initial experience in Brazil and a review of the literature

    Directory of Open Access Journals (Sweden)

    Carlo Camargo Passerotti

    2012-02-01

    Full Text Available CONTEXT AND PURPOSE: Partial nephrectomy has become the standard of care for renal tumors less than 4 cm in diameter. Controversy still exists, however, regarding the best surgical approach, especially when minimally invasive techniques are taken into account. Robotic-assisted laparoscopic partial nephrectomy (RALPN has emerged as a promising technique that helps surgeons achieve the standards of open partial nephrectomy care while offering a minimally invasive approach. The objective of the present study was to describe our initial experience with robotic-assisted laparoscopic partial nephrectomy and extensively review the pertinent literature. MATERIALS AND METHODS: Between August 2009 and February 2010, eight consecutive selected patients with contrast enhancing renal masses observed by CT were submitted to RALPN in a private institution. In addition, we collected information on the patients' demographics, preoperative tumor characteristics and detailed operative, postoperative and pathological data. In addition, a PubMed search was performed to provide an extensive review of the robotic-assisted laparoscopic partial nephrectomy literature. RESULTS: Seven patients had RALPN on the left or right sides with no intraoperative complications. One patient was electively converted to a robotic-assisted radical nephrectomy. The operative time ranged from 120 to 300 min, estimated blood loss (EBL ranged from 75 to 400 mL and, in five cases, the warm ischemia time (WIT ranged from 18 to 32 min. Two patients did not require any clamping. Overall, no transfusions were necessary, and there were no intraoperative complications or adverse postoperative clinical events. All margins were negative, and all patients were disease-free at the 6-month follow-up. CONCLUSIONS: Robotic-assisted laparoscopic partial nephrectomy is a feasible and safe approach to small renal cortical masses.Further prospective studies are needed to compare open partial nephrectomy with

  7. Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial

    NARCIS (Netherlands)

    Freeman, Liv M.; Bloemenkamp, Kitty W. M.; Franssen, Maureen T. M.; Papatsonis, Dimitri N. M.; Hajenius, Petra J.; van Huizen, Marloes E.; Bremer, Henk A.; van den Akker, Eline S. A.; Woiski, Mallory D.; Porath, Martina M.; van Beek, Erik; Schuitemaker, Nico; van der Salm, Paulien C. M.; Fong, Bianca F.; Radder, Celine; Bax, Caroline J.; Sikkema, Marko; van den Akker-van Marle, M. Elske; van Lith, Jan M. M.; Lopriore, Enrico; Uildriks, Renske J.; Struys, Michel M. R. F.; Mol, Ben Willem J.; Dahan, Albert; Middeldorp, Johanna M.

    2012-01-01

    Background: Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a res

  8. Percutaneous transcatheter closure of atrial septal defects: initial single-centre experience and follow-up results. Initial experience with three-dimensional echocardiography.

    Science.gov (United States)

    De Ridder, Serge; Suttorp, Maarten-Jan; Ernst, Sjef M P G; Six, Jacob A; Mannaerts, Herman F J; Kamp, Otto; Plokker, Thijs H W M; Jaarsma, Wybren

    2005-04-01

    Registry to report our single-centre experience in closing defects of the atrial septum. Between 1996 and 2001, transcatheter device closure of significant atrial septal defects was performed in 32 adults (mean age 45.1 years, range from 15 to 76 years), using different device types. Six patients had a patent foramen ovale (PFO) and 26 patients had a secundum atrial septal defect (ASD II). Defects were selected by means of two-dimensional transoesophageal echocardiography (2D TOE). For 12 defects additional three-dimensional transoesophageal echocardiography (3D TOE) was performed. Mean balloon-stretched diameter was 19.3 mm (range from 11 to 24 mm). A device was successfully placed in all PFO patients (100%) without complications at follow-up. Successful immediate device placement occurred in 24 out of 26 ASD patients. Two immediate placement failures, 1 device embolisation and 1 device non-fixation, occurred and required urgent surgery. There was 1 patient with pericardial effusion after the intervention, requiring pericardiocentesis. Three late placement failures occurred: 2 device embolisations and 1 device dislocation. Clinical success after 3 to 6 months follow-up, defined as the absence of shunt or small shunt, was achieved in all 6 PFO patients and in 21 out of 23 ASD patients (1 device embolisation, requiring surgery, occurred before follow-up was completed). Two patients with significant shunt, 1 late device dislocation and 1 late device embolisation, underwent elective surgery. For patient selection, 3D TOE proved useful in the evaluation of large and/or complex defects. Transcatheter device closure of carefully selected atrial septal defects is an alternative to surgery. Although the results are promising, surgical back-up is often needed.

  9. Greening of a Campus through Waste Management Initiatives: Experience from a Higher Education Institution in Thailand

    Science.gov (United States)

    Tangwanichagapong, Siwaporn; Nitivattananon, Vilas; Mohanty, Brahmanand; Visvanathan, Chettiyappan

    2017-01-01

    Purpose: This paper aims to describe the effects of 3R (reduce, reuse and recycle) waste management initiatives on a campus community. It ascertains the environmental attitudes and opinions of the residents and investigates their behavioral responses to waste management initiatives. Practical implications for enhancing sustainable waste management…

  10. Project Description Advanced Fuel Cycle Initiative AFC-2A and AFC-2B Experiments

    Energy Technology Data Exchange (ETDEWEB)

    AFCI AFC-2A and AFC-2B Experiments Project Executi

    2007-03-01

    The proposed AFC-2A and AFC-2B irradiation experiments are a continuation of the AFC-1 fuel test series currently in progress in the ATR. This document discusses the experiments and the planned activities that will take place.

  11. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    epidural analgesia significantly lowers the risk of thromboembolic complications after lower body procedures, while no effect is seen after major abdominal surgery. Unfortunately, many studies have inadequate study design, with use of lumbar epidural analgesia for abdominal procedures, or the epidural...

  12. Influence of adrenergic and cholinergic mechanisms in baclofen induced analgesia.

    Science.gov (United States)

    Tamayo, L; Rifo, J; Contreras, E

    1988-01-01

    1. Baclofen induced analgesia was confirmed by means of the mouse hot plate test. 2. Physostigmine significantly increased the response to baclofen whilst neostigmine was ineffective. Baclofen analgesia was reduced by atropine. 3. The response to baclofen was increased by the administration of tolazoline, propranolol and nadolol. In contrast, the analgesic response to morphine was attenuated by the antiadrenergic drugs phenoxybenzamine, tolazoline and nadolol.

  13. Initial Experience of Transurethral Resection with Pediatric Resectoscope for Incomplete Anterior Urethral Stricture

    Directory of Open Access Journals (Sweden)

    Won Seok Jang

    2013-04-01

    Full Text Available Purpose Endoscopic urethrotomy is an alternative method in treatment of urethral stricture. However, it have high recurrence rate because of the remained fibrotic tissue. Removal of the fibrotic tissue can maintain the patency of the urethral lumen after the procedure. We report the therapeutic efficacy of our initial experience using pediatric resectoscope for treating anterior urethral stricture in 16 cases. Materials and Methods From January 2009 to April 2011, transurethral resection with pediatric resectoscope was primarily performed on 16 patients with anterior urethral stricture. Retrograde urethrography, uroflowmetry, postvoid residual volume, IPSS score and QoL score were performed preoperatively. We used 11.5Fr pediatric resectoscope (Wolf and monopolar electrosurgical generator. The stricture was incised under vision at the 12 o'clock location or the site of maximum scar tissue or narrowing in asymmetric strictures for working space. After incision, transurethral resection with pediatric resectoscope was performed to all scar tissues. Monopolar cutting current was set on 45 watt and coagulation current was set on 30 watt, fulgurate mode. Postoperatively, drainage of the bladder was performed for 7 days using an 18F latex catheter. Patients were followed up by IPSS score, QoL score, uroflowmetry and postvoid residual volume. Results Successful results without recurrence were achieved in 11 of 16patients. Postoperative urethral dilation had been performed average 2.4 times (0∼6 times. When we classified the results by etiology, the number of successful results in strictures with a trauma, iatrogenic, or unknown cause was 5 (7/11, 3 (3/4 and 1 (1/1, respectively. In 5 patients who failed treatment, we repeated transurethral resection with pediatric resectoscope in 1 patient, and periodic urethral dilation in 4 patients. No operative complications occurred in any patients. Conclusions Transurethral resection with pediatric resectoscope

  14. Supporting ITM Missions by Observing System Simulation Experiments: Initial Design, Challenges and Perspectives

    Science.gov (United States)

    Yudin, V. A.; England, S.; Matsuo, T.; Wang, H.; Immel, T. J.; Eastes, R.; Akmaev, R. A.; Goncharenko, L. P.; Fuller-Rowell, T. J.; Liu, H.; Solomon, S. C.; Wu, Q.

    2014-12-01

    We review and discuss the capability of novel configurations of global community (WACCM-X and TIME-GCM) and planned-operational (WAM) models to support current and forthcoming space-borne missions to monitor the dynamics and composition of the Ionosphere-Thermosphere-Mesosphere (ITM) system. In the specified meteorology model configuration of WACCM-X, the lower atmosphere is constrained by operational analyses and/or short-term forecasts provided by the Goddard Earth Observing System (GEOS-5) of GMAO/NASA/GSFC. With the terrestrial weather of GEOS-5 and updated model physics, WACCM-X simulations are capable to reproduce the observed signatures of the perturbed wave dynamics and ion-neutral coupling during recent (2006-2013) stratospheric warming events, short-term, annual and year-to-year variability of prevailing flows, planetary waves, tides, and composition. With assimilation of the NWP data in the troposphere and stratosphere the planned-operational configuration of WAM can also recreate the observed features of the ITM day-to-day variability. These "terrestrial-weather" driven whole atmosphere simulations, with day-to-day variable solar and geomagnetic inputs, can provide specification of the background state (first guess) and errors for the inverse algorithms of forthcoming NASA ITM missions, such as ICON and GOLD. With two different viewing geometries (sun-synchronous, for ICON and geostationary for GOLD) these missions promise to perform complimentary global observations of temperature, winds and constituents to constrain the first-principle space weather forecast models. The paper will discuss initial designs of Observing System Simulation Experiments (OSSE) in the coupled simulations of TIME-GCM/WACCM-X/GEOS5 and WAM/GIP. As recognized, OSSE represent an excellent learning tool for designing and evaluating observing capabilities of novel sensors. The choice of assimilation schemes, forecast and observational errors will be discussed along with challenges

  15. Myocardial stress perfusion magnetic resonance: initial experience in a pediatric and young adult population using regadenoson

    Energy Technology Data Exchange (ETDEWEB)

    Noel, Cory V. [Baylor College of Medicine, Department of Pediatric Cardiology, Houston, TX (United States); Texas Children' s Hospital, Department of Pediatric Cardiology, Houston, TX (United States); Krishnamurthy, Ramkumar; Krishnamurthy, Rajesh [Texas Children' s Hospital, Department of Radiology, Houston, TX (United States); Moffett, Brady [Texas Children' s Hospital, Department of Pharmacology, Houston, TX (United States)

    2017-03-15

    Dipyridamole and adenosine are traditional pharmacological stressors for myocardial perfusion. Regadenoson, a selective adenosine A2A agonist, has a lower side effect profile with lower incidence of bronchospasm and bradycardia. There is a growing need for myocardial perfusion assessment within pediatrics. There is no report on the utility of regadenoson as a stress agent in children. To observe the safety and feasibility of regadenoson as a pharmacologic stressor for perfusion cardiac MR in a pilot cohort of pediatric patients weighing more than 40 kg who have congenital heart disease and pediatric acquired heart disease. We reviewed our initial experience with regadenoson stress cardiac MR in 31 pediatric patients 15.8 ± 1.7 years (range 12-22 years) with congenital heart disease and acquired heart disease. Mean patient weight was 60 ± 15 kg (range of 40-93 kg). All patients underwent cardiac MR because of concern for ischemia. The cohort included a heterogeneous group of patients at a pediatric institution with potential risk for ischemia. Subjects' heart rate and blood pressure were monitored and pharmacologic stress was induced by injection of 400 mcg of regadenoson. We evaluated their hemodynamic response and adverse effects using changes in vital signs and onset of symptoms. A pediatric cardiologist and radiologist qualitatively assessed myocardial perfusion and viability images. One child was unable to complete the stress perfusion portion of the examination, but did complete the remaining portion of the CMR. Resting heart rate was 72 ± 14 beats per minute (bpm) and rose to peak of 124 ± 17 bpm (95 ± 50% increase, P < 0.005) with regadenoson. Image quality was considered good or diagnostic in all cases. Three patients had irreversible perfusion defects. Four patients had reversible perfusion defects. Nine of the patients underwent cardiac catheterization with angiography and the findings showed excellent agreement. Regadenoson might be a safe and

  16. Initial experiences of implementation of functional integration (FI) in LEPRA India projects in Orissa.

    Science.gov (United States)

    Rao, V Prabhakara; Bhuskade, R A; Raju, M Sathi; Rao, P V Ranganadha; Desikan, K V

    2002-06-01

    In 2000, the Government of the State of Orissa (population 37 million) in India decided to introduce functional integration for the control of leprosy, in place of the long-established vertical programme, using the general health services and the primary health care system. This paper describes the initial (9 months) experience of implementing this strategy in two projects run by LEPRA India. One of these, in the district of Koraput, was established in 1991 and covers a population of 1.5 million people. The other, in Kalahandi district, started in 1997 and covers a population of 600,000. Both projects operate under difficult conditions with regard to terrain, the use of numerous tribal languages, illiteracy, water shortage, poor roads and communications. The preparatory phase included intensive health education of the public on leprosy, using a wide range of educational media and techniques. At the same time, LEPRA India supported the Government in the training and orientation of trainers, medical officers, primary health care staff and female health workers at village level. In all, over 2000 were trained. This paper describes all aspects of the implementation of functional integration in these two areas. In the 9-month period, 4207 suspect cases were referred to medical officers by health workers, but only 256 (6%) were confirmed as having leprosy. There were 169 confirmed self-reporting cases. Despite the clearly understood intention to involve primary health staff in case detection, 67% of all cases were in fact detected by LEPRA India, possibly due to overlapping attendance at clinics by vertical and general staff. There is obviously a need for further training of the general staff since only 6% of cases referred by them were confirmed as having leprosy. Steps must also be taken to ensure that the emphasis on case detection, confirmation and treatment shifts from the vertical to the general health staff. The supply of anti-leprosy drugs and steroids to primary

  17. E-learning course: Basis of Harvest and Preservation of Tissues – design and initial experience

    Directory of Open Access Journals (Sweden)

    Pavel Měřička

    2014-05-01

    Full Text Available Background: The design and initial experience with the e-learning course “Basis of Harvest and Preservation of Tissues” used as a support of an elective subject is presented. The aim of the e-learning course was to enable the students to learn the theoretical principles of the subject individually and to present the gained knowledge at the final seminar. Methods: All functions of the course were operated in Moodle, local application of the Charles University in Prague, Faculty of Medicine in Hradec Králové. The course was divided into 3 main topics corresponding with topics of lectures: 1. Principles of tissue and organ donation, 2. Low temperature preservation of cells, tissues and organs, 3. Quality and safety assurance in practice of tissue and procurement establishments. A test consisting of 5 questions selected randomly from the bank of questions followed each topic. If the student answers correctly at least 3 questions he is allowed to pass to the next topic. The fourth topic “Basic processes in the tissue establishment and principles of their validation” was added into the electronic version as a tool for repeating and improving of knowledge. The fifth topic was represented by a database for uploading theses presented by students at the final seminar. The final test consisted of 15 questions (5 ones from each basic topic. It was necessary to answer correctly at least 10 questions to receive a certificate of completing the course. Results: The course was put into operation during the summer term of the academic year 2012/2013. To the date 15 of September the total of 23 students enrolled (17, i.e. all students of the elective subject in the Czech version, 2 students of this subject in the English version, 2 postgraduate students and 2 medical doctors. All enrolled students used the course for on-line learning, downloading, or printing course study materials. All undergraduate students were obliged to use it for preparation

  18. An initial experience with a digital drainage system during the postoperative period of pediatric thoracic surgery.

    Science.gov (United States)

    Costa, Altair da Silva; Bachichi, Thiago; Holanda, Caio; Rizzo, Luiz Augusto Lucas Martins De

    2016-01-01

    To report an initial experience with a digital drainage system during the postoperative period of pediatric thoracic surgery. This was a prospective observational study involving consecutive patients, ≤ 14 years of age, treated at a pediatric thoracic surgery outpatient clinic, for whom pulmonary resection (lobectomy or segmentectomy via muscle-sparing thoracotomy) was indicated. The parameters evaluated were air leak (as quantified with the digital system), biosafety, duration of drainage, length of hospital stay, and complications. The digital system was used in 11 children (mean age, 5.9 ± 3.3 years). The mean length of hospital stay was 4.9 ± 2.6 days, the mean duration of drainage was 2.5 ± 0.7 days, and the mean drainage volume was 270.4 ± 166.7 mL. The mean maximum air leak flow was 92.78 ± 95.83 mL/min (range, 18-338 mL/min). Two patients developed postoperative complications (atelectasis and pneumonia, respectively). The use of this digital system facilitated the decision-making process during the postoperative period, reducing the risk of errors in the interpretation and management of air leaks. Relatar a experiência inicial com um sistema de drenagem digital no pós-operatório de cirurgia torácica pediátrica. Estudo observacional e prospectivo envolvendo pacientes consecutivos do ambulatório de cirurgia torácica pediátrica da instituição, com idade até 14 anos, e com indicação de ressecção pulmonar (lobectomia e/ou segmentectomia através de toracotomia poupadora muscular). Os parâmetros avaliados foram perda aérea (quantificada com o sistema digital), biossegurança, tempo de drenagem, tempo de internação e complicações. O sistema digital foi utilizado em 11 crianças, com média de idade de 5,9 ± 3,3 anos. A média do tempo de internação foi de 4,9 ± 2,6 dias, a de tempo de drenagem foi de 2,5 ± 0,7 dias, e a de volume de drenagem foi de 270,4 ± 166,7 ml. A média da perda aérea máxima foi de 92,78 ± 95,83 ml

  19. Epidural analgesia for labour: maternal knowledge, preferences and informed consent.

    LENUS (Irish Health Repository)

    2012-02-29

    Epidural analgesia has become increasingly popular as a form of labour analgesia in Ireland. However obtaining true inform consent has always been difficult. Our study recruited 100 parturients who had undergone epidural analgesia for labour, aimed to determine the information they received prior to regional analgesia, and to ascertain their preferences regarding informed consent. Only 65 (65%) of patients planned to have an epidural. Knowledge of potential complications was variable and inaccurate, with less than 30 (30%) of women aware of the most common complications. Most women 79 (79%) believed that discomfort during labour affected their ability to provide informed consent, and believe consent should be taken prior to onset of labour (96, 96%). The results of this study helps define the standards of consent Irish patients expect for epidural analgesia during labour.

  20. Relationship between analgesia and turnover of brain biogenic amines.

    Science.gov (United States)

    Bensemana, D; Gascon, A L

    1978-10-01

    The analgesic activity of morphine, delta9THC, and sodium salicylate was studied concomitantly with changes in brainstem and cortex turnover of dopamine (DA), noradrenaline (NA), and serotonin (5HT). The results show that a correlation exists between the presence of analgesia and the increased turnover rates of the three biogenic amines. Morphine and sodium salicylate induced analgesia is accompanied by an increased turnover rate of all three biogenic amines; delta9THC-induced analgesia is accompanied by an increased turnover rate of DA and 5HT only. There is, however, no consistent relationship between the degree of analgesia and the degree of change in the turnover rates. The existence of the endogenous morphine-like substances, endorphines, may explain why morphine analgesia is distinct from that of delta9THC and sodium salicylate. The possible relationship between this morphine-like substance and biogenic amines is discussed.

  1. Characterizing Design Cognition of High School Students: Initial Analyses Comparing Those with and without Pre-Engineering Experiences

    Science.gov (United States)

    Wells, John; Lammi, Matthew; Gero, John; Grubbs, Michael E.; Paretti, Marie; Williams, Christopher

    2016-01-01

    Reported in this article are initial results from of a longitudinal study to characterize the design cognition and cognitive design styles of high school students with and without pre-engineering course experience over a 2-year period, and to compare them with undergraduate engineering students. The research followed a verbal protocol analysis…

  2. Preventive analgesia for postoperative pain control: a broader concept

    Directory of Open Access Journals (Sweden)

    Vadivelu N

    2014-04-01

    Full Text Available Nalini Vadivelu,1 Sukanya Mitra,2 Erika Schermer,3 Vijay Kodumudi,4 Alan David Kaye,5 Richard D Urman61Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA; 2Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India; 3Yale College, New Haven, 4School of Liberal Arts and Science, University of Connecticut, Storrs, CT, 5Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, 6Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USAAbstract: Pain from surgical procedures occurs as a consequence of tissue trauma and may result in physical, cognitive, and emotional discomfort. Almost a century ago, researchers first described a possible relationship between intraoperative tissue damage and an intensification of acute pain and long-term postoperative pain, now referred to as central sensitization. Nociceptor activation is mediated by chemicals that are released in response to cellular or tissue damage. Pre-emptive analgesia is an important concept in understanding treatment strategies for postoperative analgesia. Pre-emptive analgesia focuses on postoperative pain control and the prevention of central sensitization and chronic neuropathic pain by providing analgesia administered preoperatively but not after surgical incision. Additional research in pre-emptive analgesia is warranted to better determine good outcome measurements and a better appreciation with regard to treatment optimization. Preventive analgesia reduces postoperative pain and consumption of analgesics, and this appears to be the most effective means of decreasing postoperative pain. Preventive analgesia, which includes multimodal preoperative and postoperative analgesic therapies, results in decreased postoperative pain and less postoperative consumption of analgesics.Keywords: preventive analgesia, central

  3. A COMPARISON OF ANALGESIA AND FOETAL OUTCOME IN TERM PARTURIENTS WITH AND WITHOUT LOW DOSE COMBINED SPINAL EPIDURAL LABOUR ANALGESIA

    Directory of Open Access Journals (Sweden)

    Manjunath

    2015-11-01

    Full Text Available : STUDY OBJECTIVE: We aimed to find a safe method of labor analgesia with minimal side effects and toxicity in mother and fetus using combined ‘low dose’ spinal and epidural (CSE. DESIGN: prospective case control study. SETTING: Labour suite of a tertiary care hospital. PATIENTS: study population included 120 pregnant women of ASA physical status I and II parturients in active labor who requested analgesia, 60 of these patients were given labour analgesia - ‘GROUP T’ and 60 of who underwent a delivery without labour analgesia -‘GROUP C’. MEASUREMENTS AND MAIN RESULTS: Maternal hemodynamics, degree of pain relief, duration of labour, fetal heart rate, Apgar scores, mode of delivery, intervention to relieve pain, Adverse effects because of procedure and drugs used were also noted. Low dose epidural analgesia does not prolong labour and does not increase the incidence of instrumental deliveries when compared to parturients undergoing delivery without labour analgesia. Even with the reduced dose of fentanyl the parturients had acceptable pain relief and a decreased incidence of intervention for pain. It does not cause more fetal depression when compared to normally laboring term parturients. ‘Low dose’ labour analgesia is a safe technique for painless labour with no harmful effects on the mother or baby and it does not significantly affect the obstetric outcome. CONCLUSION: ‘Low dose’ labour analgesia is a safe technique for painless labour with no harmful effects on the mother or baby and it does not significantly affect the obstetric outcome.

  4. The Relationship of a Pilot's Educational Background, Aeronautical Experience and Recency of Experience to Performance In Initial Training at a Regional Airline

    Science.gov (United States)

    Shane, Nancy R.

    The purpose of this study was to determine how a pilot's educational background, aeronautical experience and recency of experience relate to their performance during initial training at a regional airline. Results show that variables in pilots' educational background, aeronautical experience and recency of experience do predict performance in training. The most significant predictors include years since graduation from college, multi-engine time, total time and whether or not a pilot had military flying experience. Due to the pilot shortage, the pilots entering regional airline training classes since August 2013 have varied backgrounds, aeronautical experience and recency of experience. As explained by Edward Thorndike's law of exercise and the law of recency, pilots who are actively using their aeronautical knowledge and exercising their flying skills should exhibit strong performance in those areas and pilots who have not been actively using their aeronautical knowledge and exercising their flying skills should exhibit degraded performance in those areas. Through correlation, chi-square and multiple regression analysis, this study tests this theory as it relates to performance in initial training at a regional airline.

  5. [Maternal postures and epidural analgesia during labour].

    Science.gov (United States)

    Ducloy-Bouthors, A-S; De Gasquet, B; Davette, M; Cuisse, M

    2006-06-01

    The evolution of birth is of interest for obstetricians and midwives. Postures with asymmetric stretching and balance, kneeling, or sitting have been claimed to be able to help foetal head rotation. Although walking during labour have no influence on the outcome of labour, hip-flexed postures enlarging the pelvic diameter are yet evaluated to improve the obstetric course of labour. In a prospective randomised study including 93 parturients, we compared the supine 30 degrees lateral tilt (control group) to three hip-flexed postures: sitting (S), right hip-flexed left lateral position (L) and left hip-flexed right lateral position (R). Epidural analgesia with 12 ml ropivacaine 0.1% and sufentanil 0.5 microg/ml was administered over a period of six minutes. The total epidural spread was 15+/-0.3 dermatomes and the upper level of thermo-analgesic blockade reached T7-T8 (T5 to T10) in each group. There were no differences between groups for the left and right total spread and upper level of epidural blockade, for the time to maximal block and pain relief. There was no motor block and no maternal or foetal side effects. We conclude that, for the three hip-flexed postures tested, position does not influence local anesthetic spread or symmetry of analgesia after induction of obstetric epidural anaesthesia.

  6. Regional analgesia in postsurgical critically ill patients.

    Science.gov (United States)

    Moliner Velázquez, S; Rubio Haro, R; De Andrés Serrano, C; De Andrés Ibáñez, J

    2017-03-01

    Regional analgesia intrinsically, based on its physiological effects, is routinely used for the perioperative treatment of pain associated with surgical procedures. However, in other areas such as the non-surgical treatment of acute pain for patients in a critical condition, it has not been subjected to specific prospective studies. If we confine ourselves to the physiological effects of the nerve block, in a situation of stress, the indications for regional anaesthesia in this group of patients extend to the management of a wide variety of medical as well as postsurgical conditions, of trauma patients and of other painful procedures performed in the patient's bed. The critical patient certainly must be analyzed individually as their own primary conditions is of vital importance, as well as any associated conditions they have developed that can potentially increase the risk of systemic toxicity or morbidity, such as, coagulopathies, infection, immunosuppressive states, sedation and problems associated with mechanical ventilation. This review aims to assess the role of regional analgesia in critically ill patients, placing it within the algorithm decision tree of the professional responsible for patients in critical care units, all based on the evidence of potential benefits according to the published literature. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Intrapleural analgesia after endoscopic thoracic sympathectomy.

    Science.gov (United States)

    Silva, Patrícia Gomes da; Cataneo, Daniele Cristina; Leite, Fernanda; Hasimoto, Erica Nishida; Barros, Guilherme Antonio Moreira de

    2011-12-01

    To compare analgesia traditionally used for thoracic sympathectomy to intrapleural ropivacaine injection in two different doses. Twenty-four patients were divided into three similar groups, and all of them received intravenous dipyrone. Group A received intravenous tramadol and intrapleural injection of saline solution. Group B received intrapleural injection of 0.33% ropivacaine, and Group C 0.5% ropivacaine. The following aspects were analyzed: inspiratory capacity, respiratory rate and pain. Pain was evaluated in the immediate postoperative period by means of the visual analog scale and over a one-week period. In Groups A and B, reduced inspiratory capacity was observed in the postoperative period. In the first postoperative 12 hours, only 12.5% of the patients in Groups B and C showed intense pain as compared to 25% in Group A. In the subsequent week, only one patient in Group A showed mild pain while the remainder reported intense pain. In Group B, half of the patients showed intense pain, and in Group C, only one presented intense pain. Intrapleural analgesia with ropivacaine resulted in less pain in the late postoperative period with better analgesic outcomes in higher doses, providing a better ventilatory pattern.

  8. Initial experiments on the effectiveness of telephone access to government services

    CSIR Research Space (South Africa)

    Cloete, Jacob PL

    2004-08-01

    Full Text Available - and post-experiment interviews and an observed experiment. The experiments were performed at the Department of Labour in Pretoria, South Africa, in November 2003. Unscreened participants were solicited from the queue of UIF applicants. 14 callers used..., a number of conclusions were reached. Although transaction- completion rates were comparable for the speech-input and DTMF systems, users were much more comfortable with the speech-based system as reflected in somewhat higher user-satisfaction...

  9. Sensitivity Experiments of an Eastward-Moving Southwest Vortex to Initial Perturbations

    Institute of Scientific and Technical Information of China (English)

    王智; 高坤

    2003-01-01

    Whether the initial conditions contain pronounced mesoscale signals is important to the simulation of the southwest vortex. An eastward-moving southwest vortex is simulated using the PSU/NCAR MM5. A modest degree of success is achieved, but the most serious failure is that the formation and displacement of the simulated vortex in its early phase are about fourteen hours later than the observed vortex. Considering the relatively sparse data on the mesoscale vortex and in an attempt to understand the cause of the forecast failure, an adjoint model is used to examine the sensitivity of the southwest vortex to perturbations of initial conditions. The adjoint sensitivity indicates how small perturbations of model variables at the initial time in the model domain can influence the vortex. A large sensitivity for zonal wind is located under 400 hPa, a large sensitivity for meridional wind is located under 500 hPa, a large sensitivity for temperature is located between 500 and 900 hPa, and almost all of the large sensitivity areas are located in the southwestern area. Based on the adjoint sensitivity results, perturbations are added to initial conditions to improve the simulation of the southwest vortex. The results show that the initial conditions with perturbations can successfully simulate the formation and displacement of the vortex; the wind perturbations added to the initial conditions appear to be a cyclone circulation under the middle level of the atmosphere in the southwestern area with an anticyclone circulation to its southwest; a water vapor perturbation added to initial conditions can strengthen the vortex and the speed of its displacement.

  10. Reproducibility of scratch assays is affected by the initial degree of confluence: Experiments, modelling and model selection.

    Science.gov (United States)

    Jin, Wang; Shah, Esha T; Penington, Catherine J; McCue, Scott W; Chopin, Lisa K; Simpson, Matthew J

    2016-02-01

    Scratch assays are difficult to reproduce. Here we identify a previously overlooked source of variability which could partially explain this difficulty. We analyse a suite of scratch assays in which we vary the initial degree of confluence (initial cell density). Our results indicate that the rate of re-colonisation is very sensitive to the initial density. To quantify the relative roles of cell migration and proliferation, we calibrate the solution of the Fisher-Kolmogorov model to cell density profiles to provide estimates of the cell diffusivity, D, and the cell proliferation rate, λ. This procedure indicates that the estimates of D and λ are very sensitive to the initial density. This dependence suggests that the Fisher-Kolmogorov model does not accurately represent the details of the collective cell spreading process, since this model assumes that D and λ are constants that ought to be independent of the initial density. Since higher initial cell density leads to enhanced spreading, we also calibrate the solution of the Porous-Fisher model to the data as this model assumes that the cell flux is an increasing function of the cell density. Estimates of D and λ associated with the Porous-Fisher model are less sensitive to the initial density, suggesting that the Porous-Fisher model provides a better description of the experiments.

  11. Seventh Fleet field training exercise : Fleet Battle Experiment Kilo : fires initiatives final report

    OpenAIRE

    Schacher, G. E.; Pilnick, Steve; Irvine, Nelson; Gallup, Shelley

    2003-01-01

    Fleet Battle Experiment Kilo was conducted during Seventh Fleet exercise Tandem Thrust 03. During the Field Training Exercise phase, testing of Time Sensitive Targets processes using the Joint Fires Network was carried out. This report contains results obtained on contributions made by the Joint Fires Network to Navy Time Sensitive Targeting and experiment lessons learned. NA

  12. Eating at worksites in Nordic countries: national experiences and policy initiatives

    DEFF Research Database (Denmark)

    Jørgensen, Michael Søgaard; Arsky, Gunn Helene; Brandhøj, Mia

    2010-01-01

    with healthier worksite eating schemes based on employee participation can change the worksite eating substantially, also at blue-collar worksites. However, the dissemination to other worksites not participating in experiments seems limited. There is need for more research in the embedding of experiments...

  13. Initial Results on Neutralized Drift Compression Experiments (NDCX-IA) for High Intensity Ion Beam

    CERN Document Server

    Roy, Prabir K; Baca, David; Bieniosek, Frank; Coleman, Joshua E; Davidson, Ronald C; Efthimion, Philip; Eylon, Shmuel; Gilson, Erik P; Grant Logan, B; Greenway, Wayne; Henestroza, Enrique; Kaganovich, Igor D; Leitner, Matthaeus; Rose, David; Sefkow, Adam; Sharp, William M; Shuman, Derek; Thoma, Carsten H; Vanecek, David; Waldron, William; Welch, Dale; Yu, Simon

    2005-01-01

    Ion beam neutralization and compression experiments are designed to determine the feasibility of using compressed high intensity ion beams for high energy density physics (HEDP) experiments and for inertial fusion power. To quantitatively ascertain the various mechanisms and methods for beam compression, the Neutralized Drift Compression Experiment (NDCX) facility is being constructed at Lawrence Berkeley National Laboratory (LBNL). In the first compression experiment, a 260 KeV, 25 mA, K+ ion beam of centimeters size is radially compressed to a mm size spot by neutralization in a meter-long plasma column and beam peak current is longitudinally compressed by an induction velocity tilt core. Instrumentation, preliminary results of the experiments, and practical limits of compression are presented. These include parameters such as emittance, degree of neutralization, velocity tilt time profile, and accuracy of measurements (fast and spatially high resolution diagnostic) are discussed.

  14. Developments in labour analgesia and their use in Australia.

    Science.gov (United States)

    Eley, V A; Callaway, L; van Zundert, A A

    2015-07-01

    Since the introduction of chloroform for labour analgesia in 1847, different methods and medications have been used to relieve the pain of labour. The use of heavy sedative medication in the early 1900s was encouraged by enthusiastic doctors and by women empowered by the women's suffrage movement in America. Nitrous oxide by inhalation has been used in Australia since the 1950s and improved methods of administration have made this method of analgesia safe and practical. Caudal epidural analgesia and lumbar epidural analgesia were first made popular in America and by the 1970s these techniques were more widely available in Australia. In 1847, physicians and the public were unsure whether relieving labour pains was the 'right' thing to do. However, many medical and social changes have occurred thanks to the clinical connection between Australia and the United Kingdom and those first settlers to land on Australian shores. Thanks to this historical connection, in today's Australia there is no question that women should use analgesia as a pain relief if they wish. Currently, the majority of women worldwide use some form of analgesia during labour and different methods are widely available. This paper discusses the four milestones of the development of obstetric analgesia and how they were introduced into patient care in Australia.

