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Sample records for cecostomy tube placement

  1. Constipation and Outcomes of Cecostomy.

    Science.gov (United States)

    Arya, Shruti; Gupta, Nancy; Gupta, Rahul; Aggarwal, Arun

    Constipation, defined as delay or difficulty in defecation, present for 2 or more weeks, is a common problem encountered by both primary and specialty medical providers. There are no randomized controlled trials on the use of antegrade enemas in the pediatric population. Most published papers are based on the experience at a particular center. The aim of this article is to describe the pathophysiology of constipation, review the contribution of colonic manometry to the diagnosis of constipation, summarize the advancements in the management of constipation through the use of antegrade enemas, and study the outcomes of cecostomy at different centers. This study is a comprehensive literature review generated by computerized search of literature, supplemented by review of monographs and textbooks in pathology, gastroenterology, and surgery. Literature search was performed using the publications from 1997 to 2012. The search included publications of all types presenting or reviewing data on cecostomy. The antegrade continence enema is a therapeutic option for defecation disorders when maximal conventional therapy is not successful. Symptoms of defecation disorders in children with different underlying etiologies improve significantly after a cecostomy is created. In addition, there is a benefit on the patients' physical activity, healthcare utilization, and general well-being. Based on the review of published literature it seems that antegrade enemas are a successful therapeutic option in children with severe constipation and/or fecal incontinence. With the advent of cecostomy buttons, patient compliance and the overall cosmetic appearance have improved.

  2. Fluoroscopic placement of jejunal feeding tubes

    International Nuclear Information System (INIS)

    Hoffer, F.; Mandell, V.S.; Sandler, R.H.; Leichner, A.; Kaplan, L.C.; Haynie, M.

    1992-01-01

    Over a two-and-one-half year period, 50 children underwent placements of jejunal tubes through a nasal route (NJ, n=47) or through an existing gastrostomy site (GJ, n=119). There were four attempted placements (98% success rate). The NJ tubes remained in place an average of 13 days, and the GJ tubes remained in place an average of 37 days. Fluoroscopic time for placement of an NJ tube an averaged 6 min (29 cases) and for a GJ tube 8 minutes (91 cases). In spite of the limited retention time, fluoroscopic time, and availability of alternative methods, fluoroscopically placed jejunal feedings tubes are still playing an active role in this institution. (orig.)

  3. Ultrasonography for confirmation of gastric tube placement.

    Science.gov (United States)

    Tsujimoto, Hiraku; Tsujimoto, Yasushi; Nakata, Yukihiko; Akazawa, Mai; Kataoka, Yuki

    2017-04-17

    Gastric tubes are commonly used for the administration of drugs and tube feeding for people who are unable to swallow. Feeding via a tube misplaced in the trachea can result in severe pneumonia. Therefore, the confirmation of tube placement in the stomach after tube insertion is important. Recent studies have reported that ultrasonography provides good diagnostic accuracy estimates in the confirmation of appropriate tube placement. Hence, ultrasound could provide a promising alternative to X-rays in the confirmation of tube placement, especially in settings where X-ray facilities are unavailable or difficult to access. To assess the diagnostic accuracy of ultrasound for gastric tube placement confirmation. We searched the Cochrane Library (2016, Issue 3), MEDLINE (to March 2016), Embase (to March 2016), National Institute for Health Research (NIHR) PROSPERO Register (to May 2016), Aggressive Research Intelligence Facility Databases (to May 2016), ClinicalTrials.gov (to May 2016), ISRCTN registry (May 2016), World Health Organization International Clinical Trials Registry Platform (to May 2016) and reference lists of articles, and contacted study authors. We included studies that evaluated the diagnostic accuracy of naso- and orogastric tube placement confirmed by ultrasound visualization using X-ray visualization as the reference standard. We included cross-sectional studies, and case-control studies. We excluded case series or case reports. Studies were excluded if X-ray visualization was not the reference standard or if the tube being placed was a gastrostomy or enteric tube. Two review authors independently assessed the risk of bias and extracted data from each of the included studies. We contacted authors of the included studies to obtain missing data. We identified 10 studies (545 participants and 560 tube insertions) which met our inclusion criteria.No study was assigned low risk of bias or low concern in every QUADAS-2 domain. We judged only three (30

  4. Acute complications associated with bedside placement of feeding tubes.

    Science.gov (United States)

    Baskin, William N

    2006-02-01

    Several types of feeding tubes can be placed at a patient's bedside; examples include nasogastric, nasointestinal, gastrostomy, and jejunostomy tubes. Nasoenteral tubes can be placed blindly at bedside or with the assistance of placement devices. Nasoenteric tubes can also be placed via fluoroscopy and endoscopy. Gastrostomy and jejunostomy tubes can be placed using endoscopic techniques. This paper will describe the indications and contraindications for different types of tubes that can be placed at the bedside and complications associated with tube placement. Complications associated with nasoenteral tubes include inadvertent malpositioning of the tube, epistaxis, sinusitis, inadvertent tube removal, tube clogging, tube-feeding-associated diarrhea, and aspiration pneumonia. Complications from percutaneous gastrostomy and jejunostomy tube placements include procedure-related mishaps, site infection, leakage, buried bumper syndrome, tube malfunction, and inadvertent removal. These complications will be reviewed, along with a discussion of incidence, cause, treatment, and prevention approaches.

  5. Nasogastric and feeding tubes. The importance of proper placement.

    Science.gov (United States)

    Gharib, A M; Stern, E J; Sherbin, V L; Rohrmann, C A

    1996-05-01

    The authors' experience in a radiology department suggested to them that there is a wide range of beliefs among practitioners regarding proper placement of nasogastric and feeding tubes. Improper positioning can cause serious problems, as they explain. Indications for different tube positions, complications of incorrect tube placement, and directions for proper positioning are discussed and illustrated.

  6. A novel placement technique for nasogastric and nasoesophageal tubes.

    Science.gov (United States)

    Herring, Jennifer M

    2016-07-01

    Early enteral nutrition in dogs and cats can have significant benefit in the therapeutic management of critical illness. Blind placement of nasogastric or nasoesophageal feeding tubes to accomplish this goal has become standard practice. However, complications from tube misdirection into the tracheobronchial tree can lead to significant patient morbidity and mortality. Safe and consistent alternatives are desirable to minimize these risks. A modified method for placement of nasoenteric tubes is described. The main variation from standard procedure involves a second tube measurement, with the distal tip of the tube positioned at the thoracic inlet and measured to the nostril. The tube is advanced to this level and tested for negative pressure using a 12 mL syringe attached to the end of the feeding tube. This improves confidence in esophageal positioning before complete advancement of the tube to its distal endpoint. This procedural adaptation to feeding tube placement has the potential to reduce bronchopulmonary trauma from intratracheal misdirection by providing an early safety check to identify malpositioning. Prospective validation studies are needed to support its advantages over standard tube placement techniques. © Veterinary Emergency and Critical Care Society 2016.

  7. Complications of nasogastric tube placement--don't blow it.

    LENUS (Irish Health Repository)

    Leonard, S

    2012-04-01

    Preventable complications maybe associated with the placement of nasogastric tubes. Our report raises awareness of the potentially fatal complications that can occur. We also recommend an approach for clinicians which maybe used to avoid significant patient morbidity.

  8. Fibreoptic Bronchoscope for Nasogastric Tube Placement

    Directory of Open Access Journals (Sweden)

    Bhandari Dhiraj

    2015-09-01

    Full Text Available A patient of stage III squamous cell carcinoma of mandible with hemi-mandibulectomy, modified radical neck dissection and radiotherapy required Ryle’s Tube (RT insertion for feeding. This case report describes use of fibreoptic bronchoscope to place an endotracheal tube in oesophagus through nasal route which was then used as a conduit to pass a RT into stomach.

  9. A virtual reality based simulator for learning nasogastric tube placement.

    Science.gov (United States)

    Choi, Kup-Sze; He, Xuejian; Chiang, Vico Chung-Lim; Deng, Zhaohong

    2015-02-01

    Nasogastric tube (NGT) placement is a common clinical procedure where a plastic tube is inserted into the stomach through the nostril for feeding or drainage. However, the placement is a blind process in which the tube may be mistakenly inserted into other locations, leading to unexpected complications or fatal incidents. The placement techniques are conventionally acquired by practising on unrealistic rubber mannequins or on humans. In this paper, a virtual reality based training simulation system is proposed to facilitate the training of NGT placement. It focuses on the simulation of tube insertion and the rendering of the feedback forces with a haptic device. A hybrid force model is developed to compute the forces analytically or numerically under different conditions, including the situations when the patient is swallowing or when the tube is buckled at the nostril. To ensure real-time interactive simulations, an offline simulation approach is adopted to obtain the relationship between the insertion depth and insertion force using a non-linear finite element method. The offline dataset is then used to generate real-time feedback forces by interpolation. The virtual training process is logged quantitatively with metrics that can be used for assessing objective performance and tracking progress. The system has been evaluated by nursing professionals. They found that the haptic feeling produced by the simulated forces is similar to their experience during real NGT insertion. The proposed system provides a new educational tool to enhance conventional training in NGT placement. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Gastrostomy Tube Placement Without Nasogastric Tube: A Retrospective Evaluation in 85 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Heberlein, Wolf E., E-mail: weheberlein@uams.edu; Goodwin, Whitney J.; Wood, Clint E.; Yousaf, Muhammad; Culp, William C. [University of Arkansas for Medical Sciences, Department of Radiology (United States)

    2012-12-15

    Purpose: Our study evaluated techniques for percutaneous gastrostomy (G)-tube placement without the use of a nasogastric (NG) tube. Instead, direct puncture of a physiologic air bubble or effervescent-enhanced gastric bubble distention was performed in patients with upper digestive tract obstruction (UDTO) or psychological objections to NG tubes. Materials and Methods: A total of 886 patients underwent G-tube placement in our department during a period of 7 years. We present our series of 85 (9.6%) consecutive patients who underwent percutaneous G-tube placement without use of an NG tube. Results: Of these 85 patients, fluoroscopic guided access was attempted by direct puncture of a physiologically present gastric air bubble in 24 (28%) cases. Puncture of an effervescent-induced large gastric air bubble was performed in 61 (72%) patients. Altogether, 82 (97%) of 85 G tubes were successfully placed in this fashion. The three failures comprised refusal of effervescent, vomiting of effervescent, and one initial tube misplacement when a deviation from our standard technique occurred. Conclusion: The described techniques compare favorably with published large series on G-tube placement with an NG tube in place. The techniques are especially suited for patients with UDTO due to head, neck, or esophageal malignancies, but they should be considered as an alternative in all patients. Direct puncture of effervescent-enhanced gastric bubble distention is a safe, patient-friendly and effective technique.

  11. Advantages of laparoscopic stented choledochorrhaphy over T-tube placement.

    Science.gov (United States)

    Isla, A M; Griniatsos, J; Karvounis, E; Arbuckle, J D

    2004-07-01

    Postoperative complications after laparoscopic choledochotomy are mainly related to the T tube. Both laparoscopic endobiliary stent placement with primary closure of the common bile duct (CBD) and primary closure of the CBD without drainage have been proposed as safe and effective alternatives to T tube placement. This was a retrospective analysis of data collected prospectively on 53 consecutive patients suffering from proven choledocholithiasis who underwent laparoscopic CBD exploration through a choledochotomy between January 1999 and January 2003. In the early period a T tube was placed at the end of the procedure (n = 32). Biliary stent placement and primary CBD closure was performed from June 2001 (n = 21). There were no significant differences in epidemiological characteristics, preoperative factors or intraoperative findings between the groups. Seven patients developed complications, six in the T tube group and one in the stent group. Univariate analysis revealed a significantly lower morbidity rate and shorter postoperative hospital stay in the stent group. Placement of a biliary endoprosthesis after laparoscopic choledochotomy achieves biliary decompression, and avoids the complications of a T tube, leading to a shorter postoperative hospital stay. The method is a safe and effective alternative method of CBD drainage after laparoscopic choledochotomy. Copyright 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  12. Outcome analysis of cirrhotic patients undergoing chest tube placement.

    Science.gov (United States)

    Liu, Lawrence U; Haddadin, Hassan A; Bodian, Carol A; Sigal, Samuel H; Korman, Jessica D; Bodenheimer, Henry C; Schiano, Thomas D

    2004-07-01

    Patients with cirrhosis can acquire pulmonary conditions that may or may not be related to their illness. Although posing a greater risk for complications, chest tubes are sometimes placed as treatment for hepatic hydrothorax and other pulmonary conditions. The aim of this study was to analyze the outcomes of chest tube placement in cirrhotic patients. A retrospective analysis was performed of 59 adults with cirrhosis undergoing chest tube placement. Variables that were investigated included reason for chest tube placement, complications developing while having the tube in place, and outcome. The 59 subjects were classified as having Child-Turcotte-Pugh (CTP) class A cirrhosis (n = 3), CTP class B cirrhosis (n = 31), and CTP class C cirrhosis (n = 25). Indications for having a chest tube placed were hepatic hydrothorax (n = 24), pneumothorax (n = 9), empyema (n = 8), video-assisted thoracoscopy (VAT) [n = 7], non-VAT (n = 5), and hemothorax (n = 3). The CTP class A subjects had their chest tubes removed without further complications early in the course, and were excluded from further statistical analysis. Twenty-five subjects (42%) had significant pleural effusions requiring chest tube placement. Among the CTP class B and class C subjects, the median duration with chest tube in place was 5.0 days (range, 1 to 53 days). Serum total bilirubin levels, presence of portosystemic encephalopathy, and CTP C classification were predictors of mortality. Mortalities were seen in 5 of 31 CTP class B subjects (16%), and 10 of 25 CTP class C subjects (40%). The tubes were successfully removed in a total of 39 subjects (66%) with no further procedure. Forty-seven subjects (80%) acquired one or more of the following complications: renal dysfunction, electrolyte imbalances, and infection. When placed for all indications, chest tubes may be successfully removed in the majority of cirrhotic patients. However, a third of all patients still die with the chest tube still in place

  13. Percutaneous gastrostomy tube placement in patients with ventriculoperitoneal shunts

    Energy Technology Data Exchange (ETDEWEB)

    Sane, S.S.; Towbin, A.; Bergey, E.A.; Kaye, R.D.; Fitz, C.R.; Albright, L.; Towbin, R.B. [Department of Radiology, Children`s Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213 (United States)

    1998-07-01

    Objective. The purpose of this study is to determine the risk of CNS and/or peritoneal infection in children with ventriculoperitoneal shunts in whom a percutaneous gastrostomy tube is placed. Materials and methods. We placed 205 gastrostomy or gastrojejunostomy tubes from January of 1991 to December 1996. Twenty-three patients (10 boys, 13 girls) had ventriculoperitoneal shunts at the time of placement. All shunts were placed at least 1 month prior to placement of the gastrostomy tube. The patients ranged in age from 8 months to 16 years with a mean age of 6 years, 9 months. Patient weight ranged from 2 kg to 60 kg. All 23 children required long-term nutritional support due to severe neurologic impairment. No prophylactic antibiotics were given prior to the procedure. Of the patients, 21/23 had a 14-F Sacks-Vine gastrostomy tube with a fixed terminal retention device inserted, using percutaneous fluoroscopic antegrade technique. Two of the 23 patients had a Ross 14-F Flexi-flo gastrostomy tube which required a retrograde technique due to a small caliber esophagus in these children. Results. All 23 children had technically successful placements of percutaneous gastrostomy (7) or gastrojejunostomy (16) tubes. Of the children, 21/23 (91 %) had no complications from the procedure. Two of 23 (9 %) patients demonstrated signs of peritonitis after placement of their gastrostomy tubes and subsequently had shunt infections. In both, children CSF culture grew gram-positive cocci. The antegrade technique was used in both children who developed peritonitis. Conclusion. Our study indicates children with ventriculoperitoneal shunts who undergo percutaneous gastrostomy are at greater risk for infection and subsequent shunt malfunction. Therefore, we recommend prophylactic antibiotic therapy to cover for skin and oral flora. (orig.) With 1 fig., 7 refs.

  14. Percutaneous gastrostomy tube placement in patients with ventriculoperitoneal shunts

    International Nuclear Information System (INIS)

    Sane, S.S.; Towbin, A.; Bergey, E.A.; Kaye, R.D.; Fitz, C.R.; Albright, L.; Towbin, R.B.

    1998-01-01

    Objective. The purpose of this study is to determine the risk of CNS and/or peritoneal infection in children with ventriculoperitoneal shunts in whom a percutaneous gastrostomy tube is placed. Materials and methods. We placed 205 gastrostomy or gastrojejunostomy tubes from January of 1991 to December 1996. Twenty-three patients (10 boys, 13 girls) had ventriculoperitoneal shunts at the time of placement. All shunts were placed at least 1 month prior to placement of the gastrostomy tube. The patients ranged in age from 8 months to 16 years with a mean age of 6 years, 9 months. Patient weight ranged from 2 kg to 60 kg. All 23 children required long-term nutritional support due to severe neurologic impairment. No prophylactic antibiotics were given prior to the procedure. Of the patients, 21/23 had a 14-F Sacks-Vine gastrostomy tube with a fixed terminal retention device inserted, using percutaneous fluoroscopic antegrade technique. Two of the 23 patients had a Ross 14-F Flexi-flo gastrostomy tube which required a retrograde technique due to a small caliber esophagus in these children. Results. All 23 children had technically successful placements of percutaneous gastrostomy (7) or gastrojejunostomy (16) tubes. Of the children, 21/23 (91 %) had no complications from the procedure. Two of 23 (9 %) patients demonstrated signs of peritonitis after placement of their gastrostomy tubes and subsequently had shunt infections. In both, children CSF culture grew gram-positive cocci. The antegrade technique was used in both children who developed peritonitis. Conclusion. Our study indicates children with ventriculoperitoneal shunts who undergo percutaneous gastrostomy are at greater risk for infection and subsequent shunt malfunction. Therefore, we recommend prophylactic antibiotic therapy to cover for skin and oral flora. (orig.)

  15. A Novel Endoscopic Technique for Failed Nasogastric Tube Placement.

    Science.gov (United States)

    Boston, Andrew G

    2015-10-01

    Direct visualization of the nasopharynx gives the otolaryngologist a unique advantage for addressing difficult nasopharyngeal anatomy. One common situation is being consulted to assist when the blind placement of a nasogastric tube has failed. A novel technique for managing a patient with a nasogastric tube embedded in the adenoid remnant is described with illustrations. The atraumatic method is easily employed by a resident armed with a portable nasolaryngoscope and plain suture. By using a repeated pull-through technique, the nasogastric tube can be guided past difficult nasopharyngeal anatomy and into a position from where it can be advanced into the patient's esophagus. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.

  16. [Feeding tube placement: auscultatory method and x-ray agreement].

    Science.gov (United States)

    Beghetto, Mariur Gomes; Anziliero, Franciele; Leães, Dória Migotto; de Mello, Elza Daniel

    2015-12-01

    to evaluate the correlation between the auscultation test and X-ray when detecting the position of an enteral feeding tube. cross-sectional study in an intensive care unit in southern Brazil, in 2011. Clinical nurse and nurse researcher performed auscultation test recording the impressions regarding the placement of an enteral feeding tube in 80 patients. A doctor evaluated the X-ray. Kappa coefficient and PABAK reviewed the agreements. The X-ray showed that 70% of the enteral tubes were in the stomach, 27.4% in the duodenum, 1.3% in the esophagus, and 1.3% in the right lung. There was a weak correlation between clinical nurses and nurse researchers (PABAK=0.054; P=0.103), clinical nurses and X-rays (PABAK=0.188; P=0.111) and nurse researchers and X-rays (PABAK=0.128; P=0.107) . The auscultation test did not detect two risk conditions, enteral feeding tube in the esophagus and the bronchus. the auscultation test showed little agreement with the X-ray on the enteral feeding tube location.

  17. Esophagojejunostomy Feeding Tube Placement in 5 Dogs with Pancreatitis and Anorexia

    Directory of Open Access Journals (Sweden)

    Forrest Cummings

    2014-01-01

    Full Text Available Enteral feeding tube placement has been described in veterinary medicine for several years. Indications include oral, esophageal, gastrointestinal, pancreatic, hepatic, and neurologic diseases. In this paper, endoscopically assisted placement of an esophagojejunostomy (EJ feeding tube in dogs with pancreatitis and prolonged anorexia is described. To the author’s knowledge there are no published reports of this procedure. Esophagojejunostomy feeding tubes provide an alternative to other forms of postgastric feeding tube placement (e.g., nasojejunal, gastrojejunostomy, and jejunostomy tubes without the associated complications of patient discomfort, sneezing, epistaxis, and peritonitis. Tube occlusion, transient vomiting and loose stool were the most commonly reported complications.

  18. Small-Bowel Feeding Tube Placement at Bedside: Electronic Medical Device Placement and X-Ray Agreement.

    Science.gov (United States)

    Carter, Michaelann; Roberts, Susan; Carson, Jo Ann

    2018-03-12

    The use of an electromagnetic placement device (EMPD) can allow trained clinicians to safely perform small-bowel feeding tube (SBFT) placement at the bedside. Before initiation of enteral nutrition, most facilities require a radiology confirmation of tube placement. Requirement of X-ray confirmation delays the start of nutrition and leads to increased costs and utilization of resources. The purpose of this study was to determine the rate of agreement between clinician interpretation of SBFT placement using the EMPD images and X-ray confirmation on tip of SBFT placement. This single-center, retrospective, observational study used data completed by registered dietitians or registered nurses after SBFT placement and compared it with radiology reports in the electronic health record. All tube placements were performed using the EMPD and were determined to be in 1 of 4 locations: stomach, duodenum, at the ligament of Trietz, or not specified within the small bowel. A total of 280 tube placements were analyzed. When differentiating between stomach and small bowel, the rate of agreement using a κ statistic was substantial agreement (κ = 0.67) and when determining tip-of-tube location within the small bowel excluding not specified locations, there was almost perfect agreement with a κ = 0.93 and n = 84. These findings suggest that EMPD images provide substantial agreement with X-ray confirmation and almost perfect agreement when the tip of the tube is within the small bowel. This indicates that the EMPD could be used without X-ray confirmation. © 2018 American Society for Parenteral and Enteral Nutrition.

  19. Easy Suprapubic Tube Placement Using a Van Buren Sound.

    Science.gov (United States)

    Wyner, Lawrence M

    2018-01-17

    To place a suprapubic tube without using specialized instruments. Suprapubic cystostomy is a straightforward urological procedure, which nevertheless may become complicated if the equipment needed to perform the operation is unavailable. Nowadays, in most operating rooms, control of urological instruments has been taken away from a small cadre of dedicated urology nurses, and instead is delegated to a central sterilization department or is even outsourced, leading to an increased rate of instrument misplacement or breakage. Disposable kits are useful, but may not be stocked at all facilities. Hence, the tools needed by the urologist to perform suprapubic cystostomy may not be readily available when they are needed. This reality was the impetus for the development of the following technique for suprapubic tube placement, which relies only upon ordinary instruments. A simple method is described for placing a suprapubic catheter using a curved Van Buren sound, a cystoscope, and a minor surgical set. Not only is the operation is easy to do, but is also advantageous in that the catheter may be exchanged over a wire, if necessary, before the establishment of a suprapubic tract. The technique depends on the presence of an intact urethra; therefore, it is contraindicated in the setting of pelvic trauma. This suprapubic cystostomy method may be used either as a primary technique or as a back-up procedure if the urologist's preferred instrumentation is not available. Copyright © 2018 Elsevier Inc. All rights reserved.

  20. Esophagojejunostomy Feeding Tube Placement in 5 Dogs with Pancreatitis and Anorexia

    OpenAIRE

    Forrest Cummings; Catherine A. Daley

    2014-01-01

    Enteral feeding tube placement has been described in veterinary medicine for several years. Indications include oral, esophageal, gastrointestinal, pancreatic, hepatic, and neurologic diseases. In this paper, endoscopically assisted placement of an esophagojejunostomy (EJ) feeding tube in dogs with pancreatitis and prolonged anorexia is described. To the author's knowledge there are no published reports of this procedure. Esophagojejunostomy feeding tubes provide an alternative to other forms...

  1. Nasoduodenal tube placement: Are two views necessary to confirm position?

    International Nuclear Information System (INIS)

    Ngo, Anh-Vu; Done, Stephen; Otto, Randolph; Friedman, Seth; Stanescu, A.L.

    2017-01-01

    Nasoduodenal tube (NDT) placement is typically performed at the bedside and two-view abdominal radiographs are usually used to confirm tube position. Anecdotally, in most instances the lateral view is unnecessary and utilizes more than twice the radiation than an anteroposterior (AP) view alone. We hypothesize that NDT location can be determined using only the AP view, with the NDT position determined on two views utilized as the gold standard. A search was performed for all two- or three-view abdominal radiographs from September 2012 to September 2013 with the phrase ''ND tube'' in the reason field of the requisition. These studies were independently reviewed by two radiologists and scored for anatomical tube position in three different scenarios: AP view alone, the lateral view alone, and both views together, with the latter serving as the gold standard. The anatomical scores were subsequently grouped to reflect clinically significant scenarios. Comparative analysis was performed with the original and clinically grouped scores. A total of 102 patients and 306 separate two-view exams were evaluated. Of the 102 patients, 55 had at least two separate exams. Across raters, concordances of AP and lateral scores relative to the gold standard assessment were 88% and 73% for anatomical scores, and 91.5% and 86.4% for clinically grouped data. Trend differences for fewer errors were found with the AP compared to the lateral view. There were statistically significant group differences with a greater number of false-negative errors in the lateral data set. No clear differences were found when comparing AP and lateral ratings for false-positive errors. Upon review of the common errors, we determined a few imaging findings on AP radiographs that can help assess the need for an additional lateral view. A single AP view is sufficient to determine the NDT position in most cases. Two views should be reserved for cases where the NDT position cannot be

  2. Nasoduodenal tube placement: Are two views necessary to confirm position?

    Energy Technology Data Exchange (ETDEWEB)

    Ngo, Anh-Vu; Done, Stephen; Otto, Randolph; Friedman, Seth; Stanescu, A.L. [Seattle Children' s Hospital, Department of Radiology, Seattle, WA (United States)

    2017-09-15

    Nasoduodenal tube (NDT) placement is typically performed at the bedside and two-view abdominal radiographs are usually used to confirm tube position. Anecdotally, in most instances the lateral view is unnecessary and utilizes more than twice the radiation than an anteroposterior (AP) view alone. We hypothesize that NDT location can be determined using only the AP view, with the NDT position determined on two views utilized as the gold standard. A search was performed for all two- or three-view abdominal radiographs from September 2012 to September 2013 with the phrase ''ND tube'' in the reason field of the requisition. These studies were independently reviewed by two radiologists and scored for anatomical tube position in three different scenarios: AP view alone, the lateral view alone, and both views together, with the latter serving as the gold standard. The anatomical scores were subsequently grouped to reflect clinically significant scenarios. Comparative analysis was performed with the original and clinically grouped scores. A total of 102 patients and 306 separate two-view exams were evaluated. Of the 102 patients, 55 had at least two separate exams. Across raters, concordances of AP and lateral scores relative to the gold standard assessment were 88% and 73% for anatomical scores, and 91.5% and 86.4% for clinically grouped data. Trend differences for fewer errors were found with the AP compared to the lateral view. There were statistically significant group differences with a greater number of false-negative errors in the lateral data set. No clear differences were found when comparing AP and lateral ratings for false-positive errors. Upon review of the common errors, we determined a few imaging findings on AP radiographs that can help assess the need for an additional lateral view. A single AP view is sufficient to determine the NDT position in most cases. Two views should be reserved for cases where the NDT position cannot be

  3. Establishing Decision Trees for Predicting Successful Postpyloric Nasoenteric Tube Placement in Critically Ill Patients.

    Science.gov (United States)

    Chen, Weisheng; Sun, Cheng; Wei, Ru; Zhang, Yanlin; Ye, Heng; Chi, Ruibin; Zhang, Yichen; Hu, Bei; Lv, Bo; Chen, Lifang; Zhang, Xiunong; Lan, Huilan; Chen, Chunbo

    2016-08-31

    Despite the use of prokinetic agents, the overall success rate for postpyloric placement via a self-propelled spiral nasoenteric tube is quite low. This retrospective study was conducted in the intensive care units of 11 university hospitals from 2006 to 2016 among adult patients who underwent self-propelled spiral nasoenteric tube insertion. Success was defined as postpyloric nasoenteric tube placement confirmed by abdominal x-ray scan 24 hours after tube insertion. Chi-square automatic interaction detection (CHAID), simple classification and regression trees (SimpleCart), and J48 methodologies were used to develop decision tree models, and multiple logistic regression (LR) methodology was used to develop an LR model for predicting successful postpyloric nasoenteric tube placement. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of these models. Successful postpyloric nasoenteric tube placement was confirmed in 427 of 939 patients enrolled. For predicting successful postpyloric nasoenteric tube placement, the performance of the 3 decision trees was similar in terms of the AUCs: 0.715 for the CHAID model, 0.682 for the SimpleCart model, and 0.671 for the J48 model. The AUC of the LR model was 0.729, which outperformed the J48 model. Both the CHAID and LR models achieved an acceptable discrimination for predicting successful postpyloric nasoenteric tube placement and were useful for intensivists in the setting of self-propelled spiral nasoenteric tube insertion. © 2016 American Society for Parenteral and Enteral Nutrition.

  4. Establishing Decision Trees for Predicting Successful Postpyloric Nasoenteric Tube Placement in Critically Ill Patients.

    Science.gov (United States)

    Chen, Weisheng; Sun, Cheng; Wei, Ru; Zhang, Yanlin; Ye, Heng; Chi, Ruibin; Zhang, Yichen; Hu, Bei; Lv, Bo; Chen, Lifang; Zhang, Xiunong; Lan, Huilan; Chen, Chunbo

    2018-01-01

    Despite the use of prokinetic agents, the overall success rate for postpyloric placement via a self-propelled spiral nasoenteric tube is quite low. This retrospective study was conducted in the intensive care units of 11 university hospitals from 2006 to 2016 among adult patients who underwent self-propelled spiral nasoenteric tube insertion. Success was defined as postpyloric nasoenteric tube placement confirmed by abdominal x-ray scan 24 hours after tube insertion. Chi-square automatic interaction detection (CHAID), simple classification and regression trees (SimpleCart), and J48 methodologies were used to develop decision tree models, and multiple logistic regression (LR) methodology was used to develop an LR model for predicting successful postpyloric nasoenteric tube placement. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of these models. Successful postpyloric nasoenteric tube placement was confirmed in 427 of 939 patients enrolled. For predicting successful postpyloric nasoenteric tube placement, the performance of the 3 decision trees was similar in terms of the AUCs: 0.715 for the CHAID model, 0.682 for the SimpleCart model, and 0.671 for the J48 model. The AUC of the LR model was 0.729, which outperformed the J48 model. Both the CHAID and LR models achieved an acceptable discrimination for predicting successful postpyloric nasoenteric tube placement and were useful for intensivists in the setting of self-propelled spiral nasoenteric tube insertion. © 2016 American Society for Parenteral and Enteral Nutrition.

  5. Variables associated with feeding tube placement in head and neck cancer.

    Science.gov (United States)

    Cheng, Sara S; Terrell, Jeffrey E; Bradford, Carol R; Ronis, David L; Fowler, Karen E; Prince, Mark E; Teknos, Theodoros N; Wolf, Gregory T; Duffy, Sonia A

    2006-06-01

    To identify clinical factors associated with enteral feeding tube placement in a head and neck cancer population. A self-administered survey was given to patients being treated for head and neck cancer while they were waiting to be seen in 1 of 4 otolaryngology clinics. The post hoc analysis presented here combines survey and chart review data to determine clinical and demographic variables associated with feeding tube placement. Four otolaryngology clinics. Otolaryngology clinic patients being treated for head and neck cancer. Enteral feeding tube placement. Of the 724 patients eligible for this study, 14% (n = 98) required enteral feeding tube placement. Multivariate analysis found the following variables to be independently associated with feeding tube placement: oropharynx/hypopharynx tumor site (odds ratio [OR], 2.4; P = .01), tumor stage III/IV (OR, 2.1; P = .03), flap reconstruction (OR, 2.2; P = .004), current tracheotomy (OR, 8.0; P<.001), chemotherapy (OR, 2.6; P<.001), and increased age (OR, 1.3; P = .02). In addition, there was a curvilinear relationship between time since treatment and feeding tube placement, with about 30% having a feeding tube at 1 month posttreatment, tapering down during the first 3 years to about 8% and leveling off thereafter. Identification of factors associated with an increased risk of feeding tube placement may allow physicians to better counsel patients regarding the possibility of feeding tube placement during treatment. Since feeding tube placement has been linked to decreased quality of life in head and neck cancer, such counseling is an integral part of the clinical management of these patients.

  6. Electromagnetic-Guided Bedside Placement of Nasoenteral Feeding Tubes by Nurses Is Non-Inferior to Endoscopic Placement by Gastroenterologists: A Multicenter Randomized Controlled Trial

    NARCIS (Netherlands)

    Gerritsen, Arja; de Rooij, Thijs; Dijkgraaf, Marcel G.; Busch, Olivier R.; Bergman, Jacques J.; Ubbink, Dirk T.; van Duijvendijk, Peter; Erkelens, G. Willemien; Klos, Mariël; Kruyt, Philip M.; Bac, Dirk Jan; Rosman, Camiel; Tan, Adriaan C.; Molenaar, I. Quintus; Monkelbaan, Jan F.; Mathus-Vliegent, Elisabeth M.; Besselink, Marc G.

    2016-01-01

    Electromagnetic (EM)-guided bedside placement of nasoenteral feeding tubes by nurses may improve efficiency and reduce patient discomfort and costs compared with endoscopic placement by gastroenterologists. However, evidence supporting this task shift from gastroenterologists to nurses is limited.

  7. Electromagnetic-Guided Bedside Placement of Nasoenteral Feeding Tubes by Nurses Is Non-Inferior to Endoscopic Placement by Gastroenterologists: A Multicenter Randomized Controlled Trial

    NARCIS (Netherlands)

    Gerritsen, A.; Rooij, T. de; Dijkgraaf, M.G.; Busch, O.R.; Bergman, J.J.; Ubbink, D.T.; Duijvendijk, P. van; Erkelens, G.W.; Klos, M.; Kruyt, P.M.; Bac, D.J.; Rosman, C.; Tan, A.C.; Molenaar, I.Q.; Monkelbaan, J.F.; Mathus-Vliegent, E.M.; Besselink, M.G.

    2016-01-01

    OBJECTIVES: Electromagnetic (EM)-guided bedside placement of nasoenteral feeding tubes by nurses may improve efficiency and reduce patient discomfort and costs compared with endoscopic placement by gastroenterologists. However, evidence supporting this task shift from gastroenterologists to nurses

  8. Electromagnetic-guided bedside placement of nasoenteral feeding tubes by nurses is non-inferior to endoscopic placement by gastroenterologists : A multicenter randomized controlled trial

    NARCIS (Netherlands)

    Gerritsen, Arja; De Rooij, Thijs; Dijkgraaf, Marcel G.; Busch, Olivier R.; Bergman, Jacques J.; Ubbink, Dirk T.; Van Duijvendijk, Peter; Erkelens, G. Willemien; Klos, Mariël; Kruyt, Philip M.; Bac, Dirk Jan; Rosman, Camiel; Tan, Adriaan C.; Molenaar, I. Quintus; Monkelbaan, Jan F.; Mathus-Vliegent, Elisabeth M.; Besselink, Marc G.

    2016-01-01

    OBJECTIVES: Electromagnetic (EM)-guided bedside placement of nasoenteral feeding tubes by nurses may improve efficiency and reduce patient discomfort and costs compared with endoscopic placement by gastroenterologists. However, evidence supporting this task shift from gastroenterologists to nurses

  9. Nasogastric Tube Placement and Esophageal Perforation in Extremely Low Birth Weight Infants.

    Science.gov (United States)

    Yong, Su-Boon; Ma, Jui-Shan; Chen, Feng-Shun; Chung, Mei-Yung; Yang, Kuender D

    2016-10-01

    Perforation of the esophagus associated with placement of nasogastric tubes is not uncommon in preterm infants. Herein we report three cases of iatrogenic esophageal perforation associated with nasogastric tube placement. With nonsurgical management of parenteral nutrition and broad-spectrum antimicrobial therapy, all three neonates survived without sequelae. Effective strategies to prevent such complications are discussed. Copyright © 2013. Published by Elsevier B.V.

  10. The practice of gastrostomy tube placement across a Canadian regional health authority.

    Science.gov (United States)

    Pruthi, Deepak; Duerksen, Donald R; Singh, Harminder

    2010-07-01

    We sought to conduct an assessment of the practice of gastrostomy (G) tube placement across an entire city, which would reflect usual clinical care as compared with referral center practice. We reviewed and retrospectively extracted data from patient records for all percutaneous endoscopic G (PEG) and radiological percutaneous G (RPG) tube placements at six Winnipeg hospitals between 1 April 2005 and 31 March 2007. A total of 418 patients had G tubes (376 PEG, 42 RPG) inserted during the study period. The most common indications were cerebrovascular accidents (25%), head and neck cancer (23%), and head trauma (10%). The position of the external bolster was not documented in 38% of patients. The median time to the first complication was 10 days, initiation of feeding was 48 hours, and tube removal was 40 days. Complications developed in 102 (24%) patients. Patients with RPG tubes had more infections and were less likely to receive prophylactic antibiotics (PRPG tubes and after insertions by lowest procedure volume physicians. Overall mortality was 12% within 30 days of G-tube placement. Death of one patient was directly related to peritonitis after G-tube insertion. In usual clinical practice, there is an underuse of prophylactic antibiotics and a delay in the institution of nutritional support after G-tube placement. A small but significant proportion of patients may develop major complications, with associated risk of mortality. The higher complication rate after procedures performed by lowest volume physicians needs further evaluation.

  11. Magnetic Resonance-Guided Nasogastric Feeding Tube Placement for Neonates: A Preclinical Study.

    Science.gov (United States)

    Daniels, Barret; Ireland, Christopher; Kraus, Steven; Racadio, John; Hilvert, Nicole; Dunn, Richard; Dumoulin, Charles

    2017-11-01

    Establishing postnatal nutrition delivery is challenging in neonates with immature sucking and swallowing ability. Enteral feeding is the gold standard for such patients, but their small size and fragility present challenges in nasogastric (NG) feeding tube placement. Feeding tubes are typically placed with x-ray guidance, which provides minimal soft tissue contrast and exposes the baby to ionizing radiation. This research investigates magnetic resonance (MR) guidance of NG feeding tube placement in neonates to provide improved soft tissue visualization without ionizing radiation. A novel feeding tube incorporating 3 solenoid coils for real-time tracking and guidance in the MR environment was developed. The feeding tube was placed 5 times in a rabbit with conventional x-ray guidance to assess mechanical stability and function. After x-ray procedures, the rabbit was transferred to a neonatal MR system, and the tube was placed 5 more times. In procedures guided by x-ray and MR, the feeding tube provided sufficient mechanical strength and functionality to access the esophagus and stomach of the rabbit. MR imaging provided significantly improved soft tissue contrast versus x-ray, which aided in proper tube guidance. Moreover, MR guidance allowed for real-time placement of the tube without the use of ionizing radiation. The feasibility and benefits offered by an MR-guided approach to NG feeding tube placement were demonstrated. The ability to acquire high-quality MR images of soft tissue without ionizing radiation and a contrast agent, coupled with accurate 3-dimensional device tracking, promises to have a powerful impact on future neonatal feeding tube placements.

  12. Systematic review on bedside electromagnetic-guided, endoscopic, and fluoroscopic placement of nasoenteral feeding tubes

    NARCIS (Netherlands)

    Gerritsen, Arja; Van Der Poel, Marcel J.; De Rooij, Thijs; Molenaar, IQ; Bergman, Jacques J.; Busch, Olivier R.; Mathus-Vliegen, Elisabeth M.; Besselink, Marc G.

    2015-01-01

    Background Nasoenteral tube feeding is frequently required in hospitalized patients to either prevent or treat malnutrition, but data on the optimal strategy of tube placement are lacking. Objective To compare the efficacy and safety of bedside electromagnetic (EM)-guided, endoscopic, and

  13. Development and characterization of a technique for percutaneous radiologic gastrojejunostomy tube placement in the dog.

    Science.gov (United States)

    Mack, Rebekah M; Staiger, Benjamin; Langlois, Daniel K; Mehler, Stephen J; Lam, Nathaniel; Moore, Trevor; Brown, Andrew; Beal, Matthew W

    2016-09-01

    To develop and describe a technique for percutaneous radiologic gastrojejunostomy tube placement in the dog. Prospective technique development study. University teaching hospital. Six healthy adult male Beagles. Following anesthetic induction, fluoroscopic and ultrasound guidance were used to identify an appropriate gastropexy site on the left lateral abdomen. Gastropexy was performed using gastrointestinal suture anchors. An over-the-wire catheter technique using fluoroscopic guidance was used to achieve jejunal access. An 18F/8F, 58 cm, dual-lumen gastrojejunal feeding tube was placed via serial over-the-wire dilation of the body wall using an 18F peel-away introducer kit. Tube location was determined radiographically immediately following placement and on days 2, 4, after emesis on day 4, and at time of gastrojejunal feeding tube removal (day 16-18). Percutaneous radiologic gastrojejunostomy (PRGJ) tube placement was successful in all dogs. Median time to pyloric passage with the guide wire was 23.5 minutes (range, 9-93 minutes). Median total procedure time was 53 minutes (range, 49-113 minutes). Significant tube migration was not observed at any point during the study. One dog developed linear foreign body obstruction secondary to the tube on day 5 that was relieved by release of the jejunal component. Other complications were minor and included mild-to-moderate peristomal inflammation in all dogs and removal of the feeding tube on day 3 by 1 dog. Feedings were well tolerated in all dogs. PRGJ tube placement in the dog is a safe and minimally invasive technique that allows for jejunal feeding without surgery or endoscopy. The high success rates, acceptable procedural times, and minimal complications are appealing for use in critically ill patients. Although additional evaluations are needed, PRGJ tube placement may be considered for dogs that require postpyloric feeding with or without gastric decompression. © Veterinary Emergency and Critical Care Society

  14. Endoscopically guided nasojejunal tube placement in dogs for short-term postduodenal feeding.

    Science.gov (United States)

    Pápa, Kinga; Psáder, Roland; Sterczer, Agnes; Pap, Akos; Rinkinen, Minna; Spillmann, Thomas

    2009-12-01

    To evaluate a method for endoscopically guided nasojejunal tube placement allowing short-term postduodenal feeding and chyme withdrawal in dogs. Pilot study. University teaching hospital. Three healthy Beagle dogs with jejunal nipple valve fistulas. After the dogs were anesthetized, an 8 Fr, 250-cm polyvinyl chloride catheter was advanced through a gastroscope into the jejunum. Correct jejunal placement was established using endoscopic visualization and confirmed by fluoroscopy and radiography. The proximal end of the tube was pulled out through 1 nostril and sutured to the skin of the forehead. Thereafter, jejunal feeding was administered for 4 days. Follow-up examinations included daily confirmation of the tube's position using radiography, physical examination, and blood analyses. Withdrawal of jejunal chyme was performed after jejunal and oral feeding. Fluoroscopic examination confirmed that endoscopic visualization alone allowed correct jejunal placement. During a 4-day postduodenal feeding period, repeated radiographic examination revealed stable positioning of the tubes within the jejunum with minor cranial displacement. The tubes were functional throughout the study without causing identifiable problems. Repeated physical examinations and blood analysis showed no abnormalities. We were able to administer the daily caloric requirements as a liquid diet. Jejunal chyme was successfully withdrawn via the tube. Endoscopically guided nasojejunal tube placement was shown to be a minimally invasive, well-tolerated method for short-term jejunal feeding in healthy dogs. This technique is a viable option for dogs requiring jejunal feeding but not laparotomy. The feasibility of chyme sampling is another unique application of the procedure.

  15. Chest tube placement in thorax trauma - comparison chest X-ray and computed tomography (CT)

    International Nuclear Information System (INIS)

    Heim, P.; Maas, R.; Buecheler, E.; Tesch, C.

    1998-01-01

    Estimation of chest tube placement in patients with thoracic trauma with regard to chest tube malposition in chest radiography in the supine position compared to additional computed tomography of the thorax. Material and methods: Apart from compulsory chest radiography after one or multiple chest tube insertions, 31 severely injured patients with thoracic trauma underwent a CT scan of the thorax. These 31 patients with 40 chest tubes constituted the basis for the present analysis. Results: In chest radiography in the supine position there were no chest tube malpositions (n=40); In the CT scans 25 correct positions, 7 pseudo-malpositions, 6 intrafissural and 2 intrapulmonary malpositions were identified. Moreover 16 sufficient, 18 insufficient and 6 indifferent functions of the chest tubes were seen. Conclusion: In case of lasting clinical problems and questionable function of the chest tube, chest radiography should be supplemented by a CT scan of the thorax in order to estimate the position of the chest tube. (orig.) [de

  16. Endoscopically assisted nasojejunal feeding tube placement: technique and results in five dogs.

    Science.gov (United States)

    Campbell, Scott Ayers; Daley, Catherine A

    2011-01-01

    Interest in noninvasive feeding tube placement in companion animals led to the adaption of a human technique utilizing endoscopy to place nasojejunal feeding tubes. Data from medical records in which nasojejunal feeding tubes were attempted were reviewed. Feeding tubes were attempted and successfully placed in five dogs within a median of 35 min. Feeding tubes remained in place for approximately 7 days. Complications included facial irritation (5/5), sneezing (5/5), fractured facial sutures (4/5), vomiting (3/5), diarrhea (3/5), crimping of feeding tube (3/5), regurgitation (1/5), epistaxis (1/5), clogging of the feeding tube (2/5), and oral migration with premature removal of the feeding tube (1/5). The deployment technique used in this study was found to be cumbersome. Despite minor complications, endoscopy can be used to rapidly and accurately place nasoenteric feeding devices.

  17. Accuracy of targeted wire guided tube thoracostomy in comparison to classical surgical chest tube placement - A clinical study.

    Science.gov (United States)

    Protic, Alen; Barkovic, Igor; Ivancic, Aldo; Kricka, Ozren; Zuvic-Butorac, Marta; Sustic, Alan

    2015-11-01

    Chest tube malfunction, after the tube thoracostomy, is often the result of an inappropriate chest tube tip position. The aim of this study was to analyse the precision of chest tube placement using the targeted wire guide technique (TWG technique) with curve dilator and to compare it to the classical surgical technique (CS technique). In this clinical study 80 patients with an indication for thoracic drainage, due to pneumothorax or pleural effusion were included. Experimental group contained 39 patients whose chest tube was placed using the TWG technique. The control group contained 41 patients whose chest tube was placed using the CS technique. The comparison of the outcomes of the two techniques applied suggests that the TWG technique was significantly more successful in achieving adequate (precise) chest tube placement, irrespective of patient diagnosis (TWG vs. CS in all patients, 78.4% vs. 36.6%, ppleural effusion group, TWG and CS had success rates of 78.2% and 37.5% (p=0.005), respectively, while in pneumothorax group, TWG and CS had success rates of 78.6% and 35.3% (p=0.029), respectively. Using a curved dilator and the TWG technique for the thoracic drainage procedure we found statistically significant advantage to the TWG technique in comparison to the CS technique (78% vs. 37%) regarding precise chest tube placement within the pleural cavity. Introducing the materials and technique used in this clinical trial into clinical practice may improve the quality of thoracic drainage, including residual volume of air and/or fluid, poor functioning of the chest tube, and, as a consequence of both, prolonged hospitalisation. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Pneumothorax Following Feeding Tube Placement: Precaution and Treatment

    Directory of Open Access Journals (Sweden)

    Morteza Zahmatkesh

    2012-05-01

    Full Text Available Nasojejunal feeding tubes are being used at an increased frequency, but it is not without complications that could be life-threatening. We report two cases of pneumothorax following small-bore feeding tube insertion into the pleural cavity, resulting in pneumothorax. We further discuss the potential measures that can be taken to prevent and treat this serious complication.