  15. Intracortical modulation, and not spinal inhibition, mediates placebo analgesia.

    Science.gov (United States)

    Martini, M; Lee, M C H; Valentini, E; Iannetti, G D

    2015-02-01

    Suppression of spinal responses to noxious stimulation has been detected using spinal fMRI during placebo analgesia, which is therefore increasingly considered a phenomenon caused by descending inhibition of spinal activity. However, spinal fMRI is technically challenging and prone to false-positive results. Here we recorded laser-evoked potentials (LEPs) during placebo analgesia in humans. LEPs allow neural activity to be measured directly and with high enough temporal resolution to capture the sequence of cortical areas activated by nociceptive stimuli. If placebo analgesia is mediated by inhibition at spinal level, this would result in a general suppression of LEPs rather than in a selective reduction of their late components. LEPs and subjective pain ratings were obtained in two groups of healthy volunteers - one was conditioned for placebo analgesia while the other served as unconditioned control. Laser stimuli at three suprathreshold energies were delivered to the right hand dorsum. Placebo analgesia was associated with a significant reduction of the amplitude of the late P2 component. In contrast, the early N1 component, reflecting the arrival of the nociceptive input to the primary somatosensory cortex (SI), was only affected by stimulus energy. This selective suppression of late LEPs indicates that placebo analgesia is mediated by direct intracortical modulation rather than inhibition of the nociceptive input at spinal level. The observed cortical modulation occurs after the responses elicited by the nociceptive stimulus in the SI, suggesting that higher order sensory processes are modulated during placebo analgesia.

  16. Assessment of pain experience in adults and children after bracket bonding and initial archwire insertion

    Directory of Open Access Journals (Sweden)

    Marcio José da Silva Campos

    2013-10-01

    Full Text Available INTRODUCTION: Ninety five percent of orthodontic patients routinely report pain, due to alterations in the periodontal ligament and surrounding soft tissues, with intensity and prevalence varying according to age. OBJECTIVE: This study aimed to assess toothache and buccal mucosal pain in adults and children during two initial phases of the orthodontic treatment. METHODS: The intensity of toothache and buccal mucosal pain reported by 20 patients, 10 children (11-13 years and 10 adults (18-37 years was recorded with the aid of a Visual Analog Scale (VAS, during 14 days - 7 days with bonded brackets only and 7 days with the initial archwire inserted. RESULTS: There was no significant difference in pain intensity among adults and children. After bracket bonding, 50% of the children and 70% of the adults reported pain. 70% of both groups reported pain after initial archwire insertion. While adults reported constant, low intensity, buccal mucosal pain, the children showed great variation of pain intensity, but with a trend towards decreasing pain during the assessment period. After initial archwire insertion the peaks of toothache intensity and prevalence occurred 24 hours in children and 48 hours in adults. CONCLUSIONS: In general, children reported pain less frequently than adults did, though with greater intensity.

  17. English as an Additional Language and Initial Teacher Education: Views and Experiences from Northern Ireland

    Science.gov (United States)

    Skinner, Barbara

    2010-01-01

    This paper addresses training for teaching English as an Additional Language (EAL) at initial teacher education (ITE) level in Northern Ireland. This small-scale qualitative study describes 15 primary and post-primary teachers' perspectives on their preparation for teaching EAL in Northern Ireland. It explores reflections on EAL content in ITE…

  18. Robotics in hepatobiliary surgery-initial experience, first reported case series from India

    Directory of Open Access Journals (Sweden)

    S. Goja

    2017-01-01

    Conclusion: This initial series adds to existing data on the feasibility of robotic hepatobiliary cases with inherent advantages of minimal invasive surgery, however with limitation of availability and use of devices like cavitron ultrasonic surgical aspirator (CUSA and higher operative cost.

  19. Experiments with Metadata-Derived Initial Values and Linesearch Bundle Adjustment in Architectural Photogrammetry

    Science.gov (United States)

    Börlin, N.; Grussenmeyer, P.

    2013-07-01

    According to the Waldhäusl and Ogleby (1994) "3 x 3 rules", a well-designed close-range architectural photogrammetric project should include a sketch of the project site with the approximate position and viewing direction of each image. This orientation metadata is important to determine which part of the object each image covers. In principle, the metadata could be used as initial values for the camera external orientation (EO) parameters. However, this has rarely been used, partly due to convergence problem for the bundle adjustment procedure. In this paper we present a photogrammetric reconstruction pipeline based on classical methods and investigate if and how the linesearch bundle algorithm of Börlin et al. (2004) and/or metadata can be used to aid the reconstruction process in architectural photogrammetry when the classical methods fail. The primary initial values for the bundle are calculated by the five-point algorithm by Nistér (Stewénius et al., 2006). Should the bundle fail, initial values derived from metadata are calculated and used for a second bundle attempt. The pipeline was evaluated on an image set of the INSA building in Strasbourg. The data set includes mixed convex and non-convex subnetworks and a combination of manual and automatic measurements. The results show that, in general, the classical bundle algorithm with five-point initial values worked well. However, in cases where it did fail, linesearch bundle and/or metadata initial values did help. The presented approach is interesting for solving EO problems when the automatic orientation processes fail as well as to simplify keeping a link between the metadata containing the plan of how the project should have become and the actual reconstructed network as it turned out to be.

  20. Sexual experience promotes adult neurogenesis in the hippocampus despite an initial elevation in stress hormones.

    Directory of Open Access Journals (Sweden)

    Benedetta Leuner

    Full Text Available Aversive stressful experiences are typically associated with increased anxiety and a predisposition to develop mood disorders. Negative stress also suppresses adult neurogenesis and restricts dendritic architecture in the hippocampus, a brain region associated with anxiety regulation. The effects of aversive stress on hippocampal structure and function have been linked to stress-induced elevations in glucocorticoids. Normalizing corticosterone levels prevents some of the deleterious consequences of stress, including increased anxiety and suppressed structural plasticity in the hippocampus. Here we examined whether a rewarding stressor, namely sexual experience, also adversely affects hippocampal structure and function in adult rats. Adult male rats were exposed to a sexually-receptive female once (acute or once daily for 14 consecutive days (chronic and levels of circulating glucocorticoids were measured. Separate cohorts of sexually experienced rats were injected with the thymidine analog bromodeoxyuridine in order to measure cell proliferation and neurogenesis in the hippocampus. In addition, brains were processed using Golgi impregnation to assess the effects of sexual experience on dendritic spines and dendritic complexity in the hippocampus. Finally, to evaluate whether sexual experience alters hippocampal function, rats were tested on two tests of anxiety-like behavior: novelty suppressed feeding and the elevated plus maze. We found that acute sexual experience increased circulating corticosterone levels and the number of new neurons in the hippocampus. Chronic sexual experience no longer produced an increase in corticosterone levels but continued to promote adult neurogenesis and stimulate the growth of dendritic spines and dendritic architecture. Chronic sexual experience also reduced anxiety-like behavior. These findings suggest that a rewarding experience not only buffers against the deleterious actions of early elevated

  1. Expectancy and treatment interactions: A dissociation between acupuncture analgesia and expectancy evoked placebo analgesia

    Science.gov (United States)

    Kong, Jian; Kaptchuk, Ted J; Polich, Ginger; Kirsch, Irving; Vangel, Mark; Zyloney, Carolyn; Rosen, Bruce; Gollub, Randy

    2009-01-01

    Recent advances in placebo research have demonstrated the mind’s power to alter physiology. In this study, we combined an expectancy manipulation model with both verum and sham acupuncture treatments to address: 1) how and to what extent treatment and expectancy effects --including both subjective pain intensity levels (pain sensory ratings) and objective physiological activations (fMRI) -- interact; and 2) if the underlying mechanism of expectancy remains the same whether placebo treatment is given alone or in conjunction with active treatment. The results indicate that although verum acupuncture + high expectation and sham acupuncture + high expectation induced subjective reports of analgesia of equal magnitude, fMRI analysis showed that verum acupuncture produced greater fMRI signal decrease in pain related brain regions during application of calibrated heat pain stimuli on the right arm. We believe our study provides brain imaging evidence for the existence of different mechanisms underlying acupuncture analgesia and expectancy evoked placebo analgesia. Our results also suggest that the brain network involved in expectancy may vary under different treatment situations (verum and sham acupuncture treatment). PMID:19159691

  2. Next generation experiments and models for shock initiation and detonation of solid explosives

    Energy Technology Data Exchange (ETDEWEB)

    Tarver, C M

    1999-06-01

    Current phenomenological hydrodynamic reactive flow models, such as Ignition and Growth and Johnson- Tang-Forest, when normalized to embedded gauge and laser velocimetry data, have been very successful in predicting shock initiation and detonation properties of solid explosives in most scenarios. However, since these models use reaction rates based on the compression and pressure of the reacting mixture, they can not easily model situations in which the local temperature, which controls the local reaction rate, changes differently from the local pressure. With the advent of larger, faster, parallel computers, microscopic modeling of the hot spot formation processes and Arrhenius chemical kinetic reaction rates that dominate shock initiation and detonation can now be attempted. Such a modeling effort can not be successful without nanosecond or better time resolved experimental data on these processes. The experimental and modeling approaches required to build the next generation of physically realistic reactive flow models are discussed.

  3. Initial results of NEXT-DEMO, a large-scale prototype of the NEXT-100 experiment

    CERN Document Server

    Álvarez, V; Cárcel, S; Castel, J; Cebrián, S; Cervera, A; Conde, C A N; Dafni, T; Dias, T H V T; Díaz, J; Egorov, M; Esteve, R; Evtoukhovitch, P; Fernandes, L M P; Ferrario, P; Ferreira, A L; Freitas, E D C; Gehman, V M; Gil, A; Goldschmidt, A; Gómez, H; Gómez-Cadenas, J J; González-Díaz, D; Gutiérrez, R M; Hauptman, J; Morata, J A Hernando; Herrera, D C; Iguaz, F J; Irastorza, I G; Jinete, M A; Labarga, L; Laing, A; Liubarsky, I; Lopes, J A M; Lorca, D; Losada, M; Luzón, G; Marí, A; Martín-Albo, J; Martínez, A; Miller, T; Moiseenko, A; Monrabal, F; Monteiro, C M B; Mora, F J; Moutinho, L M; Vidal, J Muñoz; da Luz, H Natal; Navarro, G; Nebot, M; Nygren, D; Oliveira, C A B; Palma, R; Pérez, J; Aparicio, J L Pérez; Renner, J; Ripoll, L; Rodríguez, A; Rodríguez, J; Santos, F P; Santos, J M F dos; Segui, L; Serra, L; Shuman, D; Simón, A; Sofka, C; Sorel, M; Toledo, J F; Tomás, A; Torrent, J; Tsamalaidze, Z; Vázquez, D; Veloso, J F C A; Villar, J A; Webb, R; White, J T; Yahlali, N

    2012-01-01

    NEXT-DEMO is a large scale prototype and demonstrator of the NEXT-100 High Pressure Xenon Gas TPC, which will search for the neutrinoless double beta decay of Xe-136 using 100-150 kg of enriched xenon gas. The apparatus was built to prove the expected performance of NEXT-100, namely, energy resolution better than 1% FWHM at 2.5 MeV and event topological reconstruction. In this paper we describe the operation and initial results of the detector.

  4. Seeding Entrepreneurship Across Campus Early Implementation Experiences of the Kauffman Campuses Initiative

    OpenAIRE

    Lara Hulsey; Linda Rosenberg; Benita Kim

    2006-01-01

    Entrepreneurship has long been a fundamental aspect of American society, serving as an important contributor to economic growth. However, only recently has entrepreneurship begun to develop as an academic field in U.S. colleges and universities. The Ewing Marion Kauffman Foundation launched the Kauffman Campuses Initiative in eight U.S. universities to encourage campuswide expansion of entrepreneurship programs and activities. This report provides a cross-site analysis of implementation exper...

  5. Initiating an Action Research Programme for University EFL Teachers: Early Experiences and Responses

    Directory of Open Access Journals (Sweden)

    Anne Burns

    2016-10-01

    Full Text Available Accounts of how teacher educators begin to plan, develop, and support action research programmes for language teachers are rare, as are descriptions of the responses of the teachers who participate. This article documents and analyses the initial processes of introducing and supporting a new programme of action research for language teachers at the Universidad Chileno-Británica de Cultura (UCBC in Santiago, Chile. To evaluate the setting up of the programme and how the teachers have perceived it in its early stages, the authors, who are the programme facilitators, have conducted a meta- study. Data include workshop and meeting recordings, workshop observation notes, a reflective account, and a teacher questionnaire. The findings indicate that the teachers value the input and collaboration provided by an initial workshop, and subsequent meetings and discussions, very highly, but that issues of time, student involvement, and academic literature are areas for further debate and development. The article ends by drawing out the broader implications for UCBC and for others wishing to initiate similar action research programmes.

  6. Initial Experience of Laparoendoscopic Single-Site Radical Prostatectomy Requiring Well-Equipped Appliances and a Skilled Technique

    Directory of Open Access Journals (Sweden)

    Joo Yong Lee

    2010-12-01

    Full Text Available We report an initial experience in laparoendoscopic single-site radical prostatectomy (LESSRP using a homemade single-port device for prostate cancer. A 63-year-old man was diagnosed with prostate cancer. The patient underwent LESSRP using an Alexis® wound retractor, which was inserted through an umbilical incision. A homemade single-port device was made by fixing a 61/2 surgical glove to the retractor’s outer ring and securing the glove finger to the end of 4 trocars with a tie. Using the flexible laparoscopic and rigid instruments, LESSRP was performed using a procedure similar to conventional laparoscopic radical prostatectomy (LRP. In the current case, we could not perform complete LESSRP, so we report our initial experience and consider the reason why laparoendoscopic single-site surgery was converted to conventional LRP.

  7. Initiation of Addiction Treatment and Access to Services: Young Adults' Accounts of Their Help-Seeking Experiences.

    Science.gov (United States)

    Wagner, Vincent; Bertrand, Karine; Flores-Aranda, Jorge; Acier, Didier; Brunelle, Natacha; Landry, Michel; Brochu, Serge

    2016-12-04

    Substance addiction in young adults is particularly problematic. Yet, much remain at stake in understanding the specifics of this population's access to services. The objective of this study is to explore young adults' initiation of substance misuse treatment. Our study sample was composed of 35 individuals aged 18 to 30 with problematic psychoactive substance use who have been identified in criminal courts, hospital emergency departments, and Health and Social Services Centers in Québec (Canada). A thematic analysis was performed on the 62 semi-structured interviews conducted with participants. Three components emerged. First, personal elements-expectations, individual motivations, perceptions of use, and capacity to control it-influence initiation of substance misuse treatment. Second, family and peers have noticeable influences. Finally, system characteristics and prior care experiences also shape the process. Consideration should be given to tailor interventions that can reach young adults and encourage them to initiate appropriate care.

  8. Post operatory analgesia in caesarean surgery.

    Directory of Open Access Journals (Sweden)

    Bárbara Lucía Cabezas Poblet

    2003-12-01

    Full Text Available Background: Post-operatory pain is a spread and constant problem during the care of the surgical patient. The tendency to find new therapeutic techniques to alleviate pain has lead scientists to make and use a great variety of analgesics which are administered by different vias. The effects of narcotics on the new born are well known and the author´s worries about this problem has been the motivational point to search about the use of epidural and intratecal narcotics in the obstetric patient. Objective: To assess the use of peridural liophilized morphine in the Caesarean Section Method: A study of a series of cases was carried out at the Surgical Unit of the Gynecobstetric service of the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ from February 2001 to August 2002 . This search included 120 patient who were selected to elective iterative caesarean section The variables under study were blood pressure, pulse and respiration during the pre- trans and post operative phases, onset of the anaesthetic effect and its duration, peri operatory complications , quality of the post operatory analgesia and its effect on the newborn measured by using Apgar values . The statistical procedure was developed by using the statistical package Epi Info 6. Results: The onset of the anesthetic effect and the duration of the anesthesia were not modified with the use of liophilized morphine. Vital signs remained within normal limits in most of the patients during the pre- trans and post operatory phases. The complications were: pruritus, urinary retention, nausea nad vomiting. The quality of the analgesia was satisfactory in most of the patients. The Apgar values were normal in all neonates. Conclusion: The administration of peridural liophilized morphine in elective caesarean sections is a reliable, sure and useful method in our environment.

  9. Analgesia acupuntural en las extracciones dentarias

    Directory of Open Access Journals (Sweden)

    Juana María Abreu Correa

    1997-12-01

    Full Text Available Se compararon los resultados de la exodoncia con anestesia y con analgesia con acupuntura en 2 grupos de 60 pacientes cada uno, en los cuales se evaluaron los efectos de ambos tratamientos a las 24, 48 y 72 horas de realizada la extracción. Los aspectos evaluados fueron las complicaciones posextracción y la presencia de dolor, molestias o inflamación con posterioridad a ésta. En el grupo de los pacientes a los que se les aplicó la anestesia a las 24 horas, 51 tenían inflamación y a las 72 horas 31 continuaban con ligero enrojecimiento e inflamación, 3 casos presentaron alveolitis fungosa. Entre los que recibieron la acupuntura a las 24 horas, 26 tenían ligero enrojecimiento que desapareció antes de las 72 horas sin otras complicaciones.The results of exodontia with anesthesia and with acupuncture analgesia are compared in two groups of 60 patients each, in which the effects of both treatments were evaluated 24, 48 and 72 hours after the extraction. The aspects evaluated were the postextraction complications and the presence of pain, disturbance or inflammation after it. In the group of patients that received anesthesia, 51 had inflammation 24 hours after the extraction, whereas 31 still had a mild redness and inflammation 72 hours later. 3 patients presented fungous alveolitis. Among those who were treated with acupuncture, 26 showed a mild redness 24 hours after the extraction that dissapeared before the 72 hours without other complications.

  10. Preemptive analgesia with ketamine for laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Harsimran Singh

    2013-01-01

    Full Text Available Background: The aim of preemptive analgesia is to reduce central sensitization that arises from noxious inputs across the entire perioperative period. N-methyl d-aspartate receptor antagonists have the potential for attenuating central sensitization and preventing central neuroplasticity. Materials and Methods: Patients undergoing laparoscopic cholecystectomy were randomized into four groups of 20 patients each, who were administered the study drug intravenously 30 min before incision. Groups A, B, and C received ketamine in a dose of 1.00, 0.75 and 0.50 mg/kg, respectively, whereas group D received isotonic saline. Anesthetic and surgical techniques were standardized. Postoperatively, the degree of pain at rest, movement, and deep breathing using visual analogue scale, time of request for first analgesic, total opioid consumption, and postoperative nausea and vomiting were recorded in postanesthesia care unit for 24 h. Results: Pain scores were highest in Group D at 0 h. Groups A, B, and C had significantly decreased postoperative pain scores at 0, 0.5, 3, 4, 5, 6, and 12 h. Postoperative analgesic consumption was significantly less in groups A, B, and C as compared with group D. There was no significant difference in the pain scores among groups A, B, and C. Group A had a significantly higher heart rate and blood pressure than groups B and C at 0 and 0.5 h along with 10% incidence of hallucinations. Conclusion: Preemptive ketamine has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. The lower dose of 0.5 mg/kg being devoid of any adverse effects and hemodynamic changes is an optimal dose for preemptive analgesia in patients undergoing laparoscopic cholecystectomy.

  11. Preemptive analgesia with Ketamine for Laparoscopic cholecystectomy

    Science.gov (United States)

    Singh, Harsimran; Kundra, Sandeep; Singh, Rupinder M; Grewal, Anju; Kaul, Tej K; Sood, Dinesh

    2013-01-01

    Background: The aim of preemptive analgesia is to reduce central sensitization that arises from noxious inputs across the entire perioperative period. N-methyl d-aspartate receptor antagonists have the potential for attenuating central sensitization and preventing central neuroplasticity. Materials and Methods: Patients undergoing laparoscopic cholecystectomy were randomized into four groups of 20 patients each, who were administered the study drug intravenously 30 min before incision. Groups A, B, and C received ketamine in a dose of 1.00, 0.75 and 0.50 mg/kg, respectively, whereas group D received isotonic saline. Anesthetic and surgical techniques were standardized. Postoperatively, the degree of pain at rest, movement, and deep breathing using visual analogue scale, time of request for first analgesic, total opioid consumption, and postoperative nausea and vomiting were recorded in postanesthesia care unit for 24 h. Results: Pain scores were highest in Group D at 0 h. Groups A, B, and C had significantly decreased postoperative pain scores at 0, 0.5, 3, 4, 5, 6, and 12 h. Postoperative analgesic consumption was significantly less in groups A, B, and C as compared with group D. There was no significant difference in the pain scores among groups A, B, and C. Group A had a significantly higher heart rate and blood pressure than groups B and C at 0 and 0.5 h along with 10% incidence of hallucinations. Conclusion: Preemptive ketamine has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. The lower dose of 0.5 mg/kg being devoid of any adverse effects and hemodynamic changes is an optimal dose for preemptive analgesia in patients undergoing laparoscopic cholecystectomy. PMID:24249984

  12. Outcome of MRI-guided vacuum-assisted breast biopsy – initial experience at Institute of Oncology Ljubljana, Slovenia

    OpenAIRE

    Zebic-Sinkovec, Marta; Hertl, Kristijana; Kadivec, Maksimiljan; Cavlek, Mihael; Podobnik, Gasper; Snoj, Marko

    2012-01-01

    Background. Like all breast imaging modalities MRI has limited specificity and the positive predictive value for lesions detected by MRI alone ranges between 15 and 50%. MRI guided procedures (needle biopsy, presurgical localisation) are mandatory for suspicious findings visible only at MRI, with potential influence on therapeutic decision. The aim of this retrospective study was to evaluate our initial clinical experience with MRI-guided vacuum-assisted breast biopsy as an alternative to sur...

  13. An Experience-Based Learning Framework: Activities for the Initial Development of Sustainability Competencies

    Science.gov (United States)

    Caniglia, Guido; John, Beatrice; Kohler, Martin; Bellina, Leonie; Wiek, Arnim; Rojas, Christopher; Laubichler, Manfred D.; Lang, Daniel

    2016-01-01

    Purpose: This paper aims to present an experience-based learning framework that provides a bottom-up, student-centered entrance point for the development of systems thinking, normative and collaborative competencies in sustainability. Design/methodology/approach: The framework combines mental mapping with exploratory walking. It interweaves…

  14. Initial Clinical Experience With Surgical Technique of Robot-assisted Transperitoneal Laparoscopic Partial Nephrectomy

    Directory of Open Access Journals (Sweden)

    Cheng-Kuang Yang

    2009-12-01

    Conclusion: Robot-assisted LPN is feasible and may be a viable alternative to open or LPN in selected patients with small exophytic renal tumors. Compared with standard LPN, the robotic assisted LPN approach with precise renal reconstruction under a safe warm ischemia time is feasible and can be easily adopted by those with experience in robot-assisted surgery.

  15. Initial tensile test results from J316 stainless steel irradiated in the HFIR spectrally tailored experiment

    Energy Technology Data Exchange (ETDEWEB)

    Pawel, J.E.; Grossbeck, M.L.; Rowcliffe, A.F. [Oak Ridge National Lab., TN (United States)] [and others

    1995-04-01

    The objective of this work is to determine the effects of neutron irradiation on the mechanical properties of austenitic stainless steel alloys. In this experiment, the spectrum has been tailored to reduce the thermal neutron flux and achieve a He/dpa level near that expected in a fusion reactor.

  16. Experiences of Student Speech-Language Pathology Clinicians in the Initial Clinical Practicum: A Phenomenological Study

    Science.gov (United States)

    Nelson, Lori A.

    2011-01-01

    Speech-language pathology literature is limited in describing the clinical practicum process from the student perspective. Much of the supervision literature in this field focuses on quantitative research and/or the point of view of the supervisor. Understanding the student experience serves to enhance the quality of clinical supervision. Of…

  17. Initial experience with transperitoneal laparoscopic nephrectomy in an Irish hospital setting.

    LENUS (Irish Health Repository)

    Forde, J C

    2009-08-01

    Laparoscopic nephrectomy has gained widespread acceptance as a treatment for both benign and malignant conditions and is becoming increasingly popular in Irish hospitals. We report a single surgeon, single centre experience with 20 consecutive laparoscopic nephrectomies comparing them to 20 open cases performed prior to the establishment of a laparoscopic service.

  18. Initiation of subduction at Atlantic-type margins: Insights from laboratory experiments

    Science.gov (United States)

    Faccenna, Claudio; Giardini, Domenico; Davy, Philippe; Argentieri, Alessio

    1999-02-01

    We have performed scaled lithospheric experiments to simulate the behavior of a ocean-continent plate system subjected to compressional strain over a geological timescale. Experiments have been constructed using sand and silicone putty, representing the brittle upper crust and the ductile lower crust/upper mantle, respectively; the layers floated on glucose syrup simulating the asthenosphere. Compressional stress is achieved by displacing a piston at constant velocity perpendicular to the plate margin. We investigate the influence of four parameters: (1) the negative buoyancy of oceanic lithosphere, (2) the horizontal body forces between continent and ocean, and (3) the brittle and (4) the ductile strength of the passive margin. Two numbers express the importance of these parameters: the Argand number (Ar), representing the ratio between the body force of continent and its integrated strength, and the buoyancy number (F), representing the ratio between the buoyancy force of ocean and its ductile resistance. We obtain three scenarios. In experiments with Ar 3 and F 1 the continent collapses toward the ocean, producing back-arc extension and subduction, simulating the post-Alpine Neogene evolution of the Mediterranean area. In experiments with Ar 3 and F > 1 the passive margin slowly evolves toward trench nucleation with the formation of a viscous mantle instability. We conclude that the latter model can be applied to the evolution of Atlantic-type margins, where there is evidence of this ongoing process.

  19. Investigating the Impact of Mediated Learning Experiences on Cooperative Peer Communication during Group Initiatives

    Science.gov (United States)

    White, Robert; Dinos, Sokratis

    2010-01-01

    This study investigates how structured Mediated Learning Experiences may improve peer-cooperative communication within problem-solving task exercises. Two groups (n = 22) of Year 8 students (mean age 13 +/- 5 months) were randomly selected to participate in this study. The study began with two one-hour sessions of activity-based problem-solving…

  20. An Experience-Based Learning Framework: Activities for the Initial Development of Sustainability Competencies

    Science.gov (United States)

    Caniglia, Guido; John, Beatrice; Kohler, Martin; Bellina, Leonie; Wiek, Arnim; Rojas, Christopher; Laubichler, Manfred D.; Lang, Daniel

    2016-01-01

    Purpose: This paper aims to present an experience-based learning framework that provides a bottom-up, student-centered entrance point for the development of systems thinking, normative and collaborative competencies in sustainability. Design/methodology/approach: The framework combines mental mapping with exploratory walking. It interweaves…

  1. Teachers' Experiences of a Single-Sex Initiative in a Co-Education School

    Science.gov (United States)

    Gray, Colette; Wilson, Joanne

    2006-01-01

    Argued to "raise boys' grades" and "boost boys' academic achievement", single-sex classes in coeducation schools is one strategy among a plethora aimed at raising standards. This paper explores the experiences of teachers in one coeducation post-primary school that sought to raise academic performance, particularly among boys, and to improve…

  2. Lumbosacral epidural magnesium prolongs ketamine analgesia in conscious sheep Sulfato de magnésio prolonga a analgesia epidural lombosacral induzida pela quetamina em carneiros

    Directory of Open Access Journals (Sweden)

    Rafael DeRossi

    2012-02-01

    Full Text Available PURPOSE: To determine the analgesic, motor, sedation and systemic effects of lumbosacral epidural magnesium sulphate added to ketamine in the sheep. METHODS: Six healthy adult male mixed-breed sheep; weighing 43 ± 5 kg and aged 20-36 months. Each sheep underwent three treatments, at least 2 weeks apart, via epidural injection: (1 ketamine (KE; 2.5 mg/kg, (2 magnesium sulphate (MG; 100 mg, and (3 KE + MG (KEMG; 2.5 mg/kg + 100 mg, respectively. Epidural injections were administered through the lumbosacral space. Analgesia, motor block, sedation, cardiovascular effects, respiratory rate, skin temperature, and rectal temperature were evaluated before (baseline and after drug administration as needed. RESULTS: The duration of analgesia with the lumbosacral epidural KEMG combination was 115 ± 17 min (mean ± SD, that is, more than twice that obtained with KE (41 ± 7 min or MG (29 ± 5 min alone. KE and KEMG used in this experiment induced severe ataxia. The heart rate and arterial blood pressures changes were no statistical difference in these clinically health sheep. CONCLUSION: The dose of magnesium sulphate to lumbosacral epidural ketamine in sheep is feasible, and can be used in procedures analgesics in sheep.OBJETIVO: Determinar os efeitos analgésicos, motores, sedativos e sistêmicos da adição de sulfato de magnésio na analgesia epidural com quetamina em carneiros. MÉTODOS: Foram utilizados seis carneiros machos sadios, pesando 43 ± 5 kg, com idade entre 20 a 36 meses. Cada animal recebeu três tratamentos, com duas semanas entre experimentos via administração epidural: (1 quetamina (KE; 2,5 mg/kg, (2 sulfato de magnésio (MG; 100 mg e (3 KE + MG (KEMG; 2,5 mg/kg + 100 mg, respectivamente. As administrações epidurais foram administradas no espaço lombosacral. Analgesia, bloqueio motor, sedação, efeitos cardiovasculares, freqüência respiratória, temperatura retal e de pele foram avaliados antes (basal e depois da administra

  3. Ontogeny of analgesia elicited by non-nutritive suckling in acute and persistent neonatal rat pain models.

    Science.gov (United States)

    Anseloni, V; Ren, K; Dubner, R; Ennis, M

    2004-06-01

    Significant analgesic and calming effects in human infants and neonatal rodents are produced by orogustatory and orotactile stimuli associated with nursing. These naturally occurring analgesic stimuli may help to protect the vulnerable developing nervous system from the long-term effects of neonatal tissue injury. However, the efficacy of orotactile-induced analgesia across the pre-weaning period, as well as its effects on persistent inflammatory pain, is unknown. Here, we investigated the developmental profile of analgesia produced by orotactile stimulation during non-nutritive suckling in rats. The effects of suckling, as compared to non-suckling littermates, on nocifensive withdrawal responses to thermal and mechanical stimuli were examined at postnatal (P) days P0, P3, P10, P17 and P21. In some rats, Complete Freund's adjuvant (CFA) was injected in a fore- or hindpaw to produce inflammation. For thermal stimuli, suckling significantly increased forepaw withdrawal latencies at P3, P10 and P17, while hindpaw responses were increased at P3 and P10, but not at P17. In inflamed pups, suckling increased fore- and hindpaw response latencies at P10 and P17, but not at P0 or P21. Suckling-induced analgesia was naloxone-insensitive. For mechanical stimuli, suckling-induced analgesia was present at P3, P10 and P17, but not at P21, for both fore- and hindpaws in naïve and inflamed animals. Additionally, suckling had a small but significant effect at P0 for the forepaw in inflamed pups. In nearly all experiments, the peak effect of suckling for thermal and mechanical stimuli occurred at P10. These results indicate that orotactile analgesia, like orogustatory analgesia, is absent or minimal at P0, appears consistently at approximately P3 and is maximal at P10. Unlike gustatory analgesia in rats however, orotactile analgesia persists at least to P17. Orotactile stimulation during suckling effectively reduces transient pain elicited by thermal and mechanical stimuli, as well

  4. A meta-analysis of brain mechanisms of placebo analgesia: consistent findings and unanswered questions.

    Science.gov (United States)

    Atlas, Lauren Y; Wager, Tor D

    2014-01-01

    Placebo treatments reliably reduce pain in the clinic and in the lab. Because pain is a subjective experience, it has been difficult to determine whether placebo analgesia is clinically relevant. Neuroimaging studies of placebo analgesia provide objective evidence of placebo-induced changes in brain processing and allow researchers to isolate the mechanisms underlying placebo-based pain reduction. We conducted formal meta-analyses of 25 neuroimaging studies of placebo analgesia and expectancy-based pain modulation. Results revealed that placebo effects and expectations for reduced pain elicit reliable reductions in activation during noxious stimulation in regions often associated with pain processing, including the dorsal anterior cingulate, thalamus, and insula. In addition, we observed consistent reductions during painful stimulation in the amygdala and striatum, regions implicated widely in studies of affect and valuation. This suggests that placebo effects are strongest on brain regions traditionally associated with not only pain, but also emotion and value more generally. Other brain regions showed reliable increases in activation with expectations for reduced pain. These included the prefrontal cortex (including dorsolateral, ventromedial, and orbitofrontal cortices), the midbrain surrounding the periaqueductal gray, and the rostral anterior cingulate. We discuss implications of these findings as well as how future studies can expand our understanding of the precise functional contributions of the brain systems identified here.

  5. Graduate Medical Education as a Lever for Collaborative Change: One Institution's Experience with a Campuswide Patient Safety Initiative.

    Science.gov (United States)

    Vath, Richard J; Musso, Mandi W; Rabalais, Lauren S; Dunbar, Alston; Hosea, Stephen; Johnson, Angela C; Bolton, Michael; Rhynes, Vernon K; Caffery, Terrell S; Tynes, L Lee; Mantzor, Savarra; Miller, Bahnsen; Calongne, Laurinda L

    2016-01-01

    The 2013 closure of a public hospital in Baton Rouge, LA transformed graduate medical education (GME) at Our Lady of the Lake Regional Medical Center (OLOL). Administrators were tasked with incorporating residents into patient safety and quality improvement initiatives to fulfill regulatory obligations. This report outlines our experiences as we built these patient safety and quality improvement initiatives in a rapidly expanding independent academic medical center. We joined the Alliance of Independent Academic Medical Centers (AIAMC) to meet and learn from national peers. To fulfill the scholarly activity requirement of the AIAMC's National Initiative IV, we formed a multidisciplinary team to develop a patient safety education project. Prioritized monthly team meetings allowed for project successes to be celebrated and circulated within the organization. The public-private partnership that more than quadrupled the historic size of GME at OLOL has, in the past 2 years, led to the development of an interdisciplinary team. This team has expanded to accommodate residency program leadership from across the campus. Our National Initiative IV project won a national award and inspired several follow-up initiatives. In addition, this work led to the formation of a Patient Safety and Clinical Quality Improvement fellowship that matched its first fellow in 2015. Through the commitment and support of hospital and medical education leaders, as well as a focus on promoting cultural change through scholarly activity, we were able to greatly expand patient safety and quality improvement efforts in our institution.

  6. Fostering of Less Commonly Taught Language Initiatives — The Minnesota Experience

    Directory of Open Access Journals (Sweden)

    Leonard Anthony Polakiewicz

    2007-01-01

    Full Text Available First, let me express my sincere gratitude to NCOLCTL for awarding me this prestigious recognition bearing the name of a man who was responsible for many important initiatives and contributions relating to the promotion of the interests of LCTLs. Although for the past 36 years I have been teaching Russian and Polish, in my discussion today I will focus mainly on Polish, the less common of my less commonly taught languages. We can view the future of LCTLs in two ways: paraphrasing Anton Chekhov—one is the view that everything passes and nothing matters; the other view is that nothing passes and everything matters. If we are guided by the first outlook in assessing the present and future status of LCTLs we will conclude that despite all of our initiatives to promote and safeguard the interests of LCTLs, in the final analysis developments beyond our control will threaten the survival of LCTLs as part of institutionalized curriculum at many institutions. Thus, all of our efforts will prove to be in vain.

  7. Initial 10-year Experience of Sperm Cryopreservation Services for Cancer Patients

    Directory of Open Access Journals (Sweden)

    Hong-Chiang Chang

    2006-01-01

    Full Text Available Offering sperm cryopreservation to preserve the fertility of male cancer patients is a relatively recent service in Asia. This study analyzed the types of cancer, timing of collection, sperm quality, and utilization for reproductive services by patients during a 10-year period at a medical center in Taiwan. A total of 75 oncology patients elected to freeze sperm for fertility preservation at our medical center during the initial 10 years of the availability of this service. The mean age of the patients was 25.7 years. Storage was discontinued in 13 (17% patients and their survival duration was 13.1 ±11.1 months. The utilization rate of sperm cryo-preservation was 2.8% (75/2642. The types of cancer varied, with leukemia (35%, lymphoma (25%, and testicular cancer (13% comprising the largest groups. A significantly lower sperm count was found in patients with chronic myelogenous leukemia, suggesting the need for earlier sperm collection after initiation of cancer treatment. Only three (4% patients utilized their specimens for reproductive purposes. There was no clinical pregnancy during the study period, although one biochemical pregnancy was achieved. The low rates of sperm cryostorage for fertility preservation in cancer patients in this study suggest that there is a need for greater emphasis of this option for male oncology patients whose fertility is likely to be affected by chemotherapeutic treatment.