  19. A new method of placement of naso-jejunum feeding tube guided by electromagnetic positioning navigator

    Directory of Open Access Journals (Sweden)

    Jian-guo XIAO

    2015-11-01

    Full Text Available Objective To study the clinical application of electromagnetic positioning navigator assisted placement of nasojejunal feeding tube in early enteral nutrition for patients with critical illness. Methods Critically ill patients, who showed very high risks and could not withstand transferring for tube placement were selected as study subjects. The feeding tube with affiliated wire was inserted to jejunum guided by electromagnetic positioning navigator, and the site was confirmed by abdominal X-ray film or bedside ultrasound. The patients' vital signs, side effects and complications during and after the procedure were observed. Results Fifteen critically ill patients, aged 21-72 (mean 50.9±15.8 and with APACHEⅡ scores of 6-35 (mean 18.6±7.8, underwent this procedure. Of them 10 were undergoing mechanical ventilation, and 5 were given drugs to raise blood pressure. All the placement of feeding tubes were successfully. The intubation time was 5-42 minutes (mean 20.2min. Vital signs of all the patients were stable during the procedure, except for nausea 3 patients. No severe complications occurred. Conclusion The placement of naso-jejunal feeding tube guided by electromagnetic positioning navigator is easy to operate, safe and with high success rate, so it offers an effective route for early enteral nutrition for patients with critical illnesses. DOI: 10.11855/j.issn.0577-7402.2015.10.12

  20. Endoscopically assisted Crawford tube placement results in shorter general anesthesia times in pediatric patients.

    Science.gov (United States)

    Dobberpuhl, Mitchell R; Timoney, Peter J; Comer, Brett T

    2018-01-01

    Crawford tube placement is commonly used to achieve patency of nasolacrimal ducts for epiphora secondary to nasolacrimal duct obstruction. The nasal passages of pediatric patients are narrower than adults, and the result is a relatively higher risk of intranasal complications (e.g., synechiae, bleeding) with Crawford tube placement. There is evidence that general anesthesia may negatively affect the neurocognitive function and behavioral development of children, which prompts efforts to decrease operation times for potential health benefits and also potentially to reduce health care costs. Analysis of research reports supports the use of nasal endoscopy to reduce intranasal complications with Crawford tube placement; however, no publications currently address the effect of nasal endoscopy concurrent with Crawford tube placement on operative times on pediatric patients or the resulting effects on health care costs. To determine the difference in procedure time and cost between Crawford tubes placed traditionally and those placed with endoscopic assistance in pediatric patients. A chart review was performed from January 1, 2011 to December 31, 2016 for cases using CPT codes 68815 or 31231. Within this group of patients, the patient in whom nasal endoscopy was performed were placed in the "endoscopic" group and the patients without endoscopy were placed in the "traditional" group. Procedure times were noted, and the t-test was performed to examine for any statistically significant difference in operative times. Estimates of anesthesia cost savings were made. We identified 24 patients in the traditional group and 7 patients in the endoscopic group. The average operative time for the traditional group was 27.3 minutes compared with 14.0 minutes for the endoscopic group (p = 0.02). The cost comparison data revealed no significant difference with the traditional group averaging $9369 per procedure and the endoscopic group averaging $8891 (p = 0.51). An endoscopically

  1. Testing Placement of Gastric Feeding Tubes in Infants.

    Science.gov (United States)

    Metheny, Norma A; Pawluszka, Ann; Lulic, Melanie; Hinyard, Leslie J; Meert, Kathleen L

    2017-11-01

    Inadvertent positioning of a nasogastric tube in the lung can cause serious complications, so identifying methods to detect improperly inserted tubes is imperative. To compare the sensitivity, specificity, and negative and positive predictive values of 4 pH cut points (< 4.0, < 4.5, < 5.0, and < 5.5) in differentiating gastric and tracheal aspirates under various treatment conditions and to explore the utility of a pepsin assay for distinguishing between gastric and tracheal aspirates. Gastric and tracheal aspirates were collected from critically ill infants undergoing mechanical ventilation who had nasogastric or orogastric feeding tubes. Aspirates were tested with colorimetric pH indicators and a rapid pepsin assay. Information about treatment conditions was obtained from medical records. Two hundred twelve gastric aspirates and 60 tracheal aspirates were collected from 212 patients. Sensitivity was highest and specificity was lowest at the gastric aspirate pH cut point of less than 5.5. Positive predictive values were 100% at all pH cut points less than 5.0. Negative predictive values were higher at the pH cut point of less than 5.0 than at cut points less than 4.5. A higher percentage of pepsin-positive readings was found in gastric aspirates (88.3%) than in tracheal aspirates (5.4%). For a desired positive predictive value of 100%, a pH cut point of less than 5.0 provides the best negative predictive values, regardless of gastric acid inhibitor administration and feeding status. The pepsin assay is promising as an additional marker to distinguish gastric from tracheal aspirates. ©2017 American Association of Critical-Care Nurses.

  2. Acceptability and outcomes of the Percutaneous Endoscopic Gastrostomy (PEG tube placement- patients' and care givers' perspectives

    Directory of Open Access Journals (Sweden)

    Shah Hasnain A

    2006-11-01

    Full Text Available Abstract Background Percutaneous endoscopic gastrostomy tube has now become a preferred option for the long-term nutritional support device for patients with dysphagia. There is a considerable debate about the health issues related to the quality of life of these patients. Our aim of the study was to assess the outcome and perspectives of patients/care givers, about the acceptability of percutaneous endoscopic gastrostomy tube placement. Methods This descriptive analytic study conducted in patients, who have undergone percutaneous endoscopic gastrostomy tube placement during January 1998 till December 2004. Medical records of these patients were evaluated for their demographic characteristics, underlying diagnosis, indications and complications. Telephonic interviews were conducted till March 2005, on a pre-tested questionnaire to address psychological, social and physical performance status, of the health related quality of life issues. Results A total of 191 patients' medical records were reviewed, 120 (63% were males, and mean age was 63 years. Early complication was infection at PEG tube site in 6 (3% patients. In follow up over 365 ± 149 days, late complications (occurring 72 hours later were infection at PEG tube site in 29 (15 % patient and dislodgment/blockage of the tube in 26 (13.6%. Interviews were possible with 126 patients/caretakers. Karnofsky Performance Score of 0, 1, 2, 3 and 4 was found in 13(10%, 18(14%, 21(17%, 29(23% and 45(36% with p-value Conclusion PEG-tube placement was found to be relatively free from serious immediate and long- term complications. Majority of caregivers and patient felt that PEG-tube helped in feeding and prolonging the survival. Studies are needed to assess the real benefit in terms of actual nutritional gain and quality of life in such patients.

  3. Comparison of cardiopulmonary responses during sedation with epidural and local anesthesia for laparoscopic-assisted jejunostomy feeding tube placement with cardiopulmonary responses during general anesthesia for laparoscopic-assisted or open surgical jejunostomy feeding tube placement in healthy dogs.

    Science.gov (United States)

    Hewitt, Saundra A; Brisson, Brigitte A; Sinclair, Melissa D; Sears, William C

    2007-04-01

    To evaluate the use of laparoscopic-assisted jejunostomy feeding tube (J-tube) placement in healthy dogs under sedation with epidural and local anesthesia and compare cardiopulmonary responses during this epidural anesthetic protocol with cardiopulmonary responses during general anesthesia for laparoscopic-assisted or open surgical J-tube placement. 15 healthy mixed-breed dogs. Dogs were randomly assigned to receive open surgical J-tube placement under general anesthesia (n = 5 dogs; group 1), laparoscopic-assisted J-tube placement under general anesthesia (5; group 2), or laparoscopic-assisted J-tube placement under sedation with epidural and local anesthesia (5; group 3). Cardiopulmonary responses were measured at baseline (time 0), every 5 minutes during the procedure (times 5 to 30 minutes), and after the procedure (after desufflation [groups 2 and 3] or at the start of abdominal closure [group 1]). Stroke volume, cardiac index, and O(2) delivery were calculated. All group 3 dogs tolerated laparoscopic-assisted J-tube placement under sedation with epidural and local anesthesia. Comparison of cardiovascular parameters revealed a significantly higher cardiac index, mean arterial pressure, and O(2) delivery in group 3 dogs, compared with group 1 and 2 dogs. Minimal differences in hemodynamic parameters were found between groups undergoing laparoscopic-assisted and open surgical J-tube placement under general anesthesia (ie, groups 1 and 2); these differences were not considered to be clinically important in healthy research dogs. Sedation with epidural and local anesthesia provided satisfactory conditions for laparoscopic-assisted J-tube placement in healthy dogs; this anesthetic protocol caused less cardiopulmonary depression than general anesthesia and may represent a better choice for J-tube placement in critically ill patients.

  4. Rapid maxillary expansion versus middle ear tube placement: Comparison of hearing improvements in children with resistance otitis media with effusion.

    Science.gov (United States)

    Kılıç, Nihat; Yörük, Özgür; Kılıç, Songül Cömert; Çatal, Gülhan; Kurt, Sezgin

    2016-09-01

    To test the null hypothesis that there are significant differences in hearing improvements of children with resistance otitis media with effusion (OME) who undergo a rapid maxillary expansion (RME) procedure or ventilation tube placement. Forty-two children between 4.5 and 15 years old were divided into three groups: RME, ventilation tube, and control groups. The RME group consisted of 15 children with maxillary constriction and resistance OME that indicated ventilation tube placement. The ventilation tube group consisted of 16 children for whom ventilation tube placement was indicated but no maxillary constriction. The control group consisted of 11 children with no orthodontic and/or rhinologic problems. Hearing thresholds were evaluated with three audiometric records: (1) before RME/ventilation tube placement (T0); (2) after RME/ventilation tube placement (T1), and (3) after an observation period of 10 months (T2). The control group was matched to these periods, except T1. Hearing thresholds decreased significantly in both the RME and ventilation tube groups (P .05). Slight changes were observed in the control groups. The null hypothesis was rejected. RME showed similar effects as ventilation tube placement for release of otitis media and improvement of hearing thresholds levels. RME should be preferred as a first treatment option for children with maxillary constriction and resistance OME.

  5. Erythromycin for Promoting the Postpyloric Placement of Feeding Tubes: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Qing-Jun Jiang

    2018-01-01

    Full Text Available Background. Critically ill patients can benefit from enteral nutrition with postpyloric feeding tubes, but the low success rate limits its wide use. Erythromycin could elevate the success rate of tube insertion, but its clinical efficiency still remains controversial. Methods. Included studies must be RCTs which assessed the success rate of postpyloric feeding tube insertion using erythromycin. Results. 284 patients were enrolled in six studies. Meta-analysis showed that erythromycin significantly increases the rate of successful postpyloric feeding tube placement (RR 1.45, 95% CI (1.12, 1.86 and did not increase the risk of adverse effects (RR 2.15, 95% CI (0.20, 22.82. Subgroup analysis showed that unweighted feeding tubes (RR 1.47, 95% CI (1.03, 2.11 could significantly increase the success rate. Country of study, intravenous route of erythromycin, and year of participant enrollment did not influence these results. Conclusions. Erythromycin significantly increases the success rate of postpyloric feeding tube placement. This suggests that erythromycin can be used as an auxiliary method to improve the success rate of bedside insertion.

  6. Appropriate depth of placement of oral endotracheal tube and its possible determinants in Indian adult patients

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    Manu Varshney

    2011-01-01

    Full Text Available Background: Optimal depth of endotracheal tube (ET placement has been a serious concern because of the complications associated with its malposition. Aims: To find the optimal depth of placement of oral ET in Indian adult patients and its possible determinants viz. height, weight, arm span and vertebral column length. Settings and Design: This study was conducted in 200 ASA I and II patients requiring general anaesthesia and orotracheal intubation. Methods: After placing the ET with the designated black mark at vocal cords, various airway distances were measured from the right angle of mouth using a fibre optic bronchoscope. Statistical Analysis: The power of the study is 0.9. Mean (SD and median (range of various parameters and Pearson correlation coefficient was calculated. Results: The mean (SD lip-carina distance, i.e., total airway length was 24.32 (1.81 cm and 21.62 (1.34 cm in males and females, respectively. With black mark of ET between vocal cords, the mean (SD ET tip-carina distance of 3.69 (1.65 cm in males and 2.28 (1.55 cm females was found to be considerably less than the recommended safe distance. Conclusions: Fixing the tube at recommended 23 cm in males and 21 cm in females will lead to carinal stimulation or endobronchial placement in many Indian patients. The lip to carina distance best correlates with patient′s height. Positioning the ET tip 4 cm above carina as recommended will result in placement of tube cuff inside cricoid ring with currently available tubes. Optimal depth of ET placement can be estimated by the formula "(Height in cm/7-2.5."

  7. Gastrojejunoscopy facilitates placement of a percutaneous transgastric jejunostomy in a patient with a pancreaticoduodenectomy and multiple-failed feeding tube placements

    Directory of Open Access Journals (Sweden)

    Jeffrey Forris Beecham Chick, MD, MPH, DABR

    2018-02-01

    Full Text Available Enteral access is one of the most common procedures performed in abdominal and interventional radiology. The surgical anatomy of the postoperative stomach may, however, make enteral access challenging. This report describes a patient with a pancreaticoduodenectomy complicated by a gastrojejunostomy leak who underwent 2 unsuccessful transoral endoscopic nasojejunal tube placements and 2 failed percutaneous gastrojejunostomy tube placements. Eventually, a gastrojejunostomy tube was placed utilizing percutaneous techniques with fluoroscopy assistance and gastrojejunoscopy guidance. A combined technique with fluoroscopy and endoscopy, both controlled by interventional radiology, may be useful in patients with complex postsurgical gastrointestinal anatomy who require enteral access.

  8. Face and content validity of a virtual-reality simulator for myringotomy with tube placement.

    Science.gov (United States)

    Huang, Caiwen; Cheng, Horace; Bureau, Yves; Agrawal, Sumit K; Ladak, Hanif M

    2015-10-20

    Myringotomy with tube insertion can be challenging for junior Otolaryngology residents as it is one of the first microscopic procedures they encounter. The Western myringotomy simulator was developed to allow trainees to practice microscope positioning, myringotomy, and tube placement. This virtual-reality simulator is viewed in stereoscopic 3D, and a haptic device is used to manipulate the digital ear model and surgical tools. To assess the face and content validity of the Western myringotomy simulator. The myringotomy simulator was integrated with new modules to allow speculum placement, manipulation of an operative microscope, and insertion of the ventilation tube through a deformable tympanic membrane. A questionnaire was developed in consultation with instructing surgeons. Fourteen face validity questions focused on the anatomy of the ear, simulation of the operative microscope, appearance and movement of the surgical instruments, deformation and cutting of the eardrum, and myringotomy tube insertion. Six content validity questions focused on training potential on surgical tasks such as speculum placement, microscope positioning, tool navigation, ear anatomy, myringotomy creation and tube insertion. A total of 12 participants from the Department of Otolaryngology-Head and Neck Surgery were recruited for the study. Prior to completing the questionnaire, participants were oriented to the simulator and given unlimited time to practice until they were comfortable with all of its aspects. Responses to 12 of the 14 questions on face validity were predominantly positive. One issue of concern was with contact modeling related to tube insertion into the eardrum, and the second was with the movement of the blade and forceps. The former could be resolved by using a higher resolution digital model for the eardrum to improve contact localization. The latter could be resolved by using a higher fidelity haptic device. With regard to content validity, 64% of the responses

  9. Outcomes in Older Patients with Grade III Cholecystitis and Cholecystostomy Tube Placement: A Propensity Score Analysis.

    Science.gov (United States)

    Dimou, Francesca M; Adhikari, Deepak; Mehta, Hemalkumar B; Riall, Taylor S

    2017-04-01

    The Tokyo Guidelines recommend initial cholecystostomy tube drainage, antibiotics, and delayed cholecystectomy in patients with grade III cholecystitis. We used Medicare data (1996 to 2010) to identify patients 66 years and older who were admitted with grade III acute cholecystitis. We evaluated adherence to the Tokyo Guidelines and compared mortality, readmission, and complication rates with and without cholecystostomy tube placement in a propensity-matched (1:3) cohort of patients with grade III cholecystitis. There were 8,818 patients admitted with grade III cholecystitis; 565 patients (6.4%) had a cholecystostomy tube placed. Cholecystostomy tube placement increased from 3.9% to 9.7% during the study period. Compared with 1,689 propensity-matched controls, patients with cholecystostomy tube placement had higher 30-day (hazard ratio [HR] = 1.26; 95% CI 1.05 to 1.50), 90-day (HR = 1.26; 95% CI 1.08 to 1.46), and 2-year mortality (HR = 1.19; 95% CI 1.04 to 1.36) and were less likely to undergo cholecystectomy in the 2 years after initial hospitalization (33.4% vs 64.4%; HR = 0.26; 95% CI 0.21 to 0.31). Readmissions were also higher at 30 days (HR = 2.93; 95% CI 2.12 to 4.05), 90 days (HR = 3.48; 95% CI 2.60 to 4.64), and 2 years (HR = 3.08; 95% CI 2.87 to 4.90). Since the introduction of the Tokyo Guidelines (2007), use of cholecystostomy tubes in patients with grade III cholecystitis has increased, but the majority of patients do not get cholecystostomy tube drainage as first-line therapy. Cholecystostomy tube placement was associated with lower rates of definitive treatment with cholecystectomy, higher mortality, and higher readmission rates. These data suggest a need for additional evaluation and refinement of the Tokyo Guidelines. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives

    OpenAIRE

    Robinson H; Engelhardt T

    2017-01-01

    Hal Robinson, Thomas Engelhardt Department of Anaesthesia, Royal Aberdeen Children’s Hospital, Aberdeen, UK Purpose: Myringotomy and tube placement is one of the most frequently performed ear, nose and throat (ENT) surgeries in the pediatric population. Effective anesthetic management is vital to ensuring successful ambulatory care and ensuring child and parental satisfaction.Recent findings: This review summarizes recently published studies about the long-term effects of g...

  11. Investigation of the efficacy of colorimetric capnometry method used to verify the correct placement of the nasogastric tube.

    Science.gov (United States)

    Erzincanli, Saadet; Zaybak, Ayten; Güler, Ayşe

    2017-02-01

    This present study was designed to determine the efficacy of the colorimetric capnometry method used to verify the correct placement of the nasogastric tube. The present study comprised forty patients who had a nasogastric tube inserted and were being monitored in the adult intensive care unit. After the insertion of the nasogastric tube, 40 colorimetric capnometry and 40 auscultation measurements were performed. Auscultation and colorimetric capnometry results were compared with tube placement results confirmed radiologically. In the confirmation of the placement of the nasogastric tube, the consistency was 97.5% (p0.05) between the auscultatory method and the radiological method. The oesophageal placement of the nasogastric tube was detected with the colorimetric capnometry method, but the gastric and duodenal insertions were not determined. While the sensitivity and specificity of the colorimetric capnometry method in determining the correct placement of the nasogastric tube were 1.00 and 0.667 respectively, those of the auscultatory method were 0.89 and 0.0 respectively. As a result, for the confirmation of the NGT placement, the colorimetric capnometry method is considered more reliable than the auscultatory method and is compatible with the radiological method. However, the colorimetric capnometry method is inadequate to distinguish between the gastric or duodenal insertion. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Outcomes among patients with direct enteral vs nasogastric tube placement after acute stroke.

    Science.gov (United States)

    Joundi, Raed A; Saposnik, Gustavo; Martino, Rosemary; Fang, Jiming; Porter, Joan; Kapral, Moira K

    2018-02-13

    To compare complications, disability, and long-term mortality of patients who received direct enteral tube vs nasogastric tube feeding alone after acute stroke. We used the Ontario Stroke Registry to identify patients who received direct enteral tubes (DET; gastrostomy or jejunostomy) or temporary nasogastric tubes (NGT) alone during hospital stay after acute ischemic stroke or intracerebral hemorrhage from July 1, 2003, to March 31, 2013. We used propensity matching to compare groups from discharge and evaluated discharge disability, institutionalization, complications, and mortality, with follow-up over 2 years, and with cumulative incidence functions used to account for competing risks. Among 1,448 patients with DET placement who survived until discharge, 1,421 were successfully matched to patients with NGT alone. Patients with DET had reduced risk of death within 30 days after discharge (9.7% vs 15.3%; hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.49-0.75), but this difference was eliminated after matching on length of stay and discharge disability (HR 0.90, 95% CI 0.70-1.17). Patients with DET had higher rates of severe disability at discharge (modified Rankin Scale score 4-5; 89.6% vs 78.4%), discharge to long-term care (38.0% vs 16.1%), aspiration pneumonia (14.4% vs 5.1%) and other complications, and mortality at 2 years (41.1% vs 35.9%). Patients with DET placement after acute stroke have more severe disability at discharge compared to those with NGT placement alone, and associated higher rates of institutionalization, medical complications, and long-term mortality. These findings may inform goals of care discussions and decisions regarding long-term tube feeding after acute stroke. © 2018 American Academy of Neurology.

  13. Persistent conductive or mixed hearing loss after the placement of tympanostomy tubes.

    Science.gov (United States)

    Whittemore, Kenneth R; Dornan, Briana K; Lally, Tara; Dargie, Jenna M

    2012-10-01

    Described is a case series of clinical findings in children with persistent conductive or mixed hearing loss following tympanostomy tube placement for serous otitis media. Retrospective chart review. Tertiary pediatric hospital. Medical records of thirty-nine children who were referred for either conductive or mixed hearing loss post-tympanostomy tube placement were reviewed for clinical histories, physical examinations, audiological evaluations, diagnostic studies, consultations, and surgical findings. Approval was obtained from the Boston Children's Hospital Institutional Review Board. Causes of hearing loss included ossicular abnormalities, cochlear abnormalities, 'third window' effects, cholesteatomas, genetic syndromes, and unknown causes. In four patients with isolated mild low-frequency conductive hearing loss, the cause was the presence of functional tubes. All patients diagnosed with a genetic syndrome had bilateral hearing loss. Patients with mixed hearing loss were diagnosed with cochlear abnormalities, 'third window' effects, or genetic syndromes. Computed tomography led to diagnosis in sixteen of twenty-five patients. Vestibular-evoked myogenic potential testing suggested a diagnosis in three of four patients. In children with persistent hearing loss following tympanostomy tube placement, identifying the laterality and type of hearing loss appears to be of importance in diagnosis. Patients with bilateral hearing loss should be considered for genetic testing, given the possibility of a syndrome. Patients identified with a mixed hearing loss should be evaluated for inner ear anomalies. Patients with mild, low-frequency hearing losses should be monitored audiologically and investigated further only if the hearing loss progresses and/or there is no resolution following tube extrusion. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  14. Sonographic Identification of Tube Thoracostomy Study (SITTS: Confirmation of Intrathoracic Placement

    Directory of Open Access Journals (Sweden)

    Jamie A. Jenkins

    2012-09-01

    Full Text Available Introduction: Thoracostomy tubes (TT are commonly placed in the management of surgical, emergency, and trauma patients and chest radiographs (CXR and computed tomography (CT are performed to confirm placement. Ultrasound (US has not previously been used as a means to confirm intrathoracic placement of chest tubes. This study involves a novel application of US to demonstrate chest tubes passing through the pleural line, thus confirming intrathoracic placement.Methods: This was an observational proof-of-concept study using a convenience sample of patients with TTs at a tertiary-care university hospital. Bedside US was performed by the primary investigatorusing first the low-frequency (5–1 MHz followed by the high-frequency (10–5 MHz transducers, in both 2-dimensional gray-scale and M-modes in a uniform manner. The TTs were identified in transverse and longitudinal views by starting at the skin entry point and scanning to where the TT passed the pleural line, entering the intrathoracic region. All US images were reviewed by US fellowship-trained emergency physicians. CXRs and CTs were used as the standard for confirmation ofTT placement.Results: Seventeen patients with a total of 21 TTs were enrolled. TTs were visualized entering the intrathoracic space in 100% of cases. They were subjectively best visualized with the high-frequency (10–5 MHz linear transducer. Sixteen TTs were evaluated using M-mode. TTs produced a distinct pattern on M-mode.Conclusion: Bedside US can visualize the TT and its entrance into the thoracic cavity and it can distinguish it from the pleural line by a characteristic M-mode pattern. This is best visualized with the high-frequency (10–5 MHz linear transducer. [West J Emerg Med. 2012;13(4:305–311.

  15. The role of gastrostomy tube placement in advanced dementia with dysphagia: a critical review

    Directory of Open Access Journals (Sweden)

    Goldberg LS

    2014-10-01

    Full Text Available Leanne S Goldberg,1 Kenneth W Altman2 1Department of Otolaryngology, Mount Sinai School of Medicine, New York, NY, USA; 2Baylor College of Medicine, Houston, TX, USAPurpose: Over 4.5 million people in North America had a diagnosis of dementia in the year 2000, and more than half had advanced disease with potential aspiration risk. There is much controversy regarding the use and timing of enteral feeding support in these patients with dysphagia. The management of dysphagia is far more complex when considering quality of life, “comfort care” hand feeding, the use of percutaneous endoscopic gastrostomy tube (PEG, and associated mortality rates. This study seeks to critically review the literature that evaluates PEG placement in this population. Methods: A systematic literature review of PubMed, from 1995–2012, was conducted to identify studies relating to PEG placement in dementia patients with dysphagia. The principal outcomes and related survival rates for this population were compared. Results: In total, 100 articles were identified in the search. Of these, ten met the search criteria and were analyzed. There was one study with a 2b level of evidence, one with 3b, and the remainder had level 4. All studies discussed long-term survival in the PEG versus non-PEG populations. No studies showed definitive evidence to suggest long-term survival rates improved in patients who underwent PEG placement as compared to those who did not. Two studies documented median survival worse in patients over age 80 with dementia and PEG placement.Conclusion: There is presently no evidence to suggest long-term survival rates improved in patients with advanced dementia who underwent PEG placement for dysphagia. Relevance to quality of life, need for nutrition and hydration, and ethical considerations in the decision process are discussed.Keywords: PEG, aspiration, elderly, feeding tube, swallow

  16. Long-Term Outcomes Following Percutaneous Cholecystostomy Tube Placement for Treatment of Acute Calculous Cholecystitis.

    Science.gov (United States)

    Alvino, Donna Marie L; Fong, Zhi Ven; McCarthy, Colin J; Velmahos, George; Lillemoe, Keith D; Mueller, Peter R; Fagenholz, Peter J

    2017-05-01

    Percutaneous cholecystostomy tube (PCT) placement is considered a safe alternative to cholecystectomy for the treatment of acute calculous cholecystitis (ACC), but data regarding long-term outcomes following PCT are limited. We retrospectively reviewed our institutional experience of patients undergoing PCT for ACC between 1997 and 2015. Recurrent biliary events were defined as cholecystitis, cholangitis, or gallstone pancreatitis. PCT was placed for 288 patients with ACC. Mean age and age-adjusted Charlson comorbidity index were 72 ± 15 years and 5.3 ± 2.4, respectively. Following PCT placement, 91% of patients successfully resolved their episode of ACC. PCT dysfunction occurred in 132 patients (46%), with 80 patients (28%) requiring re-intervention, while 7% developed procedure-related complications. Interval cholecystectomy reduced the risk of recurrent biliary events to 7% from 21% (p = 0.002). Cholecystectomy was completed laparoscopically in 45% of patients receiving an interval operation vs. 22% of those undergoing urgent surgery for PCT failure or recurrent biliary event (p = 0.03). PCT placement is a highly successful treatment for acute calculous cholecystitis and is associated with low complication rate, but high rate of tube dysfunction requiring frequent re-intervention. Interval cholecystectomy is associated with a decreased likelihood of recurrent biliary events and increased likelihood of successful laparoscopic completion.

  17. Endotracheal tube placement by EMT-Basics in a rural EMS system.

    Science.gov (United States)

    Pratt, Jeffrey C; Hirshberg, Alan J

    2005-01-01

    To evaluate the effectiveness of an intubation-training module and special-waiver project in which Emergency Medical Technician (EMT)-Basics were trained to perform endotracheal intubations in a rural community. This was a prospective observational study over a four-year period (July 1998 through May 2002) of all intubation attempts by EMT-Basics in the field. The authors observed intubation data, training methods, and quality-assurance methods of a special-waiver project agreed to by the State Department of Public Health to train and allow EMT-Basics to intubate patients. Data were from documentation unique to the project. Project documentation evaluated the placement and complication(s) of endotracheal tube (ETT) placement after arrival to the emergency department. An intubation attempt was defined as direct laryngoscopy. A successful attempt was defined as an appropriately sized ETT placed and secured in the trachea below the vocal cords and above the carina. Confirmation of placement in the field included accepted clinical methods and the use of qualitative colorimetric end-tidal carbon dioxide detectors. The EMT-Basics were trained using a paramedic curriculum, including operating room intubations on live adult patients. All patients were in either cardiopulmonary or respiratory arrest. Thirty-two intubations were performed by EMT-Basics. Thirty attempts were successful and two were unsuccessful (94%; 95% confidence interval [CI] 80-98%). Unsuccessful ETT placements were managed with accepted basic life support airway standards. There were no unrecognized esophageal ETT placements (0%; 95% CI 0-11%). This study demonstrated that with an intensive training program using selected highly motivated providers and close monitoring, a program of EMT-Basic ETT placement in a rural setting can achieve acceptable success rates in patients in cardiac or respiratory arrest.

  18. Nasogastric placement of sump tube through the leak for the treatment of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma.

    Science.gov (United States)

    Jiang, Feng; Yu, Ming Feng; Ren, Bin Hui; Yin, Guo Weng; Zhang, Qin; Xu, Lin

    2011-12-01

    We seek to retrospectively analyze the nasogastric placement of sump tube through the leak for the treatment of intra-thoracic esophagastric anastomotic leak after esophagectomy for esophageal carcinoma. Esophagectomy with intrathoracic esophagogastric anastomotic procedures were performed in 2954 patients who suffered from esophageal carcinoma in our hospital between May 2004 and July 2008. Anastomotic leak had developed in 38 patients, of whom four patients were treated by reoperations. Stent insertion, the traditional "three-tube method" and the nasogastric placement of sump tube through the leak were applied in two, seven, and 25 patients, respectively. The presence of anastomotic leak was proven by radiographic contrast examinations in 38 patients (1.3%). Among them, four received reoperations and recovered. Two patients were treated with the placement of self-expanding metallic coated stents and both died 10 and 13 d after placement due to uncontrollable hematemesis. Seven and 25 patients were managed by the traditional "three-tube method" and the nasogastric placement of sump tube through the leak, respectively. The mean time interval of the leak treatment was 42 d in the traditional "three-tube method" group and 31.2 d in the nasogastric placement of sump tube through the leak group, and the relatively average hospital mortality rates were 14.3% and 12%, respectively. The nasogastric placement of sump tube through the leak appears to be an effective, technically feasible, and minimally invasive option for the treatment of intrathoracic esophagogastric anastomotic leak. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. Optimal Line and Tube Placement in Very Preterm Neonates: An Audit of Practice.

    Science.gov (United States)

    Finn, Daragh; Kinoshita, Hannah; Livingstone, Vicki; Dempsey, Eugene M

    2017-11-17

    Placement of endotracheal tubes (ETTs) and umbilical catheters (UCs) is essential in very preterm infant care. The aim of this study was to assess the effect of an educational initiative to optimize correct placement of ETTs and UCs in very preterm infants. A pre-post study design, evaluating optimal radiological position of ETTs and UCs in the first 72 h of life in infants positioning, and weight-based calculations to estimate insertion depths for endotracheal intubation. A prospective evaluation of radiological placement of ETTs and UCs was then conducted over a 12-month period. During the study period, 211 infants had at least one of the three procedures performed. One hundred and fifty-seven infants were included in the pre-education group, and 54 in the post-education group. All three procedures were performed in 50.3% (79/157) in the pre-education group, and 55.6% (30/54) in the post-education group. There was no significant difference in accurate placement following the introduction of the educational sessions; depth of ETTs (50% vs. 47%), umbilical arterial catheter (UAC) (40% vs. 43%,), and umbilical venous catheter (UVC)(14% vs. 23%). Despite education of staff on methods for appropriate ETT, UVC and UAC insertion length, the rate of accurate initial insertion depth remained suboptimal. Newer methods of determining optimal position need to be evaluated.

  20. Confirming nasogastric tube placement: Is the colorimeter as sensitive and specific as X-ray? A diagnostic accuracy study.

    Science.gov (United States)

    Mordiffi, Siti Zubaidah; Goh, Mien Li; Phua, Jason; Chan, Yiong-Huak

    2016-09-01

    The effect of delivering enteral nutrition or medications via a nasogastric tube that is inadvertently located in the tracheobronchial tract can cause respiratory complications. Although radiographic examination is accepted as the gold standard for confirming the position of patients' enteral tubes, it is costly, involves risks of radiation, and is not failsafe. Studies using carbon dioxide sensors to detect inadvertent nasogastric tube placements have been conducted in intensive care settings. However, none involved patients in general wards. The objective of this study was to ascertain the diagnostic measure of colorimeter, with radiographic examination as the reference standard, to confirm the location of nasogastric tubes in patients. A prospective observational study of a diagnostic test. This study was conducted in the general wards of an approximately 1100-bed acute care tertiary hospital of an Academic Medical Center in Singapore. Adult patients with nasogastric tubes admitted to the general wards were recruited into the study. The colorimeter was attached to the nasogastric tube to detect for the presence of carbon dioxide, suggestive of a tracheobronchial placement. The exact location of the nasogastric tube was subsequently confirmed by a radiographic examination. A total of 192 tests were undertaken. The colorimeter detected carbon dioxide in 29 tested nasogastric tubes, of which radiographic examination confirmed that four tubes were located in the tracheobronchial tract. The colorimeter failed to detect carbon dioxide in one nasogastric tube that was located in the tracheobronchial tract, thus, demonstrating a sensitivity of 0.80 [95% CI (0.376, 0.964)]. The colorimeter detected absence of carbon dioxide in 163 tested nasogastric tubes in which radiographic examination confirmed 160 gastrointestinal and one tracheobronchial placements, demonstrating a specificity of 0.865 [95% CI (0.808, 0.907)]. The colorimeter detected one tracheobronchial

  1. Pneumothorax, pleural effusion, and chest tube placement after radiofrequency ablation of lung tumors: incidence and risk factors.

    Science.gov (United States)

    Hiraki, Takao; Tajiri, Nobuhisa; Mimura, Hidefumi; Yasui, Kotaro; Gobara, Hideo; Mukai, Takashi; Hase, Soichiro; Fujiwara, Hiroyasu; Iguchi, Toshihiro; Sano, Yoshifumi; Shimizu, Nobuyoshi; Kanazawa, Susumu

    2006-10-01

    To retrospectively evaluate the incidence of and risk factors for pneumothorax, pleural effusion, and chest tube placement for pneumothorax after radiofrequency (RF) ablation of lung tumors. Institutional review board approval was obtained, with waiver of informed consent. This retrospective study comprised 224 ablation sessions for 392 tumors in 142 patients (92 men, 50 women; mean age, 64.0 years). Multiple variables were analyzed by using the Student t test or the Mann-Whitney U test for numerical values and by using the chi(2) test or the Fisher exact test for categorical values in order to assess risk factors for pneumothorax, pleural effusion, and chest tube placement for pneumothorax. The incidence of pneumothorax, pleural effusion, and chest tube placement for pneumothorax was 52% (117 of 224 sessions), 19% (42 of 224 sessions), and 21% (24 of 117 sessions), respectively. For pneumothorax, risk factors included male sex (P = .030), no history of pulmonary surgery (P pleural effusion, risk factors included the use of a cluster electrode (P = .008), decreased distance to the nearest pleura (P = .040), and decreased length of the aerated lung traversed by the electrode (P = .019). For chest tube placement for pneumothorax, risk factors included no history of pulmonary surgery (P = .002), the use of a cluster electrode (P pleural effusion can occur after RF ablation in patients with lung tumors, and chest tube placement for pneumothorax is sometimes required. (c) RSNA, 2006.

  2. Noninvasive verification of nasogastric tube placement using a magnet-tracking system: a pilot study in healthy subjects.

    Science.gov (United States)

    Bercik, Premysl; Schlageter, Vincent; Mauro, Marina; Rawlinson, John; Kucera, Pavel; Armstrong, David

    2005-01-01

    Fluoroscopic verification of nasogastric (NG) feeding tube placement is inconvenient and involves radiation exposure. We tested whether the position of an NG tube can be assessed reliably by a recently introduced magnet-tracking system. A small permanent magnet was attached at the end of an NG tube and its position was monitored using an external sensor array connected to a computer. NG tube trajectory, spontaneous movements of the magnet, and its position relative to the lower esophageal sphincter (LES) and xiphisternum were assessed in 22 healthy subjects and compared with esophageal manometry. In 12 subjects, localization of the magnet was also compared with fluoroscopy. Magnet-tracking displayed NG tube tip movement reproducibly as it moved vertically in the esophagus and then laterally into the stomach. Compared with manometry, the accuracy and sensitivity of magnet tracking for localization of the NG tube tip, above or below the diaphragm, were 100%. Compared with fluoroscopy, the accuracy of NG tube localization by magnet tracking was 100%. With the magnet in the stomach, but not in the esophagus or LES, low amplitude displacements at a frequency of 3 per minute, consistent with gastric slow wave activity, were observed. Magnet tracking allows accurate, real-time, 3-dimensional localization of an NG tube with respect to anatomic landmarks. Recorded motor patterns are indicative of the position of the NG tube. Magnet tracking may be a useful tool for bedside placement of nasogastric and enteral feeding tubes.

  3. Optimal Line and Tube Placement in Very Preterm Neonates: An Audit of Practice

    Directory of Open Access Journals (Sweden)

    Daragh Finn

    2017-11-01

    Full Text Available Background: Placement of endotracheal tubes (ETTs and umbilical catheters (UCs is essential in very preterm infant care. The aim of this study was to assess the effect of an educational initiative to optimize correct placement of ETTs and UCs in very preterm infants. Methods: A pre–post study design, evaluating optimal radiological position of ETTs and UCs in the first 72 h of life in infants <32 weeks gestational age (GA was performed. Baseline data was obtained from a preceding 34-month period. The study intervention consisted of information from the pre-intervention audit, surface anatomy images of the newborn for optimal UC positioning, and weight-based calculations to estimate insertion depths for endotracheal intubation. A prospective evaluation of radiological placement of ETTs and UCs was then conducted over a 12-month period. Results: During the study period, 211 infants had at least one of the three procedures performed. One hundred and fifty-seven infants were included in the pre-education group, and 54 in the post-education group. All three procedures were performed in 50.3% (79/157 in the pre-education group, and 55.6% (30/54 in the post-education group. There was no significant difference in accurate placement following the introduction of the educational sessions; depth of ETTs (50% vs. 47%, umbilical arterial catheter (UAC (40% vs. 43%,, and umbilical venous catheter (UVC(14% vs. 23%. Conclusion: Despite education of staff on methods for appropriate ETT, UVC and UAC insertion length, the rate of accurate initial insertion depth remained suboptimal. Newer methods of determining optimal position need to be evaluated.

  4. Noninvasive ventilation during gastrostomy tube placement in patients with severe duchenne muscular dystrophy: case reports and review of the literature.

    Science.gov (United States)

    Birnkrant, D J; Ferguson, R D; Martin, J E; Gordon, G J

    2006-02-01

    Individuals with Duchenne muscular dystrophy may benefit from gastrostomy tube feeding due to progressive dysphagia and malnutrition. However, due to their severely impaired pulmonary function, these individuals are at risk of severe complications when they are sedated or undergo anesthesia for the procedure. We previously described a technique of noninvasive positive pressure ventilation to provide respiratory support during gastrostomy tube placement in such patients, but this technique had risks and limitations. In this case report, we examine two alternative techniques we used to provide respiratory support successfully to patients with severe muscular dystrophy and malnutrition who underwent percutaneous endoscopic gastrostomy tube placement. We then review the literature and discuss the potential benefits, risks, and limitations of the above techniques and of other options for gastrostomy placement in people with severe muscular dystrophy. (c) 2005 Wiley-Liss, Inc.

  5. CT-guided lung biopsies: pleural blood patching reduces the rate of chest tube placement for postbiopsy pneumothorax.

    Science.gov (United States)

    Wagner, Jason M; Hinshaw, J Louis; Lubner, Meghan G; Robbins, Jessica B; Kim, David H; Pickhardt, Perry J; Lee, Fred T

    2011-10-01

    The objective of our study was to determine whether pleural blood patching reduces the need for chest tube placement and hospital admission for pneumothorax complicating CT-guided percutaneous lung biopsy. We reviewed 463 CT-guided lung biopsies performed between August 2006 and March 2010 to determine whether intervention for pneumothorax was required and patient outcome. Intervention was categorized as simple aspiration, aspiration and intrapleural blood patching, or chest tube placement and hospital admission. The technique for pleural blood patching consisted of complete pneumothorax aspiration, immediate placement of up to 15 mL of peripheral autologous blood into the pleural space, and positioning the patient in the ipsilateral decubitus position for 1 hour after the procedure. Intervention for pneumothorax was necessary in 45 of 463 patients (9.7%) and 19 of 463 patients (4.1%) required chest tube placement. Pleural blood patching as a method to treat a postbiopsy pneumothorax and avoid further intervention was associated with a significantly higher success rate than simple aspiration: 19 of 22 (86.4%) vs seven of 15 (46.7%) (odds ratio = 7.2, p = 0.03), respectively. Aspiration with intrapleural blood patching is superior to simple aspiration to treat pneumothorax associated with CT-guided lung biopsy. Pleural blood patching reduces the need for chest tube placement and hospital admission in this patient population.

  6. Neonatal cardiac tamponade and pleural effusion resolved with chest tube placement.

    Science.gov (United States)

    Alabsi, Samir

    2010-01-01

    Pericardial effusion and cardiac tamponade secondary to umbilical venous catheterization are rare complications but potentially fatal. This article reports a case of cardiac tamponade and right pleural effusion secondary to transudation of hyperosmolar fluid from an appropriately placed umbilical venous catheter. The infant survived as a result of early diagnosis by echocardiography and urgent chest tube placement that drained both pleural and pericardial effusions. Cardiac tamponade should be highly suspected in any neonate with a central venous catheter who develops sudden, unexplained clinical deterioration in cardiopulmonary status even when the line is properly placed, and urgent echocardiography or pericardiocentesis should be considered early in management of such patients. Umbilical venous catheterization should be considered only for a select group of sick neonates due to risks involved with these lines. When an umbilical venous catheter is placed, special precautions should be taken and maintenance guidelines followed.

  7. Prevalence of pressure equalization tube placement and hearing loss in children with down syndrome.

    Science.gov (United States)

    Bernardi, Gisele F; Pires, Carolina T F; Oliveira, Nanci P; Nisihara, Renato

    2017-07-01

    To determine the prevalence of pressure equalization tube (PET) placement and hearing loss in children with Down syndrome (DS). We evaluated 90 DS children births between 1 and 11 years old and compared to 90 children without DS paired in sex and age. Medical records were analyzed consecutively. Were collected data about proceedings PET placement, age of the patient at each PET, adenoidectomy, tonsillectomy and results for audiometry and tympanometry. Among the 90 patients with DS, 49 (54.4%) were male, median age of 58 months (15-143 months). In this group, 75 PET were placed in 26/90 children (28.9%) mostly between 3 and 5 years old. In 10/26 (38.5%) was necessary PET replaced. When compared to the control group- 6/90 (6.7%)- children with DS presented OR = 13.7 (95% CI 4.0-47.3) times more likely to use PET. Adenoidectomy and tonsillectomy (44.4% and 42.2% respectively) were significantly more frequent in DS group. The prevalence of hearing loss was 32.1% in the right ear and 26.9% in the left ear. Type B timpanometry was found in more than half of the patients with DS. We found a 13-fold higher risk of PET in DS children, especially between the ages of 3-5 years. The high prevalence of hearing loss and PET placement in patients with DS reinforcing the importance of early and regular follow-up for hearing screening in this population, mostly in preschool-aged children. Copyright © 2017. Published by Elsevier B.V.

  8. Medical image of the week: Dobhoff tube placement with Roux-en-Y gastric bypass

    Directory of Open Access Journals (Sweden)

    Ali H

    2018-04-01

    Full Text Available No abstract available. Article truncated after 150 words. Roux-en-Y gastric bypass is one of the most commonly performed bariatric operations in the United States. It involves partitioning a small gastric pouch off the proximal stomach and attaching that pouch directly to the intestine, thereby bypassing the large remainder of the stomach (1,2. Placing a Dobhoff tube (DHT and confirming its placement can be challenging due to the change in anatomy after the procedure. Here, we have a 65-year-old woman who presented to the hospital with acute encephalopathy and acute hypoxic respiratory failure due to multifocal pneumonia requiring intubation and prolonged ICU stay. A DHT was inserted after intubation for feeding purposes. An abdominal X-ray was obtained to confirm placement of the DHT (Figure 1. Normally the DHT tip should be placed in the 2nd to 3rd portion of the duodenum and would create a C-shaped tracing on the X-ray. However, in our patient who had history of Roux-en-Y …

  9. Same-Day Evaluation and Surgery for Otitis Media and Tympanostomy Tube Placement: A Feasibility Study.

    Science.gov (United States)

    Billings, Kathleen R; Hajduk, John; Rose, Allison; De Oliveira, Gildasio S; Suresh, Suresh S; Thompson, Dana M

    2016-10-01

    To determine the feasibility of providing streamlined same-day evaluation and surgical management of children with recurrent otitis media or chronic serous otitis media who meet criteria for tympanostomy tube (TT) placement. Retrospective matched case series. Tertiary care children's hospital. A comparison group (age, sex, insurance product) was utilized to determine if the same-day process decreased facility time and surgical time for the care episode. A parent satisfaction survey was administered. Thirty children, with a median age of 16 months (range, 12-22 months), participated in the same-day surgery process for TT. Twenty-one patients (70.0%) were male, and these patients were matched to a comparison group (similar age, sex, and insurance product) having non-same-day (routine) TT placement. The same-day patients spent significantly less time in clinic for the preoperative physician visit (average, 15 minutes) when compared with the non-same-day patients (average, 51.5 minutes; P otitis media. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  10. Risks of PEG tube placement in patients with cirrhosis-associated ascites

    Directory of Open Access Journals (Sweden)

    Al-Abboodi Y

    2017-09-01

    Full Text Available Yasir Al-Abboodi,1 Ali Ridha,2 Matthew Fasullo,3 Tarek H Naguib4 1Internal Medicine Department, Saint Davis Round Rock Medical Centre, Round Rock, TX, USA, 2Internal Medicine Department, University of Arkansas for Medical Science, Little Rock, AR, USA, 3Internal Medicine Department, Umass Memorial Medical Center, Worcester, MA, USA, 4Internal Medicine Department, Texas Tech University Health and Sciences Center, Amarillo, TX, USA Abstract: This study examined the safety of placing percutaneous endoscopic gastrostomy (PEG tube in people with liver cirrhosis. The target population was further subdivided into people with ascites (case group and people without ascites (control. We compare the morbidity and the mortality difference of PEG placement in cirrhotic patients with ascites vs cirrhotic patients without ascites. We then examined multiple factors including sex, race, chronic illness including hypertension, congestive heart failure, and others and their influence on the inpatient mortality of all cirrhotic patients who had PEG placement. A total of 38,175 inpatient PEG tube placements were identified. Only 583 patients out of 38,175 had a history of cirrhosis. One hundred seven had ascites and the rest did not. Mean age of the patients was 61.14 years. Patient demography included (65.2% male and the rest were female, 359 were white (64.4%, 90 black (14.8%, 84 Hispanic (13.7%, 23 Asians (3.3%, 7 Native Americans (0.4%, and 20 others (3.5%. Complications from PEG procedure in cirrhosis with ascites vs non-ascites included bleeding of 4 (0.8% vs 2 (1.9% (P=0.35, surgical site infection 2 (0.4% vs 1 (0.9% (P=0.51, and urinary tract infection 105 (22.1% vs 34 (23.8% (P=0.34, respectively. There was no colonic injury in either group. The total inpatient mortality was 75 out of the 583. Fifty-six (11.8% were in the ascites group and 19 (17.8% in the non-ascites group (P=0.097. Factors including ascites, postsurgical bleeding, and surgical site

  11. Nasogastric tube placement with video-guided laryngoscope: A manikin simulator study.

    Science.gov (United States)

    Lee, Xiao-Lun; Yeh, Li-Chun; Jin, Yau-Dung; Chen, Chun-Chih; Lee, Ming-Ho; Huang, Ping-Wun

    2017-08-01

    This study aimed to investigate video-guided laryngoscopy for nasogastric tube placement. This was an observational comparative study performed in a hospital. The participants included volunteers from the medical staff (physicians and nurses) experienced with nasogastric intubation, and non-medical staff (medical students, pharmacists and emergent medical technicians) with knowledge of nasogastric intubation but lacking procedural experience. Medical and non-medical hospital staff performed manual, laryngoscope-assisted and video-guided laryngoscope nasogastric intubation both in the presence and in the absence of an endotracheal tube, using a manikin. Nasogastric intubation times were compared between groups and methods. Using the video-guided laryngoscope resulted in a significantly shorter intubation time compared to the other 2 methods, both with and without an endotracheal tube, for the medical and non-medical staff alike (all p guided laryngoscope without endotracheal intubation, direct laryngoscope with endotracheal intubation and video-guided laryngoscope with endotracheal intubation compared to manual intubation without endotracheal intubation (0.49, 0.63 and 0.72 vs. 5.63, respectively, p ≤ 0.008). For non-medical staff, nasogastric intubation time was significantly shorter using video-guided laryngoscope without endotracheal intubation, direct laryngoscope with endotracheal intubation and video-guided laryngoscope with endotracheal intubation compared to manual intubation without endotracheal intubation (1.67, 1.58 and 0.95 vs. 6.9, respectively, p ≤ 0.002). And mean nasogastric intubation time for video-guided laryngoscope endotracheal intubation was significantly shorter for medical staff than for non-medical staff (0.49 vs. 1.67 min, respectively, p = 0.041). Video-guided laryngoscope reduces nasogastric intubation time compared to manual and direct laryngoscope intubation, which promotes a consistent technique when performed by

  12. Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives

    Directory of Open Access Journals (Sweden)

    Robinson H

    2017-04-01

    Full Text Available Hal Robinson, Thomas Engelhardt Department of Anaesthesia, Royal Aberdeen Children’s Hospital, Aberdeen, UK Purpose: Myringotomy and tube placement is one of the most frequently performed ear, nose and throat (ENT surgeries in the pediatric population. Effective anesthetic management is vital to ensuring successful ambulatory care and ensuring child and parental satisfaction.Recent findings: This review summarizes recently published studies about the long-term effects of general anesthesia in young children, novel approaches to preoperative fasting and simplified approaches to the assessment and management of emergence delirium (ED and emergence agitation (EA. New developments in perioperative ambulatory care, including management of comorbidities and day care unit logistics, are discussed.Summary: Long-term follow-up of children exposed to general anesthesia before the age of 4 years has limited impact on academic achievement or cognitive performance and should not delay the treatment of common ENT pathology, which can impair speech and language development. A more liberal approach to fasting, employing a 6–4–0 regime allowing children fluids up until theater, may become an accepted practice in future. ED and EA should be discriminated from pain in recovery and, where the child is at risk of harm, should be treated promptly. Postoperative pain at home remains problematic in ambulatory surgery and better parental education is needed. Effective ambulatory care ultimately requires a well-coordinated team approach from effective preassessment to postoperative follow-up. Keywords: myringotomy, ventilation tubes, anesthesia, pediatrics, ambulatory, day case

  13. Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives.