  8. The Accelerating Access Initiative: experience with a multinational workplace programme in Africa.

    Science.gov (United States)

    Van der Borght, S; Janssens, V; Schim van der Loeff, M F; Kajemba, A; Rijckborst, H; Lange, J M A; Rinke de Wit, T F

    2009-10-01

    A multinational company with operations in several African countries was committed to offer antiretroviral treatment to its employees and their dependants. The Accelerating Access Initiative (AAI), an initiative of six pharmaceutical companies and five United Nations' agencies, offered the possibility of obtaining brand antiretroviral drugs (ARVs) at 10% of the commercial price. PharmAccess, a foundation aimed at removing barriers to AIDS treatment in Africa, helped to establish an HIV policy and treatment guidelines, and a workplace programme was rolled out from September 2001. Private sector employers in Africa are keen to take more responsibility in HIV prevention and AIDS care. An important hurdle for African employers remains the price and availability of ARVs. The programme encountered various hurdles, among them the need for multiple contracts with multiple companies, complex importation procedures, taxes levied on ARVs, lack of support from pharmaceutical companies in importation and transportation, slow delivery of the drugs, lack of institutional memory in pharmaceutical companies and government policies excluding the company from access to ARVs under the AAI. The launch of the AAI enabled this multinational company to offer access to ARVs to its employees and dependants. The private sector should have access to these discounted drugs under the AAI. A network of local AAI offices should be created to assist in logistics of drugs ordering, purchase and clearance. No taxes should be levied on ARVs.

  9. Neostigmine Decreases Bupivacaine Use by Patient-Controlled Epidural Analgesia During Labor: A Randomized Controlled Study

    Science.gov (United States)

    Ross, Vernon H.; Pan, Peter H.; Owen, Medge D; Seid, Melvin H.; Harris, Lynne; Clyne, Brittany; Voltaire, Misa; Eisenach, James C.

    2009-01-01

    Background Intrathecal neostigmine produces analgesia, but also severe nausea. In contrast, epidural neostigmine enhances opioid and local anesthetic analgesia without causing nausea. Previous studies examined only single epidural neostigmine bolus administration and did not assess the efficacy of continuous epidural infusion or several aspects of maternal and fetal safety. We therefore tested the hypothesis that epidural neostigmine in combination with bupivacaine by continuous infusion during labor would reduce the amount of bupivacaine required. Methods Twelve healthy women scheduled for elective cesarean delivery were assigned to receive epidural neostigmine, 40 μg (first 6 subjects) or 80 μg (second 6 subjects) as a single bolus, with fetal heart rate and uterine contractions monitored for 20 minutes. In a subsequent experiment, 40 healthy laboring women were randomized to receive bupivacaine 1.25 mg/mL alone or with neostigmine 4 μg/mL by patient-controlled epidural analgesia. The primary outcome measure was hourly bupivacaine use. Results Epidural neostigmine bolus did not alter baseline fetal heart rate, induce contractions or produce nausea. Epidural neostigmine infusion reduced bupivacaine requirement by 19% in all patients and 25% in those with > 4 hours of treatment (P<0.05 for both), but might have contributed to the incidence of mild sedation. Mode of delivery, incidence of maternal nausea and fetal heart rate abnormality were similar between groups. Conclusions These data show that adding epidural neostigmine 4 μg/mL reduces the hourly bupivacaine requirement by 19% to 25% with patient-controlled epidural analgesia during labor. Administered as a bolus and by continuous infusion at the studied doses, epidural neostigmine does not cause nausea and does not induce uterine contractions or fetal heart rate abnormalities, but mild sedation can occur. PMID:19377050

  10. Radiopurity control in the NEXT-100 double beta decay experiment: procedures and initial measurements

    CERN Document Server

    Alvarez, V; Bettini, A; Borges, F I G M; Carcel, S; Castel, J; Catala, J M; Cebrian, S; Cervera, A; Conde, C A N; Dafni, T; Dias, T H V T; Diaz, J; Egorov, M; Esteve, R; Evtoukhovitch, P; Fernandes, L M P; Ferrario, P; Ferreira, A L; Ferrer-Ribas, E; Freitas, E D C; Gehman, V M; Gil, A; Giomataris, I; Goldschmidt, A; Gomez, H; Gomez-Cadenas, J J; Gonzalez, K; Gonzalez-Diaz, D; Gutierrez, R M; Hauptman, J; Morata, J A Hernando; Herrera, D C; Herrero, V; Iguaz, F J; Irastorza, I G; Kalinnikov, V; Labarga, L; Liubarsky, I; Lopes, J A M; Lorca, D; Losada, M; Luzon, G; Mari, A; Martin-Albo, J; Martinez, A; Miller, T; Moiseenko, A; Monrabal, F; Monteiro, C M B; Monzo, J M; Mora, F J; Moutinho, L M; Vidal, J Munoz; da Luz, H Natal; Navarro, G; Nebot, M; Nygren, D; Oliveira, C A B; de Solorzano, A Ortiz; Palma, R; Perez, J; Aparicio, J L Perez; Renner, J; Ripoll, L; Rodriguez, A; Rodriguez, J; Santos, F P; Santos, J M F dos; Segui, L; Serra, L; Shuman, D; Simon, A; Sofka, C; Sorel, M; Toledo, J F; Tomas, A; Torrent, J; Tsamalaidze, Z; Vazquez, D; Velicheva, E; Veloso, J F C A; Villar, J A; Webb, R C; Weber, T; White, J; Yahlali, N

    2012-01-01

    The Neutrino Experiment with a Xenon TPC (NEXT) is intended to investigate the neutrinoless double beta decay of 136Xe, which requires a severe suppression of potential backgrounds. An extensive screening and material selection process is underway for NEXT since the control of the radiopurity levels of the materials to be used in the experimental set-up is a must for rare event searches. First measurements based on Glow Discharge Mass Spectrometry and gamma-ray spectroscopy using ultra-low background germanium detectors at the Laboratorio Subterr\\'aneo de Canfranc (Spain) are described here. Activity results for natural radioactive chains and other common radionuclides are summarized, being the values obtained for some materials like copper and stainless steel very competitive. The implications of these results for the NEXT experiment are also discussed.

  11. Role of laser myringotomy in a pediatric otolaryngology practice: initial experience

    Science.gov (United States)

    Shah, Udayan K.

    2001-05-01

    A new technology (OtoLAM) to fenestrate the tympanic membrane with the carbon dioxide laser (CO2), in the office or the operating room, has been introduced over the last three years. While not new conceptually, this product offers the ability to easily create a precise window into the middle ear using a portable system. Controversy regarding the indications and benefits of this technique, amplified by the costs of the system and the marketing of the technology prior to extensive clinical testing, has plagued the clinical application of this technology. We report our experience over the past year with this system in a busy pediatric otolaryngology practice. Laser fenestration of the tympanic membrane has been useful for the insertion of tympanostomy tubes, and for the minimally invasive evaluation of the middle ear. Our small experience to date reveals that there is a limited role for laser tympanic membrane fenestration in a busy pediatric otolaryngology practice.

  12. [Epidural obstetric analgesia, maternal fever and neonatal wellness parameters].

    Science.gov (United States)

    Fernández-Guisasola, J; Delgado Arnáiz, C; Rodríguez Caravaca, G; Serrano Rodríguez, M L; García del Valle, S; Gómez-Arnau, J I

    2005-04-01

    To study the relation between epidural analgesia and the development of maternal fever during labor and childbirth, and to determine the possible relation between that association and neonatal welfare and in the performance of tests to rule out sepsis in newborns. Prospective study of all women who gave birth at Fundación Hospital Alcorcón over a period of 3 years. All the women were offered epidural analgesia based on infusion of 0.0625% bupivacaine and 2 microg x mL(-1). Data collected were age, nulliparity, epidural analgesia infusion, induction of labor, uterine stimulation with oxytocin, type of birth, fetal weight, duration of dilation and expulsion, Apgar score (at 1 and 5 minutes), umbilical artery pH, and maternal temperature. Data for 4364 women were analyzed. Fever developed during labor in 5.7%; 93.7% of the fevers occurred in women receiving epidural analgesia (Pneonatal wellness parameters studied.

  13. Shock initiation behavior of PBXN-9 determined by gas gun experiments

    Energy Technology Data Exchange (ETDEWEB)

    Sanchez, Nathaniel J [Los Alamos National Laboratory; Gustavsen, Richard L [Los Alamos National Laboratory; Hooks, Daniel E [Los Alamos National Laboratory

    2009-01-01

    The shock to detonation transition was evaluated in the HMX based explosive PBXN-9 by a series of light-gas gun experiments. PBXN-9 consists of 92 wt% HMX, 2wt% Hycar 4054 & 6 wt% dioctyl adipate with a density of 1.75 g/cm{sup 3} and 0.8% voids. The experiments were designed to understand the specifics of wave evolution and the run distance to detonation as a function of input shock pressure. These experiments were conducted on gas guns in order to vary the input shock pressure accurately. The primary diagnostics were embedded magnetic gauges, which are based on Faraday's law of induction, and Photon Doppler Velocimetry (PDV). The run distance to detonation vs. shock pressure, or 'Pop plot,' was redefined as log(X*) = 2.14-1.82 log(P), which is substantially different than previous data. The Hugoniot was refined as U{sub s} = 2.32 + 2.21 U{sub p}. This data will be useful for the development of predictive models for the safety and performance of PBXN-9 along with providing increased understanding of HMX based explosives in varying formulations.

  14. Conventional versus Analgesia-Oriented Combination Sedation on Recovery Profiles and Satisfaction after ERCP: A Randomized Trial.

    Directory of Open Access Journals (Sweden)

    Seokyung Shin

    Full Text Available The importance of providing effective analgesia during sedation for complex endoscopic procedures has been widely recognized. However, repeated administration of opioids in order to achieve sufficient analgesia may carry the risk of delayed recovery after propofol based sedation. This study was done to compare recovery profiles and the satisfaction of the endoscopists and patients between conventional balanced propofol sedation and analgesia-oriented combination sedation for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP.Two hundred and two adult patients scheduled for ERCP were sedated by either the Conventional (initial bolus of meperidine with propofol infusion or Combination (repeated bolus doses of fentanyl with propofol infusion method. Recovery profiles, satisfaction levels of the endoscopists and patients, drug requirements and complications were compared between groups.Patients of the Combination Group required significantly less propofol compared to the Conventional Group (135.0 ± 68.8 mg vs. 165.3 ± 81.7 mg, P = 0.005. Modified Aldrete scores were not different between groups throughout the recovery period, and recovery times were also comparable between groups. Satisfaction scores were not different between the two groups in both the endoscopists and patients (P = 0.868 and 0.890, respectively.Considering the significant reduction in propofol dose, the non-inferiority of recovery profiles and satisfaction scores of the endoscopists and patients, analgesia oriented combination sedation may be a more safe yet effective sedative method compared to conventional balanced propofol sedation during ERCP.

  15. Conventional versus Analgesia-Oriented Combination Sedation on Recovery Profiles and Satisfaction after ERCP: A Randomized Trial.

    Science.gov (United States)

    Shin, Seokyung; Oh, Tak Geun; Chung, Moon Jae; Park, Jeong Youp; Park, Seung Woo; Chung, Jae Bok; Song, Si Young; Cho, Jooyoun; Park, Sang-Hun; Yoo, Young Chul; Bang, Seungmin

    2015-01-01

    The importance of providing effective analgesia during sedation for complex endoscopic procedures has been widely recognized. However, repeated administration of opioids in order to achieve sufficient analgesia may carry the risk of delayed recovery after propofol based sedation. This study was done to compare recovery profiles and the satisfaction of the endoscopists and patients between conventional balanced propofol sedation and analgesia-oriented combination sedation for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Two hundred and two adult patients scheduled for ERCP were sedated by either the Conventional (initial bolus of meperidine with propofol infusion) or Combination (repeated bolus doses of fentanyl with propofol infusion) method. Recovery profiles, satisfaction levels of the endoscopists and patients, drug requirements and complications were compared between groups. Patients of the Combination Group required significantly less propofol compared to the Conventional Group (135.0 ± 68.8 mg vs. 165.3 ± 81.7 mg, P = 0.005). Modified Aldrete scores were not different between groups throughout the recovery period, and recovery times were also comparable between groups. Satisfaction scores were not different between the two groups in both the endoscopists and patients (P = 0.868 and 0.890, respectively). Considering the significant reduction in propofol dose, the non-inferiority of recovery profiles and satisfaction scores of the endoscopists and patients, analgesia oriented combination sedation may be a more safe yet effective sedative method compared to conventional balanced propofol sedation during ERCP.

  16. Conventional versus Analgesia-Oriented Combination Sedation on Recovery Profiles and Satisfaction after ERCP: A Randomized Trial

    Science.gov (United States)

    Chung, Moon Jae; Park, Jeong Youp; Park, Seung Woo; Chung, Jae Bok; Song, Si Young; Cho, Jooyoun; Park, Sang-Hun; Yoo, Young Chul; Bang, Seungmin

    2015-01-01

    Background The importance of providing effective analgesia during sedation for complex endoscopic procedures has been widely recognized. However, repeated administration of opioids in order to achieve sufficient analgesia may carry the risk of delayed recovery after propofol based sedation. This study was done to compare recovery profiles and the satisfaction of the endoscopists and patients between conventional balanced propofol sedation and analgesia-oriented combination sedation for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Methods Two hundred and two adult patients scheduled for ERCP were sedated by either the Conventional (initial bolus of meperidine with propofol infusion) or Combination (repeated bolus doses of fentanyl with propofol infusion) method. Recovery profiles, satisfaction levels of the endoscopists and patients, drug requirements and complications were compared between groups. Results Patients of the Combination Group required significantly less propofol compared to the Conventional Group (135.0 ± 68.8 mg vs. 165.3 ± 81.7 mg, P = 0.005). Modified Aldrete scores were not different between groups throughout the recovery period, and recovery times were also comparable between groups. Satisfaction scores were not different between the two groups in both the endoscopists and patients (P = 0.868 and 0.890, respectively). Conclusions Considering the significant reduction in propofol dose, the non-inferiority of recovery profiles and satisfaction scores of the endoscopists and patients, analgesia oriented combination sedation may be a more safe yet effective sedative method compared to conventional balanced propofol sedation during ERCP. PMID:26402319

  17. Stability of piritramide in patient-controlled analgesia (PCA) solutions.

    Science.gov (United States)

    Remane, D; Scriba, G; Meissner, W; Hartmann, M

    2009-06-01

    For patient controlled analgesia, syringes with solutions of 1.5 mg/ml piritramide in 0.9% aqueous sodium chloride are used. The physical and chemical stability for dilutions of the commercially available preparation of piritramide is limited up to 72 hours by the manufacturer. Since application duration for patient-controlled analgesia can exceed that limited time, stability was investigated by HPLC. Our results show that these solutions are chemically stable over a time period of 60 days.

  18. Proinflammatory cytokines oppose opioid induced acute and chronic analgesia

    OpenAIRE

    Hutchinson, Mark R.; Coats, Benjamen D; Lewis, Susannah S.; Zhang, Yingning; Sprunger, David B.; Rezvani, Niloofar; Baker, Eric M.; Jekich, Brian M.; Wieseler, Julie L.; Somogyi, Andrew A; Martin, David; Poole, Stephen; Judd, Charles M.; Steven F. Maier; Watkins, Linda R.

    2008-01-01

    Spinal proinflammatory cytokines are powerful pain-enhancing signals that contribute to pain following peripheral nerve injury (neuropathic pain). Recently, one proinflammatory cytokine, interleukin-1, was also implicated in the loss of analgesia upon repeated morphine exposure (tolerance). In contrast to prior literature, we demonstrate that the action of several spinal proinflammatory cytokines oppose systemic and intrathecal opioid analgesia, causing reduced pain suppression. In vitro morp...

  19. The Neuroanatomy of Sexual Dimorphism in Opioid Analgesia

    Science.gov (United States)

    2014-04-13

    2012 for review). Studies utilizing orofacial, somatosensory or visceral pain assays typically report that morphine produces a significantly greater...The reported sex differences in morphine analgesia are not trivial; in both persistent inflammatory pain (Wang et al., 2006) and visceral pain (Ji et al...117 (3), 433–442. Ji, Y., Murphy, A.Z., Traub, R.J., 2006. Sex differences in morphine-induced analgesia of visceral pain are supraspinally and

  20. Initial experience with optical-CT scanning of RadBall Dosimeters

    Energy Technology Data Exchange (ETDEWEB)

    Oldham, M; Clift, C; Thomas, A; Farfan, E; Foley, T; Jannik, T; Adamovics, J; Holmes, C; Stanley, S, E-mail: Mark.Oldham@Duke.ed

    2010-11-01

    The RadBall dosimeter is a novel device for providing 3-D information on the magnitude and distribution of contaminant sources of unknown radiation in a given hot cell, glovebox, or contaminated room. The device is presently under evaluation by the National Nuclear Lab (NNL, UK) and the Savannah River National Laboratory (SRNL, US), for application as a diagnostic device for such unknown contaminants in the nuclear industry. A critical component of the technique is imaging the dose distribution recorded in the RadBall using optical-CT scanning. Here we present our initial investigations using the Duke Mid-sized Optical-CT Scanner (DMOS) to image dose distributions deposited in RadBalls exposed to a variety of radiation treatments.

  1. Antimicrobial Resistance Control Strategies: A Coordinated Research Initiative Experience in the Asia Pacific Region.

    Science.gov (United States)

    Lapierre, Lisette; Asenjo, Gabriela; Vergara, Constanza; Cornejo, Javiera

    2017-05-01

    The objective was to gather information on the status of antimicrobial surveillance in the Asia Pacific region and suggest control strategies. Twenty-one economies of the Asia Pacific region participated in this initiative. A survey was conducted on antimicrobial use and surveillance throughout the region. A workshop was carried out to create awareness about the issue and discuss the implementation of control strategies. Based on the survey results and workshop conclusions, it can be established that there is better understanding of the implications of antimicrobial resistance in the human medicine area. Only few economies take actions to control antimicrobial resistance on a veterinary/agricultural level. To confront antimicrobial resistance, it is critical to raise awareness; cooperation between all countries is needed to apply international standards, to be able to have harmonized public policies. Countries must align and improve their systems for surveillance and monitoring of antimicrobial resistance in human, animals, and the environment.

  2. Robotic pulmonary lobectomy for lung cancer treatment: program implementation and initial experience

    Directory of Open Access Journals (Sweden)

    Ricardo Mingarini Terra

    Full Text Available ABSTRACT Objective: To describe the implementation of a robotic thoracic surgery program at a public tertiary teaching hospital and to analyze its initial results. Methods: This was a planned interim analysis of a randomized clinical trial aimed at comparing video-assisted thoracoscopic surgery and robotic surgery in terms of the results obtained after pulmonary lobectomy. The robotic surgery program developed at the Instituto do Câncer do Estado de São Paulo, in the city of São Paulo, Brazil, is a multidisciplinary initiative involving various surgical specialties, as well as anesthesiology, nursing, and clinical engineering teams. In this analysis, we evaluated the patients included in the robotic lobectomy arm of the trial during its first three months (from April to June of 2015. Results: Ten patients were included in this analysis. There were eight women and two men. The mean age was 65.1 years. All of the patients presented with peripheral tumors. We performed right upper lobectomy in four patients, right lower lobectomy in four, and left upper lobectomy in two. Surgical time varied considerably (range, 135-435 min. Conversion to open surgery or video-assisted thoracoscopic surgery was not necessary in any of the cases. Intraoperative complications were not found. Only the first patient required postoperative transfer to the ICU. There were no deaths or readmissions within the first 30 days after discharge. The only postoperative complication was chest pain (grade 3, in two patients. Pathological examination revealed complete tumor resection in all cases. Conclusions: When there is integration and proper training of all of the teams involved, the implementation of a robotic thoracic surgery program is feasible and can reduce morbidity and mortality.

  3. Initial Thomson Scattering Survey of Local Helicity Injection and Ohmic Plasmas at the Pegasus Toroidal Experiment

    Science.gov (United States)

    Schlossberg, D. J.; Bodner, G. M.; Bongard, M. W.; Fonck, R. J.; Winz, G. R.

    2014-10-01

    A multipoint Thomson scattering diagnostic has recently been installed on the Pegasus ST. The system utilizes a frequency-doubled Nd:YAG laser (λ0 ~ 532 nm), spectrometers with volume phase holographic gratings, and a gated, intensified CCD camera. It provides measurements of Te and ne at 8 spatial locations for each spectrometer once per discharge. A new multiple aperture and beam dump system has been implemented to mitigate interference from stray light. This system has provided initial measurements in the core region of plasmas initiated by local helicity injection (LHI), as well as conventional Ohmic L- and H-mode discharges. Multi-shot averages of low-density (ne ~ 3 ×1018 m-3) , Ip ~ 0 . 1 MA LHI discharges show central Te ~ 75 eV at the end of the helicity injection phase. Ip ~ 0 . 13 MA Ohmic plasmas at moderate densities (ne ~ 2 ×1019 m-3) have core Te ~ 150 eV in L-mode. Generally, these plasmas do not reach transport equilibrium in the short 25 ms pulse length available. After an L-H transition, strong spectral broadening indicates increasing Te, to values above the range of the present spectrometer system with a high-dispersion VPH grating. Near-term system upgrades will focus on deploying a second spectrometer, with a lower-dispersion grating capable of measuring the 0.1-1.0 keV range. The second spectrometer system will also increase the available number of spatial channels, enabling study of H-mode pedestal structure. Work supported by US DOE Grant DE-FG02-96ER54375.

  4. Multi-frequency harmonic arrays: initial experience with a novel transducer concept for nonlinear contrast imaging.

    Science.gov (United States)

    Forsberg, Flemming; Shi, William T; Jadidian, Bahram; Winder, Alan A

    2004-12-01

    Nonlinear contrast imaging modes such as second harmonic imaging (HI) and subharmonic imaging (SHI) are increasingly important for clinical applications. However, the performance of currently available transducers for HI and SHI is significantly constrained by their limited bandwidth. To bypass this constraint, a novel transducer concept termed multi-frequency harmonic transducer arrays (MFHA's) has been designed and a preliminary evaluation has been conducted. The MFHA may ultimately be used for broadband contrast enhanced HI and SHI with high dynamic range and consists of three multi-element piezo-composite sub-arrays (A-C) constructed so the center frequencies are 4f(A) = 2f(B) = f(C) (specifically 2.5/5.0/10.0 MHz and 1.75/3.5/7.0 MHz). In principle this enables SHI by transmitting on sub-array C receiving on B and, similarly, from B to A as well as HI by transmitting on A receiving on B and, likewise, from B to C. Initially transmit and receive pressure levels of the arrays were measured with the elements of each sub-array wired in parallel. Following contrast administration, preliminary in vitro HI and SHI signal-to-noise ratios of up to 40 dB were obtained. In conclusion, initial design and in vitro characterization of two MFHA's have been performed. They have an overall broad frequency bandwidth of at least two octaves. Due to the special design of the array assembly, the SNR for HI and SHI was comparable to that of regular B-mode and better than commercially available HI systems. However, further research on multi-element MFHA's is required before their potential for in vivo nonlinear contrast imaging can be assessed.

  5. Epidural blood flow and regression of sensory analgesia during continuous postoperative epidural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Højgaard, L; Scott, N B;

    1988-01-01

    Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours for postopera......Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours...... surgery, and 8, 12, and 16 hours later during the continuous infusion. Initial blood flow was 6.0 +/- 0.7 ml/min per 100 g tissue (mean +/- SEM). After epidural bupivacaine, blood flow increased in all seven patients to 7.4 +/- 0.7 ml (P less than 0.02). Initial level of sensory analgesia was T4.5 +/- 0...... than 0.03) in the other five patients as the level of sensory analgesia regressed postoperatively. These data suggest that changes in epidural blood flow during continuous epidural infusion of bupivacaine, and thus changes in rates of vascular absorption of bupivacaine from the epidural space, may...

  6. Conceptual design of initial opacity experiments on the national ignition facility

    Science.gov (United States)

    Heeter, R. F.; Bailey, J. E.; Craxton, R. S.; Devolder, B. G.; Dodd, E. S.; Garcia, E. M.; Huffman, E. J.; Iglesias, C. A.; King, J. A.; Kline, J. L.; Liedahl, D. A.; McKenty, P. W.; Opachich, Y. P.; Rochau, G. A.; Ross, P. W.; Schneider, M. B.; Sherrill, M. E.; Wilson, B. G.; Zhang, R.; Perry, T. S.

    2017-02-01

    Accurate models of X-ray absorption and re-emission in partly stripped ions are necessary to calculate the structure of stars, the performance of hohlraums for inertial confinement fusion and many other systems in high-energy-density plasma physics. Despite theoretical progress, a persistent discrepancy exists with recent experiments at the Sandia Z facility studying iron in conditions characteristic of the solar radiative-convective transition region. The increased iron opacity measured at Z could help resolve a longstanding issue with the standard solar model, but requires a radical departure for opacity theory. To replicate the Z measurements, an opacity experiment has been designed for the National Facility (NIF). The design uses established techniques scaled to NIF. A laser-heated hohlraum will produce X-ray-heated uniform iron plasmas in local thermodynamic equilibrium (LTE) at temperatures eV and electron densities 21~\\text{cm}-3$ . The iron will be probed using continuum X-rays emitted in a ps, diameter source from a 2 mm diameter polystyrene (CH) capsule implosion. In this design, of the NIF beams deliver 500 kJ to the mm diameter hohlraum, and the remaining directly drive the CH capsule with 200 kJ. Calculations indicate this capsule backlighter should outshine the iron sample, delivering a point-projection transmission opacity measurement to a time-integrated X-ray spectrometer viewing down the hohlraum axis. Preliminary experiments to develop the backlighter and hohlraum are underway, informing simulated measurements to guide the final design.

  7. SU-E-E-05: Initial Experience On Physics Rotation of Radiological Residents

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, J; Williams, D; DiSantis, D; Hardy, P; Oates, M [University of Kentucky, Lexington, KY (United States)

    2014-06-01

    Purpose: The new ABR core exam integrates physics into clinical teaching, with an emphasis on understanding image quality, image artifacts, radiation dose and patient safety for each modality and/or sub-specialty. Accordingly, physics training of radiological residents faces a challenge. A traditional teaching of physics through didactic lectures may not fully fulfill this goal. It is also difficult to incorporate physics teaching in clinical practice due to time constraints. A dedicated physics rotation may be a solution. This study is to evaluate a full week physics workshop developed for the first year radiological residents. Methods: The physics rotation took a full week. It included three major parts, introduction lectures, hand-on experiences and observation of technologist operation. An introduction of basic concepts was given to each modality at the beginning. Hand-on experiments were emphasized and took most of time. During hand-on experiments, residents performed radiation measurements, studied the relationship between patient dose and practice (i.e., fluoroscopy), investigated influence of acquisition parameters (i.g., kV, mAs) on image quality, and evaluated image quality using phantoms A physics test before and after the workshop was also given but not for comparison purpose. Results: The evaluation shows that the physics rotation during the first week of residency in radiology is preferred by all residents. The length of a full week of physics workshop is appropriate. All residents think that the intensive workshop can significantly benefit their coming clinical rotations. Residents become more comfortable regarding the use of radiation and counseling relevant questions such as a pregnant patient risk from a CE PE examination. Conclusion: A dedicated physics rotation, assisting with didactic lectures, may fulfill the requirements of physics of the new ABR core exam. It helps radiologists deeply understand the physics concepts and more efficiently use

  8. Initial experience in setting up a medical student first responder scheme in South Central England.

    Science.gov (United States)

    Seligman, William H; Ganatra, Sameer; England, David; Black, John J M

    2016-02-01

    Prehospital emergency medicine (PHEM) is a recently recognised subspecialty of emergency medicine, and anaesthetics, intensive care and acute medicine, in the UK, and yet it receives little to no mention in many undergraduate medical curricula. However, there is growing interest in PHEM among medical students and junior doctors. Several programmes are in existence across the UK that serve to provide teaching and exposure of prehospital care to medical students and junior doctors. However, relatively few students are able to gain significant first-hand experience of treating patients in the prehospital phase. In this short report, we discuss our experience of launching the student first responder (SFR) scheme across three counties in the Thames Valley. Medical students are trained by the regional ambulance service and respond to life-threatening medical emergencies in an ambulance response vehicle. The scheme is likely to benefit the ambulance service by providing a wider pool of trained volunteer first responders able to attend to emergency calls, to benefit patients by providing a quick response at their time of need, and to benefit medical students by providing first-hand experience of medical emergencies in the community. In its first 15 months of operation, SFRs were dispatched to 343 incidents. This scheme can serve as a training model for other ambulance services and medical schools across the UK. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  9. Initial Results from the Radiation Dosimetry Experiment (RaD-X) Balloon Flight Mission

    Science.gov (United States)

    Mertens, Christopher J.

    2015-01-01

    The NASA Radiation Dosimetry Experiment (RaD-X) high-altitude balloon mission was successfully launched from Fort Sumner, New Mexico USA on 25 September, 2015. Over 15 hours of science data were obtained from four dosimeters at altitudes above about 25 km. The four dosimeters flown on the RaD-X science payload are a Hawk version 3.0 Tissue Equivalent Proportional Counter (TEPC) manufactured by Far West Technologies, a Liulin dosimeter-spectrometer produced by the Solar Research and Technology Institute, Bulgarian Academy of Sciences, a total ionizing dose detector manufactured by Teledyne Microelectronic Technologies, and the RaySure detector provided by the University of Surrey.

  10. [Initial experiences with the new environmental medicine course in graduate education].

    Science.gov (United States)

    Nemitz, B

    1995-08-01

    The "master of environmental medicine" is a new medical subspeciality in Germany. Specialised physicians can qualify for it, if they have spent at least an additional period of 1.5 years at a recognized institution in the field. Furthermore the attendance of a 200 hours comprehensive specialist's training course is required. Preliminary experience with this comprehensive course, as offered by our institution (Academy of Occupational and Environmental Medicine, Berlin, Germany) is lined out. Additionally, details of the curriculum, which was specifically designed for this purpose by our institution, are given. The results of an evaluation-procedure (questionnaire) among those participants, who completed the first parts of the course, are discussed.

  11. Strain localization and evolving kinematic efficiency of initiating strike-slip faults within wet kaolin experiments

    Science.gov (United States)

    Hatem, Alexandra E.; Cooke, Michele L.; Toeneboehn, Kevin

    2017-08-01

    Using wet kaolin experiments, we document the evolution of strain localization during strike-slip fault maturation under variable boundary conditions (pre-existing fault, depth of and distribution of basal shear). While the nature of the basal shear influences strain localization observed at the clay surface, similarities between experiments reveal a general conceptual model of strain accommodation. First, shear strain is accommodated as distributed shear (Stage 0), then by development of echelon faults (Stage I), then by interaction, lengthening and propagation of those echelon faults (Stage II) and, finally, by slip along through-going fault (Stage III). Stage II serves as a transitory period when the system reorganizes after sufficient strain localization. Here, active fault system complexity is maximized as faults link producing apparent rotation of active fault surfaces without material rotation. As the shear zone narrows, off-fault deformation decreases while fault slip and kinematic efficiency increases. We quantify kinematic efficiency as the ratio of fault slip to applied displacement. All fault systems reach a steady-state efficiency in excess of 80%. Despite reducing off-fault deformation, the through-going fault maintains <1.5 cm structural irregularities (i.e., stepovers), which suggests that small (<3 km) stepovers may persist along mature, efficient faults in the crust.

  12. Application of Radar Reflectivity Factor in Initializing Cloud-Resolving Mesoscale Model. Part Ⅱ: Numerical Simulation Experiments

    Institute of Scientific and Technical Information of China (English)

    LIU Hongya; XU Haiming; XUE Jishan; HU Zhijin; SHEN Tongli

    2008-01-01

    Microphysics elements and vertical velocity retrieved were incorporated using the nudging method into the initial data assimilation of GRAPES (Global/Regional Assimilation and Prediction System) model.Simulation experiments indicated that nudging technique was effective in forcing the model forecast gradually consistent to the observations, yielding the thermodynamically and dynamically balanced analysis field. As viewed from the simulation results, water vapor is vital to precipitation, and it is a governing factor for the amount and duration of precipitation. The initial cloud water, rain water, and vertical velocity determine the strength distribution of convection and precipitation at the beginning time of forecast; the horizontal wind field steers the motion of the mesoscale weather system embedded in and impacts the position of precipitation zone to a large extent. The simulation experiments show that the influence of the initial retrieval data on prediction weakens with the increase of forecast time, and within the first hour of forecast, the retrieval data have an important impact on the evolution of the weather system, but its influence becomes trivial after the first three hours. Changing the nudging coefficient and the integral time-spacing of numerical model will bring some influences to the results. Herein only one radar reflectivity was used, the radar observations did not cover the whole model domain, and some empirical parameters were used in the retrieval method, therefore some differences still lie between simulation and observation to a certain extent, and further studies on several aspects are expected.

  13. Combined laparoscopic and thoracoscopic Ivor Lewis esophagectomy for esophageal cancer: initial experience from China

    Institute of Scientific and Technical Information of China (English)

    LI Hui; HU Bin; YOU Bin; MIAO Jin-bai; FU Yi-li; CHEN Qi-rui

    2012-01-01

    Background Minimally invasive lvor Lewis esophagectomy was usually performed with either hand-sewn or circular stapler anastomosis through a small thoracotomy or using a side-to-side stapler anastomotic technique.This study aimed to present our initial results of lvor Lewis esophagectomy using a circular-stapled anastomosis with transoral anvil technique.Methods Six patients with esophageal cancer underwent minimally invasive lvor Lewis esophagectomy with an intrathoracic circular-stapled end-to-end anastomosis.The abdominal portion was operated on laparoscopically,and the thoracic portion was done using thoracoscopic techniques.A 25 mm anvil connected to a 90 cm long delivery tube was introduced transorally to the esophageal stump in a tilted position,the anvil head was then connected to circular stapler.The anastomosis was completed under direct thoracoscopic view.Results A total of six patients in this report successfully underwent total laparoscopic and thoracoscopic lvor Lewis esophagectomy with a circular-stapled anastomosis using a transoral anvil.They were five male and one female patients,and had a mean age of 55 years (range,38-69 years).The thoracic and abdominal operations were successfully performed without any intraoperative complications or conversion to laparotomy or thoracotomy.The passage of the anvil head was technically easy and successful in all six cases.The mean overall operative time was (260±42) minutes (range,220-300 minutes),and the mean estimated blood loss was (520±160) ml (range,130-800 ml).Patients resumed a liquid oral diet on postoperative day seven.The median length of hospital stay was 17 days (range,9-25 days).The postoperative pathological diagnosis was esophageal squamous cell carcinoma in five patients and esophageal small cell carcinoma in one patient.Tumors were staged as T2N0M0 in three cases,T2N1M0 in one case,and T3N0M0 in two cases.During the mean follow-up of 2.5 months (range,2-4months),there were no intraoperative

  14. Intent at day case laparoscopic cholecystectomy in Owerri, Nigeria: Initial experiences

    Directory of Open Access Journals (Sweden)

    Christopher Nonso Ekwunife

    2013-01-01

    Full Text Available Background and Objective: Laparoscopic cholecystectomy has been the default operation for cholelithiasis at Federal Medical Centre, Owerri for the past 2 years and the outcomes have been good. The duration of post operative stay has been decreasing. We therefore initiated a preliminary 2-year prospective study in May 2010 to determine the feasibility of carrying out day case laparoscopic cholecystectomy in our hospital. Materials and Methods: Patients undergoing laparoscopic cholecystectomy were included in the study if they satisfied the following criteria: Age < 65 years, body mass index < 35 kg/m 2 , American Society of Anaesthesiology physical status class I and II, patient residence within 20 km radius of the hospital, patient acceptance of the procedure and absence of previous complicated upper abdominal surgery. Results: Twelve patients (10 females, 2 males were worked up with the intent of achieving same-day discharge of the patients. Five of the patients (41.7% were discharged on the day of operation. The reasons for overnight stay included inadequate pain control, insertion of drain and patient wishes. There was no conversion to open surgery, no major complications and no case of readmission to the hospital. Conclusions: Day case laparoscopic cholecystectomy in our environment could be safely promoted but will depend on improved facilities and patient enlightenment.