    Science.gov (United States)

    Robinson, Hal; Engelhardt, Thomas

    2017-01-01

    Myringotomy and tube placement is one of the most frequently performed ear, nose and throat (ENT) surgeries in the pediatric population. Effective anesthetic management is vital to ensuring successful ambulatory care and ensuring child and parental satisfaction. This review summarizes recently published studies about the long-term effects of general anesthesia in young children, novel approaches to preoperative fasting and simplified approaches to the assessment and management of emergence delirium (ED) and emergence agitation (EA). New developments in perioperative ambulatory care, including management of comorbidities and day care unit logistics, are discussed. Long-term follow-up of children exposed to general anesthesia before the age of 4 years has limited impact on academic achievement or cognitive performance and should not delay the treatment of common ENT pathology, which can impair speech and language development. A more liberal approach to fasting, employing a 6-4-0 regime allowing children fluids up until theater, may become an accepted practice in future. ED and EA should be discriminated from pain in recovery and, where the child is at risk of harm, should be treated promptly. Postoperative pain at home remains problematic in ambulatory surgery and better parental education is needed. Effective ambulatory care ultimately requires a well-coordinated team approach from effective preassessment to postoperative follow-up.

  14. Minority race and male sex as risk factors for non-beneficial gastrostomy tube placements after stroke.

    Science.gov (United States)

    Faigle, Roland; Carrese, Joseph A; Cooper, Lisa A; Urrutia, Victor C; Gottesman, Rebecca F

    2018-01-01

    Percutaneous endoscopic gastrostomy (PEG) tubes are widely used for enteral feeding after stroke; however, PEG tubes placed in patients in whom death is imminent are considered non-beneficial. We sought to determine whether placement of non-beneficial PEG tubes differs by race and sex. In this retrospective cohort study, inpatient admissions for stroke patients who underwent palliative/withdrawal of care, were discharged to hospice, or died during the hospitalization, were identified from the Nationwide Inpatient Sample between 2007 and 2011. Logistic regression was used to evaluate the association between race and sex with PEG placement. Of 36,109 stroke admissions who underwent palliative/withdrawal of care, were discharge to hospice, or experienced in-hospital death, a PEG was placed in 2,258 (6.3%). Among PEG recipients 41.1% were of a race other than white, while only 22.0% of patients without PEG were of a minority race (prace was associated with PEG placement compared to whites (OR 1.75, 95% CI 1.57-1.96), and men had 1.27 times higher odds of PEG compared to women (95% CI 1.16-1.40). Racial differences were most pronounced among women: ethnic/racial minority women had over 2-fold higher odds of a PEG compared to their white counterparts (OR 2.09, 95% CI 1.81-2.41), while male ethnic/racial minority patients had 1.44 increased odds of a PEG when compared to white men (95% CI 1.24-1.67, p-value for interaction race and male sex are risk factors for non-beneficial PEG tube placements after stroke.

  15. Procedures for measuring and verifying gastric tube placement in newborns: an integrative review.

    Science.gov (United States)

    Dias, Flávia de Souza Barbosa; Emidio, Suellen Cristina Dias; Lopes, Maria Helena Baena de Moraes; Shimo, Antonieta Keiko Kakuda; Beck, Ana Raquel Medeiros; Carmona, Elenice Valentim

    2017-07-10

    to investigate evidence in the literature on procedures for measuring gastric tube insertion in newborns and verifying its placement, using alternative procedures to radiological examination. an integrative review of the literature carried out in the Cochrane, LILACS, CINAHL, EMBASE, MEDLINE and Scopus databases using the descriptors "Intubation, gastrointestinal" and "newborns" in original articles. seventeen publications were included and categorized as "measuring method" or "technique for verifying placement". Regarding measuring methods, the measurements of two morphological distances and the application of two formulas, one based on weight and another based on height, were found. Regarding the techniques for assessing placement, the following were found: electromagnetic tracing, diaphragm electrical activity, CO2 detection, indigo carmine solution, epigastrium auscultation, gastric secretion aspiration, color inspection, and evaluation of pH, enzymes and bilirubin. the measuring method using nose to earlobe to a point midway between the xiphoid process and the umbilicus measurement presents the best evidence. Equations based on weight and height need to be experimentally tested. The return of secretion into the tube aspiration, color assessment and secretion pH are reliable indicators to identify gastric tube placement, and are the currently indicated techniques. investigar, na literatura, evidências sobre procedimentos de mensuração da sonda gástrica em recém-nascidos e de verificação do seu posicionamento, procedimentos alternativos ao exame radiológico. revisão integrativa da literatura nas bases Biblioteca Cochrane, LILACS, CINAHL, EMBASE, MEDLINE e Scopus, utilizando os descritores "intubação gastrointestinal" e "recém-nascido" em artigos originais. dezessete publicações foram incluídas e categorizadas em "método de mensuração" ou "técnica de verificação do posicionamento". Como métodos de mensuração, foram encontrados os de tomada

  16. Effect of physician education and patient counseling on inpatient nonsurgical percutaneous feeding tube placement rate, indications, and outcome.

    Science.gov (United States)

    Swaminath, Arun; Longstreth, George F; Runnman, Eva M; Yang, Su-Jau

    2010-02-01

    The decision to place a percutaneous feeding tube (PFT) in patients who are at the end of life is multidimensional and often complicated. We assessed the effect of physician education and counseling for patients and their surrogates on inpatient nonsurgical (endoscopic and radiologic) PFT placement rates, indications, complications, and mortality. In a pre-paid group practice, a geriatrician initiated a program of physician education and patient/surrogate counseling on the ethical and nutritional aspects of long-term enteral feeding. We compared rates of nonsurgical PFT placement (excluding those for cancer therapy or gastric decompression), indications, complications, and short- and long-term mortality in adult inpatients before (2004) and after (2005) the program. In 2004 and 2005, 115 and 60 inpatients underwent PFT placement, respectively. The annual number of hospital admissions was similar, but the rate of PFT placement declined (0.80% vs. 0.44%, P 0.05. Severe infectious complications occurred in 4 (3%) versus 0 (0%) patients, P > 0.05. Mortality (2004 versus 2005) at 30 days (23 [20%] versus 11 [18%]), 1 year (62 [54%] versus 29 [48%]) and 2 years (72 [63%] versus 31 [52%]) was similar, P > 0.05. A pilot program of educating referring physicians and counseling patients and their surrogates reduced the rate of inpatient PFT placement by nearly 50%. Indications, severe complications and short- and long-term mortality remained unchanged.

  17. Image-guided placement of percutaneous de novo low-profile gastrojejunostomy tubes in the pediatric population: a study of feasibility and efficacy.

    Science.gov (United States)

    Gill, Anne E; Gallagher, Nicholas; McElhanon, Barbara O; Painter, Amy R; Gold, Benjamin D; Hawkins, C Matthew

    2018-02-08

    De novo low-profile gastrojejunostomy tubes in pediatric patients offer less external catheter bulk and decreased propensity for dislodgement as children become more mobile. While small cohort studies have evaluated de novo placement of coaxial, adjustable-length, percutaneous gastrojejunostomy (GJ) tubes in children, placement of de novo low-profile GJ tubes in pediatric patients has not been analyzed. This study evaluates technical feasibility, safety and clinical efficacy of percutaneous, retrograde placement of de novo low-profile GJ tubes in infants and children. Following institutional review board approval, all de novo low-profile GJ tube placements in patients were retrospectively reviewed between May 2014 and May 2017. Technical parameters of fluoroscopy time, tube size, T-fasteners and complications were recorded. Clinical data, including age, indication, weight gain and complications, were analyzed. Thirty-four de novo low-profile GJ tubes were placed in 34 patients (median age: 9.4 months, range: 2 months-11.8 years; median pre-procedural weight: 7.5 kg, range: 2.9-31.6 kg). Twenty-one 14-Fr and 13 16-Fr GJ tubes were placed with technical success rate of 100%. Average weight gain 3 months' post procedure was 1.1 kg (range: 0.3-4.8 kg) and average weight percentile for age increase was 9.6% (range: -48.9% to 53.5%). One major complication occurred following balloon inflation within the tract causing pain requiring urgent replacement of the GJ tube. Minor complications occurred in 11 patients (32%): accidental dislodgement (n=9), skin irritation (n=4), tube dysfunction (n=2), leakage (n=2) and tube migration into the esophagus (n=1). Percutaneous, antegrade, image-guided placement of de novo low-profile GJ tubes is technically feasible, safe and clinically efficacious in appropriately selected pediatric patients.

  18. Diagnostic accuracy of ultrasonography for detecting nasogastric tube (NGT) placement in adults: A systematic review and meta analysis.

    Science.gov (United States)

    Lin, Tian; Gifford, Wendy; Lan, Yutao; Qin, Xiuqun; Liu, Xuelian; Wang, Juan; Yang, Biping; You, Tianhui; Chen, Ken

    2017-06-01

    To review the evidence on diagnostic accuracy of ultrasonography for detecting correct nasogastric tube (NGT) placement in adults compared to X-ray as the reference standard. This is a systematic review and meta-analysis of observational studies, searched in the literature between 1961 and 2015. We included studies which compared the diagnostic accuracy of ultrasonography detection for NGT placement with X-ray in adult patients who were undergoing NGT placement for any reason in any care setting. We searched published studies in the following electronic databases: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, Web of Science, WanFang Data, China Journal Net, and the Chinese Biomedical Literature Database. Both English and non-English-language articles were retrieved. Risk of bias was assessed using a standard procedure according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria. We included five studies involving a total of 420 adult patients undergoing nasogastric tube placement: three trials were undertaken in mechanically ventilated patients in prehospital settings and two involved participants with comma or severe trauma in emergency room or intensive care unit (ICU). Pooled results showed that ultrasonography had a sensitivity of 0.93 (95% CI 0.87 to 0.97), and specificity of 0.97 (95% CI 0. 23 to 1.00), suggesting that diagnostic performance of ultrasound is useful to confirm correct NGT placement, but not optimal to detect incorrect NGT position. This was confirmed through a summary receiver operator characteristics (SROC) curve that showed the area under the curve was 0.96 (95% CI 0.94 to 0.98). The main limitation of the review is the relatively moderate level of heterogeneity of included studies which may partially undermine the reliability and reproducibility of results. The insufficient studies included did not allow identification of possible sources of heterogeneity and exploration of reporting bias

  19. Routine gastrostomy tube placement in gastric bypass patients: impact on length of stay and 30-day readmission rate.

    Science.gov (United States)

    Moon, Rena; Teixeira, Andre; Potenza, Kelly; Jawad, Muhammad A

    2013-02-01

    Laparoscopic Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbid obesity. Current average length of hospital stay (LOS) after RYGB is 2-3 days and 30-day readmission rate is 8-13 %. The aim of our study is to evaluate the effect of routine gastrostomy tube placement in perioperative outcomes of RYGB patients. Between January 2008 and December 2010, a total of 840 patients underwent RYGB at our institution. All RYGB patients had gastrostomy tube placed, which was kept for 6 weeks. A retrospective review of a prospectively collected database was performed for all RYGB patients, noting the outcomes and complications of the procedure. Average LOS in our patient population was 1.1 days (range, 1-14 days), and 824 (98.3 %) patients were discharged on postoperative day 1. Readmissions within 30 days after the index RYGB was observed in 31 (3.7 %) patients. Reasons included abdominal pain (n = 14), nausea/vomiting (n = 6), gastrostomy tube-related complications (n = 5), chest pain (n = 3), allergic reaction (n = 1), urinary tract infection (n = 1), and dehydration (n = 1). Of these readmitted patients, nine (1.1 %) patients required reoperations due to small bowel obstruction (n = 5), perforated anastomotic ulcer (n = 1), anastomotic leak (n = 1), subphrenic abscess (n = 1), and appendicitis (n = 1). Routine gastrostomy tube placement in the gastric remnant at the time of RYGB seems to have contributed to our short LOS and low 30-day readmission rate.

  20. Correlates associated with the desire for PEG tube placement at the end of life among community-dwelling older Mexican Americans: a pilot study.

    Science.gov (United States)

    Finley, M Rosina; Macias, R Lillianne; Becho, Johanna; Wood, Robert C; Hernandez, Arthur E; Espino, David V

    2013-04-01

    Use of percutaneous endoscopic gastrostomy (PEG) tubes in older adults remains controversial. This cross-sectional study examines community-dwelling Mexican American older adults' attitudes toward PEG tube placement in the hypothetical event of a terminal illness. Interviews were conducted with 100 community-dwelling Mexican American (MA's) adults, age 60 and over, in San Antonio, Texas. Subjects were screened for cognitive competence using Folstein's mini-mental examination. This was followed by an evaluation of socioeconomic status, depressive symptoms, religiosity, health status and attitudes toward end-of-life care, including PEG tube feeding. Higher income MA's, professionals, those without a living will, those who saw religious belief as not important and those who attended church less than once a month were more likely to agree with PEG placement (all P desire for insertion of a PEG tube at the end of life. This is the first community-based study to describe older Mexican American's attitudes toward PEG tube placement at the end of life. Older community-dwelling Mexican Americans with higher incomes, lack of a living will or low religious involvement might be more likely to choose PEG tube placement even in the context of a terminal condition.

  1. Abdominal Plain Film Before Gastrostomy Tube Placement to Predict Success of Percutaneous Endoscopic Procedure

    NARCIS (Netherlands)

    Pruijsen, J. M.; de Bruin, A.; Sekema, G.; Koetse, H. A.; van Rheenen, P. F.

    Objectives: Percutaneous endoscopic gastrostomy (PEG) tube feeding is a convenient method for children requiring long-term enteral nutrition. Preoperative fitness of the majority of pediatric PEG candidates is graded as American Society of Anesthesiologists physical status >= III, indicating

  2. The Effect of Needle Gauge on the Risk of Pneumothorax and Chest Tube Placement After Percutaneous Computed Tomographic (CT)-Guided Lung Biopsy.

    Science.gov (United States)

    Kuban, Joshua D; Tam, Alda L; Huang, Steven Y; Ensor, Joe E; Philip, Asher S; Chen, Geraldine J; Ahrar, Judy; Murthy, Ravi; Avritscher, Rony; Madoff, David C; Mahvash, Armeen; Ahrar, Kamran; Wallace, Michael J; Nachiappan, Arun C; Gupta, Sanjay

    2015-12-01

    The aim of this study was to evaluate the effect of coaxial guide needle gauge (18 vs. 19 gauge) on the risk of pneumothorax and chest tube placement after CT-guided lung biopsy. Imaging records of all patients who had undergone CT-guided lung biopsies at our institution from March 1, 2006 to December 9, 2010 were retrospectively reviewed. Univariate and multivariate logistic regression analyses were performed to assess the effect of various patient-, lesion-, and procedure-related variables on subsequent pneumothorax and chest tube placement rates. The study included 4262 biopsies (2304 with 18-gauge and 1958 with 19-gauge coaxial guide needles) in 3917 patients. The rates of pneumothorax and chest tube placement were 30.2 and 15%, respectively. Pneumothorax occurred in 35% of procedures performed with 18-gauge needles and in 24.5% of procedures performed with 19-gauge needles (p gauge needles and in 13.1% of procedures performed with 19-gauge needles (p = 0.0011). Multivariate logistic regression models demonstrated that the use of an 18-gauge needle was associated with a higher rate of pneumothorax (p gauge coaxial guide needle significantly decreases the risk of pneumothorax and chest tube placement compared with an 18-guage needle.

  3. A cost utility analysis of the clinical algorithm for nasogastric tube placement confirmation in adult hospital patients.

    Science.gov (United States)

    McFarland, Agi

    2017-01-01

    The aim of this study was to evaluate the effectiveness of pH paper testing of aspirate and chest x-ray for determining nasogastric tube (NGT) placement in terms of cost and patient outcome. Nasogastric tubes are frequently used in clinical practice, however during insertion the practitioner is blinded as to the precise final location. Despite robust checking procedures, recognized patient morbidity and mortality associated with this procedure have resulted in national safety alerts prompting the revision of all NGT care clinical guidelines. Cost utility analysis using economic modelling. A decision tree was built and populated with effectiveness data gathered from a systematic search of the extant literature. Specificity, pooled sensitivity and event probabilities were calculated using statistical software. Patient outcome was measured in terms of quality of life. Health state utilities were gathered from a sample (n = 23) of adult surgical patients using a recognized instrument. Cost data were gathered using published sources. The study adopted a third party payer perspective in a Scottish context and was completed in June 2013. The results confirm that the current UK algorithm advocated by the National Patient Safety Agency appears to offer the most cost effective approach to NGT confirmation in terms of cost and patient outcome. Sensitivity analyses indicate that these findings may be significantly altered by tube aspiration success and the rates of chest x-ray interpretation errors. The results confirm current UK recommendations and have wider policy implications for those areas, whereby chest x-ray is recommended as the first and only acceptable confirmation approach. © 2016 John Wiley & Sons Ltd.

  4. Real-time image-guided nasogastric feeding tube placement: A case series using Kangaroo with IRIS Technology in an ICU.

    Science.gov (United States)

    Mizzi, Anna; Cozzi, Silvano; Beretta, Luigi; Greco, Massimiliano; Braga, Marco

    2017-05-01

    Pulmonary misplacement during the blind insertion of enteral feeding tubes is frequent, particularly in ventilated and neurologically impaired patients. This is probably the first clinical study using the Kangaroo Feeding Tube with IRIS technology (IRIS) which incorporates a camera designed to provide anatomic landmark visualization during insertion. The study aim was to evaluate IRIS performance during bedside gastric placement. This is the first prospective study to collect data on the use of IRIS. Twenty consecutive unconscious patients requiring enteral nutrition were recruited at a single center. IRIS placement was considered complete when a clear image of the gastric mucosa appeared. Correct placement was confirmed using a contrast-enhanced abdominal X-ray. To evaluate the device performance over time, the camera was activated every other day up to 17 d postplacement. In 7 (35%) patients, the trachea was initially visualized, requiring a second placement attempt with the same tube. The IRIS camera allowed recognition of the gastric mucosa in 18 (90%) patients. The esophagogastric junction was identified in one patient, while in a second patient the quality of visualization was poor. Contrast-enhanced X-ray confirmed the gastric placement of IRIS in all patients. IRIS allowed identification of gastric mucosa in 14 (70%) patients 3 d after placement. Performance progressively declined with time (P = 0.006, chi-square for trend). IRIS placement could have spared X-ray confirmation in almost all patients and prevented misplacement into the airway in about one third. Visualization quality needs to be improved, particularly after the first week. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Pre-hospital pleural decompression and chest tube placement after blunt trauma: A systematic review.

    Science.gov (United States)

    Waydhas, Christian; Sauerland, Stefan

    2007-01-01

    Pre-hospital insertion of chest tubes or decompression of air within the pleural space is one of the controversial topics in emergency medical care of trauma patients. While a wide variety of opinions exist medical personnel on the scene require guidance in situations when tension pneumothorax or progressive pneumothorax is suspected. To ensure evidence based decisions we performed a systematic review of the current literature with respect to the diagnostic accuracy in the pre-hospital setting to identify patients with (tension) pneumothorax, the efficacy and safety of performing pleural decompression in the field and the choice of method and technique for the procedure. The evidence found is presented and discussed and recommendations are drawn from the authors' perspective.

  6. Fluoroscopy-guided placement of nasoenteral tubes in children using intermittent digital pulse fluoroscopy and last image save/grab technique.

    Science.gov (United States)

    Rao, A G; Simmons, C E; Collins, H; Tipnis, S V; Hill, J G; Ritenour, E R

    2016-09-01

    To document the radiation exposure metrics, including fluoroscopic radiation time and radiation dose-area product, in children fluoroscopy time, and radiation dose-area product were collected retrospectively in all paediatric patients who underwent fluoroscopically guided nasoenteral tube placement during a 5-year period. Three paediatric radiology faculty members, a radiologist assistant, and trainee residents during their paediatric radiology rotation performed the procedures on two different digital fluoroscopic machines using radiation-minimising techniques. Median values of the fluoroscopy time and radiation dose-area product were calculated and compared to values reported in the literature using the Wilcoxon procedure. There were 41 male and 33 female patients with a median age of 4 years and 6 months. Median fluoroscopy time used for placing a nasoenteral tube was 1.25 minutes with a median radiation exposure dose-area product of 0.245 Gy·cm(2). All patients had successful placement of nasoenteral tube without immediate procedure-related complications. Fluoroscopy-guided nasoenteral feeding tube placement can be performed successfully with minimal radiation exposure without compromising procedural success. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  7. Defining the learning curve of point-of-care ultrasound for confirming endotracheal tube placement by emergency physicians.

    Science.gov (United States)

    Chenkin, Jordan; McCartney, Colin J L; Jelic, Tomislav; Romano, Michael; Heslop, Claire; Bandiera, Glen

    2015-12-01

    Unrecognized esophageal intubations are associated with significant patient morbidity and mortality. No single confirmatory device has been shown to be 100 % accurate at ruling out esophageal intubations in the emergency department. Recent studies have demonstrated that point-of-care ultrasound (POCUS) may be a useful adjunct for confirming endotracheal tube placement; however, the amount of practice required to become proficient at this technique is unclear. The purpose of this study is to determine the amount of practice required by emergency physicians to become proficient at interpreting ultrasound video clips of esophageal and endotracheal intubations. Emergency physicians and emergency medicine residents completed a baseline interpretation test followed by a 10 min online tutorial. They then interpreted POCUS clips of esophageal and endotracheal intubations in a randomly selected order. If an incorrect response was provided, the participant completed another practice session with feedback. This process continued until they correctly interpreted ten consecutive ultrasound clips. Descriptive statistics were used to summarize the data. Of the 87 eligible physicians, 66 (75.9 %) completed the study. The mean score on the baseline test was 42.9 % (SD 32.7 %). After the tutorial, 90.9 % (60/66) of the participants achieved proficiency after one practice attempt and 100 % achieved proficiency after two practice attempts. Six intubation ultrasound clips were misinterpreted, for a total error rate of 0.9 % (6/684). Overall, the participants had a sensitivity of 98.3 % (95 % CI 96.3-99.4 %) and specificity of 100 % (95 % CI 98.9-100 %) for detecting correct tube location. Scans were interpreted within an average of 4 s (SD 2.9 s) of the intubation. After a brief online tutorial and only two practice attempts, emergency physicians were able to quickly and accurately interpret ultrasound intubation clips of esophageal and endotracheal intubations.

  8. A model for training and evaluation of myringotomy and tube placement skills.

    Science.gov (United States)

    Malekzadeh, Sonya; Hanna, Glenn; Wilson, Brette; Pehlivanova, Marieta; Milmoe, Gregory

    2011-07-01

    Simulation is emerging as a mandatory component of surgical training and a means of demonstrating surgical competency. We designed a cost-effective, low-fidelity model to further acquisition of technical skills related to myringotomy and ventilation tube insertion (M&T). The purpose of the study was to examine the skills trainer as a method of assessment to evaluate competency, timeliness, and procedure confidence in junior residents. Prospective, randomized. A simplistic M&T skills box was developed. General surgery interns (n = 20) with no prior procedure training were randomized to receive either didactic instruction or skills training using the model. One hour of lecture or technical skills training was provided to each group. A blinded examiner evaluated the subjects in both groups before and after training. Performance was measured using a global rating scale, task-specific checklist, and time-to-completion. Pre- and postsession questionnaires assessed procedure confidence. Analysis revealed a trend toward improvement in global rating scores between groups. There was a statistically significant difference in time improvement between groups (P = .0211). The skills lab group felt they could perform the procedure faster and with improved abilities, as compared to the didactic group (P = .0069 and 0.0007, respectively). Junior surgical residents performed an M&T procedure using a novel, low-cost model. This study demonstrated the skills lab's positive effect on training as measured by global rating scale, time-to-completion, and overall resident confidence. We anticipate its application to be valuable not only in training residents but also in assessing competency. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

  9. Combination of intravenous dexmedetomidine with topicalization of airway for placement of double lumen tube in a spontaneously breathing patient of giant lung bullae

    Directory of Open Access Journals (Sweden)

    Vikas Karne

    2016-10-01

    Here we present a patient with giant lung bulla in left lower lobe with severely reduced pulmonary reserves and significant air-trapping posted for VAT assisted bullectomy. Anaesthesia challenges including pathological changes, its effects during induction of anaesthesia, and issues related to placement of double lumen tube in a spontaneously breathing patient are discussed with possible advantages of dexmedetomidine in this special group of patients.

  10. Endoscopy versus fluoroscopy for the placement of postpyloric nasoenteric tubes in critically ill patients: A meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Zhu, Youfeng; Yin, Haiyan; Zhang, Rui; Ye, Xiaoling; Wei, Jianrui

    2016-06-01

    Early postpyloric nasoenteric nutrition is considered an accepted method of nutritional support in critically ill patients. Both endoscopy and fluoroscopy placement of postpyloric nasoenteric tubes (PNTs) have the highest percentages of placement success rate. We aimed to evaluate the differences in efficacy and safety between endoscopy and fluoroscopy methods for the placement of PNTs in critically ill patients. We searched MEDLINE, Embase, and electronic databases of Cochrane Central Register of Controlled Trials. We included randomized controlled trials comparing endoscopy and fluoroscopy placement of PNTs in critically ill patients. Two reviewers assessed the quality of each study and collected data independently. We performed the meta-analysis with Cochrane Collaboration RevMan 5.3. Three randomized controlled trials involving 243 patients were included. There were no significant differences in the placement success rate (RR, 0.99; 95% CI, 0.93, 1.06; z = 0.20, P = .84,) or procedure time (standardized mean difference, -0.08; 95% CI, -6.93, 6.77; z = 0.02, P = .98) between the 2 groups. No severe complications (digestive tract hemorrhage, perforation, respiratory problems, hemodynamic instability, or death) were noted in the three studies. There was a slight difference in the incidence of minor complications (RR, 8.12; 95% CI, 1.07, 61.53; z = 2.03, P = .04) between the 2 groups. Endoscopy and fluoroscopy placement of PNTs can be accurately and safely performed in critically ill patients. Endoscopy may be at least equally as safe as fluoroscopy for the placement of PNTs. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Tubeless percutaneous nephrolithotomy with non-absorbable hemostatic sealant (Quikclot®) versus nephrostomy tube placement: a propensity score-matched analysis.

    Science.gov (United States)

    Koo, Kyo Chul; Park, Sang Un; Jang, Ho Sung; Hong, Chang-Hee

    2015-11-01

    The purpose of this study was to determine the efficacy and safety of tubeless percutaneous nephrolithotomy (PNL) using a non-absorbable hemostatic sealant (Quikclot(®)) as an adjunct compared to nephrostomy tube placement in patients exhibiting significant parenchymal bleeding following PNL. We identified 113 PNL cases performed between May 2011 and October 2014. For patients with insignificant parenchymal bleeding following stone removal, defined as a clear visualization of the surgical field at full irrigation of the nephroscope, tubeless PNL was performed. For patients with significant parenchymal bleeding, we introduced the tubeless Quikclot(®) technique as of September 2013 and have performed it ever since. Formerly, nephrostomy placement PNL was performed. In this study, 40 Quikclot(®) applied PNL cases were matched with an equal number of nephrostomy placement cases by propensity scoring based on body mass index, stone size, and Guy's stone score. The mean postoperative drop in hematocrit was comparative between the Quikclot(®) group and the nephrostomy group on both postoperative days 1 (p = 0.459) and 2 (p = 0.325). Quikclot(®) application was associated with lower VAS scores throughout the postoperative period, lower cumulative analgesic requirement (p = 0.025), and with shorter hospitalization (p = 0.002). Complication rates were comparable with no need for blood transfusions in any patients. Tubeless Quikclot(®) PNL was safe and provided effective hemostasis of significant parenchymal bleeding. By avoiding nephrostomy placement, we were able to reduce postoperative pain, analgesic requirements, and hospitalization. Application of Quikclot(®) may be considered prior to nephrostomy placement in patients with significant parenchymal bleeding.

  12. Is It Time to Review Guidelines for ETT Positioning in the NICU? SCEPTIC—Survey of Challenges Encountered in Placement of Endotracheal Tubes in Canadian NICUs

    Directory of Open Access Journals (Sweden)

    Pankaj Sakhuja

    2016-01-01

    Full Text Available Objectives. To examine current opinions and practices regarding endotracheal tube placement across several Canadian Neonatal Intensive Care Units. Design. Clinical directors from Canadian Neonatal Network affiliated NICUs and Neonatal-Perinatal Programs across Canada were invited via email to participate in and disseminate the online survey to staff neonatologists, neonatal fellows, respiratory therapists, and nurse practitioners. Result. There is wide variability in the beliefs and practices related to ETT placement. The majority use “weight +6” formula and “aim to black line” on ETT at vocal cords to estimate the depth of an oral ETT and reported estimation as challenging in ELBW infants. The majority agreed that mid-trachea is an ideal ETT tip position; however their preferred position on chest X-ray varied. Many believe that ETT positioning could be improved with more precise ETT markings. Conclusion. Further research should focus on developing more effective guidelines for ETT tip placement in the ELBW infants.

  13. Efetividade da sondagem pós-pilórica usando guia magnético Effectiveness of post-pyloric tube placement using magnetic guidance

    Directory of Open Access Journals (Sweden)

    Renata Andrea Pietro Pereira Viana

    2011-03-01

    enteral nutrition by means of tubes placed in the post-pyloric position has been suggested to improve the nutrition tolerance. The aim of this study was to compare the rate of successful post-pyloric placement using a real-time electromagnetic positioning device to the success rate using the conventional placement method. METHODS: This was a prospective, randomized and controlled study, conducted in a tertiary hospital over a period of three months. The patients were randomized to one of two groups: electromagnetically guided system group, whose patients underwent real-time monitoring of post-pyloric tube placement; or the control group, whose patients underwent tube placment using to the conventional blinded technique. The rates of successful post-pyloric placement and the procedure times were assessed and compared between the groups. RESULTS: Thirty-seven patients were enrolled, 18 in the electromagnetic group and 19 in the control group. The final tube position was evaluated using radiography. The electromagnetic guided group showed better success rates and shorter procedure times when compared to the control group. Additionally, in the electromagnetic guided group, higher pH values were found in the fluids aspirated from the probe, suggesting successful postpyloric placement. CONCLUSION: The electromagnetically guided method provided better placement accuracy than did the conventional technique.

  14. The effectiveness of ultrasonography in verifying the placement of a nasogastric tube in patients with low consciousness at an emergency center

    Science.gov (United States)

    2012-01-01

    Background This study was designed to compare the effectiveness of using auscultation, pH measurements of gastric aspirates, and ultrasonography as physical examination methods to verify nasogastric tube(NGT) placement in emergency room patients with low consciousness who require NGT insertion. Methods The study included 47 patients who were all over 18 years of age. In all patients, tube placement was verified by chest X-rays. Auscultation, pH analysis of gastric aspirates, and ultrasonography were conducted on each patient in random order. The mean patient age was 57.62 ± 17.24 years, and 28 males (59.6%) and 19 females (40.4%) were included. The NGT was inserted by an emergency room resident. For pH testing, gastric aspirates were dropped onto litmus paper, and the resulting color of the paper was compared with a reference table. Ultrasonography was performed by an emergency medicine specialist, and the chest X-ray examination was interpreted by a different emergency medicine specialist who did not conduct the ultrasonography test. The results of the auscultation, gastric aspirate pH, and ultrasonography examinations were compared with the results of the chest x-ray examination. Results The sensitivity and specificity were 100% and 33.3%, respectively, for auscultation and 86.4% and 66.7%, respectively, for ultrasonography. Kappa values were the highest for auscultation at 0.484 compared to chest x-rays, followed by 0.299 for ultrasonography and 0.444 for pH analysis of the gastric aspirate. The ultrasonography has a positive predictive value of 97.4% and a negative predictive value of 25%. Conclusions Ultrasonography is useful for confirming the results of auscultation after NGT insertion among patients with low consciousness at an emergency center. When ultrasound findings suggest that the NGT placement is not gastric, additional chest X-ray should be performed. PMID:22691418

  15. Perioperative management of gastrostomy tube placement in Duchenne muscular dystrophy adolescent and young adult patients: A role for a perioperative surgical home.

    Science.gov (United States)

    Boivin, Ariane; Antonelli, Richard; Sethna, Navil F

    2018-02-01

    In past decades, Duchenne muscular dystrophy patients have been living longer and as the disease advances, patients experience multisystemic deterioration. Older patients often require gastrostomy tube placement for nutritional support. For optimizing the perioperative care, a practice of multidisciplinary team can better anticipate, prevent, and manage possible complications and reduce the overall perioperative morbidity and mortality. The aim of this study was to review our experience with perioperative care of adolescent and young adults with Duchenne muscular dystrophy undergoing gastrostomy by various surgical approaches in order to identify challenges and improve future perioperative care coordination to reduce morbidity. We retrospectively examined cases of gastrostomy tube placement in patients of ages 15 years and older between 2005 and 2016. We reviewed preoperative evaluation, anesthetic and surgical management, and postoperative complications. Twelve patients were identified; 1 had open gastrostomy, 3 laparoscopic gastrostomies, 5 percutaneous endoscopic guided, and 3 radiologically inserted gastrostomy tubes. All patients had preoperative cardiac evaluation with 6 patients demonstrating cardiomyopathy. Nine patients had preoperative pulmonary consultations and the pulmonary function tests reported forced vital capacity of ≤36% of predicted. Eight patients were noninvasive positive pressure ventilation dependent. General anesthesia with tracheal intubation was administered in 8 patients, and intravenous sedation in 4 patients; 1 received sedation supplemented with regional anesthesia and 3 received deep sedation. One patient had a difficult intubation that resulted in trauma and prolonged tracheal intubation. Three patients developed postoperative respiratory complications. Two patients' procedures were postponed due to inadequate preoperative evaluation and 1 because of disagreement between anesthesia and procedural services as to the optimal

  16. Nutritional status and feeding-tube placement in patients with locally advanced hypopharyngeal cancer included in an induction chemotherapy-based larynx preservation program.

    Science.gov (United States)

    Bozec, Alexandre; Benezery, Karen; Chamorey, Emmanuel; Ettaiche, Marc; Vandersteen, Clair; Dassonville, Olivier; Poissonnet, Gilles; Riss, Jean-Christophe; Hannoun-Lévi, Jean-Michel; Chand, Marie-Eve; Leysalle, Axel; Saada, Esma; Sudaka, Anne; Haudebourg, Juliette; Hebert, Christophe; Falewee, Marie-Noelle; Demard, François; Santini, José; Peyrade, Frédéric

    2016-09-01

    The objective of the study is to evaluate the nutritional status and determine its impact on clinical outcomes in patients with locally advanced hypopharyngeal cancer included in an induction chemotherapy (ICT)-based larynx preservation program without prophylactic feeding-tube placement. All patients with locally advanced (T3/4, N0-3, M0) hypopharyngeal squamous cell carcinoma, technically suitable for total pharyngolaryngectomy, treated by docetaxel, cisplatin and 5-fluorouracil (TPF)-ICT for larynx preservation at our institution between 2004 and 2013, were included in this retrospective study. Patients' nutritional status was closely monitored. Enteral nutrition was used if and when a patient was unable to sustain per-oral nutrition and hydration. The impact of nutritional status on clinical outcomes was investigated in univariate and multivariate analysis. A total of 53 patients (42 men and 11 women, mean age = 58.6 ± 8.2 years) were included in this study. Six (11.3 %) patients had lost more than 10 % of their usual body weight before therapy. Compared with patients' usual weight, the mean maximum patient weight loss during therapeutic management was 8.7 ± 4.5 kg. Enteral nutrition was required in 17 patients (32 %). We found no influence of the tested nutritional status-related factors on response to ICT, toxicity of ICT, overall, cause-specific and recurrence-free survival, and on post-therapeutic swallowing outcome. Maximum weight loss was significantly associated with a higher risk of enteral tube feeding during therapy (p = 0.03) and of complications (grade ≥3, p = 0.006) during RT. Without prophylactic feeding-tube placement, approximately one-third of the patients required enteral nutrition. There was no significant impact of nutritional status on oncologic or functional outcomes.

  17. Sonographic confirmation of the correct placement of a nasoenteral tube in a woman with hyperemesis gravidarum: case report.

    Science.gov (United States)

    Swartzlander, Ty K; Carlan, S J; Locksmith, Greg; Elms, Luke

    2013-01-01

    Hyperemesis gravidarum is a serious systemic disorder of pregnant women characterized by intractable vomiting resulting in metabolic, biochemical, and hematologic changes. Enteral nutrition has been used successfully and has a lower complication rate than parenteral nutrition. Tube feeding requires location of the feeding tube tip before the infusion of nutritional substance is started. We report a case of assisted feeding tube tip location using real time sonography in a pregnant women treated for hyperemesis gravidarum. Sonographic examination may be used as an alternative to x-ray for the confirmation of feeding tube location in pregnant women and thus eliminate exposure of the fetus to ionizing radiation. Copyright © 2013 Wiley Periodicals, Inc., A Wiley Company.

  18. Protective effect of early placement of nasogastric tube with solid dilator on tissue damage and stricture formation after caustic esophageal burns in rabbits.

    Science.gov (United States)

    Defagó, Victor; Moyano, Jimena; Bernhardt, Celina; Sambuelli, Gabriela; Cuestas, Eduardo

    2015-08-01

    The ingestion of caustic substances remains an important public health issue worldwide. Children represent 80% of the ingestion injury population globally. Accidental alkaline material accounts for most caustic ingestions. There is no conclusive evidence of tissue damage and stricture protection of a nasogastric-tube with a solid dilator in the literature, therefore it was hypothesized that early intraesophageal tube placement does not cause additional histopathologic damage and prevents strictures. An exploratory study on experimental caustic esophageal burns in a rabbit model was designed. In the treated group a silicone tube was placed immediately after causing the burns, while the untreated group followed the natural course of the burn. On the twenty-secondday, an esophagectomy was performed on all animals for microscopic (Histopathologic Damage Score and Stenosis Index) and macroscopic analysis. Forty animals were randomly divided into two groups. The Histopathologic Damage Score was 3.7±1.1 in the treated group versus 3.9±1.2 in the untreated group (p=.9690). The Stenosis Index was 0.6±0.1 in treated rabbits versus 2.3±0.2 in untreated (ptube with solid dilator prevents stenosis formation and does not produce greater tissue damage. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Nasogastric tube placement into the hepaticojejunostomy anastomosis in pancreaticoduodenectomy: a simple surgical technique for prevention of bile leak.

    Science.gov (United States)

    Kaya, Bulent; Ozcabi, Yetkin; Tasdelen, Iksan; Onur, Ender; Memisoglu, Kemal

    2016-05-01

    Hepaticojejunostomy is an important part of many surgical procedures including pancreaticoduodenectomy. Biliary leakage from hepaticojejunostomy may be associated with intraabdominal abscess formation, biliary peritonitis, and even mortality. A 72-year-old female patient was admitted to our hospital with obstructive jaundice. After initial evaluation, she was diagnosed with distal common bile duct obstruction without accurate diagnosis. Before planned pancreaticoduodenectomy, biliary drainage with a T-tube was performed due to the presence of cholangitis. After the first operation, pancreaticoduodenectomy was performed. Postinflammatory changes around the hilar region made the hepaticojejunostomy risky. A bilio-digestive anastomosis was performed using a new technique. A nasogastric tube was placed into the common bile duct proximal to the anastomosis. The postoperative course of the patient was uneventful. The use of a nasogastric tube as a stent in risky hepaticojejunostomies is a simple technique that can be beneficial.

  20. Nasogastric and feeding tubes.

    Science.gov (United States)

    Gharib, Ahmed M; Stern, Eric J; Sherbin, Vandy L; Rohrmann, Charles A

    1996-05-01

    Preview The authors' experience in a radiology department suggested to them that there is a wide range of beliefs among practitioners regarding proper placement of nasogastric and feeding tubes. Improper positioning can cause serious problems, as they explain. Indications for different tube positions, complications of incorrect tube placement, and directions for proper positioning are discussed and illustrated.

  1. What Does Tympanostomy Tube Placement in Children Teach Us About the Association Between Atopic Conditions and Otitis Media?

    Science.gov (United States)

    Juhn, Young J.; Wi, Chung-Il

    2014-01-01

    Otitis media is the most common infection second only to viral upper respiratory infection in the outpatient setting. Tympanostomy tube insertion (TTI) is the most common ambulatory surgical procedure in the United States. While many risk factors for otitis media have been identified, atopic conditions have been under-recognized as risk factors for recurrent and persistent otitis media. Given that asthma and other atopic conditions are the most common chronic conditions during childhood, it is worth examining the association between atopic conditions and risk of otitis media, which can provide insight into how atopic conditions influence the risk of microbial infections. This paper focuses its discussion on otitis media, however it is important that the association between atopic conditions and risk of otitis media be interpreted in the context of the association of atopic conditions with increased risks of various microbial infections. PMID:24816652

  2. The Effect of Listening to Music During Percutaneous Nephrostomy Tube Placement on Pain, Anxiety, and Success Rate of Procedure: A Randomized Prospective Study.

    Science.gov (United States)

    Hamidi, Nurullah; Ozturk, Erdem

    2017-05-01

    To evaluate the effect of listening to music on pain, anxiety, and success of procedure during office-based percutaneous nephrostomy tube placement (PNTP). One hundred consecutive patients (age >18 years) with hydronephrosis were prospectively enrolled in this study. All patients were prospectively randomized to undergo office-based PNTP with (Group I, n = 50) or without music (Group II, n = 50). Anxiety levels were evaluated with State Trait Anxiety Inventory. A visual analog scale was used to evaluate pain levels, patient's satisfaction, and willingness to undergo the procedure. We also compared success rates of procedures. The mean age, duration of procedure, and gender distribution were statistically similar between the two groups. The mean postprocedural heart rates and systolic blood pressures in Group I patients were significantly lower than Group II patients (p = 0.01 and p = 0.028, respectively), whereas preprocedural pulse rate and systolic blood pressure were similar. The mean anxiety level and mean pain score of Group I were significantly lower than those of Group II (p = 0.008 and p music during office-based PNTP decreases anxiety or pain and increases success rate of procedure. As an alternative to sedation or general anesthesia, music is easily accessible without side effect and cost.

  3. Selecting pH cut-offs for the safe verification of nasogastric feeding tube placement: a decision analytical modelling approach.

    Science.gov (United States)

    Ni, Melody Zhifang; Huddy, Jeremy R; Priest, Oliver H; Olsen, Sisse; Phillips, Lawrence D; Bossuyt, Patrick M M; Hanna, George B

    2017-11-04

    The existing British National Patient Safety Agency (NPSA) safety guideline recommends testing the pH of nasogastric (NG) tube aspirates. Feeding is considered safe if a pH of 5.5 or lower has been observed; otherwise chest X-rays are recommended. Our previous research found that at 5.5, the pH test lacks sensitivity towards oesophageal placements, a major risk identified by feeding experts. The aim of this research is to use a decision analytic modelling approach to systematically assess the safety of the pH test under cut-offs 1-9. We mapped out the care pathway according to the existing safety guideline where the pH test is used as a first-line test, followed by chest x-rays. Decision outcomes were scored on a 0-100 scale in terms of safety. Sensitivities and specificities of the pH test at each cut-off were extracted from our previous research. Aggregating outcome scores and probabilities resulted in weighted scores which enabled an analysis of the relative safety of the checking procedure under various pH cut-offs. The pH test was the safest under cut-off 5 when there was ≥30% of NG tube misplacements. Under cut-off 5, respiratory feeding was excluded; oesophageal feeding was kept to a minimum to balance the need of chest X-rays for patients with a pH higher than 5. Routine chest X-rays were less safe than the pH test while to feed all without safety checks was the most risky. The safety of the current checking procedure is sensitive to the choice of pH cut-offs, the impact of feeding delays, the accuracy of the pH in the oesophagus, as well as the extent of tube misplacements. The pH test with 5 as the cut-off was the safest overall. It is important to understand the local clinical environment so that appropriate choice of pH cut-offs can be made to maximise safety and to minimise the use of chest X-rays. ISRCTN11170249; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No

  4. A comparison of the McGrath® Series 5 videolaryngoscope and Macintosh laryngoscope for double-lumen tracheal tube placement in patients with a good glottic view at direct laryngoscopy.

    Science.gov (United States)

    Yao, W L; Wan, L; Xu, H; Qian, W; Wang, X R; Tian, Y K; Zhang, C H

    2015-07-01

    We compared the McGrath® Series 5 videolaryngoscope with the Macintosh laryngoscope for double-lumen tracheal tube placement in patients with a predicted good glottic view on assessment of the airway. An initial laryngoscopy was performed using the Macintosh laryngoscope; 96 patients with Cormack and Lehane grade-1 or -2a views were randomly assigned to undergo intubation using either the McGrath or Macintosh device. Compared with the Macintosh laryngoscope, the McGrath videolaryngoscope provided more Cormack and Lehane grade-1 views (47 (97.9%) vs 29 (60.4%), p Cormack and Lehane grade ≥ 2b on initial laryngoscopy using the Macintosh, the glottic view was improved on intubation with the McGrath videolaryngoscope, with a total success rate of double-lumen tube placement of 94.4% and mean (SD) intubation time of 50.0 (18.6) s. We recommend that in patients with a low airway risk index score requiring intubation with a double-lumen tracheal tube, the Macintosh laryngoscope is used as the first device and the McGrath videolaryngoscope is used only if this provides a poor glottic view. © 2015 The Association of Anaesthetists of Great Britain and Ireland.

  5. Efficacy of a Self-expanding Tract Sealant Device in the Reduction of Pneumothorax and Chest Tube Placement Rates After Percutaneous Lung Biopsy: A Matched Controlled Study Using Propensity Score Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Ahrar, Judy U., E-mail: judy.ahrar@mdanderson.org; Gupta, Sanjay [The University of Texas M.D. Anderson Cancer Center, Department of Interventional Radiology (United States); Ensor, Joe E. [Houston Methodist Research Institute, The Houston Methodist Cancer Center (United States); Mahvash, Armeen; Sabir, Sharjeel H.; Steele, Joseph R.; McRae, Stephen E.; Avritscher, Rony; Huang, Steven Y.; Odisio, Bruno C.; Murthy, Ravi; Ahrar, Kamran; Wallace, Michael J.; Tam, Alda L. [The University of Texas M.D. Anderson Cancer Center, Department of Interventional Radiology (United States)

    2017-02-15

    PurposeTo evaluate the use of a self-expanding tract sealant device (BioSentry™) on the rates of pneumothorax and chest tube insertion after percutaneous lung biopsy.Materials and MethodsIn this retrospective study, we compared 318 patients who received BioSentry™ during percutaneous lung biopsy (treated group) with 1956 patients who did not (control group). Patient-, lesion-, and procedure-specific variables, and pneumothorax and chest tube insertion rates were recorded. To adjust for potential selection bias, patients in the treated group were matched 1:1 to patients in the control group using propensity score matching based on the above-mentioned variables. Patients were considered a match if the absolute difference in their propensity scores was ≤equal to 0.02.ResultsBefore matching, the pneumothorax and chest tube rates were 24.5 and 13.1% in the control group, and 21.1 and 8.5% in the treated group, respectively. Using propensity scores, a match was found for 317 patients in the treatment group. Chi-square contingency matched pair analysis showed the treated group had significantly lower pneumothorax (20.8 vs. 32.8%; p = 0.001) and chest tube (8.2 vs. 20.8%; p < 0.0001) rates compared to the control group. Sub-analysis including only faculty who had >30 cases of both treatment and control cases demonstrated similar findings: the treated group had significantly lower pneumothorax (17.6 vs. 30.2%; p = 0.002) and chest tube (7.2 vs. 18%; p = 0.001) rates.ConclusionsThe self-expanding tract sealant device significantly reduced the pneumothorax rate, and more importantly, the chest tube placement rate after percutaneous lung biopsy.

  6. Electromagnetic guided bedside or endoscopic placement of nasoenteral feeding tubes in surgical patients (CORE trial) : Study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Gerritsen, Arja; de Rooij, Thijs; Dijkgraaf, Marcel G.; Busch, Olivier R.; Bergman, Jacques J.; Ubbink, Dirk T.; van Duijvendijk, Peter; Erkelens, G. Willemien; Molenaar, IQ; Monkelbaan, JF; Rosman, Camiel; Tan, Adriaan C.; Kruyt, Philip M.; Bac, Dirk Jan; Mathus-Vliegen, Elisabeth M.; Besselink, Marc G.