  15. Local Control of Perivascular Malignant Liver Lesions Using Percutaneous Irreversible Electroporation: Initial Experiences

    Energy Technology Data Exchange (ETDEWEB)

    Eller, Achim, E-mail: Achim.Eller@uk-erlangen.de; Schmid, Axel, E-mail: axel.schmid@uk-erlangen.de [University Hospital Erlangen, University of Erlangen-Nuremberg, Department of Radiology (Germany); Schmidt, Joachim, E-mail: joachim.schmidt@kfa.imed.uni-erlangen.de [University Hospital Erlangen, University of Erlangen-Nuremberg, Department of Anesthesiology (Germany); May, Matthias, E-mail: matthias.may@uk-erlangen.de; Brand, Michael, E-mail: michael.brand@uk-erlangen.de; Saake, Marc, E-mail: marc.saake@uk-erlangen.de; Uder, Michael, E-mail: michael.uder@uk-erlangen.de; Lell, Michael, E-mail: michael.lell@uk-erlangen.de [University Hospital Erlangen, University of Erlangen-Nuremberg, Department of Radiology (Germany)

    2015-02-15

    PurposeThis study was designed to assess efficacy and safety in the treatment of perivascular malignant liver lesions using percutaneous, computed tomography (CT)-guided irreversible electroporation (IRE).MethodsFourteen patients (mean age 58 ± 11 years) with 18 malignant liver lesions were consecutively enrolled in this study. IRE was performed in patients not eligible for surgery and lesions abutting large vessels or bile ducts. Follow-up exams were performed using multislice-CT (MS-CT) or MRI.ResultsMedium lesion diameter was 20 ± 5 mm. Ten of 14 (71 %) were successfully treated with no local recurrence to date (mean follow-up 388 ± 160 days). One case left initial tumor control unclear and additional RFA was performed 4 weeks after IRE. Complications occurred in 4 of 14 (29 %) cases. In one case, intervention was terminated and abdominal bleeding required laparotomy. In two cases, a postinterventional hematothorax required intervention. In another case, abdominal bleeding could be managed conservatively. No complications related to the bile ducts occurred.ConclusionsPercutaneous IRE seems to be effective in perivascular lesions but is associated with a higher complication rate compared with thermoablative techniques.

  16. [Telecommunication--a medium for improving prenatal diagnosis and gynecologic ultrasound diagnosis? Initial experiences].

    Science.gov (United States)

    Sohn, C; Beldermann, F; Wallwiener, D; Lepold, H; Bastert, G

    1997-01-01

    To establish the requirements for real-time transfer of an ultrasound examination via telecommunication network the following tests were performed: The ultrasound data were transferred from the video out of an ultrasound system to a basis terminal of the German Telekom. Simultaneously, an external video camera filmed the positioning and movements of the ultrasound transducer, and the verbal comments were recorded. These informations were transmitted to Karlsruhe and London, where they were rerouted to the examination room in Heidelberg. Here the informations were received on a Telecom reception unit/terminal and compared directly with the initial signal. The quality was sufficient if the moving ultrasound images and the camera image of the transducer as well as the oral comment were transmitted over 2 parallel ISDN lines. The delay to a real-time transmission of the examination process is only in the range of milliseconds. If only one ISDN line is used, the image quality is unsatisfactory, three parallel lines do not bring significant improvement of image quality. Telemedicine seems a new possibility to bring the knowledge of specialized centers to the practicing gynaecologists thus avoiding unnecessary referrals. Still unanswered, however, are the problem of liability, data protection and costs.

  17. Initial operating experience of the 12-MW La Ola photovoltaic system.

    Energy Technology Data Exchange (ETDEWEB)

    Ellis, Abraham; Lenox, Carl (SunPower Corporation, Richmond, CA); Johnson, Jay; Quiroz, Jimmy Edward; Schenkman, Benjamin L.

    2011-10-01

    The 1.2-MW La Ola photovoltaic (PV) power plant in Lanai, Hawaii, has been in operation since December 2009. The host system is a small island microgrid with peak load of 5 MW. Simulations conducted as part of the interconnection study concluded that unmitigated PV output ramps had the potential to negatively affect system frequency. Based on that study, the PV system was initially allowed to operate with output power limited to 50% of nameplate to reduce the potential for frequency instability due to PV variability. Based on the analysis of historical voltage, frequency, and power output data at 50% output level, the PV system has not significantly affected grid performance. However, it should be noted that the impact of PV variability on active and reactive power output of the nearby diesel generators was not evaluated. In summer 2011, an energy storage system was installed to counteract high ramp rates and allow the PV system to operate at rated output. The energy storage system was not fully operational at the time this report was written; therefore, analysis results do not address system performance with the battery system in place.

  18. Can we reduce the burden of depression? The Australian experience with beyondblue: the national depression initiative.

    Science.gov (United States)

    Hickie, Ian

    2004-01-01

    Throughout the Asia Pacific region, there is an urgent need to reduce the burden of depression by increasing depression awareness, reducing stigma and dismantling those social barriers that prevent full participation by people with depression. This paper describes the development and early achievements of the Australian depression initiative, beyondblue. A review of the key priorities of beyondblue and their impacts during the first three years of operation (2001-03). Key achievements include: the degree of national recognition of beyondblue; size and scope of media impact; growth in website utilisation; increased reporting of the community's recognition of people with depression; genuine reforms in life insurance and income protection; development of a new national consumer and carer organisation; establishment of major population-based preventative and early intervention programs; system-wide reform of primary care-based mental health services; national educational program uptake by general practitioners; and, development of key awareness and intervention programs for use in schools and the workplace. In its first three years of operation, beyondblue has had a major impact on depression awareness in Australia and demonstrable gains have been made in reducing stigma and major social barriers. A pre-existing national mental health policy and implementation plan, a substantial funding base and participation by key political, media and community leaders have been essential elements of its short-term success. Its longer-term impact will now depend on more sustainable community and business partnerships as well as the growth of a more influential consumer and carer voice.

  19. Intraoperative perfusion contrast echocardiography. Initial experience during coronary artery bypass grafting.

    Science.gov (United States)

    Kabas, J S; Kisslo, J; Flick, C L; Johnson, S H; Craig, D M; Stanley, T E; Smith, P K

    1990-03-01

    Intraoperative evaluation of the effectiveness of myocardial revascularization has been limited by an inability to assess regional myocardial perfusion. Microbubbles of sonicated diatrizoate sodium and diatrizoate meglumine (Renografin) have been an effective echocardiographic contrast agent and have been employed clinically during cardiac catheterization. This recent development in contrast-enhanced two-dimensional echocardiography permits real-time imaging of transmural myocardial blood flow but has not been evaluated in the operating room. This study represents the initial surgical application of this directed technique and was designed to evaluate the safety and efficacy of intraoperative perfusion contrast echocardiography in assessing the results of coronary artery bypass grafting. Twenty men with significant coronary artery disease ranging in age from 49 to 73 years were studied. Direct contrast agent injection into completed saphenous vein bypass grafts caused the myocardium supplied by each graft to be well delineated and provided a tomographic view of contrast distribution. The enhanced region was well correlated with the size and distribution of the native vessel. Rapid contrast washout (less than 20 seconds) indicated satisfactory regional perfusion. Contrast echocardiography prolonged the operation less than 10 minutes and did not result in any perioperative complications.

  20. Participation in ICZM initiatives: critical aspects and lessons learnt from the Mediterranean and Black Sea experiences.

    Science.gov (United States)

    Soriani, Stefano; Buono, Fabrizia; Tonino, Marco; Camuffo, Monica

    2015-03-15

    Public participation is recognized as a necessary tool to ensure a successful implementation of Integrated Coastal Zone Management (ICZM) strategies and plans. This paper, based on the experiences carried out in the Mediterranean and in the Black Sea within the EU FP7 project PEGASO, presents some critical aspects and lessons learnt regarding participation in ICZM projects. The research shows that data availability, the complexity of data interpretation, an inadequate legal and cultural framework and the difficulties in promoting integration of all the components of coastal management within short term projects are all elements that if not properly considered since the beginning of the participatory process may hinder public participation effectiveness. Moreover the definition of the spatial scale of coastal phenomenon as well as the discrepancy between the local scale of coastal governance and the complex multi-scale nature of coastal systems remain highly critical aspects to be addressed.

  1. EXPERIENCES INITIATING SOFTWARE PRODUCT LINE ENGINEERING IN SMALL TEAMS WITH PULSE

    DEFF Research Database (Denmark)

    Mærsk-Møller, Hans Martin; Jørgensen, Bo Nørregaard

    2010-01-01

    papers and collective results on Software Product Line Engineering (SPLE) in the context of small teams. This paper remedies this situation by providing experiences from a successful approach of applying software product line engineering in a small team. We conduct a transition from single......-system production to Software Product Line (SPL) in the domain of greenhouse climate control systems. The domain contains inherent variabilities and extensive commonalities between the products in scope, which makes it a prime candidate for SPLE - besides having good business prospects. The transitioning to SPLE...... an existing methodology, PuLSETM, drew advantages of NetBeans Rich Client Platform, and based the product line on the existing application....

  2. Significance of assessment experiences during initial teacher training in physical education

    Directory of Open Access Journals (Sweden)

    Wagner dos Santos

    2016-03-01

    Full Text Available Abstract This study investigates how students in the final semester of their teacher training program (licensure at the Center of Physical Education and Sports (CEFD, Espírito Santo Federal University, Brazil, (reinterpret their assessment experiences, an integral component of their teacher training. It employs the narrative as a theoretical and methodological perspective, and it utilizes student portfolios, as well as focus groups and semi-structured individual interviews as inputs for data generation. Ten students in their eighth, or final, semester participated in this study. These were the total respondents to a "call for volunteers" among the 2014 graduating class. The results suggest that the students believe the assessment processes of their teaching practices in physical education are disjointed. They feel that the disciplines that allow them to review their own performance during teacher training are more efficient and play a stronger role in their education.

  3. Intracoronary brachytherapy in the treatment of in-stent restenosis. Initial experience in Brazil

    Directory of Open Access Journals (Sweden)

    Fábio Sândoli de Brito Jr

    2001-09-01

    Full Text Available Intracoronary brachytherapy using beta or gamma radiation is currently the most efficient type of therapy for preventing the recurrence of coronary in-stent restenosis. Its implementation depends on the interaction among interventionists, radiotherapists, and physicists to assure the safety and quality of the method. The authors report the pioneering experience in Brazil of the treatment of 2 patients with coronary in-stent restenosis, in whom beta radiation was used as part of the international multicenter randomized PREVENT study (Proliferation REduction with Vascular ENergy Trial. The procedures were performed rapidly and did not require significant modifications in the traditional techniques used for conventional angioplasty. Alteration in the radiological protection devices of the hemodynamic laboratory were also not required, showing that intracoronary brachytherapy using beta radiation can be incorporated into the interventional tools of cardiology in our environment.

  4. Experimental warming delays autumn senescence in a boreal spruce bog: Initial results from the SPRUCE experiment

    Science.gov (United States)

    Richardson, Andrew; Furze, Morgan; Aubrecht, Donald; Milliman, Thomas; Nettles, Robert; Krassovski, Misha; Hanson, Paul

    2016-04-01

    Phenology is considered one of the most robust indicators of the biological impacts of global change. In temperate and boreal regions, long-term data show that rising temperatures are advancing spring onset (e.g. budburst and flowering) and delaying autumn senescence (e.g. leaf coloration and leaf fall) in a wide range of ecosystems. While warm and cold temperatures, day length and insolation, precipitation and water availability, and other factors, have all been shown to influence plant phenology, the future response of phenology to rising temperatures and elevated CO2 still remains highly uncertain because of the challenges associated with conducting realistic manipulative experiments to simulate future environmental conditions. At the SPRUCE (Spruce and Peatland Responses Under Climatic and Environmental Change) experiment in the north-central United States, experimental temperature (0 to +9° C above ambient) and CO2 (ambient and elevated) treatments are being applied to mature, and intact, Picea mariana-Sphagnum spp. bog communities in their native habitat through the use of ten large (approximately 12 m wide, 10 m high) open-topped enclosures. We are tracking vegetation green-up and senescence in these chambers, at both the individual and whole-community level, using repeat digital photography. Within each chamber, digital camera images are recorded every 30 minutes and uploaded to the PhenoCam (http://phenocam.sr.unh.edu) project web page, where they are displayed in near-real-time. Image processing is conducted nightly to extract quantitative measures of canopy color, which we characterize using Gcc, the green chromatic coordinate. Data from a camera mounted outside the chambers (since November 2014) indicate strong seasonal variation in Gcc for both evergreen shrubs and trees. Shrub Gcc rises steeply in May and June, and declines steeply in September and October. By comparison, tree Gcc rises gradually from March through June, and declines gradually from

  5. Simple electrical model and initial experiments for intra-body communications.

    Science.gov (United States)

    Gao, Y M; Pun, S H; Du, M; Mak, P U; Vai, M I

    2009-01-01

    Intra-Body Communication(IBC) is a short range "wireless" communication technique appeared in recent years. This technique relies on the conductive property of human tissue to transmit the electric signal among human body. This is beneficial for devices networking and sensors among human body, and especially suitable for wearable sensors, telemedicine system and home health care system as in general the data rates of physiologic parameters are low. In this article, galvanic coupling type IBC application on human limb was investigated in both its mathematical model and related experiments. The experimental results showed that the proposed mathematical model was capable in describing the galvanic coupling type IBC under low frequency. Additionally, the calculated result and experimental result also indicated that the electric signal induced by the transmitters of IBC can penetrate deep into human muscle and thus, provide an evident that IBC is capable of acting as networking technique for implantable devices.

  6. UNIX trademark in high energy physics: What we can learn from the initial experiences at Fermilab

    Energy Technology Data Exchange (ETDEWEB)

    Butler, J.N.

    1991-03-01

    The reasons why Fermilab decided to support the UNIX operating system are reviewed and placed in the content of an overall model for high energy physics data analysis. The strengths and deficiencies of the UNIX environment for high energy physics are discussed. Fermilab's early experience in dealing with a an open'' multivendor environment, both for computers and for peripherals, is described. The human resources required to fully exploit the opportunities are clearly growing. The possibility of keeping the development and support efforts within reasonable bounds may depend on our ability to collaborate or at least to share information even more effectively than we have in the past. 7 refs., 4 figs., 5 tabs.

  7. Hepatobilio-pancreatic robotic surgery: initial experience from a single center institute.

    Science.gov (United States)

    Quijano, Yolanda; Vicente, Emilio; Ielpo, Benedetto; Duran, Hipolito; Diaz, Eduardo; Fabra, Isabel; Malave, Luis; Ferri, Valentina; Plaza, Carlos; Lindemann, Jan Lammel; D'Andrea, Vito; Caruso, Riccardo

    2016-12-30

    The use of robotic surgery in the hepatobilio-pancreatic (HBP) field is still limited. Our aim is to present our early experience of robotic liver resection. A retrospective review of robotic pancreatic and liver resection was performed at Sanchinarro University hospital from October 2010 to April 2016. Since the beginning of the robotic program in our center, 22 hepatic procedures and 45 pancreatic robotic procedures have been performed. Of the 21 patients subjected to liver resection, 13 (65%) were for malignancy. There were two left hepatectomies, one right hepatectomy, one associated liver partition and portal vein ligation staged procedure (both steps by robotic approach), three bisegmentectomies and three segmentectomies, eight wedge resections, and three pericystectomies. The mean operating time was 282 min. The overall conversion rate and postoperative complication rate were 4.7 and 19%, respectively. The mean length of hospital stay was 13.4 days (range 4-64 days). Of the 45 patients subjected to pancreatic resection, 22 were male and 23 female. The average age of all patients was 62 years (range 31-82 years). The mean operating room (OR) time was 370 min (120-780 min). Among the procedures performed were 15 pancreatico-duodenectomies, 19 distal pancreatectomies, and 11 enucleations. All procedures in the HBP area were R0. Our early experience shows that robotic surgery is a safe and feasible procedure in the HBP area. The complication and mortality rates are comparable to those of open surgery, but with the advantages of minimally invasive surgery.

  8. Assessment of Initial Test Conditions for Experiments to Assess Irradiation Assisted Stress Corrosion Cracking Mechanisms

    Energy Technology Data Exchange (ETDEWEB)

    Busby, Jeremy T [ORNL; Gussev, Maxim N [ORNL

    2011-04-01

    Irradiation-assisted stress corrosion cracking is a key materials degradation issue in today s nuclear power reactor fleet and affects critical structural components within the reactor core. The effects of increased exposure to irradiation, stress, and/or coolant can substantially increase susceptibility to stress-corrosion cracking of austenitic steels in high-temperature water environments. . Despite 30 years of experience, the underlying mechanisms of IASCC are unknown. Extended service conditions will increase the exposure to irradiation, stress, and corrosive environment for all core internal components. The objective of this effort within the Light Water Reactor Sustainability program is to evaluate the response and mechanisms of IASCC in austenitic stainless steels with single variable experiments. A series of high-value irradiated specimens has been acquired from the past international research programs, providing a valuable opportunity to examine the mechanisms of IASCC. This batch of irradiated specimens has been received and inventoried. In addition, visual examination and sample cleaning has been completed. Microhardness testing has been performed on these specimens. All samples show evidence of hardening, as expected, although the degree of hardening has saturated and no trend with dose is observed. Further, the change in hardening can be converted to changes in mechanical properties. The calculated yield stress is consistent with previous data from light water reactor conditions. In addition, some evidence of changes in deformation mode was identified via examination of the microhardness indents. This analysis may provide further insights into the deformation mode under larger scale tests. Finally, swelling analysis was performed using immersion density methods. Most alloys showed some evidence of swelling, consistent with the expected trends for this class of alloy. The Hf-doped alloy showed densification rather than swelling. This observation may be

  9. Endoscopic endonasal skull base approach for parasellar lesions: Initial experiences, results, efficacy, and complications

    Directory of Open Access Journals (Sweden)

    Shigetoshi Yano

    2014-01-01

    Full Text Available Background: Endoscopic surgery is suitable for the transsphenoidal approach; it is minimally invasive and provides a well-lit operative field. The endoscopic skull base approach through the large opening of the sphenoid sinus through both nostrils has extended the surgical indication for various skull base lesions. In this study, we describe the efficacy and complications associated with the endoscopic skull base approach for extra- or intradural parasellar lesions based on our experiences. Methods: Seventy-four cases were treated by an endoscopic skull base approach. The indications for these procedures included 55 anterior extended approaches, 10 clival approaches, and 9 cavernous approaches. The operations were performed through both the nostrils using a rigid endoscope. After tumor removal, the skull base was reconstructed by a multilayered method using a polyglactin acid (PGA sheet. Results: Gross total resection was achieved in 82% of pituitary adenomas, 68.8% of meningiomas, and 60% of craniopharyngiomas in anterior extended approach and in 83.3% of chordomas in clival approach, but only in 50% of the tumors in cavernous approach. Tumor consistency, adhesion, and/or extension were significant limitations. Visual function improvements were achieved in 37 of 41 (90.2% cases. Cerebrospinal fluid (CSF leakage (9.5%, infections (5.4%, neural injuries (4.1%, and vascular injuries (2.7% were the major complications. Conclusions: Our experiences show that the endoscopic skull base approach is a safe and effective procedure for various parasellar lesions. Selection of patients who are unlikely to develop complications seems to be an important factor for procedure efficacy and good outcome.

  10. Initial experience at a university teaching hospital from using telemedicine to promote education through video conferencing

    Directory of Open Access Journals (Sweden)

    Bruno Monteiro Tavares Pereira

    Full Text Available CONTEXT AND OBJECTIVE: Telehealth and telemedicine services are advancing rapidly, with an increasing spectrum of information and communication technologies that can be applied broadly to the population's health, and to medical education. The aim here was to report our institution's experience from 100 videoconferencing meetings between five different countries in the Americas over a one-year period. DESIGN AND SETTING: Retrospective study at Universidade Estadual de Campinas. METHODS: Through a Microsoft Excel database, all conferences in all specialties held at our institution from September 2009 to August 2010 were analyzed retrospectively. RESULTS: A total of 647 students, physicians and professors participated in telemedicine meetings. A monthly mean of 8.3 (± 4.3 teleconferences were held over the analysis period. Excluding holidays and the month of inaugurating the telemedicine theatre, our teleconference rate reached a mean of 10.3 (± 2.7, or two teleconferences a week, on average. Trauma surgery and meetings on patient safety were by far the most common subjects discussed in our teleconference meetings, accounting for 22% and 21% of the total calls. CONCLUSION: Our experience with telemedicine meetings has increased students' interest; helped our institution to follow and discuss protocols that are already accepted worldwide; and stimulated professors to promote telemedicine-related research in their own specialties and keep up-to-date. These high-technology meetings have shortened distances in our vast country, and to other reference centers abroad. This virtual proximity has enabled discussion of international training with students and residents, to increase their overall knowledge and improve their education within this institution.

  11. Initial experience at a university teaching hospital from using telemedicine to promote education through video conferencing.

    Science.gov (United States)

    Pereira, Bruno Monteiro Tavares; Calderan, Thiago Rodrigues Araújo; Silva, Marcos Tadeu Nolasco da; Silva, Antonio Carlos da; Marttos, Antonio Carlos; Fraga, Gustavo Pereira

    2012-01-01

    Telehealth and telemedicine services are advancing rapidly, with an increasing spectrum of information and communication technologies that can be applied broadly to the population's health, and to medical education. The aim here was to report our institution's experience from 100 videoconferencing meetings between five different countries in the Americas over a one-year period. Retrospective study at Universidade Estadual de Campinas. Through a Microsoft Excel database, all conferences in all specialties held at our institution from September 2009 to August 2010 were analyzed retrospectively. A total of 647 students, physicians and professors participated in telemedicine meetings. A monthly mean of 8.3 (± 4.3) teleconferences were held over the analysis period. Excluding holidays and the month of inaugurating the telemedicine theatre, our teleconference rate reached a mean of 10.3 (± 2.7), or two teleconferences a week, on average. Trauma surgery and meetings on patient safety were by far the most common subjects discussed in our teleconference meetings, accounting for 22% and 21% of the total calls. Our experience with telemedicine meetings has increased students' interest; helped our institution to follow and discuss protocols that are already accepted worldwide; and stimulated professors to promote telemedicine-related research in their own specialties and keep up-to-date. These high-technology meetings have shortened distances in our vast country, and to other reference centers abroad. This virtual proximity has enabled discussion of international training with students and residents, to increase their overall knowledge and improve their education within this institution.

  12. ROPIVACAINE CONTINUOUS WOUND INFUSION VERSUS CONTINUOUS EPIDURAL VERSUS SYSTEMIC ANALGESIA FOR POST CAESAREAN DELIVERY UNDER SPINAL ANAESTHESIA: A PROSPECTIVE RANDOMISED CONTROLLED STUDY

    Directory of Open Access Journals (Sweden)

    Paleti

    2014-07-01

    Full Text Available BACKGROUND: Opioid based analgesic regimens have been the gold standard for post caesarean analgesia until recently. Regional techniques like local intra-wound infusion techniques are becoming popular now. Our aim is to evaluate the efficacy of 0.2% Ropivacaine continuous wound infusion versus continuous epidural versus conventional systemic analgesia for post caesarean delivery. METHODOLOGY: 60 healthy parturients of ASA I/II were randomized after elective caesarean section into 3 groups of 20 each. Group-A: Received 0.2% Ropivacaine via an epidural catheter placed into subcutaneous tissue and fascia before skin closure at the rate of 5ml/hr. through infusion pump. Group-B: Received 0.2% Ropivacaine continuous epidural infusion via an epidural catheter at the rate of 8ml/hr. An initial bolus of 10ml was given in groups A&B. Group-C: Received standard systemic analgesia with diclofenac sodium and rescue opioid. Post operatively parturients were assessed for VAS scores for pain at rest and during movement, total Ropivacaine consumption, Tramadol consumption and side effects. Data were analyzed using SPSS software version 22. RESULTS: There were no significant differences in the mean VAS scores at rest and at movement between groups A or B and C. The consumption of Tramadol was significantly greater in Group C (p value AC=0.025, BC=0.0000 than A or B. Mean Ropivacaine consumption is significantly higher in Group B (p=0.000 than Group A. CONCLUSION: Continuous local intra-wound analgesia with Ropivacaine produced comparable analgesia to that of continuous epidural and superior analgesia compared to standard systemic analgesia.

  13. The Role of Model and Initial Condition Error in Numerical Weather Forecasting Investigated with an Observing System Simulation Experiment

    Science.gov (United States)

    Prive, Nikki C.; Errico, Ronald M.

    2013-01-01

    A series of experiments that explore the roles of model and initial condition error in numerical weather prediction are performed using an observing system simulation experiment (OSSE) framework developed at the National Aeronautics and Space Administration Global Modeling and Assimilation Office (NASA/GMAO). The use of an OSSE allows the analysis and forecast errors to be explicitly calculated, and different hypothetical observing networks can be tested with ease. In these experiments, both a full global OSSE framework and an 'identical twin' OSSE setup are utilized to compare the behavior of the data assimilation system and evolution of forecast skill with and without model error. The initial condition error is manipulated by varying the distribution and quality of the observing network and the magnitude of observation errors. The results show that model error has a strong impact on both the quality of the analysis field and the evolution of forecast skill, including both systematic and unsystematic model error components. With a realistic observing network, the analysis state retains a significant quantity of error due to systematic model error. If errors of the analysis state are minimized, model error acts to rapidly degrade forecast skill during the first 24-48 hours of forward integration. In the presence of model error, the impact of observation errors on forecast skill is small, but in the absence of model error, observation errors cause a substantial degradation of the skill of medium range forecasts.

  14. Peripheral morphine analgesia in dental surgery.

    Science.gov (United States)

    Likar, R; Sittl, R; Gragger, K; Pipam, W; Blatnig, H; Breschan, C; Schalk, H V; Stein, C; Schäfer, M

    1998-05-01

    The recent identification of opioid receptors on peripheral nerve endings of primary afferent neurons and the expression of their mRNA in dorsal root ganglia support earlier experimental data about peripheral analgesic effects of locally applied opioids. These effects are most prominent under localized inflammatory conditions. The clinical use of such peripheral analgesic effects of opioids was soon investigated in numerous controlled clinical trials. The majority of these have tested the local, intraarticular administration of morphine in knee surgery and have demonstrated potent and long-lasting postoperative analgesia. As the direct application of morphine into the pain-generating site of injury and inflammation appears most promising, we examined direct morphine infiltration of the surgical site in a unique clinical model of inflammatory tooth pain. Forty-four patients undergoing dental surgery entered into this prospective, randomized, double-blind study. Before surgery they received, together with a standard local anesthetic solution (articaine plus epinephrine) a submucous injection of either 1 mg of morphine (group A) or saline (group B). Postoperative pain intensity was assessed using the visual analog scale (VAS) and numeric rating scale (NRS) at 2, 4, 6, 8, 10, 12, 16, 20 and 24 h after surgery. In addition, patients recorded the occurrence of side effects and the supplemental consumption of diclofenac tablets. Results of 27 patients were analyzed (group A: n=14, group B: n=13). Pain scores which were moderate to severe preoperatively were reduced to a similar extent in both groups up to 8 h postoperatively. Thereafter, pain scores in group A were significantly lower than those in group B for up to 24 h, demonstrating the analgesic efficacy of additional morphine. The time to first analgesic intake and the total amount of supplemental diclofenac were less in group A than in group B. No serious side effects were reported. Our results show that 1 mg of

  15. Meningitis tras anestesia y analgesia espinal

    Directory of Open Access Journals (Sweden)

    M. Robles Romero

    2013-08-01

    Full Text Available El objetivo de esta revisión es una puesta al día en la etiología, diagnóstico, profilaxis y tratamiento de la meningitis tras anestesia y analgesia espinales. Aunque es una complicación mayor de esta técnica y su incidencia es baja, cada vez son más frecuentes los casos publicados en la literatura médica. Según su etiología se les clasifica en meningitis sépticas, víricas y asépticas. Las meningitis sépticas son las más frecuentes, y en su etiología cada vez juega un papel más destacado como agente implicado el estreptococo salivarius. Como meningitis asépticas se clasifican aquellas en las que el cultivo de líquido cefalorraquídeo es negativo, con un periodo de latencia de síntomas inferior a seis horas, que pueden cursar con eosinofilia en el líquido cefalorraquídeo y unos niveles cercanos a la normalidad en la glucorraquia. Suelen tener buena respuesta y evolución con tratamiento antibiótico con vancomicina y cefalosporinas de tercera generación. Como profilaxis incidir en las medidas de asepsia, sobre todo en el uso de mascarilla facial para realizar la técnica, como práctica para disminuir la incidencia de gérmenes cuyo origen está en la cavidad oral y orofaringe. Asimismo podrían reducir la incidencia de meningitis las medidas de asepsia tales como el lavado de manos, uso de guantes y asepsia de la piel. La diferenciación entre meningitis séptica y aséptica se hará con mayor seguridad cuando se estandaricen las técnicas para detectar genoma bacteriano en el líquido cefalorraquídeo; actualmente se etiquetan como meningitis asépticas aquellas en las que el cultivo de líquido cefalorraquídeo es negativo y cuya tinción de Gram es negativa. Pese a que el pronóstico y evolución en rasgos generales de las meningitis tras anestesia y analgesia espinal es bueno, en comparación con las meningitis adquiridas en la comunidad, por la escasa virulencia de las bacterias implicadas (Estreptococo salivarius

  16. Initial Surgical Experience with Aortic Valve Repair: Clinical and Echocardiographic Results

    Science.gov (United States)

    da Costa, Francisco Diniz Affonso; Colatusso, Daniele de Fátima Fornazari; da Costa, Ana Claudia Brenner Affonso; Balbi Filho, Eduardo Mendel; Cavicchioli, Vinicius Nesi; Lopes, Sergio Augusto Veiga; Ferreira, Andrea Dumsch de Aragon; Collatusso, Claudinei

    2016-01-01

    Introduction Due to late complications associated with the use of conventional prosthetic heart valves, several centers have advocated aortic valve repair and/or valve sparing aortic root replacement for patients with aortic valve insufficiency, in order to enhance late survival and minimize adverse postoperative events. Methods From March/2012 thru March 2015, 37 patients consecutively underwent conservative operations of the aortic valve and/or aortic root. Mean age was 48±16 years and 81% were males. The aortic valve was bicuspid in 54% and tricuspid in the remaining. All were operated with the aid of intraoperative transesophageal echocardiography. Surgical techniques consisted of replacing the aortic root with a Dacron graft whenever it was dilated or aneurysmatic, using either the remodeling or the reimplantation technique, besides correcting leaflet prolapse when present. Patients were sequentially evaluated with clinical and echocardiographic studies and mean follow-up time was 16±5 months. Results Thirty-day mortality was 2.7%. In addition there were two late deaths, with late survival being 85% (CI 95% - 68%-95%) at two years. Two patients were reoperated due to primary structural valve failure. Freedom from reoperation or from primary structural valve failure was 90% (CI 95% - 66%-97%) and 91% (CI 95% - 69%-97%) at 2 years, respectively. During clinical follow-up up to 3 years, there were no cases of thromboembolism, hemorrhage or endocarditis. Conclusions Although this represents an initial series, these data demonstrates that aortic valve repair and/or valve sparing aortic root surgery can be performed with satisfactory immediate and short-term results. PMID:27556321

  17. Reflectance confocal microscopy-guided laser ablation of basal cell carcinomas: initial clinical experience.

    Science.gov (United States)

    Sierra, Heidy; Yélamos, Oriol; Cordova, Miguel; Chen, Chih-Shan Jason; Rajadhyaksha, Milind

    2017-08-01

    Laser ablation offers a procedure for precise, fast, and minimally invasive removal of superficial and early nodular basal cell carcinomas (BCCs). However, the lack of histopathological confirmation has been a limitation toward widespread use in the clinic. A reflectance confocal microscopy (RCM) imaging-guided approach offers cellular-level histopathology-like feedback directly on the patient, which may then guide and help improve the efficacy of the ablation procedure. Following an ex vivo benchtop study (reported in our earlier papers), we performed an initial study on 44 BCCs on 21 patients in vivo, using a pulsed erbium:ytterbium aluminum garnet laser and a contrast agent (aluminum chloride). In 10 lesions on six patients, the RCM imaging-guided detection of either presence of residual tumor or complete clearance was immediately confirmed with histopathology. Additionally, 34 BCCs on 15 patients were treated with RCM imaging-guided laser ablation, with immediate confirmation for clearance of tumor (no histopathology), followed by longer-term monitoring, currently in progress, with follow-up imaging (again, no histopathology) at 3, 6, and 18 months. Thus far, the imaging resolution appears to be sufficient and consistent for monitoring efficacy of ablation in the wound, both immediately postablation and subsequently during recovery. The efficacy results appear to be promising, with observed clearance in 19 cases of 22 cases with follow-ups ranging from 6 to 21 months. An additional 12 cases with 1 to 3 months of follow-ups has shown clearance of tumor but a longer follow-up time is required to establish conclusive results. Further instrumentation development will be necessary to cover larger areas with a more automatically controlled instrument for more uniform, faster, and deeper imaging of margins. (2017) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE).

  18. Initial clinical experience with scanned proton beams at the Italian National Center for Hadrontherapy (CNAO).

    Science.gov (United States)

    Tuan, J; Vischioni, B; Fossati, P; Srivastava, A; Vitolo, V; Iannalfi, A; Fiore, M R; Krengli, M; Mizoe, J E; Orecchia, R

    2013-07-01

    We report the initial toxicity data with scanned proton beams at the Italian National Center for Hadrontherapy (CNAO). In September 2011, CNAO commenced patient treatment with scanned proton beams within two prospective Phase II protocols approved by the Italian Health Ministry. Patients with chondrosarcoma or chordoma of the skull base or spine were eligible. By October 2012, 21 patients had completed treatment. Immobilization was performed using rigid non-perforated thermoplastic-masks and customized headrests or body-pillows as indicated. Non-contrast CT scans with immobilization devices in place and MRI scans in supine position were performed for treatment-planning. For chordoma, the prescribed doses were 74 cobalt grey equivalent (CGE) and 54 CGE to planning target volume 1 (PTV1) and PTV2, respectively. For chondrosarcoma, the prescribed doses were 70 CGE and 54 CGE to PTV1 and PTV2, respectively. Treatment was delivered five days a week in 35-37 fractions. Prior to treatment, the patients' positions were verified using an optical tracking system and orthogonal X-ray images. Proton beams were delivered using fixed-horizontal portals on a robotic couch. Weekly MRI incorporating diffusion-weighted-imaging was performed during the course of proton therapy. Patients were reviewed once weekly and acute toxicities were graded with the Common Terminology Criteria for Adverse Events (CTCAE). Median age of patients = 50 years (range, 21-74). All 21 patients completed the proton therapy without major toxicities and without treatment interruption. Median dose delivered was 74 CGE (range, 70-74). The maximum toxicity recorded was CTCAE Grade 2 in four patients. Our preliminary data demonstrates the clinical feasibility of scanned proton beams in Italy.