    2015-01-01

    Background: Gastroparesis is common in surgical patients and frequently leads to the need for enteral tube feeding. Nasoenteral feeding tubes are usually placed endoscopically by gastroenterologists, but this procedure is relatively cumbersome for patients and labor-intensive for hospital staff.

  7. Percutaneous endoscopic cecostomy (introducer method) in chronic intestinal pseudo-obstruction: Report of two cases and literature review.

    Science.gov (United States)

    Küllmer, Armin; Schmidt, Arthur; Caca, Karel

    2016-03-01

    We report on two patients with recurrent episodes of chronic intestinal pseudo-obstruction (CIPO). A 50-year-old woman with severe multiple sclerosis and an 84-year-old man with Parkinson's disease and dementia had multiple hospital admissions because of pain and distended abdomen. Radiographic and endoscopic findings showed massive dilation of the colon without any evidence of obstruction. Conservative management resolved symptoms only for a short period of time. As these patients were poor candidates for any surgical treatment we carried out percutaneous endoscopic colostomy by placing a 20-Fr tube in the cecum with the introducer method. The procedure led to durable symptom relief without complications. We present these two cases and give a review through the existing literature of the procedure in CIPO. © 2015 Japan Gastroenterological Endoscopy Society.

  8. Comparing insertion characteristics on nasogastric tube placement by using GlideScope™ visualization vs. MacIntosh laryngoscope assistance in anaesthetized and intubated patients.

    Science.gov (United States)

    Wan Ibadullah, Wan Hafsah; Yahya, Nurlia; Ghazali, Siti Salmah; Kamaruzaman, Esa; Yong, Liu Chian; Dan, Adnan; Md Zain, Jaafar

    2016-01-01

    This was a prospective, randomized clinical study to compare the success rate of nasogastric tube insertion by using GlideScope™ visualization versus direct MacIntosh laryngoscope assistance in anesthetized and intubated patients. Ninety-six ASA I or II patients, aged 18-70 years were recruited and randomized into two groups using either technique. The time taken from insertion of the nasogastric tube from the nostril until the calculated length of tube had been inserted was recorded. The success rate of nasogastric tube insertion was evaluated in terms of successful insertion in the first attempt. Complications associated with the insertion techniques were recorded. The results showed success rates of 74.5% in the GlideScope™ Group as compared to 58.3% in the MacIntosh Group (p=0.10). For the failed attempts, the nasogastric tube was successfully inserted in all cases using rescue techniques. The duration taken in the first attempt for both techniques was not statistically significant; Group A was 17.2±9.3s as compared to Group B, with a duration of 18.9±13.0s (p=0.57). A total of 33 patients developed complications during insertion of the nasogastric tube, 39.4% in Group A and 60.6% in Group B (p=0.15). The most common complications, which occurred, were coiling, followed by bleeding and kinking. This study showed that using the GlideScope™ to facilitate nasogastric tube insertion was comparable to the use of the MacIntosh laryngoscope in terms of successful rate of insertion and complications. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  9. [Comparing insertion characteristics on nasogastric tube placement by using GlideScope™ visualization vs. MacIntosh laryngoscope assistance in anaesthetized and intubated patients].

    Science.gov (United States)

    Wan Ibadullah, Wan Hafsah; Yahya, Nurlia; Ghazali, Siti Salmah; Kamaruzaman, Esa; Yong, Liu Chian; Dan, Adnan; Md Zain, Jaafar

    2016-01-01

    This was a prospective, randomized clinical study to compare the success rate of nasogastric tube insertion by using GlideScope™ visualization versus direct MacIntosh laryngoscope assistance in anesthetized and intubated patients. Ninety-six ASA I or II patients, aged 18-70 years were recruited and randomized into two groups using either technique. The time taken from insertion of the nasogastric tube from the nostril until the calculated length of tube had been inserted was recorded. The success rate of nasogastric tube insertion was evaluated in terms of successful insertion in the first attempt. Complications associated with the insertion techniques were recorded. The results showed success rates of 74.5% in the GlideScope™ Group as compared to 58.3% in the MacIntosh Group (p=0.10). For the failed attempts, the nasogastric tube was successfully inserted in all cases using rescue techniques. The duration taken in the first attempt for both techniques was not statistically significant; Group A was 17.2±9.3s as compared to Group B, with a duration of 18.9±13.0s (p=0.57). A total of 33 patients developed complications during insertion of the nasogastric tube, 39.4% in Group A and 60.6% in Group B (p=0.15). The most common complications, which occurred, were coiling, followed by bleeding and kinking. This study showed that using the GlideScope™ to facilitate nasogastric tube insertion was comparable to the use of the MacIntosh laryngoscope in terms of successful rate of insertion and complications. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  10. Selecting pH cut-offs for the safe verification of nasogastric feeding tube placement: a decision analytical modelling approach

    NARCIS (Netherlands)

    Ni, Melody Zhifang; Huddy, Jeremy R.; Priest, Oliver H.; Olsen, Sisse; Phillips, Lawrence D.; Bossuyt, Patrick M. M.; Hanna, George B.

    2017-01-01

    Objectives The existing British National Patient Safety Agency (NPSA) safety guideline recommends testing the pH of nasogastric (NG) tube aspirates. Feeding is considered safe if a pH of 5.5 or lower has been observed; otherwise chest X-rays are recommended. Our previous research found that at 5.5,

  11. El product placement en el videoclip: análisis de contenido del emplazamiento de marca en los vídeos musicales preferidos por los usuarios de YouTube

    Directory of Open Access Journals (Sweden)

    José Patricio Pérez Rufí

    2014-05-01

    Full Text Available Esta investigación estudia el emplazamiento de productos en el videoclip musical con mayor número de reproducciones en YouTube en el plazo de un mes. Entendemos el product placement como una técnica que mezcla diversas estrategias de comunicación publicitaria a partir de su presencia en el discurso audiovisual. Nuestro objetivo principal es conocer de qué forma se utiliza esta técnica de comunicación comercial en el formato del vídeo musical. Intentamos igualmente determinar su idoneidad para la transmisión de un mensaje comercial. Para lograr estos objetivos, realizamos un análisis de contenido de los 50 vídeos musicales con mayor número de reproducciones en YouTube durante el mes de enero de 2013. Aplicamos una metodología cuantitativa y cualitativa basada en la propuesta de Méndiz que enumera y valora la presencia de marcas. El análisis concluye que se trata de una estrategia comercial extraordinariamente frecuente, aunque no todos los vídeos resultan apropiados para ello. De igual forma, determinadas marcas y productos encuentran en el videoclip una vía idónea para introducir sus novedades en el mercado. La proximidad con el lenguaje del anuncio de televisión perjudica la credibilidad del discurso.

  12. Multi-Mode Vibration Suppression in MIMO Systems by Extending the Zero Placement Input Shaping Technique: Applications to a 3-DOF Piezoelectric Tube Actuator

    Directory of Open Access Journals (Sweden)

    Yasser Al Hamidi

    2016-04-01

    Full Text Available Piezoelectric tube actuators are extensively used in scanning probe microscopes to provide dynamic scanning motions in open-loop operations. Furthermore, they are employed as micropositioners due to their high bandwidth, high resolution and ease of excitation. However, these piezoelectric micropositioners exhibit badly damped vibrations that occur when the input excites the dynamic response, which tends to degrade positioning accuracy and performance. This paper deals with vibrations’ feedforward control of a multi-degrees of freedom (DOF piezoelectric micropositioner in order to damp the vibrations in the direct axes and to reduce the cross-couplings. The novelty in this paper relative to the existing vibrations feedforward controls is the simplicity in design approach, the minimal number of shaper impulses for each input required to damp all modes of vibration at each output, and the account for the strong cross-couplings which only occur in multi-DOF cases. A generalization to a multiple degrees of freedom actuator is first proposed. Then simulation runs on a 3-DOF piezoelectric tube micropositioner have been effectuated to demonstrate the efficiency of the proposed method. Finally, experimental tests were carried out to validate and to confirm the predicted simulation.

  13. complementary roles of interventional radiology and therapeutic endoscopy in gastroenterology

    DEFF Research Database (Denmark)

    Ray, David M; Srinivasan, Indu; Tang, Shou-Jiang

    2017-01-01

    radiology have resulted in the paradigm shift in the management of these conditions. In this paper, we discuss the patient's work up, indications, and complementary roles of endoscopic and angiographic management in the settings of gastrointestinal bleeding, enteral feeding, cecostomy tube placement...

  14. STUDENT PLACEMENT

    African Journals Online (AJOL)

    User

    students express lack of interest in the field they are placed, it ... be highly motivated to learn than students placed in a department ... the following research questions. Research Questions. •. Did the criteria used by Mekelle. University for placement of students into different departments affect the academic performance of ...

  15. Private placements

    International Nuclear Information System (INIS)

    Bugeaud, G. J. R.

    1998-01-01

    The principles underlying private placements in Alberta, and the nature of the processes employed by the Alberta Securities Commission in handling such transactions were discussed. The Alberta Securities Commission's mode of operation was demonstrated by the inclusion of various documents issued by the Commission concerning (1) special warrant transactions prior to listing, (2) a decision by the Executive Director refusing to issue a receipt for the final prospectus for a distribution of securities of a company and the reasons for the refusal, (3) the Commission's decision to interfere with the Executive Director's decision not to issue a receipt for the final prospectus, with full citation of the Commission's reasons for its decision, (4) and a series of proposed rules and companion policy statements regarding trades and distributions outside and in Alberta. Text of a sample 'short form prospectus' was also included

  16. Sediment Placement Areas 2012

    Data.gov (United States)

    California Department of Resources — Dredge material placement sites (DMPS), including active, inactive, proposed and historical placement sites. Dataset covers US Army Corps of Engineers San Francisco...

  17. Endotracheal tube verification in adult mechanically ventilated patients

    African Journals Online (AJOL)

    To explore the methods that can be used to verify endotracheal tube (ETT) placement in adult mechanically ventilated patients. ... Electronic databases searched were: the Cumulative Index of Nursing and Allied Health (CINAHL), MEDLINE, PubMed, the ... 'critical care AND endotracheal tube placement'; 'full text journal.

  18. Feeding Tubes

    Science.gov (United States)

    ... the TPN. Tubes Used for Enteral Feeds NG (Nasogastric Tube) A flexible tube is placed via the nose, ... portion of the small intestine Naso – nose NG – Nasogastric Tube -ostomy – new opening Percutaneous – through the skin PEJ – ...

  19. Boat boarding ladder placement

    Science.gov (United States)

    1998-04-01

    Presented in three volumes; 'Boat Boarding Ladder Placement,' which explores safety considerations including potential for human contact with a rotating propeller; 'Boat Handhold Placement,' which explores essential principles and methods of fall con...

  20. Tension Pneumothorax and Subcutaneous Emphysema Complicating Insertion of Nasogastric Tube

    Directory of Open Access Journals (Sweden)

    Narjis AL Saif

    2015-01-01

    Full Text Available Nasogastric tube has a key role in the management of substantial number of hospitalized patients particularly the critically ill. In spite of the apparent simple insertion technique, nasogastric tube placement has its serious perhaps fatal complications which need to be carefully assessed. Pulmonary misplacement and associated complications are commonplace during nasogastric tube procedure. We present a case of tension pneumothorax and massive surgical emphysema in critically ill ventilated patient due to inadvertent nasogastric tube insertion and also discussed the risk factors, complication list, and arrays of techniques for safer tube placement.

  1. Tension Pneumothorax and Subcutaneous Emphysema Complicating Insertion of Nasogastric Tube.

    Science.gov (United States)

    Al Saif, Narjis; Hammodi, Adel; Al-Azem, M Ali; Al-Hubail, Rasheed

    2015-01-01

    Nasogastric tube has a key role in the management of substantial number of hospitalized patients particularly the critically ill. In spite of the apparent simple insertion technique, nasogastric tube placement has its serious perhaps fatal complications which need to be carefully assessed. Pulmonary misplacement and associated complications are commonplace during nasogastric tube procedure. We present a case of tension pneumothorax and massive surgical emphysema in critically ill ventilated patient due to inadvertent nasogastric tube insertion and also discussed the risk factors, complication list, and arrays of techniques for safer tube placement.

  2. A Placement Advisory Test

    Science.gov (United States)

    Hughes, Chris

    2010-01-01

    The primary method of placement at Portland CC (PCC) is the Compass Placement test. For the most part, students are placed correctly, but there are cases when students feel that they have been placed too low. In such cases we use our newly created Placement Advisory Test (PAT) to help us place them appropriately. (Contains 2 figures.)

  3. Early Experience with the StopLoss Jones Tube.

    Science.gov (United States)

    Bagdonaite, Laura; Pearson, Andrew R

    2015-06-01

    Extrusion is the most common reason for failure after Jones tube placement. The StopLoss Jones tube (SLJT) is a new innovation in Jones tubes that incorporates a flexible silicone internal flange to resist extrusion. We present our early experience of using this new tube and associated introducer system. We retrospectively analysed the case notes of a single surgeon consecutive series of patients having SLJT placement from November 2011 to November 2013. 29 SLJTs were placed in 25 eyes of 19 patients. Tube follow-up ranged from 1-25 months (mean 10 months) with a total of 291 tube-months. The indications for SLJT placement were: previous LJT complications (52%), failed canalicular-DCR surgery (31%), primary placement for inoperable canalicular occlusion (14%) and patent non-functioning DCR (3%). Tube length ranged from 10-16 mm. The tube introducer system was simple and effective and there were no intra-operative complications. The tube extrusion rate was 0%. Complications occurred in 5 tubes: 1 was too long, and 4 others (14%) developed conjunctival overgrowth/medial tube migration. Patient satisfaction with the tube was: 86% fully satisfied, 10% was moderately satisfied, 3% not satisfied. The overall final surgical success rate at last follow-up was 92%. In this short follow-up initial study the SLJT is simple to use and has a high rate of success and patient satisfaction. The addition of the internal silicone flange appears to prevent the previously common problem of extrusion.

  4. Differential outcome of fissure-positioned tube in closed thoracostomy for primary spontaneous pneumothorax.

    Science.gov (United States)

    Kim, Yong Won; Byun, Chun Sung; Cha, Yong Sung; Kim, Oh Hyun; Lee, Kang Hyun; Park, Il Hwan

    2015-05-01

    Closed tube thoracostomy is often used to evacuate a primary spontaneous pneumothorax (PSP). Occasionally, this procedure is complicated by placement of the chest tube location in the fissural area instead of pleural space. There is a paucity of studies on outcomes according to chest tube placement. As such, we investigated outcomes of chest tube placement in fissural versus pleural area in closed thoracostomy for PSP. Patients between 14 and 65 years of age who had been treated with chest tube insertion to evacuate PSP were selected based on retrospective review of medical records. Patients selected for this study received chest tube placement at either the fissural or pleural spaces. Those with pre-existing lung disease or those transferred into our hospital after closed thoracostomy were excluded. Of the 255 patients with PSP treated with chest tube insertion, 172 patients were enrolled in this study. Twenty-nine (16.9%) had fissural tube placement and 143 (83.1%) had pleural tube placement. A higher proportion of patients in the fissural versus pleural group required additional chest tube insertion (20.7% vs 4.9%, P = 0.010, respectively). There was no significant difference in body mass index, smoker status, symptom duration, number of episodes, post-thoracostomy complications, need for subsequent management, and duration of hospitalization in either group. In closed thoracostomy for PSP, there is a higher chance of tube dysfunction when the chest tube is positioned at fissural area as compared with the pleural space.

  5. Right pleural insertion of a small bore feeding tube

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2011-06-01

    Full Text Available We report a case of a 56 year old man who had a feeding tube inadvertently malpositioned into the right pleural space and had approximately 600 ml of tube feedings infused. After the malposition was recognized, the patient underwent chest tube placement, followed by video assisted thoracic surgery 5 days later. He made an uneventful recovery. The case illustrates the problems with identification and treating feeding tube insertion into the lung.

  6. Right pleural insertion of a small bore feeding tube

    OpenAIRE

    Robbins RA; Glenn T; Singarajah CU

    2011-01-01

    We report a case of a 56 year old man who had a feeding tube inadvertently malpositioned into the right pleural space and had approximately 600 ml of tube feedings infused. After the malposition was recognized, the patient underwent chest tube placement, followed by video assisted thoracic surgery 5 days later. He made an uneventful recovery. The case illustrates the problems with identification and treating feeding tube insertion into the lung.

  7. Rhinosinusitis; A Potential hazard of Nasogastric tube insertion

    African Journals Online (AJOL)

    582. 3. Bailey BJ, Pillsbury III HC, Johnson JT, Kohut RI,. Tardy, Jr.ME: Head & Neck Surgery-Otolaryngology. Philadelphia: Lippincott-Raven 1996. 4. Metheny NA, Meert KL, Clouse RE, Complications related to feeding tube placement. Curr Opin.

  8. Evaluation of surgically placed gastrojejunostomy feeding tubes in critically ill dogs.

    Science.gov (United States)

    Cavanaugh, Ryan P; Kovak, Janet R; Fischetti, Anthony J; Barton, Linda J; Bergman, Philip

    2008-02-01

    To evaluate complications and outcomes associated with surgical placement of gastrojejunostomy feeding tubes in dogs with naturally occurring disease. Prospective study. 26 dogs. Multiple preoperative, intraoperative, and postoperative variables were evaluated. Daily postoperative abdominal radiographic examinations were performed to determine the presence of the following mechanical tube complications: kinking, coiling, knotting, and migration. Tube stoma abnormalities (erythema, cellulitis, and discharge) were observed daily and recorded by use of a standardized visual analog grading scale. Additionally, presence of complications was compared with median survival times. The most common indication for gastrojejunostomy tube placement was gastrointestinal disease (n = 11), with confirmed septic peritonitis in 8 of 11 dogs. Other indications for gastrojejunostomy tube placement included extrahepatic biliary surgery (n = 6) and pancreatic disease (9). Mean +/- SD surgical time required for tube placement was 26 +/- 14 minutes. Overall, mechanical tube complication rate was 46% (12/26), including coiling (7), migration (4), and kinking (2). Overall minor tube stoma complication rate was 77% (20/26) and included erythema (16), cellulitis (13), and discharge (17). Dislodgement or self-induced tube trauma resulted in accidental tube removal in 2 of 26 dogs, and inadvertent tube damage necessitated premature removal by the clinician in 1 of 26 dogs. Kaplan-Meier median survival time was 39 days with 13 of 26 dogs still alive. Gastrojejunostomy tube placement affords flexibility in the postoperative nutritional regimen by allowing for postgastric feeding with simultaneous access to the stomach.

  9. ESL Placement and Schools

    Science.gov (United States)

    Callahan, Rebecca; Wilkinson, Lindsey; Muller, Chandra; Frisco, Michelle

    2010-01-01

    In this study, the authors explore English as a Second Language (ESL) placement as a measure of how schools label and process immigrant students. Using propensity score matching and data from the Adolescent Health and Academic Achievement Study and the National Longitudinal Study of Adolescent Health, the authors estimate the effect of ESL placement on immigrant achievement. In schools with more immigrant students, the authors find that ESL placement results in higher levels of academic performance; in schools with few immigrant students, the effect reverses. This is not to suggest a one-size-fits-all policy; many immigrant students, regardless of school composition, generational status, or ESL placement, struggle to achieve at levels sufficient for acceptance to a 4-year university. This study offers several factors to be taken into consideration as schools develop policies and practices to provide immigrant students opportunities to learn. PMID:20617111

  10. Product Placement in Cartoons

    Directory of Open Access Journals (Sweden)

    Irena Oroz Štancl

    2014-06-01

    Full Text Available Product placement is a marketing approach for integrating products or services into selected media content. Studies have shown that the impact of advertising on children and youth are large, and that it can affect their preferences and attitudes. The aim of this article is to determine the existing level of product placement in cartoons that are broadcast on Croatian television stations. Content analysis of cartoons in a period of one month gave the following results: in 30% of cartoons product placement was found; most product placement were visual ads, in 89%, however, auditory product placement and plot connection was also found. Most ads were related to toys and it is significant that even 65% of cartoons are accompanied by a large amount of products available on the Croatian market. This is the result of two sales strategies: brand licensing (selling popular cartoon characters to toys, food or clothing companies and cartoon production based on existing line of toys with the sole aim of making their sales more effective.

  11. Confirming nasogastric tube position with electromagnetic tracking versus pH or X-ray and tube radio-opacity.

    Science.gov (United States)

    Taylor, Stephen; Allan, Kaylee; McWilliam, Helen; Manara, Alex; Brown, Jules; Toher, Deirdre; Rayner, Wendy

    Recent evidence suggests official statistics greatly underestimate the occurrence of complications from misplaced nasogastric (NG) tubes, even when detected. Current methods of confirming tube position do not provide adequate protection from misplacement. In addition, some tubes are inadequately radio-opaque. We prospectively audited placement of Cortrak polyurethane tubes (PUTs) to determine: accuracy of the electromagnetic (EM) trace in confirming tube position, radio-opacity of PUTs compared with previously placed polyvinylchloride (PVC) Ryles tubes and whether 12 French PUTs can be used to aspirate gastric residual volumes (GRVs). A total of 127 PUTs were placed in 113 patients. EM traces accurately confirmed tube position compared with X-ray (100% agreement). A 'gastric' EM trace has been defined for future use by other operators. PUTs were adequately radio-opaque with good agreement between interpreters (>98%) whereas PVC Ryles tubes were insufficiently radio-opaque (57-73%), invisible in 23% of cases and with poor agreement between interpreters leaving risk of error. The alternative of using pH confirmation was not possible in 44%. In these cases subsequent X-ray incurred a 2-hour delay to feed and medicines. In addition, neither post-placement pH testing nor X-ray warn of lung placement and potential trauma, whereas the EM trace warned of lung placement prior to damage in 7% of placements. 12 French, single-port PUTs appear adequate to aspirate large GRVs. EM tracing may be considered a standalone method of confirming NG tube position. Corflo (Cortrak) PUTs are adequately radio-opaque. Use of PVC Ryles and other inadequately radio-opaque tubes should stop.

  12. Ear Tubes

    Science.gov (United States)

    ... of the ear drum or eustachian tube, Down Syndrome, cleft palate, and barotrauma (injury to the middle ear caused by a reduction of air pressure, ... specialist) may be warranted if you or your child has experienced repeated ... fluid in the middle ear, barotrauma, or have an anatomic abnormality that ...

  13. Neutron tubes

    Science.gov (United States)

    Leung, Ka-Ngo [Hercules, CA; Lou, Tak Pui [Berkeley, CA; Reijonen, Jani [Oakland, CA

    2008-03-11

    A neutron tube or generator is based on a RF driven plasma ion source having a quartz or other chamber surrounded by an external RF antenna. A deuterium or mixed deuterium/tritium (or even just a tritium) plasma is generated in the chamber and D or D/T (or T) ions are extracted from the plasma. A neutron generating target is positioned so that the ion beam is incident thereon and loads the target. Incident ions cause D-D or D-T (or T-T) reactions which generate neutrons. Various embodiments differ primarily in size of the chamber and position and shape of the neutron generating target. Some neutron generators are small enough for implantation in the body. The target may be at the end of a catheter-like drift tube. The target may have a tapered or conical surface to increase target surface area.

  14. A prospective randomized trial of transnasal ileus tube vs nasogastric tube for adhesive small bowel obstruction

    Science.gov (United States)

    Chen, Xiao-Li; Ji, Feng; Lin, Qi; Chen, Yi-Peng; Lin, Jian-Jiang; Ye, Feng; Yu, Ji-Ren; Wu, Yi-Jun

    2012-01-01

    AIM: To study the therapeutic efficacy of a new transnasal ileus tube advanced endoscopically for adhesive small bowel obstruction. METHODS: A total of 186 patients with adhesive small bowel obstruction treated from September 2007 to February 2011 were enrolled into this prospective randomized controlled study. The endoscopically advanced new ileus tube was used for gastrointestinal decompression in 96 patients and ordinary nasogastric tube (NGT) was used in 90 patients. The therapeutic efficacy was compared between the two groups. RESULTS: Compared with the NGT group, the ileus tube group experienced significantly shorter time for relief of clinical symptoms and improvement in the findings of abdominal radiograph (4.1 ± 2.3 d vs 8.5 ± 5.0 d) and laboratory tests (P tube group and 46.7% in the NGT group (P tube group and 53.3% of the NGT group underwent surgery. For recurrent adhesive bowel obstruction, ileus tube was also significantly more effective than NGT (95.8% vs 31.6%). In the ileus tube group, the drainage output on the first day and the length of hospital stay were significantly different depending on the treatment success or failure (P tube can be used for adhesive small bowel obstruction. Endoscopic placement of the ileus tube is convenient and worthy to be promoted despite the potential risks. PMID:22563179

  15. photomultiplier tubes

    CERN Multimedia

    photomultiplier tubes. A device to convert light into an electric signal (the name is often abbreviated to PM). Photomultipliers are used in all detectors based on scintillating material (i.e. based on large numbers of fibres which produce scintillation light at the passage of a charged particle). A photomultiplier consists of 3 main parts: firstly, a photocathode where photons are converted into electrons by the photoelectric effect; secondly, a multiplier chain consisting of a serie of dynodes which multiply the number of electron; finally, an anode, which collects the resulting current.