  19. Conversion to sirolimus immunosuppression in liver transplantation recipients with hepatocellular carcinoma: Report of an initial experience

    Institute of Scientific and Technical Information of China (English)

    Jian Zhou; Yi-Feng He; Yu-Qi Wang; Zhao-You Tang; Jia Fan; Zheng Wang; Zhi-Quan Wu; Shuang-Jian Qiu; Xiao-Wu Huang; Yao Yu; Jian Sun; Yong-Sheng Xiao

    2006-01-01

    AIM: To report a retrospective analysis of preliminary results of 36 patients who received sirolimus (SRL, Rapamune(R), rapamycin) in a consecutive cohort of 248 liver allograft recipients.METHODS: Thirty-six liver transplant patients with hepatocellular carcinoma (HCC) who were switched to SRL-based immunosuppression therapy from tacrolimus were enrolled in this study. The patients who were diagnosed as advanced HCC before orthotopic liver transplantation (OLT) were divided into group A (n = 11), those who were found to have HCC recurrence and/or metastasis after OLT were assigned to group B (n = 18), and those who developed renal insufficiency caused by calcineurin inhibitor (CNI) were assigned to group C (n = 7) after OLT.RESULTS: The patients were followed up for a median of 10.4 mo (range, 3.8-19.1 mo) after conversion to SRL therapy and 12.3 mo (range, 5.1-34.4 mo) after OLT.Three patients developed mild acute cellular rejection 2 wk after initiating SRL therapy, which was fully reversed after prednisolone pulse therapy. In group A, only 1 patient was found to have HCC recurrence and metastasis 12 mo after OLT. In group B, 66.7% (12/18) patients (2 with progressive tumor, 7 with stable tumor and 3 without tumor) were still alive due to conversing to SRL and/or resection for HCC recurrence at the end of a median follow-up of 6.8 mo post conversion and 10.7 mo posttransplant. In group C, no HCC recurrence was demonstrated in 7 patients, and renal function became normal after SRL therapy. Thrombocytopenia (n = 2), anemia (n = 8), and oral aphthous ulcers (n = 7) found in our cohort were easily manageable.CONCLUSION: The conversion to SRL-based immunosuppression may inhibit the recurrence and metastasis of HCC and improve CNI-induced renal insufficiency in OLT patients with HCC.

  20. Analgesia epidural para parto en la gestante obesa Epidural analgesia for labour in obese patients

    Directory of Open Access Journals (Sweden)

    E. Guasch

    2006-10-01

    Full Text Available La obesidad es un problema global de salud en continuo aumento en el mundo desarrollado. Dado que la incidencia de la obesidad es mayor en mujeres que en hombres, los anestesiólogos con especial dedicación a la obstetricia, tendrán mayor oportunidad de enfrentarse a este tipo de pacientes. Nuestro objetivo es determinar la dificultad en la realización de la técnica epidural para analgesia de parto y analizar la incidencia de complicaciones ocurridas durante la punción en las gestantes obesas, así como evaluar la eficacia de la analgesia epidural en este grupo de pacientes en un estudio observacional retrospectivo de todos los bloqueos epidurales para analgesia de parto realizados en un hospital universitario de nivel 4 durante un periodo de cuatro años. Se ha estudiado un total de 13616 pacientes, clasificándolas según el índice de masa corporal en Kg./m² (IMC. En las pacientes no obesas (IMCObesity is an increasing global health problem in Developer countries. As its incidence is grater in women than men, obstetric anesthesiologists wil be envolved in the care of the obese patient more often. Our aim is to study punction dificulties in obese parturients requiring epidural analgesia for labor, and to compare punction complications between obese and non obese parturients as analgesic efficacy between obese and non obese patients in a retrospective observational study among all the epidural analgesic blocks performed in a universitary hospital in a four years period. We studied 13616 patients, who were classified according to body mass index in Kg/m² (BMI. In the non obese group patients (BMI<30; first attempt epidural success was achieved in 76,5%. Mild obese patients (BMI 30-32, severe obese (BMI 33-39 and morbid obese (BMI≥40, the percents were 69, 3%, 63,2% y 47,4% respectively. The comparison among obese and non obese patients was significati-vely different (p<0,001. Punction complications did not show differences among groups

  1. Conceptual design of initial opacity experiments on the national ignition facility

    Energy Technology Data Exchange (ETDEWEB)

    Heeter, R.  F.; Bailey, J.  E.; Craxton, R.  S.; DeVolder, B.  G.; Dodd, E.  S.; Garcia, E.  M.; Huffman, E.  J.; Iglesias, C.  A.; King, J.  A.; Kline, J.  L.; Liedahl, D.  A.; McKenty, P.  W.; Opachich, Y.  P.; Rochau, G.  A.; Ross, P.  W.; Schneider, M.  B.; Sherrill, M.  E.; Wilson, B.  G.; Zhang, R.; Perry, T.  S.

    2017-01-09

    Accurate models of X-ray absorption and re-emission in partly stripped ions are necessary to calculate the structure of stars, the performance of hohlraums for inertial confinement fusion and many other systems in high-energy-density plasma physics. Despite theoretical progress, a persistent discrepancy exists with recent experiments at the Sandia Z facility studying iron in conditions characteristic of the solar radiative–convective transition region. The increased iron opacity measured at Z could help resolve a longstanding issue with the standard solar model, but requires a radical departure for opacity theory. To replicate the Z measurements, an opacity experiment has been designed for the National Facility (NIF). The design uses established techniques scaled to NIF. A laser-heated hohlraum will produce X-ray-heated uniform iron plasmas in local thermodynamic equilibrium (LTE) at temperatures${\\geqslant}150$ eV and electron densities${\\geqslant}7\\times 10^{21}~\\text{cm}^{-3}$. The iron will be probed using continuum X-rays emitted in a${\\sim}200$ ps,${\\sim}200~\\unicode[STIX]{x03BC}\\text{m}$diameter source from a 2 mm diameter polystyrene (CH) capsule implosion. In this design

  2. Initial experience in 115 patients with the retrievable Cook Celect vena cava filter.

    Science.gov (United States)

    Doody, O; Given, M F; Kavnoudias, H; Street, M; Thomson, K R; Lyon, S M

    2009-02-01

    The aim of this study was to evaluate our experience with the retrievable Cook Celect inferior vena cava (IVC) filter (William Cook, Europe) with regard to insertion, efficiency, ease of retrieval, and any associated complications. A retrospective review was performed of 115 patients (41 female, 74 male, mean age 47.97 years) who underwent Cook Celect IVC filter insertion between December 2005 and October 2007. Filter insertion was successful in all patients. Of the 115 filters inserted, 57 have been successfully retrieved (49.6%) to date. The successful retrieval rate from attempted retrieval was 93.4%. The mean dwell time of successfully retrieved filters was 114.9 days (range 14-267 days). Failed retrievals were due to a thrombosed vena cava (n = 1) and endothelialisation of the filter (n = 3). In the failed retrieval group the mean implantation time was 142 days (range 78-211 days). While this is the first retrospective clinical study on the Cook Celect filter, results to date are promising. We demonstrated an efficacious filter with a high successful retrieval rate of 93.4% and a low complication rate. The filter was assessed with extended dwell times (range 14-267 days). Failed retrieval secondary to hook endothelialisation continues to be an issue with this filter. We recognize that a limitation of our study was the lack of systematic follow-up for clinically silent complications. Further studies to evaluate longer term outcomes and effectiveness of this filter are warranted.

  3. [A new balloon-expandable plastic endoprosthesis. Initial report of experience with the malleable thermostent].

    Science.gov (United States)

    Beck, A

    1990-07-01

    A new system of balloon-expandable stents for different purposes is presented. A special plastic material that can be shaped by a hot balloon technique or other internal or external heating modalities has been developed. The plastic material - a distant derivative of polyurethane - is caprolactone, which is soft from 52 degrees C to 70 degrees C. Using balloon techniques, the "thermo-stent" can be modeled to suit the form of the vessels, the bile ducts or the bronchial tree, as required. The balloon can be heated simply by means of a warm NaCl solution, electric matter in the balloon itself or microwaves. The plastic material can even be heated directly, which is especially beneficial if the stent needs to be thicker, e.g. in the bronchial tree, by an electric network within the plastic material, which heats the material to the necessary temperature by electric current. When the balloon is cooled after the dilatation the new form, the plastic has been modeled to is maintained exactly. The advantages of this thermo-stent will be the perfect adaptation to every individual situation in the intraluminal vessels, the bile ducts, and even the bronchi. The problems encountered hitherto with conventional metallic stents, e.g. high thrombogenicity, risk of metal intoxication or metallic rupture of filaments, have not be seen so far in animal experiments.

  4. Initial SAM Calibration Gas Experiments on Mars: Quadrupole Mass Spectrometer Results and Implications

    Science.gov (United States)

    Franz, Heather B.; Trainer, Melissa G.; Malespin, Charles A.; Mahaffy, Paul R.; Atreya, Sushil K.; Becker, Richard H,; Benna, Mehdi; Conrad, Pamela G.; Eigenbrode, Jennifer L.; Freissinet, Caroline; hide

    2017-01-01

    The Sample Analysis at Mars (SAM) instrument suite of the Mars Science Laboratory (MSL) Curiosity rover is equipped to analyze both martian atmospheric gases and volatiles released by pyrolysis of solid surface materials, with target measurements including chemical and isotopic composition (Mahaffy et al., 2012). To facilitate assessment of instrument performance and validation of results obtained on Mars, SAM houses a calibration cell containing CO2, Ar, N2, Xe, and several fluorinated hydrocarbon compounds (Franz et al., 2014; Mahaffy et al., 2012). This report describes the first two experiments utilizing this calibration cell on Mars and gives results from analysis of data acquired with the SAM Quadrupole Mass Spectrometer (QMS). These data support the accuracy of isotope ratios obtained with the QMS (Conrad et al., 2016; Mahaffy et al., 2013) and provide ground-truth for reassessment of analytical constants required for atmospheric measurements, which were reported in previous contributions (Franz et al., 2015, 2014). The most significant implication of the QMS data involves reinterpretation of pre-launch contamination previously believed to affect only CO abundance measurements (Franz et al., 2015) to affect N2 abundances, as well. The corresponding adjustment to the N2 calibration constant presented here brings the atmospheric volume mixing ratios for Ar and N2 retrieved by SAM into closer agreement with those reported by the Viking mission (Owen et al., 1977; Oyama and Berdahl, 1977).

  5. Use of natural user interfaces for image navigation during laparoscopic surgery: initial experience.

    Science.gov (United States)

    Sánchez-Margallo, Francisco M; Sánchez-Margallo, Juan A; Moyano-Cuevas, José L; Pérez, Eva María; Maestre, Juan

    2017-03-28

    Surgical environments require special aseptic conditions for direct interaction with the preoperative images. We aim to test the feasibility of using a set of gesture control sensors combined with voice control to interact in a sterile manner with preoperative information and an integrated operating room (OR) during laparoscopic surgery. Two hepatectomies and two partial nephrectomies were performed by three experienced surgeons in a porcine model. The Kinect, Leap Motion, and MYO armband in combination with voice control were used as natural user interfaces (NUIs). After surgery, surgeons completed a questionnaire about their experience. Surgeons required <10 min training with each NUI. They stated that NUIs improved the access to preoperative patient information and kept them more focused on the surgical site. The Kinect system was reported as the most physically demanding NUI and the MYO armband in combination with voice commands as the most intuitive and accurate. The need to release one of the laparoscopic instruments in order to use the NUIs was identified as the main limitation. The presented NUIs are feasible to directly interact in a more intuitive and sterile manner with the preoperative images and the integrated OR functionalities during laparoscopic surgery.

  6. Initial SAM calibration gas experiments on Mars: Quadrupole mass spectrometer results and implications

    Science.gov (United States)

    Franz, Heather B.; Trainer, Melissa G.; Malespin, Charles A.; Mahaffy, Paul R.; Atreya, Sushil K.; Becker, Richard H.; Benna, Mehdi; Conrad, Pamela G.; Eigenbrode, Jennifer L.; Freissinet, Caroline; Manning, Heidi L. K.; Prats, Benito D.; Raaen, Eric; Wong, Michael H.

    2017-04-01

    The Sample Analysis at Mars (SAM) instrument suite of the Mars Science Laboratory (MSL) Curiosity rover is equipped to analyze both martian atmospheric gases and volatiles released by pyrolysis of solid surface materials, with target measurements including chemical and isotopic composition (Mahaffy et al., 2012). To facilitate assessment of instrument performance and validation of results obtained on Mars, SAM houses a calibration cell containing CO2, Ar, N2, Xe, and several fluorinated hydrocarbon compounds (Franz et al., 2014; Mahaffy et al., 2012). This report describes the first two experiments utilizing this calibration cell on Mars and gives results from analysis of data acquired with the SAM Quadrupole Mass Spectrometer (QMS). These data support the accuracy of isotope ratios obtained with the QMS (Conrad et al., 2016; Mahaffy et al., 2013) and provide ground-truth for reassessment of analytical constants required for atmospheric measurements, which were reported in previous contributions (Franz et al., 2015, 2014). The most significant implication of the QMS data involves reinterpretation of pre-launch contamination previously believed to affect only CO abundance measurements (Franz et al., 2015) to affect N2 abundances, as well. The corresponding adjustment to the N2 calibration constant presented here brings the atmospheric volume mixing ratios for Ar and N2 retrieved by SAM into closer agreement with those reported by the Viking mission (Owen et al., 1977; Oyama and Berdahl, 1977).

  7. Initial experience with a group presentation of study results to research participants

    Directory of Open Access Journals (Sweden)

    Bent Stephen

    2008-03-01

    Full Text Available Abstract Background Despite ethical imperatives, informing research participants about the results of the studies in which they take part is not often performed. This is due, in part, to the costs and burdens of communicating with each participant after publication of the results. Methods Following the closeout and publication of a randomized clinical trial of saw palmetto for treatment of symptoms of benign prostatic hyperplasia, patients were invited back to the research center to participate in a group presentation of the study results. Results Approximately 10% of participants attended one of two presentation sessions. Reaction to the experience of the group presentation was very positive among the attendees. Conclusion A group presentation to research participants is an efficient method of communicating study results to those who desire to be informed and was highly valued by those who attended. Prospectively planning for such presentations and greater scheduling flexibility may result in higher attendance rates. Trial Registration Number Clinicaltrials.gov #NCT00037154

  8. Pain modulation as a function of hypnotizability: Diffuse noxious inhibitory control induced by cold pressor test vs explicit suggestions of analgesia.

    Science.gov (United States)

    Fidanza, Fabrizia; Varanini, Maurizio; Ciaramella, Antonella; Carli, Giancarlo; Santarcangelo, Enrica L

    2017-03-15

    The aim of the present study was to compare the effects of explicit suggestions of analgesia and of the activation of the Diffuse Noxious Inhibitory Control (DNIC) by cold pressor test on pain perception and heart rate in healthy participants with high (highs, N=18), low (lows, N=18) and intermediate scores of hypnotizability (mediums, N=15) out of hypnosis. Pain reports and the stimulus-locked heart rate changes induced by electrical nociceptive stimulation of the left hand were studied in the absence of concomitant stimuli (Control), during suggestions of analgesia (SUGG, glove analgesia) and during cold pressor test used as a conditioning stimulus to the right hand (DNIC, water temperature=10-12°C) in the REAL session. Participants were submitted also to a SHAM session in which the DNIC water temperature was 30°C and the suggestions for analgesia were substituted with weather forecast information. Both suggestions and DNIC reduced pain significantly in all subjects; however, the percentage of reduction was significantly larger in highs (pain intensity=55% of the control condition) than in mediums (70%) and lows (80%) independently of the REAL/SHAM session and of the specific pain manipulation. Heart rate was not modulated consistently with pain experience. Findings indicate that both suggestions and DNIC influence pain experience as a function of hypnotizability and suggest that both sensory and cognitive mechanisms co-operate in DNIC induced analgesia.

  9. Safety of autologous bone marrow aspiration concentrate transplantation: initial experiences in 101 patients

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    Christian Hendrich

    2009-12-01

    Full Text Available The clinical application of cellular based therapies with ex vivo cultivation for the treatment of diseases of the musculoskeletal system has until now been limited. In particular, the advanced laboratory and technical effort necessary, regulatory issues as well as high costs are major obstacles. On the other hand, newly developed cell therapy systems permit intra-operative enrichment and application of mesenchymal and progenitor stem cells from bone marrow aspirate concentrate (BMAC in one single operative session. The objective of the present clinical surveillance study was to evaluate new bone formation after the application of BMAC as well as to record any possible therapy-specific complications For this purpose, the clinical-radiological progress of a total of 101 patients with various bone healing disturbances was documented (surveillance study. The study included 37 necrosis of the head of the femur, 32 avascular necroses/bone marrow edema of other localization, 12 non-unions, 20 other defects. The application of BMAC was performed in the presence of osteonecrosis via a local injection as part of a core decompression (n=72 or by the local adsorption of intra-operative cellular bone substitution material (scaffold incubated with BMAC during osteosynthesis (n=17 or in further surgery (n=12. After an average of 14 months (2-24 months, the patients were re-examined clinically and radiologically and interviewed. Further surgery was necessary in 2 patients within the follow-up period. These were due to a progression of a collapsed head of the femur with initial necrosis in ARCO Stage III, as well as inadequate new bone formation with secondary loss of correction after periprosthetic femoral fracture. The latter healed after repeated osteosynthesis plus BMAC application without any consequences. Other than these 2 patients, no further complications were observed. In particular, no infections, no excessive new bone formation, no induction of

  10. Establishing a health demographic surveillance site in Bhaktapur district, Nepal: initial experiences and findings

    Directory of Open Access Journals (Sweden)

    Aryal Umesh

    2012-09-01

    Full Text Available Abstract Background A health demographic surveillance system (HDSS provides longitudinal data regarding health and demography in countries with coverage error and poor quality data on vital registration systems due to lack of public awareness, inadequate legal basis and limited use of data in health planning. The health system in Nepal, a low-income country, does not focus primarily on health registration, and does not conduct regular health data collection. This study aimed to initiate and establish the first HDSS in Nepal. Results We conducted a baseline survey in Jhaukhel and Duwakot, two villages in Bhaktapur district. The study surveyed 2,712 households comprising a total population of 13,669. The sex ratio in the study area was 101 males per 100 females and the average household size was 5. The crude birth and death rates were 9.7 and 3.9/1,000 population/year, respectively. About 11% of births occurred at home, and we found no mortality in infants and children less than 5 years of age. Various health problems were found commonly and some of them include respiratory problems (41.9%; headache, vertigo and dizziness (16.7%; bone and joint pain (14.4%; gastrointestinal problems (13.9%; heart disease, including hypertension (8.8%; accidents and injuries (2.9%; and diabetes mellitus (2.6%. The prevalence of non-communicable disease (NCD was 4.3% (95% CI: 3.83; 4.86 among individuals older than 30 years. Age-adjusted odds ratios showed that risk factors, such as sex, ethnic group, occupation and education, associated with NCD. Conclusion Our baseline survey demonstrated that it is possible to collect accurate and reliable data in a village setting in Nepal, and this study successfully established an HDSS site. We determined that both maternal and child health are better in the surveillance site compared to the entire country. Risk factors associated with NCDs dominated morbidity and mortality patterns.

  11. Extracorporeal Shock-wave Lithotripsy Success Rate and Complications: Initial Experience at Sultan Qaboos University Hospital

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    Mohammed S. Al-Marhoon

    2013-07-01

    Full Text Available Objective: To assess the efficacy and safety of extracorporeal shock wave lithotripsy with Modularis Vario Siemens in the management of patients with renal and ureteral stones.Methods: Between 2007 and 2009, 225 outpatients were treated with Siemens Modularis Vario lithotripter at Sultan Qaboos University Hospital. Stone size, location, total number of shockwaves, stone-free rate, complications and adjunctive interventions were investigated. Chi-Square and Logistic Regression analyses were used, with p<0.05 set as the level of significance.Results: Of the 225 initial consecutive patients who underwent extracorporeal shock wave lithotripsy, 192 (85% had renal stones and 33 (15% had ureteric stones. The mean±SD stone size was 11.3 ± 4.5 mm, while the mean age of the patients was 39.9 ± 12.8 years with 68.5% males. The mean renal stone size was 11.6 ± 4.7 mm; a mean of 1.3 sessions was required. The mean ureteric stone size was 9.9 ± 3 mm; and a mean of 1.3 sessions was required. Treatment success (defined as complete clearance of ureteric stones, stone-free or clinically insignificant residual fragments of <4 mm for renal stones was 74% for renal stones and 88% for ureteric stones. Additional extracorporeal shock wave lithotripsy and ureteroscopy were the most adjunctive procedures used for stone clearance. Complications occurred in 74 patients (38.5% with renal stones and 13 patients (39.4% with uretetric stones. The most common complication was loin pain (experienced by 16.7% with renal stones and 21% with ureteric stones. Severe renal colic mandating admission occurred in 2% of patients with renal stones and 6% of patients with ureteric stones. In patients with renal stone, steinstrasse occurred in 3.6% and infection post extracorporeal shock wave lithotripsy in 0.5%. Using Multivariate Logistic Regression analysis, factors found to have significant effect on complete stone clearance were serum creatinine (p=0.004 and the number of

  12. Documentation of polio eradication initiative best practices: Experience from WHO African Region.

    Science.gov (United States)

    Okeibunor, Joseph; Nshimirimana, Deo; Nsubuga, Peter; Mutabaruka, Evariste; Tapsoba, Leonard; Ghali, Emmanuel; Kabir, Shaikh Humayun; Gassasira, Alex; Mihigo, Richard; Mkanda, Pascal

    2016-10-10

    The African Region is set to achieving polio eradication. During the years of operations, the Polio Eradication Initiative [PEI] in the Region mobilized and trained tremendous amount of manpower with specializations in surveillance, social mobilization, supplementary immunization activities [SIAs], data management and laboratory staff. Systems were put in place to accelerate the eradication of polio in the Region. Standardized, real-time surveillance and response capacity were established. Many innovations were developed and applied to reaching people in difficult and security challenged terrains. All of these resulted in accumulation of lessons and best practices, which can be used in other priority public health intervention if documented. The World Health Organization Regional Office for Africa [WHO/AFRO] developed a process for the documentation of these best practices, which was pretested in Uganda. The process entailed assessment of three critical elements [effectiveness, efficiency and relevance] five aspects [ethical soundness, sustainability, involvement of partners, community involvement, and political commitment] of best practices. A scored card which graded the elements and aspects on a scale of 0-10 was developed and a true best practice should score >50 points. Independent public health experts documented polio best practices in eight countries in the Region, using this process. The documentation adopted the cross-sectional design in the generation of data, which combined three analytical designs, namely surveys, qualitative inquiry and case studies. For the selection of countries, country responses to earlier questionnaire on best practices were screened for potential best practices. Another criterion used was the level of PEI investment in the countries. A total of 82 best practices grouped into ten thematic areas were documented. There was a correlation between the health system performances with DPT3 as proxy, level of PEI investment in countries

  13. Maternal satisfaction as an outcome criterion in research on labor analgesia: data analysis from the recent literature.

    Science.gov (United States)

    Dualé, Christian; Nicolas-Courbon, Aurélie; Gerbaud, Laurent; Lemery, Didier; Bonnin, Martine; Pereira, Bruno

    2015-03-01

    To investigate whether maternal satisfaction (MS) is taken into consideration as an outcome criterion in clinical research on analgesia for labor. A systematic review of articles reporting analgesia for labor from a panel of 17 influential journals was undertaken. A total of 116 articles were analyzed, including 282 within-study groups. The scope of MS, the type of outcome measure used, and the time of measurement were noted. Each available observation was assigned an ordinal value of MS (ordMS), according to data distribution. The factors influencing ordMS were identified by multivariable analysis. The methods used to assess MS were very variable, even within the different measurement tools reported. The weighted distribution of ordMS was 17.8%, 21.8%, 31.2%, and 29.3% for levels "poor," "fair," "good," and "excellent," respectively. In comparative studies, statistical differences for analgesia were related to statistical differences for MS (Pvalue was high (0.87). Power to detect a difference in MS between treatment groups was low in general, but it influenced reporting of a significant difference for MS (P<0.0001). The obstetrical factors influencing ordMS were: the body mass index, the initial cervical dilatation, and the within-study percentage of nulliparous women. The techniques alternative to epidural analgesia negatively influenced ordMS. A standard and validated tool to assess MS in clinical research on analgesia for labor is still to be developed. Power should be improved by acting on sample sizes or sensitivity of the outcome.

  14. Kidney Transplantation From Brain-Dead Donors: Initial Experience in China.

    Science.gov (United States)

    Li, Y; Li, J; Fu, Q; Chen, L; Fei, J; Deng, S; Qiu, J; Chen, G; Huang, G; Wang, C

    2016-10-01

    Experience with kidney transplantation from brain-dead donors remains limited in China. Our objective was to evaluate the outcomes of kidney transplantation from brain-dead donors (group 1), compared with those from living ones of the same age (group 2). Clinical data of kidney transplantation from brain-dead donors and living donors in the same age range (18-45 years) performed between May 2007 and December 2011 were analyzed retrospectively. Recipients were analyzed for posttransplantation serum creatinine, creatinine clearance (calculated by the Cockcroft-Gault formula), the number of acute rejection episodes and delayed graft function, and patient/graft survival. Mean donor age was comparable between the 2 groups (31.9 ± 6.5 vs 32.8 ± 7.0 years; P = .268). The terminal serum creatinine level of donors was 125.5 ± 63.5 μmol/L in group 1 (n = 30) and 65.1 ± 13.7 μmol/L in group 2 (n = 110; P = .000). Recipient creatinine clearance was comparable between the 2 groups 1 month posttransplantation and thereafter. Acute rejection episodes were seen in 7 cases in recipients of group 1 (15.9%) and in 15 cases in recipients of group 2 (13.6%; P = .716). The incidence of delayed graft function was higher in recipients of group 1 (18.2%) than that of group 2 (3.6%; P = .002). The 1-, 3-, and 5-year patient/graft survival rate was comparable between the 2 groups. Our study demonstrated kidney transplantation from brain-dead donors achieved acceptable graft function and patient/graft survival in the 5-year follow-up, encouraging the use of this approach. Copyright © 2016. Published by Elsevier Inc.

  15. Initial Clinical Experience: Symmetric-Tip Dialysis Catheter with Helical Flow Characteristics Improves Patient Outcomes.

    Science.gov (United States)

    Clark, Timothy W I; Redmond, Jonas W; Mantell, Mark P; Nadolski, Gregory J; Mondschein, Jeffrey I; Dowd, Michael F; Dagli, Mandeep S; Sudheendra, Deepak; Shlansky-Goldberg, Richard D; Cohen, Raphael D

    2015-10-01

    To report preliminary clinical experience with a new symmetric-tip dialysis catheter compared with a conventional split-tip catheter. Over a 5-month period, patients requiring a tunneled catheter for hemodialysis or undergoing exchange of a dysfunctional dialysis catheter at a tertiary academic medical center were retrospectively analyzed. Patients underwent placement of a VectorFlow or Ash Split Cath catheter at the discretion of the inserting interventional radiologist. Patient demographics, catheter patency, mean blood flow rate, and arterial and venous pressures were compared according to catheter type. Catheter failure was analyzed based on clinical and anatomic variables by using a multivariate Cox proportional-hazards model. A total of 33 VectorFlow and 46 Ash Split Cath catheters were placed. Patients in the VectorFlow group had significantly higher body mass index (P = .013) and Charlson Comorbidity Index (P = .049), as well as more non-internal jugular vein placements. At 120 days, 89% of VectorFlow catheters remained functional, compared with 45% of Ash Split Cath catheters (P = .046). The VectorFlow catheter was associated with 16% lower arterial pressures during dialysis (P = .009); mean blood flow rate was equivalent. On multivariate analysis, the risk of catheter failure was 13.3 times higher in the Ash Split Cath group compared with the VectorFlow group (P = .004). Left-sided catheters were also predictive of catheter failure (relative risk = 5.5; P = .02). The VectorFlow catheter was associated with a significant increase in intervention-free catheter patency compared with the Ash Split Cath catheter, with equivalent flow at lower arterial pressures during dialysis. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

  16. Digital storytelling and teacher education: an experience in initial teacher training

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    Marco Lazzari

    2016-07-01

    Full Text Available A group of pre-service teachers experienced the digital storytelling as part of their e-learning duties. We describe the structure of the project-work carried out by the students and discuss the results of a questionnaire they filled out after the end of the course, aiming to gather their opinions. The students claim to have enjoyed the proposal and most of them are likely to repeat it in their school, either by developing digital stories themselves or by involving their future students as designers and developers. By questionnaire and interviews with the participants, it is clear that the development experience has changed their attitude towards educational technology, enhanced their digital skills, and increased their self-esteem.Digital storytelling nella formazione iniziale degli insegnanti: un’esperienza nel Tirocinio Formativo AttivoUn gruppo di aspiranti insegnanti iscritti al Tirocinio Formativo Attivo ha affrontato un’esperienza di digital storytelling come parte dei compiti di didattica a distanza. Viene qui descritta la struttura del lavoro svolto dai corsisti e si riflette sui risultati di un questionario sottoposto al termine del corso per rilevarne le opinioni. I corsisti dichiarano di aver gradito la proposta e buona parte di loro ritiene probabile ripeterla a scuola, anche coinvolgendo gli studenti nel progetto e nella realizzazione di narrazioni digitali multimediali. Da questionario e colloqui con i corsisti si deduce che l’esperienza di sviluppo ha mutato il loro atteggiamento verso le tecnologie didattiche, aumentato la loro efficacia come comunicatori digitali e accresciuto la loro autostima.

  17. Robotic-assisted modified retroauricular cervical approach: initial experience in Latin America.

    Science.gov (United States)

    Chulam, Thiago Celestino; Lira, Renan Bezerra; Kowalski, Luiz Paulo

    2016-01-01

    to evaluate the thickness of the gastric wall at the time of intra gastric balloon (IGB) placement, at the time of its withdrawal and one month after withdrawal. fifteen morbidly obese patients underwent the introduction of IGB under general anesthesia. In all patients, there was infusion of 500ml of distilled water in the balloon for the test. Measurements of the thickness of the gastric wall were made in the antrum, body and proximal body, using a radial echoendoscope with a frequency of 12MHz and maximum zoom, and its own balloon inflated with 5ml of distilled water. the presence of IGB led to increased wall thickness of the gastric body by expanding the muscle layer. These changes were apparently transient, since 30 days after the balloon withdrawal there was a tendency to return of the wall thickness values ​​observed before the balloon insertion. the use of intragastric balloon for the treatment of obesity determines transient increase in the wall thickness of the gastric body caused by expanded muscle layer. A preocupação com a melhoria dos resultados estéticos e funcionais sem comprometimento dos resultados oncológicos na cirurgia de cabeça e pescoço tem aumentado significativamente. Os procedimentos minimamente invasivos e principalmente aqueles que utilizam a tecnologia robótica permitiram o desenvolvimento de novas abordagens, incluindo o acesso retroauricular, que agora é usado rotineiramente, especialmente na Coréia do Sul. A presente nota irá ilustrar a técnica e a experiência inicial na América Latina, demonstrando que esta abordagem é viável, segura e eficaz oncologicamente, podendo ser utilizada em casos selecionados com um benefício estético evidente.

  18. Initial experience of treating anal fistula with the Surgisis anal fistula plug.

    Science.gov (United States)

    Chan, S; McCullough, J; Schizas, A; Vasas, P; Engledow, A; Windsor, A; Williams, A; Cohen, C R

    2012-06-01

    Complex anal fistulas remain a challenge for the colorectal surgeon. The anal fistula plug has been developed as a simple treatment for fistula-in-ano. We present and evaluate our experience with the Surgisis anal fistula plug from two centres. Data were prospectively collected and analysed from consecutive patients undergoing insertion of a fistula plug between January 2007 and October 2009. Fistula plugs were inserted according to a standard protocol. Data collected included patient demographics, fistula characteristics and postoperative outcome. Forty-four patients underwent insertion of 62 plugs (27 males, mean age 45.6 years), 25 of whom had prior fistula surgery. Mean follow-up was 10.5 months Twenty-two patients (50%) had successful healing following the insertion of plug with an overall success rate of 23 out of 62 plugs inserted (35%). Nineteen out of 29 patients healed following first-time plug placement, whereas repeated plug placement was successful in 3 out of 15 patients (20%; p = 0.0097). There was a statistically significant difference in the healing rate between patients who had one or less operations prior to plug insertion (i.e. simple fistulas) compared with patients who needed multiple operations (18 out of 24 patients vs. 4 out of 20 patients; p = 0.0007). Success of treatment with the Surgisis anal fistula plug relies on the eradication of sepsis prior to plug placement. Plugs inserted into simple tracts have a higher success rate, and recurrent insertion of plugs following previous plug failure is less likely to be successful. We suggest the fistula plug should remain a first-line treatment for primary surgery and simple tracts.

  19. Epidural analgesia in cattle, buffalo, and camels

    Directory of Open Access Journals (Sweden)

    Zuhair Bani Ismail

    2016-12-01

    Full Text Available Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1 and first intercoccygeal intervertebral space (Co1-Co2. The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg, bupivacaine (0.125 mg/kg, ropivacaine (0.11 mg/kg, xylazine (0.05 mg/kg, medetomidine (15 μg/kg, romifidine (30-50 μg/kg, ketamine (0.3-2.5 mg/kg, tramadol (1 mg/kg, and neostigmine (10 μg/kg, and the clinical applications, clinical effects, recommendations, and side effects were discussed.

  20. Newborn Analgesia Mediated by Oxytocin during Delivery.

    Science.gov (United States)

    Mazzuca, Michel; Minlebaev, Marat; Shakirzyanova, Anastasia; Tyzio, Roman; Taccola, Giuliano; Janackova, Sona; Gataullina, Svetlana; Ben-Ari, Yehezkel; Giniatullin, Rashid; Khazipov, Rustem

    2011-01-01

    The mechanisms controlling pain in newborns during delivery are poorly understood. We explored the hypothesis that oxytocin, an essential hormone for labor and a powerful neuromodulator, exerts analgesic actions on newborns during delivery. Using a thermal tail-flick assay, we report that pain sensitivity is two-fold lower in rat pups immediately after birth than 2 days later. Oxytocin receptor antagonists strongly enhanced pain sensitivity in newborn, but not in 2-day-old rats, whereas oxytocin reduced pain at both ages suggesting an endogenous analgesia by oxytocin during delivery. Similar analgesic effects of oxytocin, measured as attenuation of pain-vocalization induced by electrical whisker pad stimulation, were also observed in decerebrated newborns. Oxytocin reduced GABA-evoked calcium responses and depolarizing GABA driving force in isolated neonatal trigeminal neurons suggesting that oxytocin effects are mediated by alterations of intracellular chloride. Unlike GABA signaling, oxytocin did not affect responses mediated by P2X3 and TRPV1 receptors. In keeping with a GABAergic mechanism, reduction of intracellular chloride by the diuretic NKCC1 chloride co-transporter antagonist bumetanide mimicked the analgesic actions of oxytocin and its effects on GABA responses in nociceptive neurons. Therefore, endogenous oxytocin exerts an analgesic action in newborn pups that involves a reduction of the depolarizing action of GABA on nociceptive neurons. Therefore, the same hormone that triggers delivery also acts as a natural pain killer revealing a novel facet of the protective actions of oxytocin in the fetus at birth.

  1. Epidural analgesia in cattle, buffalo, and camels.

    Science.gov (United States)

    Ismail, Zuhair Bani

    2016-12-01

    Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1) and first intercoccygeal intervertebral space (Co1-Co2). The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg), bupivacaine (0.125 mg/kg), ropivacaine (0.11 mg/kg), xylazine (0.05 mg/kg), medetomidine (15 µg/kg), romifidine (30-50 µg/kg), ketamine (0.3-2.5 mg/kg), tramadol (1 mg/kg), and neostigmine (10 µg/kg), and the clinical applications, clinical effects, recommendations, and side effects were discussed.

  2. [Nitrous oxide - oxygen analgesia in aesthetic dermatology].

    Science.gov (United States)

    Drosner, M

    2013-06-01

    Local anaesthesia often is insufficient for more extensive procedures. Instead of general anaesthesia or sedation, pediatricians, gynaecologists and dentists increasingly use nitrous oxide (N2O). This study evaluates the suitability of this form of anesthesia in dermatology. In 24 patients (18 w, 6 m, mean age 49 y.) N2O/O2 inhalation (Livopan®) was used during 46 procedures with indications including fractional RF/wrinkle reduction, IPL/rosacea, q-sw. laser/tattoos and hemosiderosis as well as fractional Er:Glass laser for scars and hypopigmentation. In 26 procedures subjective pain intensity was measured (visual analogue scale 0-10). With N2O the treatment pain was lowered from 6.6 ± 1.6 to 2.9 ± 1.7 (median, p = 0.000). 23/24 patients chose N2O for their next treatment. Beside euphoria, fatigue, slight drowsiness, dizziness, nausea or change in auditory perception, no other side effects occurred. The pronounced analgesia, the easy self-administration, the fast onset and complete recovery after a few minutes and the low ratio of side effects make the N2O/O2 inhalation to an ideal addendum in the management of larger painful procedures in dermatology as long as contraindications and safety precautions are respected.

  3. Epidural analgesia in cattle, buffalo, and camels

    Science.gov (United States)

    Ismail, Zuhair Bani

    2016-01-01

    Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1) and first intercoccygeal intervertebral space (Co1-Co2). The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg), bupivacaine (0.125 mg/kg), ropivacaine (0.11 mg/kg), xylazine (0.05 mg/kg), medetomidine (15 µg/kg), romifidine (30-50 µg/kg), ketamine (0.3-2.5 mg/kg), tramadol (1 mg/kg), and neostigmine (10 µg/kg), and the clinical applications, clinical effects, recommendations, and side effects were discussed. PMID:28096620

  4. Sedation and analgesia in the pediatric intensive care unit.

    Science.gov (United States)

    Tobias, Joseph D

    2005-08-01

    Various clinical situations may arise in the PICU that necessitate the use of sedation, analgesia, or both. Although there is a large clinical experience with midazolam in the PICU population and it remains the most commonly used benzodiazepine in this setting, lorazepam may provide an effective alternative, with a longer half-life and more predictable pharmacokinetics without the concern of active metabolites. However, there are limited reports regarding its use in the PICU population, and concerns exist regarding the potential for toxicity related to its diluent, propylene glycol. Although the synthetic opioid fentanyl frequently is chosen for use in the PICU setting because of its hemodynamic stability, preliminary data suggest morphine may have a slower development of tolerance and may cause fewer withdrawal symptoms than fentanyl. Morphine's safety profile includes long-term follow-up studies that have demonstrated no adverse central nervous system developmental effects from its use in neonates and infants. In the critically ill infant at risk following surgery for congenital heart disease, clinical experience supports the use of the synthetic opioids, given their ability to modulate PVR and prevent pulmonary hypertensive crisis. Alternatives to the benzodiazepines and opioids include ketamine, pentobarbital, or dexmedetomidine. Ketamine may be useful for patients with hemodynamic instability or airway reactivity. There are limited reports regarding the use of pentobarbital in the PICU, with one study raising concerns of a high incidence of adverse effects associated with its use. Propofol has gained great favor in the adult population as a means of providing deep sedation while allowing for rapid awakening; however, its routine use is not recommended because of its potential association with "propofol infusion syndrome." As the pediatric experience increases, it appears that there will be a role for newer agents such as dexmedetomidine.

  5. Simpatectomia cervicotoracica por videotoracoscopia: experiência inicial Thoracoscopic cervicodorsal sympathectomy: initial results

    Directory of Open Access Journals (Sweden)

    Paulo Kauffman

    1998-08-01

    Full Text Available O objetivo do presente trabalho é avaliar os resultados iniciais obtidos com a simpatectomia cervicotorácica videotoracoscópica. De outubro de 1995 a outubro de 1997 foram realizados 24 procedimentos em 14 pacientes: dez homens e quatro mulheres, com idades que variaram de 16 a 56 anos, média de 30 anos. Indicações para a operação foram: hiperidrose palmar em dez pacientes, isquemia de mão em três e causalgia em um. Nos casos de hiperidrose, a ressecção da cadeia simpática incluiu T2 e T3. Nos portadores de isquemia e causalgia também o gânglio estrelado foi ressecado. Vinte e três das 24 extremidades mostraram excelente resposta imediata à simpatectomia. Somente uma extremidade de paciente com hiperidrose permaneceu inalterada devido a procedimento incompleto, tendo sido desnervada pela mesma técnica em reoperação posterior, com bom resultado. Pneumotórax residual pós-operatório ocorreu em uma paciente com resolução espontânea. Treze pacientes tiveram seguimento que variou de dois a 18 meses, com média de 11 meses. Não houve mortalidade nessa série, e a principal complicação tardia observada nos pacientes operados por hiperidrose foi a hiperidrose compensatória, que ocorreu, em grau variado, nos nove pacientes com seguimento, sendo que em 30% deles esta manifestação foi significativa. Concluímos tratar-se de procedimento simples, seguro, eficiente e de melhor aceitação por parte dos pacientes do que a operação convencional.This report analyzes the initial results of thoracoscopic cervicodorsal sympathectomy. From October 1995 to October 1997, 24 procedures were accomplished in 14 patients. Ten were males and four were females ranging in age from 16 to 56 (mean 30. Surgical indications were: palmar hyperhidrosis in ten, ischemia of the hand in three and causalgia in one. Resection of the sympathetic chain in hyperhidrosis included T2 and T3. In those with ischemia and causalgia the stellate ganglion was

  6. Motion-Corrected Real-Time Cine Magnetic Resonance Imaging of the Heart: Initial Clinical Experience.

    Science.gov (United States)

    Rahsepar, Amir Ali; Saybasili, Haris; Ghasemiesfe, Ahmadreza; Dolan, Ryan S; Shehata, Monda L; Botelho, Marcos P; Markl, Michael; Spottiswoode, Bruce; Collins, Jeremy D; Carr, James C

    2017-08-29

    Free-breathing real-time (RT) imaging can be used in patients with difficulty in breath-holding; however, RT cine imaging typically experiences poor image quality compared with segmented cine imaging because of low resolution. Here, we validate a novel unsupervised motion-corrected (MOCO) reconstruction technique for free-breathing RT cardiac images, called MOCO-RT. Motion-corrected RT uses elastic image registration to generate a single heartbeat of high-quality data from a free-breathing RT acquisition. Segmented balanced steady-state free precession (bSSFP) cine images and free-breathing RT images (Cartesian, TGRAPPA factor 4) were acquired with the same spatial/temporal resolution in 40 patients using clinical 1.5 T magnetic resonance scanners. The respiratory cycle was estimated using the reconstructed RT images, and nonrigid unsupervised motion correction was applied to eliminate breathing motion. Conventional segmented RT and MOCO-RT single-heartbeat cine images were analyzed to evaluate left ventricular (LV) function and volume measurements. Two radiologists scored images for overall image quality, artifact, noise, and wall motion abnormalities. Intraclass correlation coefficient was used to assess the reliability of MOCO-RT measurement. Intraclass correlation coefficient showed excellent reliability (intraclass correlation coefficient ≥ 0.95) of MOCO-RT with segmented cine in measuring LV function, mass, and volume. Comparison of the qualitative ratings indicated comparable image quality for MOCO-RT (4.80 ± 0.35) with segmented cine (4.45 ± 0.88, P = 0.215) and significantly higher than conventional RT techniques (3.51 ± 0.41, P cine (1.51 ± 0.90, P = 0.088 and 1.23 ± 0.45, P = 0.182) were not different. Wall motion abnormality ratings were comparable among different techniques (P = 0.96). The MOCO-RT technique can be used to process conventional free-breathing RT cine images and provides comparable quantitative assessment of LV function and volume

  7. [Initial clinical experience with deep sclerectomy in ambulatory surgery in glaucoma].

    Science.gov (United States)

    Pitrová, S; Pesková, H; Lesták, J

    1999-01-01

    Deep sclerectomy is a non-perforating filtering operation used in surgical treatment of open angle glaucomas. The advantage of the operation is the creation of gradual filtration due to the thin trabecular Descement membrane which reduces markedly the risk of development of postoperative complications typical for perforating antiglaucomatous operations. The authors operated at the out-patient department 10 eyes of 8 patients (age 46-81 years). Indications for deep sclerectomy was seven times primary open angle glaucoma (POAG), once capsular glaucoma and twice normotensive glaucoma (NTG). In all eyes deep sclerectomy was indicated because of decompensation of the intraocular pressure with maximum tolerated therapy before surgery. None of the eyes were operated previously. The mean value of intraocular pressure before surgery was 25.1 +/- 6.5 mm Hg. From the results ensues that in nine operated eyes the intraocular pressure at the end of the 6-month follow-up period was compensated without supplementary therapy, only in one eye beta-blockers were prescribed one month after surgery. The cause of failure of filtration was the development of superficial adherence at the site of microperforatiion of the trabecular Descemet membrane which developed during operation. The mean intraocular pressure values at the end of the investigation period were 14.3 +/- 2.8 mm Hg. In two eyes haemorrhage into the anterior chamber was observed on the first day after surgery, the blood was absorbed within 24 hours. Hypotonia in two eyes was only transient and was not associated with a change in the depth of the anterior chamber or other complications. In none of the patients a decline of visual acuity was observed. In three operated eyes a change of refraction was necessary due to discontinuation of miotics after surgery. Deep sclerectomy is a delicate microsurgical technique which calls for experience and skill of the surgeon. The most complicated task is to prevent perforation of the

  8. Single-port video-assisted thoracic surgery for early lung cancer: initial experience in Japan

    Science.gov (United States)

    Takeuchi, Shingo; Usuda, Jitsuo

    2016-01-01

    Background Single-port video-assisted thoracic surgery (SPVATS) emerged several years ago as a new, minimally invasive surgery for diseases in the field of respiratory surgery, and is increasingly becoming a subject of interest for some thoracic surgeons in Europe and Asia. However, the adoption rate of this procedure in the United States and Japan remains low. We herein reviewed our experience of SPVATS for early lung cancer in our center, and evaluated the safety and minimal invasiveness of this technique. Methods We retrospectively analyzed patients who had undergone SPVATS for pathological stage I lung cancer in Nippon Medical School Chiba Hokusoh Hospital between September 2012 and October 2015. In SPVATS, an approximately 4-cm incision was made at the 4th or 5th intercostal space between the anterior and posterior axillary lines. A rib spreader was not used at the incision site, and surgical manipulation was performed very carefully in order to avoid contact between surgical instruments and the intercostal nerves. The same surgeon performed surgery on all patients, and analyzed laboratory data before and after surgery. Results Eighty-four patients underwent anatomical lung resection for postoperative pathological stage I lung cancer. The mean wound length was 4.2 cm. Eighty-four patients underwent lobectomy and segmentectomy, respectively. The mean preoperative forced expiratory volume in 1 second (FEV1%) was 1.85%±0.36%. Our patients consisted of 49 men (58.3%) and 35 women (41.7%), with 64, 18, 1, and 1 having adenocarcinoma, squamous cell carcinoma, adenosquamous carcinoma, and small-cell lung cancer, respectively. The mean operative time was 175±21 min, operative blood loss 92±18 mL, and duration of drain placement 1.9±0.6 days. The duration of the postoperative hospital stay was 7.1±1.7 days, numeric rating scale (NRS) 1 week after surgery 2.8±0.6, and occurrence rate of allodynia 1 month after surgery 10.7%. No patient developed serious

  9. Initial clinical experience with a radiation oncology dedicated open 1.0T MR-simulation.

    Science.gov (United States)

    Glide-Hurst, Carri K; Wen, Ning; Hearshen, David; Kim, Joshua; Pantelic, Milan; Zhao, Bo; Mancell, Tina; Levin, Kenneth; Movsas, Benjamin; Chetty, Indrin J; Siddiqui, M Salim

    2015-03-08

    The purpose of this study was to describe our experience with 1.0T MR-SIM including characterization, quality assurance (QA) program, and features necessary for treatment planning. Staffing, safety, and patient screening procedures were developed. Utilization of an external laser positioning system (ELPS) and MR-compatible couchtop were illustrated. Spatial and volumetric analyses were conducted between CT-SIM and MR-SIM using a stereotactic QA phantom with known landmarks and volumes. Magnetic field inhomogeneity was determined using phase difference analysis. System-related, in-plane distortion was evaluated and temporal changes were assessed. 3D distortion was characterized for regions of interest (ROIs) 5-20 cm away from isocenter. American College of Radiology (ACR) recommended tests and impact of ELPS on image quality were analyzed. Combined ultrashort echotime Dixon (UTE/Dixon) sequence was evaluated. Amplitude-triggered 4D MRI was implemented using a motion phantom (2-10 phases, ~ 2 cm excursion, 3-5 s periods) and a liver cancer patient. Duty cycle, acquisition time, and excursion were evaluated between maximum intensity projection (MIP) datasets. Less than 2% difference from expected was obtained between CT-SIM and MR-SIM volumes, with a mean distance of 3D geometric distortion was 0.59 ± 0.32 mm (maximum = 1.65 mm) and increased 10-15 cm from isocenter (mean = 1.57 ± 1.06 mm, maximum = 6.26 mm). ELPS interference was within the operating frequency of the scanner and was characterized by line patterns and a reduction in signal-to-noise ratio (4.6-12.6% for TE = 50-150 ms). Image quality checks were within ACR recommendations. UTE/Dixon sequences yielded detectability between bone and air. For 4D MRI, faster breathing periods had higher duty cycles than slow (50.4% (3 s) and 39.4% (5 s), p < 0.001) and ~fourfold acquisition time increase was measured for ten-phase versus two-phase. Superior-inferior object extent was underestimated 8% (6 mm) for two

  10. Psychophysical testing of spatial and temporal dimensions of endogenous analgesia: conditioned pain modulation and offset analgesia.

    Science.gov (United States)

    Honigman, Liat; Yarnitsky, David; Sprecher, Elliot; Weissman-Fogel, Irit

    2013-08-01

    The endogenous analgesia (EA) system is psychophysically evaluated using various paradigms, including conditioned pain modulation (CPM) and offset analgesia (OA) testing, respectively, the spatial and temporal filtering processes of noxious information. Though both paradigms assess the function of the EA system, it is still unknown whether they reflect the same aspects of EA and consequently whether they provide additive or equivalent data. Twenty-nine healthy volunteers (15 males) underwent 5 trials of different stimulation conditions in random order including: (1) the classic OA three-temperature stimulus train ('OA'); (2) a three-temperature stimulus train as control for the OA ('OAcon'); (3) a constant temperature stimulus ('constant'); (4) the classic parallel CPM ('CPM'); and (5) a combination of OA and CPM ('OA + CPM'). We found that in males, the pain reduction during the OA + CPM condition was greater than during the OA (P = 0.003) and CPM (P = 0.07) conditions. Furthermore, a correlation was found between OA and CPM (r = 0.62, P = 0.01) at the time of maximum OA effect. The additive effect found suggests that the two paradigms represent at least partially different aspects of EA. The moderate association between the CPM and OA magnitudes indicates, on the other hand, some commonality of their underlying mechanisms.

  11. RM de cuerpo entero, experiencia inicial Whole body MRI, initial experience

    Directory of Open Access Journals (Sweden)

    Ezequiel Rombolá

    2008-09-01

    Full Text Available Objetivo: Exponer y compartir nuestra experiencia en resonancia magnética de cuerpo entero (RMCE. Material y métodos: Se realizó estudio prospectivo entre octubre de 2005 y mayo de 2007 sobre 165 RMCE. Edad de los pacientes: 21 y 85 años, media de 51,64. Se utilizó equipo de 1,5 Tesla de campo magnético y tabla deslizable. El protocolo de estudio estuvo integrado por cortes coronales multicontraste (T1, T2 y STIR, axiales y sagitales en T2. Resultados: Se obtuvieron 140 (84,84 % estudios con hallazgos relevantes y 25 (15,15 % sin alteraciones. Se halló predominancia de enfermedades degenerativas articulares del esqueleto axial en 94 pacientes (56,96% sin diferencias significativas entre sexos. Trece pacientes realizaron controles oncológicos demostrándose diseminación a distancia en 6 estudios. En 1 examen se registró la distribución de polimiositis. Conclusiones: La RMCE no representa solamente una innovadora herramienta diagnóstica, sino también ostenta el potencial de competir con metodologías preexistentes en aplicaciones oncológicas y no oncológicas. La sensibilidad y especificidad del método están probadas, pero su aplicación se encuentra limitada por el alto costo y la falta de inclusión en protocolos diagnósticos de estadificación tumoral.Objective: To expose and share our experience in whole-body MRI. Material and methods: A prospective study of 165 whole-body MRI was made from october 2005 to may 2007. The age range was between 21 to 85 years old, with a mean age of 51, 64. A 1.5 Tesla MRI scan was utilized with a table-top movement. Multicontrast coronal scans (T1, T2 and STIR, sagittal and axial T2 compose the study protocol. Results: 140 (84,84 % scans with relevant results and 25 (15,15 % without abnormalities were found. The axial skeletal articular degenerative disease prevalence on 94 (56,96 % cases, without significant difference. Six MRI scans showed secondary dissemination of the oncology disease in a

  12. Ultrasound-guided Breast Biopsy in the Resource-limited Setting: An Initial Experience in Rural Uganda

    Directory of Open Access Journals (Sweden)

    Christopher R. Stark

    2017-06-01

    Full Text Available Purpose: To describe the methodology and initial experience behind creation of an ultrasoundguided percutaneous breast core biopsy program in rural Uganda. Methods and Materials: Imaging the World Africa (ITWA is the registered non-governmental organization division of Imaging the World (ITW, a not-for-profit organization whose primary aim is the integration of affordable high-quality ultrasound into rural health centers. In 2013, ITWA began the pilot phase of an IRB-approved breast care protocol at a rural health center in Uganda. As part of the protocol’s diagnostic arm, an ultrasound-guided percutaneous breast core biopsy training curriculum was implemented in tandem with creation of regionally supplied biopsy kits. Results: A surgeon at a rural regional referral hospital was successfully trained and certified to perform ultrasound-guided percutaneous breast core biopsies. Affordable and safe biopsy kits were created using locally available medical supplies with the cost of each kit totaling $10.62 USD. Conclusion: Successful implementation of an ultrasound-guided percutaneous breast core biopsy program in the resource-limited setting is possible and can be made sustainable through incorporation of local health care personnel and regionally supplied biopsy materials. Our hope is that ITWA’s initial experience in rural Uganda can serve as a model for similar programs in the future.

  13. Image guided respiratory gated hypofractionated Stereotactic Body Radiation Therapy (H-SBRT) for liver and lung tumors: Initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Wurm, R.E.; Gum, F.; Erbel, S. [Charite Campus Mitte, Berlin (Germany). Dept. of Radiation Oncology

    2006-09-15

    To evaluate our initial experience with image guided respiratory gated H-SBRT for liver and lung tumors. The system combines a stereoscopic x-ray imaging system (ExacTrac{sup R} X-Ray 6D) with a dedicated conformal stereotactic radiosurgery and radiotherapy linear accelerator (Novalis) and ExacTrac{sup R} Adaptive Gating for dynamic adaptive treatment. Moving targets are located and tracked by x-ray imaging of implanted fiducial markers defined in the treatment planning computed tomography (CT). The marker position is compared with the position in verification stereoscopic x-ray images, using fully automated marker detection software. The required shift for a correct, gated set-up is calculated and automatically applied. We present our acceptance testing and initial experience in patients with liver and lung tumors. For treatment planning CT and Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) as well as magnetic resonance imaging (MRI) taken at free breathing and expiration breath hold with internal and external fiducials present were used. Patients were treated with 8-11 consecutive fractions to a dose of 74.8-79.2 Gy. Phantom tests demonstrated targeting accuracy with a moving target to within {+-}1 mm. Inter- and intrafractional patient set-up displacements, as corrected by the gated set-up and not detectable by a conventional set-up, were up to 30 mm. Verification imaging to determine target location during treatment showed an average marker position deviation from the expected position of up to 4 mm on real patients. This initial evaluation shows the accuracy of the system and feasibility of image guided real-time respiratory gated H-SBRT for liver and lung tumors.

  14. Epidural and opioid analgesia following the Nuss procedure

    Science.gov (United States)

    Walaszczyk, Malgorzata; Knapik, Piotr; Misiolek, Hanna; Korlacki, Wojciech

    2011-01-01

    Summary Background Parents have the right to decide on behalf of their children and deny consent to regional anaesthesia. The investigators decided to investigate quality of postoperative analgesia in adolescents undergoing epidural and opioid analgesia following the Nuss procedure. Material/Methods The study subjects were 61 adolescents aged 11–18 years who underwent pectus excavatum repair with the Nuss procedure. Patients were divided into epidural (n=41) and opioid (n=20) groups, depending on their parents’ consent to epidural catheter insertion. Intraoperatively, 0.5% epidural ropivacaine with fentanyl or intermittent intravenous injections of fentanyl were used. Postoperative analgesia was achieved with either epidural infusion of 0.1% ropivacaine with fentanyl, or subcutaneous morphine via an intraoperatively inserted “butterfly” cannula. Additionally, both groups received metamizol and paracetamol. Primary outcome variables were postoperative pain scores (Numeric Rating Scale and Prince Henry Hospital Pain Score). Secondary outcome variables included hemodynamic parameters, additional analgesia and side effects. Results Heart rate and blood pressure values in the postoperative period were significantly higher in the opioid group. Pain scores requiring intervention were noted almost exclusively in the opioid group. Conclusions Denial of parental consent to epidural analgesia following the Nuss procedure results in significantly worse control of postoperative pain. Our data may be useful when discussing with parents the available anaesthetic techniques for exceptionally painful procedures. PMID:22037752

  15. Preemptive analgesia I: physiological pathways and pharmacological modalities.

    LENUS (Irish Health Repository)

    Kelly, D J

    2012-02-03

    PURPOSE: This two-part review summarizes the current knowledge of physiological mechanisms, pharmacological modalities and controversial issues surrounding preemptive analgesia. SOURCE: Articles from 1966 to present were obtained from the MEDLINE databases. Search terms included: analgesia, preemptive; neurotransmitters; pain, postoperative; hyperalgesia; sensitization, central nervous system; pathways, nociception; anesthetic techniques; analgesics, agents. Principal findings: The physiological basis of preemptive analgesia is complex and involves modification of the pain pathways. The pharmacological modalities available may modify the physiological responses at various levels. Effective preemptive analgesic techniques require multi-modal interception of nociceptive input, increasing threshold for nociception, and blocking or decreasing nociceptor receptor activation. Although the literature is controversial regarding the effectiveness of preemptive analgesia, some general recommendations can be helpful in guiding clinical care. Regional anesthesia induced prior to surgical trauma and continued well into the postoperative period is effective in attenuating peripheral and central sensitization. Pharmacologic agents such as NSAIDs (non-steroidal anti-inflammatory drugs) opioids, and NMDA (N-methyl-D-aspartate) - and alpha-2-receptor antagonists, especially when used in combination, act synergistically to decrease postoperative pain. CONCLUSION: The variable patient characteristics and timing of preemptive analgesia in relation to surgical noxious input requires individualization of the technique(s) chosen. Multi-modal analgesic techniques appear most effective.

  16. Preemptive analgesia II: recent advances and current trends.

    LENUS (Irish Health Repository)

    Kelly, D J

    2012-02-03

    PURPOSE: This two-part review summarizes the current knowledge of physiological mechanisms, pharmacological modalities and controversial issues surrounding preemptive analgesia. SOURCE: Articles from 1966 to present were obtained from the MEDLINE databases. Search terms included analgesia, preemptive; neurotransmitters; pain, postoperative; hyperalgesia; sensitization, central nervous system; pathways, nociception; anesthetic techniques; analgesics, agents. Principal findings: In Part I of this review article, techniques and agents that attenuate or prevent central and peripheral sensitization were reviewed. In Part II, the conditions required for effective preemptive techniques are evaluated. Specifically, preemptive analgesia may be defined as an antinociceptive treatment that prevents establishment of altered central processing of afferent input from sites of injury. The most important conditions for establishment of effective preemptive analgesia are the establishment of an effective level of antinociception before injury, and the continuation of this effective analgesic level well into the post-injury period to prevent central sensitization during the inflammatory phase. Although single-agent therapy may attenuate the central nociceptive processing, multi-modal therapy is more effective, and may be associated with fewer side effects compared with the high-dose, single-agent therapy. CONCLUSION: The variable patient characteristics and timing of preemptive analgesia in relation to surgical noxious input require individualization of the technique(s) chosen. Multi-modal analgesic techniques appear more effective.

  17. A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Karen Vestergaard; Bak, Marie; Christensen, Birgitte Viebæk;

    2010-01-01

    There have been few studies describing wound infiltration with additional intraarticular administration of multimodal analgesia for total knee arthroplasty (TKA). In this study, we assessed the efficacy of wound infiltration combined with intraarticular regional analgesia with epidural infusion...

  18. CORRELATION OF CRISES, CRISIS EXPERIENCES AND ORIENTATION OF TIME PERSPECTIVE AT THE INITIAL STAGE OF TRAINING IN HIGHER EDUCATION INSTITUTION

    Directory of Open Access Journals (Sweden)

    Irina A. Kurus

    2016-01-01

    Full Text Available The purpose of article is identification of an actual problem of psychological science: correlation of crises and a crisis experiences with and orientation of time perspective at the initial stage of training in institution of higher education.Methods. During the research the following psychodiagnostic methods are applied: the questionnaire of crisis experiences for student by V. R. Manukyan; a questionnaire of time perspective by F. Zimbardo in adaptation of A. Syrtsova, E. T. Sokolova, O. V. Mitina (ZTPI.Results and scientific novelty. Data on interrelation of crises and crisis experiences with an orientation of temporary prospect are obtained and analysed on the basis of representative selection of students in Novosibirsk State Medical University. Gender distinctions of crises behaviour of students are shown. It is established that temporary prospects «The negative past» and «The fatalistic present» correlate with all the crisis experiences of students at the initial stage of training in higher education institution. The temporary prospect «Future» has the return correlation with crisis experience «absence of the appreciably attractive purposes in the future», and the interrelation with crises is absent. In this regard the author proposes the correction procedure of psychological escort of first-year students.Practical significance. The research findings can be used by educational psychologists for psychological diagnostics of pupils, to search the reasons of their poor progress, during the developing and correction of programs of psychology and pedagogical escort of first-year students, in particular when writing the program of adaptive training in the centers of psychosocial maintenance of the trainees. Guidelines for a choice of the techniques and methods promoting overcoming of the problems connected with crisis of identity and biographic crises are given.

  19. The RESPITE trial: remifentanil intravenously administered patient-controlled analgesia (PCA) versus pethidine intramuscular injection for pain relief in labour: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Wilson, Matthew; MacArthur, Christine; Gao Smith, Fang; Homer, Leanne; Handley, Kelly; Daniels, Jane

    2016-12-12

    The commonest opioid used for pain relief in labour is pethidine (meperidine); however, its effectiveness has long been challenged and the drug has known side effects including maternal sedation, nausea and potential transfer across the placenta to the foetus. Over a third of women receiving pethidine require an epidural due to inadequate pain relief. Epidural analgesia increases the risk of an instrumental vaginal delivery and its associated effects. Therefore, there is a clear need for a safe, effective, alternative analgesic to pethidine. Evidence suggests that remifentanil patient-controlled analgesia (PCA) reduces epidural conversion rates compared to pethidine; however, no trial has yet investigated this as a primary endpoint. We are, therefore, comparing pethidine intramuscular injection to remifentanil PCA in a randomised controlled trial. Women in established labour, requesting systemic opioid pain relief, will be randomised to either intravenously administered remifentanil PCA (intervention) or pethidine intramuscular injection (control) in an unblinded, 1:1 individual randomised trial. Following informed consent, 400 women in established labour, who request systemic opioid pain relief, from NHS Trusts across England will undergo a minimised randomisation by a computer or automated telephone system to either pethidine or remifentanil. In order to balance the groups this minimisation is based on four parameters; parity (nulliparous versus multiparous), maternal age (relief provided by each technique will be recorded every 30 min after time zero, until epidural placement, delivery or transfer to theatre, quantified by Visual Analogue Scale. Incidence of maternal side effects including sedation, delivery mode, foetal distress requiring delivery, neonatal status at delivery and rate of initiation of breastfeeding within the first hour of birth will also be recorded. Maternal satisfaction with her childbirth experience will be determined by a postpartum

  20. Reactor physics studies for the Advanced Fuel Cycle Initiative (AFCI) Reactor-Accelerator Coupling Experiments (RACE) Project

    Science.gov (United States)

    Stankovskiy, Evgeny Yuryevich

    In the recently completed RACE Project of the AFCI, accelerator-driven subcritical systems (ADS) experiments were conducted to develop technology of coupling accelerators to nuclear reactors. In these experiments electron accelerators induced photon-neutron reactions in heavy-metal targets to initiate fission reactions in ADS. Although the Idaho State University (ISU) RACE ADS was constructed only to develop measurement techniques for advanced experiments, many reactor kinetics experiments were conducted there. In the research reported in this dissertation, a method was developed to calculate kinetics parameters for measurement and calculation of the reactivity of ADS, a safety parameter that is necessary for control and monitoring of power production. Reactivity is measured in units of fraction of delayed versus prompt neutron from fission, a quantity that cannot be directly measured in far-subcritical reactors such as the ISU RACE configuration. A new technique is reported herein to calculate it accurately and to predict kinetic behavior of a far-subcritical ADS. Experiments conducted at ISU are first described and experimental data are presented before development of the kinetic theory used in the new computational method. Because of the complexity of the ISU ADS, the Monte-Carlo method as applied in the MCNP code is most suitable for modeling reactor kinetics. However, the standard method of calculating the delayed neutron fraction produces inaccurate values. A new method was developed and used herein to evaluate actual experiments. An advantage of this method is that its efficiency is independent of the fission yield of delayed neutrons, which makes it suitable for fuel with a minor actinide component (e.g. transmutation fuels). The implementation of this method is based on a correlated sampling technique which allows the accurate evaluation of delayed and prompt neutrons. The validity of the obtained results is indicated by good agreement between experimental

  1. INITIAL COOLING EXPERIMENT (ICE)

    CERN Multimedia

    1978-01-01

    ICE was built in 1977, in a record time of 9 months, using the modified bending magnets of the g-2 muon storage ring. Its purpose was to verify the validity of stochastic and electron cooling for the antiproton project, to be launched in 1978. Already early in 1978, stochastic cooling proved a resounding success, such that the antiproton (p-pbar)project was entirely based on it. Tests of electron cooling followed later: protons of 46 MeV kinetic energy were cooled with an electron beam of 26 kV and 1.3 A. The cage seen prominently in the foreground houses the HV equipment, adjacent to the "cooler" installed in a straight section of the ring. With some modifications, the cooler was later transplanted into LEAR (Low Energy Antiproton Ring) and then, with further modifications, into the AD (Antiproton Decelerator), where it cools antiprotons to this day (2006). See also: 7711282, 7802099, 7908242.

  2. [Intrapleural catheter analgesia in patients with multiple rib fractures].

    Science.gov (United States)

    Wulf, H; Jeckström, W; Maier, C; Winckler, K

    1991-01-01

    Patients with multiple rib fractures often suffer from severe pain that impairs their respiratory performance. The effect of interpleural administration of bupivacaine (20 ml 0.25% every 4 h) for pain management was evaluated in ten patients. The initial interpleural injection resulted in significant pain relief and improvement of arterial oxygen tension. Two patients needed additional i.v. injections of opioids (piritramide 15-22.5 mg/24 h). In one patient a small asymptomatic pneumothorax was observed following placement of the catheter, which resolved spontaneously. No other complications were reported. In an intraindividual comparison, bupivacaine alone and bupivacaine plus epinephrine 1:200,000 were compared with regard to pharmacokinetics of bupivacaine, analgesic effect, side effects, and respiratory performance. The addition of epinephrine yielded only minor advantages from a pharmacokinetic point of view (median peak concentration of bupivacaine 1.8 micrograms/ml vs 2.0 micrograms/ml for bupivacaine alone). The quality and duration of analgesia and the effects on respiration were not influenced by epinephrine. The heart rate was significantly higher and the blood pressure significantly lower when epinephrine was added to the solution. Nevertheless, these differences were too small to be of clinical importance. Even though maximum total plasma concentrations of bupivacaine above 2 micrograms/ml were found in some patients, there were no signs of CNS toxicity, most probably because of the increased protein binding of bupivacaine following trauma. Accordingly, the maximum free plasma concentrations in all patients were below the threshold level of 0.24 micron/ml. We therefore conclude tht interpleural administration of bupivacaine could be a valuable means of pain relief in patients with multiple rib fractures, providing no severe pulmonary contusions or concomitant injuries are present.

  3. Ethnic differences in the use of intrapartum epidural analgesia

    Directory of Open Access Journals (Sweden)

    Jiménez-Puente Alberto

    2012-07-01

    Full Text Available Abstract Background Obstetric epidural analgesia (EA is widely applied, but studies have reported that its use may be less extensive among immigrant women or those from minority ethnic groups. Our aim was to examine whether this was the case in our geographic area, which contains an important immigrant population, and if so, to describe the different components of this phenomenon. Methods Cross-sectional observational study. Setting: general acute care hospital, located in Marbella, southern Spain. Analysis of computer records of deliveries performed from 2004 to 2010. Comparison of characteristics of deliveries according to the mothers’ geographic origins and of vaginal deliveries noting whether EA was received, using univariate and bivariate statistical analysis and multiple logistic regression (MLR. Results A total of 21,034 deliveries were recorded, and 37.4% of these corresponded to immigrant women. EA was provided to 61.1% of the Spanish women and to 51.5% of the immigrants, with important variations according to geographic origin: over 52% of women from other European countries and South America received EA, compared with around 45% of the African women and 37% of the Asian women. These differences persisted in the MLR model after adjusting for the mother's age, type of labor initiation, the weight of the neonate and for single or multiple gestation. With the Spanish patients as the reference category, all the other countries of origin presented lower probabilities of EA use. This was particularly apparent for the patients from Asia (OR 0.38; 95%CI 0.31-0.46, Morocco (OR 0.49; 95%CI 0.43-0.54 and other Africa (OR 0.55; 95%CI 0.37-0.81. Conclusions We observed a different use of EA in vaginal deliveries, according to the geographic origin of the women. The explanation for this involves a complex set of factors, depending both on the patient and on the healthcare staff.

  4. Mechanisms of acupuncture analgesia: effective therapy for musculoskeletal pain?

    Science.gov (United States)

    Staud, Roland

    2007-12-01

    Acupuncture (AP) is effective for the treatment of postoperative and chemotherapy-induced nausea/vomiting and for postoperative dental pain. Several recent randomized trials have provided strong evidence for beneficial AP effects on chronic low-back pain and pain from knee osteoarthritis. For many other chronic pain conditions, including headaches, neck pain, and fibromyalgia, the evidence supporting AP's efficacy is less convincing. AP's effects on experimental pain appear to be mediated by analgesic brain mechanisms through the release of neurohumoral factors, some of which can be inhibited by the opioid antagonist naloxone. In contrast to placebo analgesia, AP-related pain relief takes considerable time to develop and to resolve. Thus, some of the long-term effects of AP analgesia cannot be explained by placebo mechanisms. Furthermore, it appears that some forms of AP are more effective for providing analgesia than others. Particularly, electro-AP seems best to activate powerful opioid and non-opioid analgesic mechanisms.

  5. Classical conditioning and pain: conditioned analgesia and hyperalgesia.

    Science.gov (United States)

    Miguez, Gonzalo; Laborda, Mario A; Miller, Ralph R

    2014-01-01

    This article reviews situations in which stimuli produce an increase or a decrease in nociceptive responses through basic associative processes and provides an associative account of such changes. Specifically, the literature suggests that cues associated with stress can produce conditioned analgesia or conditioned hyperalgesia, depending on the properties of the conditioned stimulus (e.g., contextual cues and audiovisual cues vs. gustatory and olfactory cues, respectively) and the proprieties of the unconditioned stimulus (e.g., appetitive, aversive, or analgesic, respectively). When such cues are associated with reducers of exogenous pain (e.g., opiates), they typically increase sensitivity to pain. Overall, the evidence concerning conditioned stress-induced analgesia, conditioned hyperalagesia, conditioned tolerance to morphine, and conditioned reduction of morphine analgesia suggests that selective associations between stimuli underlie changes in pain sensitivity.

  6. CLASSICAL CONDITIONING AND PAIN: CONDITIONED ANALGESIA AND HYPERALGESIA

    Science.gov (United States)

    Miguez, Gonzalo; Laborda, Mario A.; Miller, Ralph R.

    2013-01-01

    This article reviews situations in which stimuli produce an increase or a decrease in nociceptive responses through basic associative processes and provides an associative account of such changes. Specifically, the literature suggests that cues associated with stress can produce conditioned analgesia or conditioned hyperalgesia, depending on the properties of the conditioned stimulus (e.g., contextual cues and audiovisual cues vs. gustatory and olfactory cues, respectively) and the proprieties of the unconditioned stimulus (e.g., appetitive, aversive, or analgesic, respectively). When such cues are associated with reducers of exogenous pain (e.g., opiates), they typically increase sensitivity to pain. Overall, the evidence concerning conditioned stress-induced analgesia, conditioned hyperalagesia, conditioned tolerance to morphine, and conditioned reduction of morphine analgesia suggests that selective associations between stimuli underlie changes in pain sensitivity. PMID:24269884

  7. Role of collagen fibers in acupuncture analgesia therapy on rats.

    Science.gov (United States)

    Yu, Xiaojia; Ding, Guanghong; Huang, Hong; Lin, Jun; Yao, Wei; Zhan, Rui

    2009-01-01

    Acupuncture, a traditional Chinese therapeutic technique, has been put into practice for more than 4000 years and widely used for pain management since 1958. However, what is the mechanism underlying the acupuncture for analgesia effects by stimulation of acupoints, what substances receive the original mechanical acupuncture signals from the acupoints, or what transforms these signals into effective biological signals are not well understood. In this work, the role of collagen fibers at acupoints during acupuncture analgesia on rats was investigated. When the structure of the collagen fibers at Zusanli (ST36) was destroyed by injection of type I collagenase, the needle force caused by the acupuncture declined and the analgesic effects of rotation or lift-thrusting manipulations was attenuated accompanying the restraint of the degranulation ratios of mast cells. We propose that collagen fibers play an important role in acupuncture-induced analgesia, and they participate in signal transmission and transform processes.

  8. Intravenous patient-controlled analgesia for acute postoperative pain

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; Haroutiunian, Simon

    2011-01-01

    Intravenous patient-controlled therapy is used routinely in postoperative care in much of the developed world. Intravenous patient-controlled analgesia results in higher patient satisfaction than conventional administration of analgesics, although it appears to have no advantage over conventional...... analgesia in terms of adverse effects and consumption of opioids. Standard orders and nursing procedure protocols are recommended for patients receiving intravenous patient-controlled analgesia to monitor treatment efficacy and development of adverse effects. Some subgroups of patients need special...... consideration. For example, opioid-tolerant patients need higher postoperative opioid doses to achieve satisfactory analgesic effect. In patients with renal or hepatic insufficiency, the elimination of some opioids may be substantially impaired, and the optimal opioid should be selected based on its...

  9. A PROSPECTIVE, RANDOMIZED CONTROL STUDY EVALUATING THE POSTOPERATIVE ANALGESIA USING RECTAL DICLOFENAC IN PATIENTS UNDERGOING ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY SURGERIES

    Directory of Open Access Journals (Sweden)

    Padmaja

    2015-05-01

    Full Text Available BACKGROUND: To assess the efficacy of rectal diclofenac suppository in patients undergoing elective laparoscopic cholecystectomy surgeries in management of postoperative pain, in reduction of intra operative opioid requirement and in prolongation of postoperative anal gesic initiation time. OBJECTIVES: This prospective randomized single blinded clinical trial evaluates the efficacy of rectal diclofenac suppository for the management of postoperative pain. MATERIALS AND METHODS: 100 patients undergoing elective laparosco pic cholecystectomy surgeries were randomized into two groups, Group 1 patients receiving 100mg diclofenac rectal suppository after induction of general anaesthesia, Group 2 patients does not receive any diclofenac rectal suppository. Intra operative hemod ynamic monitoring, post - operative VAS score and adverse reactions were recorded over period of 24 hrs. Intra operative opioid (fentanyl was repeated when heart rate and blood pressure variability of more than 20% from base line are noted. Post operatively if VAS score is more than 4 rescue analgesia with inj. Tramadol is given intramuscularly. RESULTS: Administration of single dose of rectal diclofenac had statistically significant reduction in VAS score post operatively compared to control group, reduced requirement of intra operative opioids (fentanyl. Post - operative rescue analgesia initiation time is prolonged in group 1 mean 9.56 hrs compared to group 2, mean 0.72 hrs (p - 0.000. CONCLUSION: Rectal Diclofenac used in laparoscopic cholecystectomy cases provide adequate, effective prolonged analgesia in the post - operative period with good safety profile

  10. Racial differences in the use of epidural analgesia for labor.

    Science.gov (United States)

    Glance, Laurent G; Wissler, Richard; Glantz, Christopher; Osler, Turner M; Mukamel, Dana B; Dick, Andrew W

    2007-01-01

    There is strong evidence that pain is undertreated in black and Hispanic patients. The association between race and ethnicity and the use of epidural analgesia for labor is not well described. Using the New York State Perinatal Database, the authors examined whether race and ethnicity were associated with the likelihood of receiving epidural analgesia for labor after adjusting for clinical characteristics, demographics, insurance coverage, and provider effect. This retrospective cohort study was based on 81,883 women admitted for childbirth between 1998 and 2003. Overall, 38.3% of the patients received epidural analgesia for labor. After adjusting for clinical risk factors, socioeconomic status, and provider fixed effects, Hispanic and black patients were less likely than non-Hispanic white patients to receive epidural analgesia: The adjusted odds ratio was 0.85 (95% CI, 0.78-0.93) for white/Hispanic and 0.78 (0.74-0.83) for blacks compared with non-Hispanic whites. Compared with patients with private insurance, patients without insurance were least likely to receive epidural analgesia (adjusted odds ratio, 0.76; 95% CI, 0.64-0.89). Black patients with private insurance had similar rates of epidural use to white/non-Hispanic patients without insurance coverage: The adjusted odds ratio was 0.66 (95% CI, 0.53-0.82) for white/non-Hispanic patients without insurance versus 0.69 (0.57-0.85) for black patients with private insurance. Black and Hispanic women in labor are less likely than non-Hispanic white women to receive epidural analgesia. These differences remain after accounting for differences in insurance coverage, provider practice, and clinical characteristics.

  11. Effect of sufentanil combined with different concentrations of ropivacaine for labor analgesia on maternal

    Institute of Scientific and Technical Information of China (English)

    Han-He Wang; Min-Jia Jiang; Wan-Dong Liao

    2016-01-01

    Objective:To study the effect of sufentanil combined with different concentration of ropivacaine for stepped analgesia on stage of labor, stress indexes and blood coagulation function.Methods:A total of 178 cases of full-term singleton primiparas who awaited delivery and received epidural labor analgesia in our hospital from January 2015 to June 2016 were selected and randomly divided into stepped analgesia group and routine analgesia group, and the stage of labor, levels of stress hormones and pain mediators during childbirth and blood coagulation function indexes after childbirth were observed between two groups.Results: The duration of latent phase of labor of stepped analgesia group was shorter than that of routine analgesia group while the duration of active phase of labor, the duration of second stage of labor and the duration of third stage of labor were not significantly different from those of routine analgesia group; serum PRL level of stepped analgesia group was significantly higher than that of routine analgesia group while PA, NE, E, DYN,β-EP, SP, PGE2, 5-HT, TF, TFPI, FPA, AT-III and DD levels were not significantly different from those of routine analgesia group.Conclusions: Sufentanil combined with different concentration of ropivacaine for stepped analgesia is with equivalent effect to routine analgesia, and can shorten the latent phase of labor and reduce the inhibitory effect of pain on prolactin without affecting the degree of stress during childbirth and the blood coagulation function after childbirth.

  12. Initial experience of dual-energy lung perfusion CT using a dual-source CT system in children

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Songpa-gu, Seoul (Korea)

    2010-09-15

    Initial experience of dual-source dual-energy (DE) lung perfusion CT in children is described. In addition to traditional identification of pulmonary emboli, the assessment of lung perfusion is technically feasible with dual-source DE CT in children with acceptable radiation dose. This article describes how to perform dual-source DE lung perfusion CT in children, including the optimization of intravenous injection method and CT dose parameters. How to produce weighted-average CT images for the assessment of pulmonary emboli and colour-coded perfusion maps for the assessment of regional lung perfusion is also detailed. Lung perfusion status can then be evaluated on perfusion maps by means of either qualitative or quantitative analysis. Potential advantages and disadvantages of this emerging CT technique compared to lung perfusion scintigraphy and cardiac MRI are discussed. (orig.)

  13. Initial results of a model rotor higher harmonic control (HHC) wind tunnel experiment on BVI impulsive noise reduction

    Science.gov (United States)

    Splettstoesser, W. R.; Lehmann, G.; van der Wall, B.

    1989-09-01

    Initial acoustic results are presented from a higher harmonic control (HHC) wind tunnel pilot experiment on helicopter rotor blade-vortex interaction (BVI) impulsive noise reduction, making use of the DFVLR 40-percent-scaled BO-105 research rotor in the DNW 6m by 8m closed test section. Considerable noise reduction (of several decibels) has been measured for particular HHC control settings, however, at the cost of increased vibration levels and vice versa. The apparently adverse results for noise and vibration reduction by HHC are explained. At optimum pitch control settings for BVI noise reduction, rotor simulation results demonstrate that blade loading at the outer tip region is decreased, vortex strength and blade vortex miss-distance are increased, resulting altogether in reduced BVI noise generation. At optimum pitch control settings for vibration reduction adverse effects on blade loading, vortex strength and blade vortex miss-distance are found.

  14. Multimedia materials for education, training, and advocacy in international health: experiences with the Schistosomiasis Control Initiative CD-ROM

    Directory of Open Access Journals (Sweden)

    TJ Beanland

    2006-10-01

    Full Text Available We describe an innovative use of multimedia materials to support training and advocacy within a schistosomiasis control programme. The Schistosomiasis Control Initiative (SCI at Imperial College London works with selected sub-Saharan African countries to develop schistosomiasis control programmes. Two elements of the SCI programme were supported by multimedia materials developed at the Wellcome Trust in collaboration with the SCI: (1 training of programme managers, district health officers, and those delivering practical elements of the programme; and (2 advocacy targeted at decision-makers and donors. Evaluation of the materials revealed high reported ratings for both user satisfaction and impact from use of the product. From this experience we draw out several general messages about development of multimedia materials and how these will play a growing future role in promoting training within international health.

  15. Multimedia materials for education, training, and advocacy in international health: experiences with the Schistosomiasis Control Initiative CD-ROM.

    Science.gov (United States)

    Beanland, T J; Lacey, S D; Melkman, D D; Palmer, S; Stothard, J R; Fleming, F; Fenwick, A

    2006-09-01

    We describe an innovative use of multimedia materials to support training and advocacy within a schistosomiasis control programme. The Schistosomiasis Control Initiative (SCI) at Imperial College London works with selected sub-Saharan African countries to develop schistosomiasis control programmes. Two elements of the SCI programme were supported by multimedia materials developed at the Wellcome Trust in collaboration with the SCI: (1) training of programme managers, district health officers, and those delivering practical elements of the programme; and (2) advocacy targeted at decision-makers and donors. Evaluation of the materials revealed high reported ratings for both user satisfaction and impact from use of the product. From this experience we draw out several general messages about development of multimedia materials and how these will play a growing future role in promoting training within international health.

  16. The mediating effect of depressive symptoms on the relationship between traumatic childhood experiences and drug use initiation.

    Science.gov (United States)

    Fishbein, Diana; Novak, Scott P; Krebs, Christopher; Warner, Tara; Hammond, Jane

    2011-05-01

    Stressful experiences such as childhood trauma and depressive symptoms have both been implicated in the initiation of drug use; however, longitudinal designs have not yet been used to elucidate their respective roles to better understand the causal sequence. In the present study, a sensitivity analysis was conducted using two mediation strategies to examine how this sequence may differ by various levels of statistical control, including (1) the standard mediational model in which the effect of lifetime traumatic stressors (Year 1) on the onset of drug use (Years 3 and 4) is mediated by levels of depressive symptoms (Year 2); and (2) a stronger test of causality such that the effect of lifetime traumatic stressors (Year 1) on the onset of drug use (Years 3 and 4) was mediated by changes in depressive symptoms (Year 1 to 2), measured by a residualized change score that controlled for levels in Year 1. Two types of trauma were studied in a community-based study of 489 Hispanic preadolescents (aged 10-12): (a) the number of lifetime traumatic stressors and (b) seven specific lifetime stressors. We also controlled for new onset traumatic stressors occurring between Years 1 and 2. Primary findings indicate that drug use initiation during early adolescence (e.g., ages 14-16) may not be tied to immediate proximal perturbations in risk factors, such as traumatic experiences and depressive symptoms. Rather, the effects of trauma on depression in this sample appear to be established earlier in childhood (ages 10-14 or younger) and persist in a relatively stable manner into middle adolescence when the risk for drug use may be heightened. Copyright © 2011 Elsevier Ltd. All rights reserved.

  17. Regional anesthesia and analgesia for oral and dental procedures.

    Science.gov (United States)

    Rochette, Judy

    2005-07-01

    Regional anesthesia and analgesia benefit the client, the patient, and the practitioner, and their use is becoming the standard for care. Familiarity with the processes involved in the generation of pain aids in understanding the benefits of preemptive and multimodal analgesia. Local anesthetic blocks should be a key component of a treatment plan, along with opioids, nonsteroidal anti-inflammatory drugs, N-methyl-D-aspartate receptor antagonists, and other therapies. Nerve blocks commonly used for dentistry and oral surgery include the infraorbital, maxillary, mental,and mandibular blocks.

  18. Effects of hypnotic focused analgesia on dental pain threshold.

    Science.gov (United States)

    Facco, Enrico; Casiglia, Edoardo; Masiero, Serena; Tikhonoff, Valery; Giacomello, Margherita; Zanette, Gastone

    2011-01-01

    The rate, intensity, and selectivity of hypnotic focused analgesia (HFA) were tested with dental pulp stimulation. Thirty-one healthy subjects were hypnotized, and hypnotic suggestions were given for anesthesia of the right mandibular arch. A posthypnotic suggestion of persisting analgesia was also given. The pain threshold of the first premolar was bilaterally measured before, during, and after hypnosis using a pulp tester. During hypnosis, the pain threshold increased significantly (p < .0001) for both sides. The posthypnotic right pain threshold was also significantly (p < .0015) higher than in the basal condition.

  19. CLINICAL EFFECTS OF ROPIVACAINE MESYLATE IN EPIDURAL ANESTHESIA AND ANALGESIA

    Institute of Scientific and Technical Information of China (English)

    Jian-qing Xu; Bo Zhu; Tie-hu Ye

    2005-01-01

    @@ SINCE the report that ropivacaine hydrochloride, a new amide local anesthetic, is of lower cardiac toxicity both in animals and humans,1 several studies have shown it to be a clinically effective local anesthetic widely used for both epidural anesthesia2-4 and analgesia5-7. Ropivacaine mesylate made in China is structurally from ropivacaine hydrochloride by substituting a mesylate group for hydrochloride group.8 This study was designed to clinically provide a double-blind comparison of ropivacaine mesylate with ropivacaine hydrochloride in epidural anesthesia and analgesia.

  20. Stellate ganglion blockade for analgesia following upper limb surgery.

    LENUS (Irish Health Repository)

    McDonnell, J G

    2012-01-31

    We report the successful use of a stellate ganglion block as part of a multi-modal postoperative analgesic regimen. Four patients scheduled for orthopaedic surgery following upper limb trauma underwent blockade of the stellate ganglion pre-operatively under ultrasound guidance. Patients reported excellent postoperative analgesia, with postoperative VAS pain scores between 0 and 2, and consumption of morphine in the first 24 h ranging from 0 to 14 mg. While these are preliminary findings, and must be confirmed in a clinical trial, they highlight the potential for stellate ganglion blockade to provide analgesia following major upper limb surgery.

  1. The initial magnetic susceptibility of polydisperse ferrofluids: A comparison between experiment and theory over a wide range of concentration

    Science.gov (United States)

    Solovyova, Anna Y.; Goldina, Olga A.; Ivanov, Alexey O.; Lebedev, Aleksandr V.; Elfimova, Ekaterina A.

    2016-08-01

    Temperature dependencies of the static initial magnetic susceptibility for ferrofluids at various concentrations are studied using experiment and statistical-mechanical theories. Magnetic susceptibility measurements are carried out for twelve samples of magnetite-based fluids stabilized with oleic acid over a wide range of temperatures (210 K ≲T ≲ 390 K); all samples have the same granulometric composition but different volume ferroparticle concentrations (0.2 ≲ φ ≲ 0.5). Experimental results are analyzed using three theories: the second-order modified mean-field theory (MMF2) [A. O. Ivanov and O. B. Kuznetsova, Phys. Rev. E 64, 41405 (2001)]; its correction for polydisperse ferrofluids arising from Mayer-type cluster expansion and taking into account the first terms of the polydisperse second virial coefficient [A. O. Ivanov and E. A. Elfimova, J. Magn. Magn. Mater 374, 327 (2015)]; and a new theory based on MMF2 combined with the first terms of the polydisperse second and third virial contributions to susceptibility. It turns out that the applicability of each theory depends on the experimental sample density. If twelve ferrofluid samples are split into three groups of strong, moderate, and low concentrated fluids, the temperature dependences of the initial magnetic susceptibility in each group are very precisely described by one of the three theories mentioned above. The determination of a universal formula predicting a ferrofluid susceptibility over a broad range of concentrations and temperatures remains as a challenge.

  2. The Joint Experiment for Crop Assessment and Monitoring (JECAM) Initiative: Developing methods and best practices for global agricultural monitoring

    Science.gov (United States)

    Champagne, C.; Jarvis, I.; Defourny, P.; Davidson, A.

    2014-12-01

    Agricultural systems differ significantly throughout the world, making a 'one size fits all' approach to remote sensing and monitoring of agricultural landscapes problematic. The Joint Experiment for Crop Assessment and Monitoring (JECAM) was established in 2009 to bring together the global scientific community to work towards a set of best practices and recommendations for using earth observation data to map, monitor and report on agricultural productivity globally across an array of diverse agricultural systems. These methods form the research and development component of the Group on Earth Observation Global Agricultural Monitoring (GEOGLAM) initiative to harmonize global monitoring efforts and increase market transparency. The JECAM initiative brings together researchers from a large number of globally distributed, well monitored agricultural test sites that cover a range of crop types, cropping systems and climate regimes. Each test site works independently as well as together across multiple sites to test methods, sensors and field data collection techniques to derive key agricultural parameters, including crop type, crop condition, crop yield and soil moisture. The outcome of this project will be a set of best practices that cover the range of remote sensing monitoring and reporting needs, including satellite data acquisition, pre-processing techniques, information retrieval and ground data validation. These outcomes provide the research and development foundation for GEOGLAM and will help to inform the development of the GEOGLAM "system of systems" for global agricultural monitoring. The outcomes of the 2014 JECAM science meeting will be discussed as well as examples of methods being developed by JECAM scientists.

  3. Initial Experience with Percutaneous Needle Aspiration of Paraspinal Lesions Using XperGuide Cone-Beam CT

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Si Lip; Park, Hee Jin; Lee, So Yeon; Chung, Eun Chul; Paark, Hae Won; Kook, Shin Ho; Rho, Myung Ho [Dept. of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2013-03-15

    The aim of this study is to report our initial experience using XperGuide cone-beam computed tomography (CBCT) for percutaneous needle aspiration of the paraspinal lesions. Between September 2011 and September 2012, 12 patients who underwent percutaneous needle aspiration of the paraspinal lesions for suspected pyogenic spondylitis, tuberculous spondylitis, or metastasis were included. The procedure was performed on the XperGuide CBCT. Based on the initial CBCT, target points and entrance were determined, using dedicated guidance software (XperGuide), and the needle pathway was visualized in various reconstructed images. Needle aspiration was performed using Westcott needle and correct needle positioning was confirmed with the second CBCT. The technical success was defined as the needle tip reached within 5 mm of the target point. Culture, smear, and polymerase chain reaction of obtained samples were performed. In all twelve patients, target areas could be determined based on XperCT data and achieved 100% technical success. Diagnosis could be made in 91.7% of cases and the median interventional procedure time was 27.8 minutes. There was no major complication in all patients. Percutaneous needle aspiration of paraspinal lesions using XperGuide CBCT is easy, accurate, safe, and useful in determining the treatment of direction.

  4. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis: initial experience in Oaxaca, Mexico.

    Science.gov (United States)

    García-Matus, Rolando; Hernández-Hernández, Carlos Alberto; Leyva-García, Omar; Vásquez-Ciriaco, Sergio; Flores-Ayala, Guillermo; Navarro-Hernández, Quetzalli; Pérez-Bustamante, Gerardo; Valencia-Mijares, Norma Miriam; Esquivel, Jesus

    2012-09-01

    Peritoneal carcinomatosis (PC) has been traditionally considered a terminal disease with median survivals reported in the literature of 6 to 12 months. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) are playing an ever increasing role in the treatment of these patients. Excellent results have been achieved in well-selected patients but there is a very steep learning curve when starting a new program. A program for peritoneal surface malignancies in which patients with PC of gastrointestinal or gynecological origin were treated using multimodality therapy with combinations of systemic therapy, cytoreductive surgery (CRS), and HIPEC was initiated in December 2007 at "Hospital Regional de Alta Especialidad de Oaxaca," Mexico. We present the results of our initial experience. From December 2007 to February 2011, 26 patients were treated with CRS and HIPEC. There were 21 female patients. Most common indication (46%) was recurrent ovarian cancer. Mean duration of surgery was 260 minutes. Mean Peritoneal Cancer Index was 9. Twenty-three (88.5%) patients had a complete cytoreduction. Major morbidity and mortality rates were 19.5 and 3.8 per cent, respectively. Mean hospital stay was 8 days. At a mean follow-up of 20 months, median survival has not been reached. Rigorous preoperative workup, strict selection criteria, and mentoring from an experienced cytoreductive surgeon are mandatory and extremely important when starting a center for PC.

  5. Intrathecal Fentanyl for Labour Analgesia in a Patient with Severe Mitral Stenosis and Atrial Fibrillation in Advanced Stage of Labour-Case Report

    Directory of Open Access Journals (Sweden)

    Vaijayanti Nitin Gadre

    2013-12-01

    Full Text Available Labour is an intensely painful experience and puts considerable physiological stress on the circulation. A case of rheumatic valvular heart disease with severe mitral stenosis in atrial fibrillation is discussed here in which analgesia with intrathecal fentanyl proved beneficial given during the advanced first stage of labour.

  6. Intrathecal Fentanyl for Labour Analgesia in a Patient with Severe Mitral Stenosis and Atrial Fibrillation in Advanced Stage of Labour-Case Report

    OpenAIRE

    Vaijayanti Nitin Gadre

    2013-01-01

    Labour is an intensely painful experience and puts considerable physiological stress on the circulation. A case of rheumatic valvular heart disease with severe mitral stenosis in atrial fibrillation is discussed here in which analgesia with intrathecal fentanyl proved beneficial given during the advanced first stage of labour.

  7. An experimental investigation of the dynamics of submarine leveed channel initiation as sediment-laden density currents experience sudden unconfinement

    Energy Technology Data Exchange (ETDEWEB)

    Rowland, Joel C [Los Alamos National Laboratory; Hilley, George E [STANFORD UNIV; Fildani, Andrea [CHEVRON ETC

    2009-01-01

    Leveed submarine channels play a critical role in the transfer of sediment from the upper continental slopes to interslope basins and ultimately deepwater settings. Despite a reasonable understanding of how these channels grow once established, how such channels initiate on previously unchannelized portions of the seafloor remains poorly understood. We conducted a series of experiments that elucidate the influence of excess density relative to flow velocity on the dynamics of, and depositional morphologies arising from, density currents undergoing sudden unconfinement across a sloped bed. Experimental currents transported only suspended sediment across a non-erodible substrate. Under flow conditions ranging from supercritical to subcritical (bulk Richardson numbers of 0.02 to 1.2) our experiments failed to produce deposits resembling or exhibiting the potential to evolve into self-formed leveed channels. In the absence of excess density, a submerged sediment-laden flow produced sharp crested lateral deposits bounding the margins of the flow for approximately a distance of two outlet widths down basin. These lateral deposits terminated in a centerline deposit that greatly exceeded marginal deposits in thickness. As excess density increased relative to the outlet velocity, the rate of lateral spreading of the flow increased relative to the downstream propagation of the density current, transitioning from a narrow flow aligned with the channel outlet to a broad radially expanding flow. Coincident with these changes in flow dynamics, the bounding lateral deposits extended for shorter distances, had lower, more poorly defined crests that were increasingly wider in separation than the initial outlet, and progressively became more oblong rather than linear. Based on our results, we conclude that leveed channels cannot initiate from sediment-laden density currents under strictly depositional conditions. Partial confinement of these currents appears to be necessary to

  8. Comparison of relative oxycodone consumption in surgical pleth index-guided analgesia versus conventional analgesia during sevoflurane anesthesia

    Science.gov (United States)

    Won, Young Ju; Lim, Byung Gun; Lee, So Hyun; Park, Sangwoo; Kim, Heezoo; Lee, Il Ok; Kong, Myoung Hoon

    2016-01-01

    Abstract Background: The surgical pleth index (SPI) is proposed for titration of analgesic drugs during general anesthesia. Several reports have investigated the effect of SPI on the consumption of opioids including remifentanil, fentanyl, and sufentanil during anesthesia, but there are no reports about oxycodone. We aimed to investigate intravenous oxycodone consumption between SPI-guided analgesia and conventional analgesia practices during sevoflurane anesthesia in patients undergoing thyroidectomy. Methods: Forty-five patients undergoing elective thyroidectomy were randomly assigned to an SPI group (SPI-guided analgesia group, n = 23) or a control group (conventional analgesia group, n = 22). Anesthesia was maintained with sevoflurane to achieve bispectral index values between 40 and 60. In the SPI group, oxycodone 1 mg was administered intravenously at SPI values over 50; in the control group, oxycodone 1 mg was administered intravenously at the occurrence of tachycardia or hypertension event. Intraoperative oxycodone consumption and extubation time were recorded. The number of hemodynamic and somatic movement events was recorded, as were postoperative pain and recovery scores. Results: Patients’ characteristics were comparable between the groups. Intraoperative oxycodone consumption in the SPI group was significantly lower than the control group (3.5 ± 2.4 vs 5.1 ± 2.4 mg; P = 0.012). Extubation time was significantly shorter in the SPI group (10.6 ± 3.5 vs 13.4 ± 4.6 min; P = 0.026). Hemodynamic and somatic movement events during anesthesia were comparable between the groups, as were numeric rating scales for pain and modified Aldrete scores at postanesthesia care unit. Conclusions: SPI-guided analgesia reduces intravenous oxycodone consumption and extubation time compared with conventional analgesia based on clinical parameters during sevoflurane anesthesia in patients undergoing thyroidectomy. PMID:27583920

  9. Mechanisms of acupuncture analgesia for clinical and experimental pain.

    Science.gov (United States)

    Staud, Roland; Price, Donald D

    2006-05-01

    There is convincing evidence that acupuncture (AP) is effective for the treatment of postoperative and chemotherapy-induced nausea/vomiting, as well as postoperative dental pain. Less convincing data support AP's efficacy for chronic pain conditions, including headache, fibromyalgia and low back pain. There is no evidence that AP is effective in treating addiction, insomnia, obesity, asthma or stroke deficits. AP seems to be efficacious for alleviating experimental pain by increasing pain thresholds in human subjects and it appears to activate analgesic brain mechanisms through the release of neurohumoral factors, some of which can be inhibited by the opioid antagonist naloxone. In contrast to placebo analgesia, AP-related pain relief takes some time to develop and to resolve. Furthermore, repetitive use of AP analgesia can result in tolerance that demonstrates cross-tolerance with morphine. However, it appears that not all forms of AP are equally effective for providing analgesia. In particular, electro-AP seems to best deliver stimuli that activate powerful opioid and nonopioid analgesic mechanisms. Thus, future carefully controlled clinical trials using adequate electro-AP may be able to provide the necessary evidence for relevant analgesia in chronic pain conditions, such as headache, fibromyalgia, irritable bowel syndrome and low back pain.

  10. Inhaled analgesia for pain management in labour (Review)

    NARCIS (Netherlands)

    Klomp, T.; Poppel, M. van; Jones, L.; Lazet, J.; Nisio, M. Di; Lagro-Janssen, A.L.M.

    2012-01-01

    BACKGROUND: Many women would like to have a choice in pain relief during labour and also would like to avoid invasive methods of pain management in labour. Inhaled analgesia during labour involves the self-administered inhalation of sub-anaesthetic concentrations of agents while the mother remains a

  11. Information Models of Acupuncture Analgesia and Meridian Channels

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    Chang Hua Zou

    2010-12-01

    Full Text Available Acupuncture and meridian channels have been major components of Chinese and Eastern Asian medicine—especially for analgesia—for over 2000 years. In recent decades, electroacupuncture (EA analgesia has been applied clinically and experimentally. However, there were controversial results between different treatment frequencies, or between the active and the placebo treatments; and the mechanisms of the treatments and the related meridian channels are still unknown. In this study, we propose a new term of infophysics therapy and develop information models of acupuncture (or EA analgesia and meridian channels, to understand the mechanisms and to explain the controversial results, based on Western theories of information, trigonometry and Fourier series, and physics, as well as published biomedical data. We are trying to build a bridge between Chinese medicine and Western medicine by investigating the Eastern acupuncture analgesia and meridian channels with Western sciences; we model the meridians as a physiological system that is mostly constructed with interstices in or between other physiological systems; we consider frequencies, amplitudes and wave numbers of electric field intensity (EFI as information data. Our modeling results demonstrate that information regulated with acupuncture (or EA is different from pain information, we provide answers to explain the controversial published results, and suggest that mechanisms of acupuncture (or EA analgesia could be mostly involved in information regulation of frequencies and amplitudes of EFI as well as neuronal transmitters such as endorphins.

  12. Bayesian prediction of placebo analgesia in an instrumental learning model

    Science.gov (United States)

    Jung, Won-Mo; Lee, Ye-Seul; Wallraven, Christian; Chae, Younbyoung

    2017-01-01

    Placebo analgesia can be primarily explained by the Pavlovian conditioning paradigm in which a passively applied cue becomes associated with less pain. In contrast, instrumental conditioning employs an active paradigm that might be more similar to clinical settings. In the present study, an instrumental conditioning paradigm involving a modified trust game in a simulated clinical situation was used to induce placebo analgesia. Additionally, Bayesian modeling was applied to predict the placebo responses of individuals based on their choices. Twenty-four participants engaged in a medical trust game in which decisions to receive treatment from either a doctor (more effective with high cost) or a pharmacy (less effective with low cost) were made after receiving a reference pain stimulus. In the conditioning session, the participants received lower levels of pain following both choices, while high pain stimuli were administered in the test session even after making the decision. The choice-dependent pain in the conditioning session was modulated in terms of both intensity and uncertainty. Participants reported significantly less pain when they chose the doctor or the pharmacy for treatment compared to the control trials. The predicted pain ratings based on Bayesian modeling showed significant correlations with the actual reports from participants for both of the choice categories. The instrumental conditioning paradigm allowed for the active choice of optional cues and was able to induce the placebo analgesia effect. Additionally, Bayesian modeling successfully predicted pain ratings in a simulated clinical situation that fits well with placebo analgesia induced by instrumental conditioning. PMID:28225816

  13. Analgesia in the horse, assessing and treating pain in equines

    NARCIS (Netherlands)

    Loon, Thijs van

    2012-01-01

    This review focuses on pain and nociception in horses and is based on the PhD thesis “Analgesia in the Horse, various approaches for assessment and treatment of pain and nociception in equines” by J.P.A.M. van Loon. Apart from a scientific review of the related literature, a multi-disciplinary appro

  14. Inhaled analgesia for pain management in labour (Review)

    NARCIS (Netherlands)

    Klomp, T.; Poppel, M. van; Jones, L.; Lazet, J.; Nisio, M. Di; Lagro-Janssen, A.L.M.

    2012-01-01

    BACKGROUND: Many women would like to have a choice in pain relief during labour and also would like to avoid invasive methods of pain management in labour. Inhaled analgesia during labour involves the self-administered inhalation of sub-anaesthetic concentrations of agents while the mother remains

  15. Difficulty in the removal of epidural catheter for labor analgesia

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    Mohamed S Hajnour

    2017-01-01

    Full Text Available For labor pain management epidural analgesia is a popular and an effective method. Difficult removal of epidural catheters occasionally occurs, and several maneuvers have been recommended. The purpose of this article is to raise awareness of the problem of retained epidural catheter fragments and identify the potential impact of complications.

  16. Difficulty in the removal of epidural catheter for labor analgesia.

    Science.gov (United States)

    Hajnour, Mohamed S; Khokhar, Rashid Saeed; Ejaz, Abdul Aziz Ahmed; Al Zahrani, Tariq; Kanchi, Naveed Uddin

    2017-01-01

    For labor pain management epidural analgesia is a popular and an effective method. Difficult removal of epidural catheters occasionally occurs, and several maneuvers have been recommended. The purpose of this article is to raise awareness of the problem of retained epidural catheter fragments and identify the potential impact of complications.

  17. Analgesia and anesthesia for neonates : Study design and ethical issues

    NARCIS (Netherlands)

    Anand, KJS; Aranda, JV; Berde, CB; Buckman, S; Capparelli, EV; Carlo, WA; Hummel, P; Lantos, P; Johnston, CC; Lehr, VT; Lynn, AM; Oberlander, TF; Raju, TNK; Soriano, SG; Taddio, A; Walco, GA; Maxwell, L.G.

    2005-01-01

    Objective: The purpose of this article is to summarize the clinical, methodologic, and ethical considerations for researchers interested in designing future trials in neonatal analgesia and anesthesia, hopefully stimulating additional research in this field. Methods: The MEDLINE, PubMed, EMBASE, and

  18. Model and experiences of initiating collaboration with traditional healers in validation of ethnomedicines for HIV/AIDS in Namibia

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    Chinsembu Kazhila C

    2009-10-01

    Full Text Available Abstract Many people with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS in Namibia have access to antiretroviral drugs but some still use traditional medicines to treat opportunistic infections and offset side-effects from antiretroviral medication. Namibia has a rich biodiversity of indigenous plants that could contain novel anti-HIV agents. However, such medicinal plants have not been identified and properly documented. Various ethnomedicines used to treat HIV/AIDS opportunistic infections have not been scientifically validated for safety and efficacy. These limitations are mostly attributable to the lack of collaboration between biomedical scientists and traditional healers. This paper presents a five-step contextual model for initiating collaboration with Namibian traditional healers in order that candidate plants that may contain novel anti-HIV agents are identified, and traditional medicines used to treat HIV/AIDS opportunistic infections are subjected to scientific validation. The model includes key structures and processes used to initiate collaboration with traditional healers in Namibia; namely, the National Biosciences Forum, a steering committee with the University of Namibia (UNAM as the focal point, a study tour to Zambia and South Africa where other collaborative frameworks were examined, commemorations of the African Traditional Medicine Day (ATMD, and consultations with stakeholders in north-eastern Namibia. Experiences from these structures and processes are discussed. All traditional healers in north-eastern Namibia were willing to collaborate with UNAM in order that their traditional medicines could be subjected to scientific validation. The current study provides a framework for future collaboration with traditional healers and the selection of candidate anti-HIV medicinal plants and ethnomedicines for scientific testing in Namibia.

  19. Model and experiences of initiating collaboration with traditional healers in validation of ethnomedicines for HIV/AIDS in Namibia.

    Science.gov (United States)

    Chinsembu, Kazhila C

    2009-10-23

    Many people with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) in Namibia have access to antiretroviral drugs but some still use traditional medicines to treat opportunistic infections and offset side-effects from antiretroviral medication. Namibia has a rich biodiversity of indigenous plants that could contain novel anti-HIV agents. However, such medicinal plants have not been identified and properly documented. Various ethnomedicines used to treat HIV/AIDS opportunistic infections have not been scientifically validated for safety and efficacy. These limitations are mostly attributable to the lack of collaboration between biomedical scientists and traditional healers. This paper presents a five-step contextual model for initiating collaboration with Namibian traditional healers in order that candidate plants that may contain novel anti-HIV agents are identified, and traditional medicines used to treat HIV/AIDS opportunistic infections are subjected to scientific validation. The model includes key structures and processes used to initiate collaboration with traditional healers in Namibia; namely, the National Biosciences Forum, a steering committee with the University of Namibia (UNAM) as the focal point, a study tour to Zambia and South Africa where other collaborative frameworks were examined, commemorations of the African Traditional Medicine Day (ATMD), and consultations with stakeholders in north-eastern Namibia. Experiences from these structures and processes are discussed. All traditional healers in north-eastern Namibia were willing to collaborate with UNAM in order that their traditional medicines could be subjected to scientific validation. The current study provides a framework for future collaboration with traditional healers and the selection of candidate anti-HIV medicinal plants and ethnomedicines for scientific testing in Namibia.

  20. Labour epidural analgesia in Poland in 2009 - a survey.

    Science.gov (United States)

    Furmanik, Jacek

    2013-01-01

    Labour analgesia in most developed countries is funded by the state, available to every woman in labour, and plays an important role in the everyday activities of most anaesthetists. This paper presents the second part of an Obstetric Anaesthesia Survey which was conducted in 2009. The first part of the Survey, relating to anaesthesia for caesarean sections, was published in 2010. The author sent out 432 questionnaires containing questions about hospital size and location, staffing levels and numbers of deliveries per year. There were also questions regarding regional and other pain relief methods used in labour, ways of administration, drugs used and monitoring of patients. The response rate was 24%. Around 45% of responding hospitals had only 1-3 deliveries per year, which makes it difficult to provide separate obstetric anaesthetic cover. Only ten hospitals (11%) employed an anaesthetist for the labour ward. Epidural analgesia was used in 55% of hospitals but only 20% provided the service for 24 hours per day and free of charge. Entonox was used very occasionally, but the most common means of pain relief was pethidine injection. There were marked differences in the medication used for labour epidurals, with 18% of units using high concentrations of local anaesthetics which could result in motor block. Despite a lack of regulations in Polish law and a lack of proper training in 50% of units, midwives were looking after the patients with established labour epidural which could create medico-legal consequences. There was also a marked variation in the parameters monitored during labour analgesia. Epidural labour analgesia was offered for 24 hours per day and free of charge in only 20% of hospitals. Without public pressure it will be difficult to get more funding from the National Health Fund (NFZ) to enable other hospitals, especially those with small obstetric units, to introduce regional labour analgesia. Although the 2009 guidelines addressed most of the issues

  1. Patient Controlled Analgesia Used to Assess the Efficacy and Potency of a New Opioid

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    Brian Ginsberg

    1996-01-01

    Full Text Available Patient controlled analgesia (PCA is widely used for the management of postoperative pain. PCA also permits a comparison to be made among analgesics in the clinical setting because it limits the variability introduced by third parties. Use of PCA to establish efficacy and potency data for an investigational drug, pentamorphone, compared with morphine is reported. Pentamorphone was found to be more efficacious than morphine in the first hour after surgery because significantly more patients were able to achieve a visual analogue scale of less than 30 mm with pentamorphone. Thereafter pentamorphone and morphine were found to be equally efficacious. Initially pentamorphone may be more potent than morphine based on the greater volume of morphine used in the first hour of therapy. However, a potency ratio could not be determined because this result was under conditions of unequal analgesia. The potency ratio determined at 24 h of therapy under equianalgesic conditions (252:1 is similar to previously reported potency data from laboratory studies (200:1. This study supports the use of PCA as a model to investigate and compare new drugs to establish their efficacy and potency.

  2. Different SNP combinations in the GCH1 gene and use of labor analgesia

    Directory of Open Access Journals (Sweden)

    Sundström-Poromaa Inger

    2010-07-01

    Full Text Available Abstract Background The aim of this study was to investigate if there is an association between different SNP combinations in the guanosine triphosphate cyclohydrolase (GCH1 gene and a number of pain behavior related outcomes during labor. A population-based sample of pregnant women (n = 814 was recruited at gestational week 18. A plasma sample was collected from each subject. Genotyping was performed and three single nucleotide polymorphisms (SNP previously defined as a pain-protective SNP combination of GCH1 were used. Results Homozygous carriers of the pain-protective SNP combination of GCH1 arrived to the delivery ward with a more advanced stage of cervical dilation compared to heterozygous carriers and non-carriers. However, homozygous carriers more often used second line labor analgesia compared to the others. Conclusion The pain-protective SNP combination of GCH1 may be of importance in the limited number of homozygous carriers during the initial dilation of cervix but upon arrival at the delivery unit these women are more inclined to use second line labor analgesia.

  3. EFFECT OF INTRATHECAL CLONIDINE ON DURATION OF SPINAL ANALGESIA

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    Sourabh

    2015-06-01

    Full Text Available BACKGROUND: Clonidine is an α 2 adrenoreceptor agonist that has been shown to effectively prolong the duration of analgesia when administered intrathecally or in the epidural space along with local anaesthetic. AIMS AND OBJECTIVE: This study was designed to evaluate the effect of two different doses of intrathecal clonidine (37.5 μg and 75 μg on the duration of analgesia and side effects produced by hyperbaric bupivacaine 0.5%. MATERIALS AND METHODS : A prospective hospital based, randomized and double blind study. Selected 75 patients who was scheduled for elective below umbilical surgeries were randomly allocated to one of three groups. Group I (n=25, control group received 3ml hyperbaric bupivacaine, Group II (n=25 3ml hyperbar ic bupivacaine + 37.5 μg clonidine and Group III (n=25 3 ml hyperbaric bupivacaine + 75μg clonidine intrathecally. Total volume (4ml remained constant by adding sterile water. Data were analyzed by using SPSS software ver.18. RESULTS: The (mean ±SD dura tion of analgesia was found to be 171.3±6.37 mins in Group I, 217.7±7.01 mins in Group II and 257.1±6.50 mins in Group III (p<0.05. It shows that 37.5  g & 75  g intrathecal clonidine increases the duration of analgesia of 15mg hyperbaric bupivacaine by abo ut 46 mins & 86 mins respectively. The addition of intrathecal clonidine upto 75 μg does not cause any significant major side effect except mild sedation, without an increase in incidence of hypotension, bradycardia and respiratory depression. CONCLUSION: Intrathecal clonidine (37.5  g & 75  g as an adjuvant to hyperbaric bupivacaine 0.5% prolong the duration of analgesia in a dose dependent manner without increase in incidence of significant side effects

  4. Epidural analgesia associated with better survival in colon cancer.

    Science.gov (United States)

    Vogelaar, F J; Abegg, R; van der Linden, J C; Cornelisse, H G J M; van Dorsten, F R C; Lemmens, V E; Bosscha, K

    2015-08-01

    Surgery remains the mainstay of treatment for potentially curable colon cancer. Otherwise, the surgical stress response might increase the likelihood of cancer dissemination during and after cancer surgery. There is growing evidence that the type of anaesthesia during cancer surgery plays a role in the metastatic process. Therefore, we assessed if the method of anaesthesia is associated with long-term survival after colon cancer surgery. A retrospective single-centre study was conducted including 588 patients who underwent colorectal cancer surgery, TNM stage I-IV, in the Jeroen Bosch Hospital between 1995 and 2003. The Cox proportional hazard model was used for statistical analysis. Adjustments were made for age, sex, comorbidity, TNM stage, chemotherapy, emergency surgery status and year of incidence. Of the 588 primary colon cancer patients with a median age of 70 years, 399 (68 %) patients underwent colon surgery with epidural anaesthesia, whilst 189 (32 %) patients were operated without epidural anaesthesia. Five-year survival for patients not receiving epidural analgesia was 42 % versus 51 % for patients receiving epidural analgesia (p = 0.03). This effect remained after adjustment for relevant patient, tumour, and treatment characteristics (hazard ratio (HR) 1.30 (95 % confidence interval (CI) 1.05-1.59), p = 0.01). Subgroup analysis in patients of 80 years and older (n = 100) showed also a better overall survival after receiving epidural analgesia (HR 1.74 (95 % CI 1.11-2.72), p = 0.01). Epidural analgesia during colon cancer surgery was associated with a better overall survival. Prospective trials evaluating the effects of locoregional analgesia on colon cancer recurrence are warranted.

  5. [Prehospital analgesia by emergency physicians and paramedics : Comparison of effectiveness].

    Science.gov (United States)

    Schempf, B; Casu, S; Häske, D

    2017-05-01

    In some German emergency medical service districts, analgesia is performed by paramedics without support of emergency physicians on scene. With regard to safety and effectiveness, paramedics should not be overshadowed by emergency physicians. Is prehospital analgesia performed by paramedics under medical supervision or emergency physicians comparable regarding processes and effectiveness in the case of isolated limb injury? As a retrospective analysis of patients with isolated limb injury, analgesia performed by paramedics and by emergency physicians was analyzed. In addition to pain reduction, prescribed monitoring, and further airway maneuvers, vital parameters (Glasgow coma scale, systolic blood pressure, heartrate and respiratory rate, oxygen saturation) were recorded at the beginning and end of prehospital treatment. Pain was reduced from NRS 8 ± 1 to NRS 2 ± 1 in the paramedic group, and from NRS 8 ± 2 to NRS 2 ± 2 in the physician group, so the mean pain reduction was 6 ± 2 in the paramedic-group and 5 ± 2 in the physician group (p < 0.001). Adequate analgesia was found in 96.9% in the physician group and 91.7% in the paramedic group (p = 0.113). ECG monitoring and oxygen administration according to SOP was significantly more frequent in the paramedic group than in the physician group (p < 0.001). Respiratory frequency was significantly more frequent in the physician group than in the paramedic group (p < 0.001). The study shows, with a given indication, that German paramedics can independently perform safe and successful analgesia under medical supervision.

  6. EPIDURAL ANALGESIA DURING LABOR Analgesia epidural para el trabajo de parto

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    Juan Carlos Zafra Pedone

    2008-12-01

    Full Text Available Introduction: The labor pain affect to all pregnant woman and it has biochemical and physiological changes that affect to mother and fetus and interact with your normal evolution. Currently there are analgesic techniques to less effectively labor pain, to provide a high satisfaction level and supply clinical and laboratory beneficial outcomes. In own context these techniques are very low used. Objective: To describe the use of epidural analgesic procedures in a pregnancy woman group during labor at the Universitarian Hospital San Jose – Popayan, Colombia. Materials and methods: Case series design. We recollected information of patients from Obstetric service during two months of 2006. The patient’s information was recollected from medical history with an instrument that content variables related with the analgesic technique and labor. The analyses were performed using descriptive statistics Results: 41 pregnant woman with a mean age of 23,4 were included. 65,9% were nulliparous and 85,4% were term pregnancy. At the moment of dural puncture the dilation and EVA pain scale mode was 6 and 8 respectively. The latency mean was 14,1 minutes. 95,1% were require a booster applied in a mean of 80 minutes and 61% were required a second booster applied in a mean of 49 min after that. The way of termination of pregnancy was vaginal predominantly. Conclusions: The results of this study are congruent to reporting in the world literature. These conclusions support the effectiveness of epidural analgesia and its favorable benefit/risk relation to the control of labor pain. Introducción: El dolor asociado con el trabajo de parto afecta a todas las pacientes e involucra alteraciones que afectan a la madre y al feto e interactúan interfiriendo con su evolución normal. Actualmente disponemos de alternativas analgésicas peridurales que han demostrado controlar en forma efectiva el dolor, proporcionar un alto grado de satisfacción de las pacientes y proveer

  7. Association between KCNJ6 (GIRK2) gene polymorphism rs2835859 and post-operative analgesia, pain sensitivity, and nicotine dependence.

    Science.gov (United States)

    Nishizawa, Daisuke; Fukuda, Ken-ichi; Kasai, Shinya; Ogai, Yasukazu; Hasegawa, Junko; Sato, Naomi; Yamada, Hidetaka; Tanioka, Fumihiko; Sugimura, Haruhiko; Hayashida, Masakazu; Ikeda, Kazutaka

    2014-01-01

    G-protein-activated inwardly rectifying potassium (GIRK) channels are expressed in many tissues and activated by several Gi/o protein-coupled receptors, such as opioid and dopamine receptors, and thus are known to be involved in the modulation of opioid-induced analgesia, pain, and reward. We focused on a GIRK-channel subunit that plays a pivotal role in the brain, GIRK2, and investigated the contribution of genetic variations of the GIRK2 (KCNJ6) gene to individual differences in the sensitivity to opioid analgesia. In our initial linkage disequilibrium analysis, a total of 27 single-nucleotide polymorphisms (SNPs) were selected within and around the regions of the KCNJ6 gene. Among them, the rs2835859 SNP, for which associations with analgesia and pain have not been previously reported, was selected in the exploratory study as a potent candidate SNP associated with opioid analgesic sensitivity. The results were corroborated in further confirmatory study. Interestingly, this SNP was also found to be associated with sensitivity to both cold and mechanical pain, susceptibility to nicotine dependence, and successful smoking cessation. The results indicate that this SNP could serve as a marker that predicts sensitivity to analgesic and pain and susceptibility to nicotine dependence.

  8. The Effects of Thoracic Epidural Analgesia on Postoperative Pain and Myocardial Protection in Coronary Artery Bypass Surgery

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    Bestami Barış Çelik

    2015-03-01

    Full Text Available Aim: Thoracic epidural analgesia (TEA in cardiac surgery provides stable hemodynamics and postoperative analgesia by reducing stress response. The aim of this study was to investigate the effects of TEA in coronary artery bypass grafting (CABG on postoperative pain, myocardial protection, intensive care unit (ICU and hospital length of stay. Methods: After receiving approval from the hospital scientific committee and obtaining written informed consent from the participants, 40 patients, who were undergoing elective CABG, were included in the study. The patients were prospectively randomized into two groups as TEA group (n=20 and control group (n=20. Epidural catheters were placed one day before surgery at the T5-T6 level, levobupivacaine 2 µg/mL and fentanyl 5 mL/hr infusions were initiated in the ICU. Control group received intravenous infusion of fentanyl 8 µg/kg/hr. Infusions continued for 24 hours in both groups. Results: Time to extubation was shorter, postoperative hypertension was less frequent and pain scores were lower in TEA group than in control group (p<0.01. There was no difference in length of stay in the ICU, CK-MB and troponin I levels between the groups, however, length of hospital stay was shorter in TEA group. Conclusion: TEA with levobupivakain in CABG was found to provide stable hemodynamics, effective analgesia and to shorten length of hospital stay. (The Medical Bulletin of Haseki 2015; 53: 72-6

  9. Epidural analgesia practices for labour: results of a 2005 national survey in Ireland.

    LENUS (Irish Health Repository)

    Fanning, Rebecca A

    2012-02-01

    BACKGROUND AND OBJECTIVE: The last 25 years have seen changes in the management of epidural analgesia for labour, including the advent of low-dose epidural analgesia, the development of new local anaesthetic agents, various regimes for maintaining epidural analgesia and the practice of combined spinal-epidural analgesia. We conducted a survey of Irish obstetric anaesthetists to obtain information regarding the conduct and management of obstetric epidural analgesia in Ireland in 2005. The specific objective of this survey was to discover whether new developments in obstetric anaesthesia have been incorporated into clinical practice. METHODS: A postal survey was sent to all anaesthetists with a clinical commitment for obstetric anaesthesia in the sites approved for training by the College of Anaesthetists, Ireland. RESULTS: Fifty-three per cent of anaesthetists surveyed responded. The majority of anaesthetists (98%) use low-dose epidural analgesia for the maintenance of analgesia. Only 11% use it for test-dosing and 32% for the induction of analgesia. The combined spinal-epidural analgesia method is used by 49%, but two-thirds of those who use it perform fewer than five per month. Patient-controlled epidural analgesia was in use at only one site. CONCLUSION: It appears that Irish obstetric anaesthetists have adopted the low-dose epidural analgesia trend for the maintenance of labour analgesia. This practice is not as widespread, however, for test dosing, the induction of analgesia dose or in the administration of intermittent epidural boluses to maintain analgesia when higher concentrations are used. Since its introduction in 2000, levobupivacaine has become the most popular local anaesthetic agent.

  10. Initial experience with live three-dimensional image overlay for ductal stenting in hypoplastic left heart syndrome.

    Science.gov (United States)

    Goreczny, Sebastian; Morgan, Gareth J; Dryzek, Pawel; Moll, Jadwiga A; Moszura, Tomasz

    2016-12-20

    Precise visualisation of ductal morphology and adjacent vessels is crucial for accurate stent choice and placement during hybrid palliation of hypoplastic left heart syndrome (HLHS). We aimed to describe our initial experience with live three-dimensional reconstruction overlay derived from rotational angiography (RA) for ductal stenting in HLHS. We carried out a retrospective review of ductal stenting in 18 newborns with HLHS, including six patients with 3D reconstruction overlay used to guide the intervention. The median age at the intervention was 20 days (range 13-31 days) and the median weight was 3.25 kg (range 3-4 kg). Eleven RA runs were performed, pre and post stent implantation in five patients and before the intervention in one patient. 3D reconstructions from all RA runs had sufficient image quality to allow stent placement without additional contrast injections. Comparison with 2D angiography-guided ductal stenting showed similar contrast usage, with the 2D angiography patients receiving a higher radiation dose. Three-dimensional rotational angiography provides accurate visualisation of the ductal morphology and nearby structures. Three-dimensional reconstruction overlay with clear landing points enabled precise stent implantation with no additional contrast injections and lower radiation doses than conventional angiography in our patients.

  11. Initial Experience with Balloon-Occluded Trans-catheter Arterial Chemoembolization (B-TACE) for Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Maruyama, Mitsunari, E-mail: mitunari@med-shimane.u.ac.jp; Yoshizako, Takeshi, E-mail: yosizako@med.shimane-u.ac.jp; Nakamura, Tomonori, E-mail: t-naka@med.shimane-u.ac.jp; Nakamura, Megumi, E-mail: megumi@med.shimane-u.ac.jp; Yoshida, Rika, E-mail: yoshidar@med.shimane-u.ac.jp; Kitagaki, Hajime, E-mail: kitagaki@med.shimane-u.ac.jp [Shimane University Faculty of Medicine, Department of Radiology (Japan)

    2016-03-15

    PurposeThis study was performed to evaluate the accumulation of lipiodol emulsion (LE) and adverse events during our initial experience of balloon-occluded trans-catheter arterial chemoembolization (B-TACE) for hepatocellular carcinoma (HCC) compared with conventional TACE (C-TACE).MethodsB-TACE group (50 cases) was compared with C-TACE group (50 cases). The ratio of the LE concentration in the tumor to that in the surrounding embolized liver parenchyma (LE ratio) was calculated after each treatment. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Effects (CTCAE) version 4.0.ResultsThe LE ratio at the level of subsegmental showed a statistically significant difference between the groups (t test: P < 0.05). Only elevation of alanine aminotransferase was more frequent in the B-TACE group, showing a statistically significant difference (Mann–Whitney test: P < 0.05). While B-TACE caused severe adverse events (liver abscess and infarction) in patients with bile duct dilatation, there was no statistically significant difference in incidence between the groups. Multivariate logistic regression analysis suggested that the significant risk factor for liver abscess/infarction was bile duct dilatation (P < 0.05).ConclusionThe LE ratio at the level of subsegmental showed a statistically significant difference between the groups (t test: P < 0.05). B-TACE caused severe adverse events (liver abscess and infarction) in patients with bile duct dilatation.

  12. In Vitro Acid-Mediated Initial Dental Enamel Loss Is Associated with Genetic Variants Previously Linked to Caries Experience

    Science.gov (United States)

    Vieira, Alexandre R.; Bayram, Merve; Seymen, Figen; Sencak, Regina C.; Lippert, Frank; Modesto, Adriana

    2017-01-01

    We have previously shown that AQP5 and BTF3 genetic variation and expression in whole saliva are associated with caries experience suggesting that these genes may have a functional role in protecting against caries. To further explore these results, we tested ex vivo if variants in these genes are associated with subclinical dental enamel mineral loss. DNA and enamel samples were obtained from 53 individuals. Enamel samples were analyzed for Knoop hardness of sound enamel, integrated mineral loss after subclinical carious lesion creation, and change in integrated mineral loss after remineralization. DNA samples were genotyped for single nucleotide polymorphisms using TaqMan chemistry. Chi-square and Fisher's exact tests were used to compare individuals above and below the mean sound enamel microhardness of the cohort with alpha of 0.05. The A allele of BTF3 rs6862039 appears to be associated with harder enamel at baseline (p = 0.09), enamel more resistant to demineralization (p = 0.01), and enamel that more efficiently regain mineral and remineralize (p = 0.04). Similarly, the G allele of AQP5 marker rs3759129 and A allele of AQP5 marker rs296763 are associated with enamel more resistant to demineralization (p = 0.03 and 0.05, respectively). AQP5 and BTF3 genetic variations influence the initial subclinical stages of caries lesion formation in the subsurface of enamel. PMID:28275354

  13. Initial Operative Experience and Short-term Hearing Preservation Results With a Mid-scala Cochlear Implant Electrode Array.

    Science.gov (United States)

    Svrakic, Maja; Roland, J Thomas; McMenomey, Sean O; Svirsky, Mario A

    2016-12-01

    To describe our initial operative experience and hearing preservation results with the Advanced Bionics (AB) Mid Scala Electrode (MSE). Retrospective review. Tertiary referral center. Sixty-three MSE implants in pediatric and adult patients were compared with age- and sex-matched 1j electrode implants from the same manufacturer. All patients were severe to profoundly deaf. Cochlear implantation with either the AB 1j electrode or the AB MSE. The MSE and 1j electrodes were compared in their angular depth of insertion and pre to postoperative change in hearing thresholds. Hearing preservation was analyzed as a function of angular depth of insertion. Secondary outcome measures included operative time, incidence of abnormal intraoperative impedance and telemetry values, and incidence of postsurgical complications. Depth of insertion was similar for both electrodes, but was more consistent for the MSE array and more variable for the 1j array. Patients with MSE electrodes had better hearing preservation. Thresholds shifts at four audiometric frequencies ranging from 250 to 2000 Hz were 10, 7, 2, and 6 dB smaller for the MSE electrode than for the 1j (p Hearing preservation at low frequencies was worse with deeper insertion, regardless of array. Secondary outcome measures were similar for both electrodes. The MSE electrode resulted in more consistent insertion depth and somewhat better hearing preservation than the 1j electrode. Differences in other surgical outcome measures were small or unlikely to have a meaningful effect.

  14. Dual-energy CT of the heart for diagnosing coronary artery stenosis and myocardial ischemia-initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Ruzsics, Balazs; Costello, Philip [Medical University of South Carolina, Department of Radiology, Charleston, SC (United States); Lee, Heon [Medical University of South Carolina, Department of Radiology, Charleston, SC (United States); Seoul Medical Center, Department of Radiology, Seoul (Korea); Zwerner, Peter L.; Schoepf, U.J. [Medical University of South Carolina, Department of Radiology, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology, Charleston, SC (United States); Gebregziabher, Mulugeta [Medical University of South Carolina, Department of Biostatistics, Bioinformatics, and Epidemiology, Charleston, SC (United States)

    2008-11-15

    We aimed to evaluate the feasibility of diagnosing coronary stenosis and myocardial ischemia with a single dual-energy CT (DECT) acquisition. Thirty-five patients underwent contrast-enhanced, ECG-gated DECT of the heart while independently operating the two tubes of a dual-source CT system at high- and low-energy X-ray spectra. From the same raw data, coronary CTA (cCTA) studies were reconstructed for stenosis detection, and the myocardial blood-pool was analyzed by determining the tissue iodine content. Two independent observers analyzed all studies for stenosis and myocardial blood-pool deficits. Results were correlated with SPECT, coronary catheterization and cCTA on a segmental basis. cCTA had 98% sensitivity, 88% specificity and 92% accuracy for detection of >50% stenosis. DECT detected myocardial ischemia with 84% sensitivity, 94% specificity and 92% accuracy. Our initial experience may warrant further exploration of DECT as a possibly feasible single imaging investigation for the comprehensive diagnosis of coronary stenosis and myocardial ischemia. (orig.)

  15. In vivo proton magnetic resonance spectroscopic imaging of the healthy human brain at 9.4 T: initial experience.

    Science.gov (United States)

    Chadzynski, Grzegorz L; Pohmann, Rolf; Shajan, Gunamony; Kolb, Rupert; Bisdas, Sotirios; Klose, Uwe; Scheffler, Klaus

    2015-06-01

    In this study, the feasibility of in vivo proton magnetic resonance spectroscopic imaging ((1)H MRSI) of the healthy human brain at a field strength of 9.4 T, using conventional acquisition techniques, is examined and the initial experience is summarized. MRSI measurements were performed on a 9.4 T MR scanner (Siemens, Erlangen, Germany) equipped with head-only gradient insert (AC84, Siemens) and custom-developed, 8-channel transmit/24-channel receive, and 16-channel transmit/31-channel receive coils. Spectra were acquired from the superior part of the human brain with a modified STEAM sequence. Spectral quantification was done with LCModel software. Reasonable quality and signal-to-noise ratio of the acquired spectra allowed reliable quantification of 12 metabolites (Cramer-Rao lower bounds < 20 %), some of which may be difficult to quantify at field strengths below 7 T due to overlapping resonances or low concentrations. While further developments are necessary to minimize chemical shift displacement and homogeneity of the transmit field, it is demonstrated that in vivo (1)H MRSI at a field strength of 9.4 T is possible. However, further studies applying up-to-date techniques to overcome high-field specific problems are needed in order to assess the potential gain in sensitivity that may be offered by MRSI at 9.4 T.

  16. In Vitro Acid-Mediated Initial Dental Enamel Loss Is Associated with Genetic Variants Previously Linked to Caries Experience.

    Science.gov (United States)

    Vieira, Alexandre R; Bayram, Merve; Seymen, Figen; Sencak, Regina C; Lippert, Frank; Modesto, Adriana

    2017-01-01

    We have previously shown that AQP5 and BTF3 genetic variation and expression in whole saliva are associated with caries experience suggesting that these genes may have a functional role in protecting against caries. To further explore these results, we tested ex vivo if variants in these genes are associated with subclinical dental enamel mineral loss. DNA and enamel samples were obtained from 53 individuals. Enamel samples were analyzed for Knoop hardness of sound enamel, integrated mineral loss after subclinical carious lesion creation, and change in integrated mineral loss after remineralization. DNA samples were genotyped for single nucleotide polymorphisms using TaqMan chemistry. Chi-square and Fisher's exact tests were used to compare individuals above and below the mean sound enamel microhardness of the cohort with alpha of 0.05. The A allele of BTF3 rs6862039 appears to be associated with harder enamel at baseline (p = 0.09), enamel more resistant to demineralization (p = 0.01), and enamel that more efficiently regain mineral and remineralize (p = 0.04). Similarly, the G allele of AQP5 marker rs3759129 and A allele of AQP5 marker rs296763 are associated with enamel more resistant to demineralization (p = 0.03 and 0.05, respectively). AQP5 and BTF3 genetic variations influence the initial subclinical stages of caries lesion formation in the subsurface of enamel.

  17. Collision Experiment of an Arched Plasma-Filled Flux Rope and a Target Cloud of Initially Neutral Gas

    Science.gov (United States)

    Wongwaitayakornkul, Pakorn; Bellan, Paul; Li, Hui; Li, Shengtai

    2016-10-01

    Shocks occur in the co-rotating interaction regions just beyond the solar corona, in the corona during CME events, and when the solar wind impacts Earth's magnetosphere. The Caltech solar loop experiment investigates shock physics by creating an arched plasma-filled flux rope that expands to collide with a pre-injected, initially-neutral gas. We focus the investigation on the situation of a heavy-gas plasma (Argon) impacting a much lighter neutral gas cloud (Hydrogen). The neutral gas target cloud ionizes immediately upon being impacted and plasma-induced shock waves propagate in the target cloud away from the impact region. Analysis of data from magnetic probes, Langmuir probes, a fast camera, and spectroscopic measurements will be presented. The measurements suggest that a thin, compressed, ionized layer of hydrogen is formed just downstream of the Argon plasma loop and that thin, supersonic shocks form further downstream and propagate obliquely away from the plasma loop. Numerical simulation of an ideal MHD plasma is underway to enable comparison of the measurements with the predictions of MHD theory.

  18. EXPERIMENTS ON ASSIMILATION OF INITIAL VALUES IN NUMERICAL PREDICTION OF A WARM-SECTOR PRECIPITATION IN SOUTH CHINA

    Institute of Scientific and Technical Information of China (English)

    ZHANG Cheng-zhong; WAN Qi-lin; HUANG Yan-yan; CHEN Zi-tong; DING Wei-yu

    2009-01-01

    In order to understand the impact of initial conditions upon prediction accuracy of short-term forecast and nowcast of precipitation in South China,four experiments i.e. a control,an assimilation of conventional sounding and surthce data,testing with nudging rainwater data and the assimilation of radar-derived radial wind,are respectively conducted to simulate a case of warm-sector heavy rainfall that occurred over South China,by using the GRAPES MESO model. The results show that (I) assimilating conventional surface and sounding observations helps improve the 24-h rainfall forecast in both the area and order of magnitude; (2) nudging rainwater contributes to a significant improvement of nowcast,and (3)the assimilation of radar-derived radial winds distinctly improves the 24-h rainfall forecast in both the area and order of magnitude. These results serve as signiticant technical reference for the study on short-term forecast and nowcast of precipitation over South China in the thture.

  19. Therapeutic rigid bronchoscopy at a tertiary care center in North India: Initial experience and systematic review of Indian literature

    Directory of Open Access Journals (Sweden)

    Karan Madan

    2014-01-01

    Full Text Available Background and Aim: Rigid bronchoscopy is often an indispensable procedure in the therapeutic management of a wide variety of tracheobronchial disorders. However, it is performed at only a few centers in adult patients in India. Herein, we report our initial 1-year experience with this procedure. Materials and Methods: A prospective observational study on the indications, outcomes, and safety of various rigid bronchoscopy procedures performed between November 2009 and October 2010. Improvement in dyspnea, cough, and the overall quality of life was recorded on a visual analog scale from 0 to 100 mm. A systematic review of PubMed was performed to identify studies reporting the use of rigid bronchoscopy from India. Results: Thirty-eight rigid bronchoscopies (50 procedures were performed in 19 patients during the study period. The commonest indication was benign tracheal stenosis followed by central airway tumor, and the procedures performed were rigid bronchoplasty, tumor debulking, and stent placement. The median procedure duration was 45 (range, 30-65 min. There was significant improvement in quality of life associated with therapeutic rigid bronchoscopy. Minor procedural complications were encountered in 18 bronchoscopies, and there was no procedural mortality. The systematic review identified 15 studies, all on the role of rigid bronchoscopy in foreign body removal. Conclusions: Rigid bronchoscopy is a safe and effective modality for treatment of a variety of tracheobronchial disorders. There is a dire need of rigid bronchoscopy training at teaching hospitals in India.

  20. Analgesia postoperatoria tras artroplastia de rodilla mediante bloqueo femoral continuo con ropivacaína Postoperative analgesia after knee arthroplasty through continuous femoral blockage with ropivacaine

    Directory of Open Access Journals (Sweden)

    M. Reina

    2004-02-01

    intervenidos de artroplastia total de rodilla, constituyendo una técnica fácil de realizar, con un elevado grado de satisfacción en los pacientes estudiados.Introduction: The aim of this study was to determine the degree of pain and satisfaction after surgery of patients that received analgesia through continuous femoral blockage for total knee arthroplasty. Material and method: ASA I-III patients diagnosed of gonarthrosis and undergoing total knee arthroplasty under intradural anaesthesia were included. In the recovery unit and under the residuary effects of intradural anaesthesia, a catheter was placed near the femoral nerve, with neurostimulation. An initial bolus of 30 ml of ropivacaine 0.375% was administered, followed by continuous infusion of ropivacaine 0.125% 10 ml.h-1 maintained during the first 48 hours of postoperative. The following variables were recorded: postoperative pain at 24 and 48 hours as assessed through EVA, pain location, presence of motor blockage, paresthesia-dysesthesia and side effects, as well as drugs used in case of inappropriate analgesia, technical difficulty and degree of satisfaction after 48 hours. Results: Eight patients were included, with an average weight and height of 78 kg and 157 cm, respectively. Pain severity recorded at 24 hours was EVA 0 (62.5%, EVA 5 (25% and EVA 6 (12.5%. At 48 hours, 87.5% of patients had EVA 0 and 12,5%, EVA 4. All the patients with pain located it at the popliteal bone. Motor blockage was absent in all the patients. Paresthesi