  16. photomultiplier tube

    CERN Multimedia

    photomultiplier tubes. A device to convert light into an electric signal (the name is often abbreviated to PM). Photomultipliers are used in all detectors based on scintillating material (i.e. based on large numbers of fibres which produce scintillation light at the passage of a charged particle). A photomultiplier consists of 3 main parts: firstly, a photocathode where photons are converted into electrons by the photoelectric effect; secondly, a multiplier chain consisting of a serie of dynodes which multiply the number of electron; finally, an anode, which collects the resulting current.

  17. Placement of an implantable port catheter in the biliary stent: an experimental study in dogs

    International Nuclear Information System (INIS)

    Ko, Gi Young; Lee, Im Sick; Choi, Won Chan

    2004-01-01

    To investigate the feasibility of port catheter placement following a biliary stent placement. We employed 14 mongrel dogs as test subject and after the puncture of their gaIl bladders using sonographic guidance, a 10-mm in diameter metallic stent was placed at the common duct. In 12 dogs, a 6.3 F port catheter was placed into the duodenum through the common duct and a port was secured at the subcutaneous space following stent placement. As a control group, an 8.5 F drain tube was placed into the gallbladder without port catheter placement in the remaining two dogs. Irrigation of the bile duct was performed every week by injection of saline into the port, and the port catheter was replaced three weeks later in two dogs. Information relating to the success of the procedure, complications and the five-week follow-up cholangiographic findings were obtained. Placement of a biliary stent and a port catheter was technically successful in 13 (93%) dogs, while stent migration (n=3), gallbladder rupture (n=1) and death (n=5) due to subcutaneous abscess and peritonitis also occurred. The follow-up was achieved in eight dogs (seven dogs with a port catheter placement and one dog with a drain tube placement). Irrigation of the bile duct and port catheter replacement were successfully achieved without any complications. Cholangiograms obtained five weeks after stent placement showed diffuse biliary dilation with granulation tissue formation. However, focal biliary stricture was seen in one dog with stent placement alone. Placement of a port catheter following biliary stent placement seems to be feasible. However, further investigation is necessary to reduce the current complications

  18. Placement of an implantable port catheter in the biliary stent: an experimental study in dogs

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Gi Young; Lee, Im Sick; Choi, Won Chan [Asan Medical Center, Seoul (Korea, Republic of)

    2004-04-01

    To investigate the feasibility of port catheter placement following a biliary stent placement. We employed 14 mongrel dogs as test subject and after the puncture of their gaIl bladders using sonographic guidance, a 10-mm in diameter metallic stent was placed at the common duct. In 12 dogs, a 6.3 F port catheter was placed into the duodenum through the common duct and a port was secured at the subcutaneous space following stent placement. As a control group, an 8.5 F drain tube was placed into the gallbladder without port catheter placement in the remaining two dogs. Irrigation of the bile duct was performed every week by injection of saline into the port, and the port catheter was replaced three weeks later in two dogs. Information relating to the success of the procedure, complications and the five-week follow-up cholangiographic findings were obtained. Placement of a biliary stent and a port catheter was technically successful in 13 (93%) dogs, while stent migration (n=3), gallbladder rupture (n=1) and death (n=5) due to subcutaneous abscess and peritonitis also occurred. The follow-up was achieved in eight dogs (seven dogs with a port catheter placement and one dog with a drain tube placement). Irrigation of the bile duct and port catheter replacement were successfully achieved without any complications. Cholangiograms obtained five weeks after stent placement showed diffuse biliary dilation with granulation tissue formation. However, focal biliary stricture was seen in one dog with stent placement alone. Placement of a port catheter following biliary stent placement seems to be feasible. However, further investigation is necessary to reduce the current complications.

  19. To characterize the incidence of airway misplacement of nasogastric tubes in anesthetized intubated patients by using a manometer technique.

    Science.gov (United States)

    Hsieh, Shao-Wei; Chen, Hung-Shu; Chen, Yi-Ting; Hung, Kuo-Chuan

    2017-04-01

    This study characterized the incidence of airway misplacement of nasogastric (NG) tubes in surgical patients, and the benefit of using a manometer to discriminate gastric placement from airway placement of NG tubes. Subjects included adult patients scheduled for abdominal surgery. After tracheal intubation, a 16 Fr. NG tube was inserted blindly through the nostril, and its position was assessed using the auscultation (10-ml air insufflation) or manometer (attached to NG tubes) techniques. Briefly, a biphasic pressure change synchronous with airway pressure during mechanical ventilation indicated airway misplacement. The presence of a notable pressure change while compressing the epigastric area indicated a gastric placement. A surgeon made the final confirmation of NG tube placement within the stomach using manual palpation of the tube immediately after laparotomy. The first-attempt success rate was 82.7 % in 104 patients. There were 29 misplacements of 130 attempted insertions (oral cavity, n = 23; trachea, n = 3; distal esophagus, n = 3). The incidence of airway misplacement was 2.9 % (3 of 104 cases). For confirmation of gastric placement, the auscultation technique had a sensitivity of 100.0 % and a specificity of 79.3 %. In contrast, the manometer technique had a sensitivity of 100.0 % and a specificity of 100.0 % in the discrimination of gastric placement from airway placement of NG tubes. Airway misplacement of NG tubes is not uncommon in surgical patients, and the manometer technique may be a reliable and safe method to discriminate gastric placement from airway placement of NG tubes.

  20. Blind bedside insertion of small bowel feeding tubes.

    LENUS (Irish Health Repository)

    Duggan, SN

    2009-12-01

    The use of Naso-Jejunal (NJ) feeding is limited by difficulty in feeding tube placement. Patients have traditionally required transfer to Endoscopy or Radiology for insertion of small bowel feeding tubes, with clear resource implications. We hypothesised that the adoption of a simple bedside procedure would be effective and reduce cost. Clinical nutrition and nurse specialist personnel were trained in the 10\\/10\\/10 method of blind bedside NJ insertion.

  1. Tracheostomy tube - eating

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000464.htm Tracheostomy tube - eating To use the sharing features on ... when you swallow foods or liquids. Eating and Tracheostomy Tubes When you get your tracheostomy tube, or ...

  2. Eustachian tube patency

    Science.gov (United States)

    Eustachian tube patency refers to how much the eustachian tube is open. The eustachian tube runs between the middle ear and the throat. It controls the pressure behind the eardrum and middle ear space. This helps keep ...

  3. Optimal placement of capacito

    Directory of Open Access Journals (Sweden)

    N. Gnanasekaran

    2016-06-01

    Full Text Available Optimal size and location of shunt capacitors in the distribution system plays a significant role in minimizing the energy loss and the cost of reactive power compensation. This paper presents a new efficient technique to find optimal size and location of shunt capacitors with the objective of minimizing cost due to energy loss and reactive power compensation of distribution system. A new Shark Smell Optimization (SSO algorithm is proposed to solve the optimal capacitor placement problem satisfying the operating constraints. The SSO algorithm is a recently developed metaheuristic optimization algorithm conceptualized using the shark’s hunting ability. It uses a momentum incorporated gradient search and a rotational movement based local search for optimization. To demonstrate the applicability of proposed method, it is tested on IEEE 34-bus and 118-bus radial distribution systems. The simulation results obtained are compared with previous methods reported in the literature and found to be encouraging.

  4. Heat exchanger tube mounts

    Science.gov (United States)

    Wolowodiuk, W.; Anelli, J.; Dawson, B.E.

    1974-01-01

    A heat exchanger in which tubes are secured to a tube sheet by internal bore welding is described. The tubes may be moved into place in preparation for welding with comparatively little trouble. A number of segmented tube support plates are provided which allow a considerable portion of each of the tubes to be moved laterally after the end thereof has been positioned in preparation for internal bore welding to the tube sheet. (auth)

  5. Imaging and intervention in the gastrointestinal tract in children.

    Science.gov (United States)

    Kaye, Robin D; Towbin, R B

    2002-09-01

    Vascular and interventional techniques have become an integral component of modern pediatric healthcare. Minimally invasive procedures of the gastrointestinal tract now comprise a large part of any active pediatric interventional practice. Magnetic resonance cholangiopancreatography offers a reliable, non-invasive means to evaluate patients with possible pancreatic or biliary pathology. This article reviews treatment of esophageal strictures and placement of gastronomy and gastrojejunostomy tubes and discusses new developments. Placement of percutaneous cecostomy tubes is a relatively new procedure that creatively uses the techniques developed for placement of percutaneous gastronomy tubes. This procedure offers significant benefits and lasting positive lifestyle changes for patients suffering from fecal incontinence. Liver biopsy in high-risk patients can be performed safely using measures designed to significantly decrease the risk of post-biopsy hemorrhage, such as track embolization or the transjugular approach.

  6. Tube holding system

    International Nuclear Information System (INIS)

    Cunningham, R.C.

    1978-01-01

    A tube holding rig is described for the lateral support of tubes arranged in tight parcels in a heat exchanger. This tube holding rig includes not less than two tube supporting assemblies, with a space between them, located crosswise with respect to the tubes, each supporting assembly comprising a first set of parallel components in contact with the tubes, whilst a second set of components is also in contact with the tubes. These two sets of parts together define apertures through which the tubes pass [fr

  7. Should Children With Cleft Palate Receive Early Long-Term Tympanostomy Tubes: One Institution's Experience.

    Science.gov (United States)

    Shaffer, Amber D; Ford, Matthew D; Choi, Sukgi S; Jabbour, Noel

    2018-03-01

    To determine whether children with cleft palate might benefit from early long-term tympanostomy tubes with the hypothesis that receiving multiple tubes is associated with shorter duration of first tubes. Retrospective cohort study. Tertiary care children's hospital. Records from 401 consecutive children with cleft palate ± cleft lip, born April 2005 to April 2010, were reviewed. After exclusion of children with cleft repair at an outside hospital, no follow-up after 5 years of age, intact secondary palate, no tubes, or tube replacement at palatoplasty, 105 children remained. Number of tubes. Armstrong grommet tubes were placed at a median age of 6.7 months (range 2.3-19.6 months). Tubes were replaced in 55.3% of patients, with 34.0% receiving ≥3 sets. Duration of first tubes was significantly longer for children with 1 set of tubes compared with those with multiple sets (median 26 vs 19 months, P = .004). Otorrhea, but not perforation, was associated with longer duration of first tubes (median 27 vs 20.5 months, P = .028). Cleft type did not impact the proportion of patients with multiple tubes. Median age at last tube placement for children with multiple tubes was 5.0 years (range 1.9-8.7 years). Short duration of first tubes is associated with receiving multiple tubes. Because most patients require repeat tubes and many require tubes until school age, there is a significant need for controlled, prospective trials of early long-term tube placement in this population.

  8. Endotracheal tube verification in adult mechanically ventilated patients

    African Journals Online (AJOL)

    To explore the methods that can be used to verify endotracheal tube (ETT) placement in adult mechanically ventilated patients. ... bilateral auscultation of chest and palpation of symmetrical chest movements, oesophageal detector devices, visualisation of the ETT, use of chest X-ray, pulse oximetry and capnography.

  9. A case of fatal internal jugular vein perforation during nasogastric tube insertion

    Science.gov (United States)

    Smith, Katherine A.; Fleming, Jeffrey P.; Bennett, Robert D.

    2017-01-01

    Abstract Nasogastric tube (NGT) insertion is a routine procedure in the management of surgical patients. We report the second case of internal jugular vein perforation during NGT insertion. A 79-year-old man presented with diffuse abdominal pain secondary to a perforated viscus. Abdominal CT revealed pneumoperitoneum, necessitating emergent exploratory laparotomy. On post-operative Day 7, the patient developed mild abdominal distension and subjective nausea for which NGT placement was ordered for decompression. Tube placement was confirmed by insufflation of air without aspiration of gastric contents. Output from the NGT upon placement revealed frank blood. The patient then developed respiratory distress requiring intubation, followed by a fatal arrhythmia. Post-mortem exam revealed the trajectory of the NGT through the pharyngeal wall into the right internal jugular vein. This case illustrates the importance of systematic evaluation of all procedures, as the outcome resulted from failure to recognize the initial error in tube placement. PMID:28721190

  10. [Laryngeal tube II : alternative airway for children?].

    Science.gov (United States)

    Schalk, R; Scheller, B; Peter, N; Rosskopf, W; Byhahn, C; Zacharowski, K; Meininger, D

    2011-06-01

    Difficult airway situations both expected and unexpected, present major challenges to every anesthesiologist, especially in pediatric anesthesia. However, the integration of extraglottic airway devices, such as the laryngeal mask, into the algorithm of difficult airways has improved the handling of difficult airway situations. A device for establishing a supraglottic airway, the laryngeal tube (LT), was introduced in 1999. The LT is an extraglottic airway designed to secure a patent airway during either spontaneous breathing or controlled ventilation. The design of the device has been revised several times and a further development is the LTS II/LTS-D, which provides an additional channel for the insertion of a gastric drain tube. This article reports on the successful use of the LTS II in 12 children aged from 2 days to 6 years when endotracheal intubation, alternative mask or laryngeal mask ventilation failed. Use of the LTS II was associated with a high level of success, securing the airway when other techniques had failed. The potential advantage of the LTS II over the standard LT is an additional suction port, which allows gastric tube placement and can be used as an indirect indicator of correct placement. With a modified insertion technique using an Esmarch manoeuvre, placement was simple and fast to perform. In emergency situations when direct laryngoscopy fails or is too time-consuming the LTS II tube is recommended as an alternative device to secure the airway. As with all extraglottic airway devices, familiarity and clinical experience with the respective device and the corresponding insertion technique are essential for safe and successful use, especially in emergency situations.

  11. Identifying eustachian tube dysfunction prior to hyperbaric oxygen therapy: Who is at risk for intolerance?

    Science.gov (United States)

    Cohn, Jason E; Pfeiffer, Michael; Patel, Niki; Sataloff, Robert T; McKinnon, Brian J

    Determine whether specific risk factors, symptoms and clinical examination findings are associated with hyperbaric oxygen therapy (HBOT) intolerance and subsequent tympanotomy tube placement. A retrospective case series with chart review was conducted from 2007 to 2016 of patients undergoing HBOT clearance at a tertiary care university hospital in an urban city. Eighty-one (n=81) patient charts were reviewed for risk factors, symptoms and clinical examination findings related to HBOT eustachian tube dysfunction and middle ear barotrauma. Relative risk was calculated for each variable to determine risk for HBOT intolerance and need for tympanotomy tube placement. Risk factor, symptom, physical examination and HBOT complication-susceptibility scores were calculated for each patient. Mean risk factor, clinical and HBOT complication-susceptibility scores were significantly higher in patients who did not tolerate HBOT compared to patients who tolerated HBOT. Patients reporting a history of otitis media, tinnitus, and prior ear surgery were at a higher risk for HBOT intolerance. Patients reporting a history of pressure intolerance and prior ear surgery were more likely to undergo tympanotomy tube placement. Patients noted to have otologic findings prior to HBOT were at a higher risk for both HBOT intolerance and tympanotomy tube placement. A thorough otolaryngological evaluation can potentially predict and identify patients at risk for HBOT intolerance and tympanotomy tube placement. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Rates and risks of gastrostomy tubes in infants with cleft palate.

    Science.gov (United States)

    Cu, Sharon R; Sidman, James D

    2011-03-01

    To review data on a cohort of infants with cleft palate to (1) determine rates of gastrostomy (G)-tube placement, (2) identify contributing comorbidities, and (3) use relative risk analyses to improve management of cleft palate in infants with feeding difficulty. Retrospective medical record review. Tertiary care children's hospital. Infants with cleft palate born between January 1, 2000, and December 31, 2008, without G-tubes prior to referral were included. Comorbidities were analyzed, including syndromes and chromosomopathies (syn/chrom) and cardiac, respiratory, neurologic, and gastrointestinal diagnoses. These comorbidities were analyzed independently. Gastrostomy-tube placement. Of 214 infants with cleft palate, 34 required G-tubes. Of these, 19 had syn/chrom. Independent of these diagnoses, 17 infants had 1 system comorbidity and 12 had multisystem comorbidities. Of the 180 patients without G-tubes, 20 had syn/chrom. Independent of these diagnoses, 10 infants had 1 system comorbidity and 2 had multisystem comorbidities. Rates of G-tube placement ranged from 3% in infants without any comorbidity to 94% in infants with respiratory comorbidity. Relative risks of G-tube placement with syn/chrom, 1 system comorbidity, and multisystem comorbidities were 5.68 (95% confidence interval, 3.18-10.16), 21.79 (8.76-54.17), and 29.66 (12.18-72.21), respectively. Diagnosis of syn/chrom or major comorbidity significantly increases risk of G-tube placement. Regardless of syn/chrom association, problems affecting the heart, respiratory system, central nervous system, and lower esophageal sphincter are the most significant risk factors, implying that particular comorbidities are more influential than a simple diagnosis of syn/chrom. These data should help identify children at greatest risk for G-tubes and those expected to overcome feeding difficulties, leading to more persistent use of nonsurgical therapy before resorting to G-tubes.

  13. Parent-reported otorrhea in children with tympanostomy tubes: incidence and predictors.

    Directory of Open Access Journals (Sweden)

    Thijs M A van Dongen

    Full Text Available PURPOSE: Although common in children with tympanostomy tubes, the current incidence of tympanostomy tube otorrhea (TTO is uncertain. TTO is generally a sign of otitis media, when middle ear fluid drains through the tube. Predictors for otitis media are therefore suggested to have predictive value for the occurrence of TTO. OBJECTIVE: To determine the incidence of TTO and its predictors. METHODS: We performed a cohort study, using a parental web-based questionnaire to retrospectively collect data on TTO episodes and its potential predictors from children younger than 10 years of age with tympanostomy tubes. RESULTS: Of the 1,184 children included in analyses (total duration of time since tube placement was 768 person years with a mean of 7.8 months per child, 616 children (52% experienced one or more episodes of TTO. 137 children (12% had TTO within the calendar month of tube placement. 597 (50% children had one or more acute TTO episodes (duration <4 weeks and 46 children (4% one or more chronic TTO episodes (duration ≥4 weeks. 146 children (12% experienced recurrent TTO episodes. Accounting for time since tube placement, 67% of children developed one or more TTO episodes in the year following tube placement. Young age, recurrent acute otitis media being the indication for tube placement, a recent history of recurrent upper respiratory tract infections and the presence of older siblings were independently associated with the future occurrence of TTO, and can therefore be seen as predictors for TTO. CONCLUSIONS: Our survey confirms that otorrhea is a common sequela in children with tympanostomy tubes, which occurrence can be predicted by age, medical history and presence of older siblings.

  14. Ultrasonographic Confirmation of Endotracheal Tube Position in Neonates.

    Science.gov (United States)

    Najib, Khadijehsadat; Pishva, Narjes; Amoozegar, Hamid; Pishdad, Parisa; Fallahzadeh, Ebrahim

    2016-10-08

    To compare endotracheal tube tip-to-carina distance obtained by ultrasonography vs. that obtained by chest X-ray in neonates. After endotracheal intubation of 40 neonates, chest X-ray and, within one hour, ultrasonography was obtained for each patient for measurement of endotracheal tube tip-to-carina distance. Means of endotracheal tube tip-to-carina distances were not significantly different by both modalities (mean difference 0.157 cm, P= 0.06). In addition, an intraclass correlation was observed between them (r2= 0.61, 95% CI= 0.26, 0.79). Ultrasonography and chest X-ray are equally accurate for determination of endotracheal tube tip-to-carina in infants. As ultrasonography is more easily available and is safer than X-ray, it may be a better modality for confirming proper placement of endotracheal tube in neonates.

  15. Tracheostomy tube - speaking

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000465.htm Tracheostomy tube - speaking To use the sharing features on ... are even speaking devices that can help you. Tracheostomy Tubes and Speaking Air passing through vocal cords ( ...

  16. X-ray tubes

    International Nuclear Information System (INIS)

    Young, R.W.

    1979-01-01

    A form of x-ray tube is described which provides satisfactory focussing of the electron beam when the beam extends for several feet from gun to target. Such a tube can be used for computerised tomographic scanning. (UK)

  17. Neural Tube Defects

    Science.gov (United States)

    Neural tube defects are birth defects of the brain, spine, or spinal cord. They happen in the ... that she is pregnant. The two most common neural tube defects are spina bifida and anencephaly. In ...

  18. Jejunostomy feeding tube

    Science.gov (United States)

    ... may replace the tube every now and then. Cleaning the Skin Around the J-tube To clean ... this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial ...

  19. Replacement of Mushroom Cage Gastrostomy Tube Using a Modified Technique to Allow Percutaneous Replacement with an Endoscopic Tube in Patients with Amyotrophic Lateral Sclerosis

    International Nuclear Information System (INIS)

    Ammar, Thoraya; Rio, Alan; Ampong, Mary Ann; Sidhu, Paul S.

    2010-01-01

    Radiologic inserted gastrostomy (RIG) is the preferred method in our institution for enteral feeding in amyotrophic lateral sclerosis (ALS). Skin-level primary-placed mushroom cage gastrostomy tubes become tight with weight gain. We describe a minimally invasive radiologic technique for replacing mushroom gastrostomy tubes with endoscopic mushroom cage tubes in ALS. All patients with ALS who underwent replacement of a RIG tube were included. Patients were selected for a modified replacement when the tube length of the primary placed RIG tube was insufficient to allow like-for-like replacement. Replacement was performed under local anesthetic and fluoroscopic guidance according to a preset technique, with modification of an endoscopic mushroom cage gastrostomy tube to allow percutaneous placement. Assessment of the success, safety, and durability of the modified technique was undertaken. Over a 60-month period, 104 primary placement mushroom cage tubes in ALS were performed. A total of 20 (19.2%) of 104 patients had a replacement tube positioned, 10 (9.6%) of 104 with the modified technique (male n = 4, female n = 6, mean age 65.5 years, range 48-85 years). All tubes were successfully replaced using this modified technique, with two minor complications (superficial wound infection and minor hemorrhage). The mean length of time of tube durability was 158.5 days (range 6-471 days), with all but one patient dying with a functional tube in place. We have devised a modification to allow percutaneous replacement of mushroom cage gastrostomy feeding tubes with minimal compromise to ALS patients. This technique allows tube replacement under local anesthetic, without the need for sedation, an important consideration in ALS.

  20. Noninvasive ventilation during percutaneous gastrostomy placement in Duchenne muscular dystrophy.

    Science.gov (United States)

    Pope, J F; Birnkrant, D J; Martin, J E; Repucci, A H

    1997-06-01

    Noninvasive positive pressure ventilation (NPPV) is used for respiratory support in a number of diseases causing acute or chronic respiratory failure. We describe a novel use of NPPV to provide respiratory support during sedation for percutaneous placement of a gastrostomy tube in a patient with Duchenne muscular dystrophy (DMD). The patient had severe respiratory insufficiency, progressive dysphagia, and undernutrition. In addition to the case in this report, we have used NPPV to provide respiratory support to DMD patients during five other gastrointestinal endoscopies without complication. The technique is highly labor intensive and requires physicians and respiratory therapists familiar with NPPV. The primary risk associated with this technique is lack of definitive airway protection during the procedure, which must be balanced against the risks of intubation in an anesthetized patient with neuromuscular disease. The potential benefit to selected patients is substantial, such as initiation of gastrostomy tube feeding in our patient, with subsequent improvement in his quality of life and nutritional status.

  1. Efficacy and complications of enteral feeding tube insertion after liver transplantation.

    Science.gov (United States)

    Chun, J H; Ahn, J Y; Jung, H-Y; Jung Park, H; Kim, G H; Lee, J H; Choi, K-S; Jung, K W; Kim, D H; Choi, K D; Song, H J; Lee, G H; Kim, J H; Song, G W; Kim, J-H

    2015-03-01

    Adequate nutritional support for patients undergoing major surgery significantly affects postoperative recovery. Data on enteral feeding after liver transplantation (LT) are scarce. The aim of this work was to determine the efficacy and complications of feeding tubes inserted with the use of fluoroscopic assistance, endoscopic assistance, or transperitoneal jejunostomy in patients who underwent LT. From January 2008 to August 2013, 2,058 LTs were performed at Asan Medical Center, Seoul, Korea. Enteral feeding tubes were inserted in 155 patients (7.5%) after LT: with the use of fluoroscopic placement in 81 (52%), endoscopic placement in 49 (32%), and transperitoneal jejunostomy in 25 (16%). We retrospectively analyzed the efficacy and complications of enteral feeding tubes. The median age was 55 years (interquartile range [IQR] 49-60). Enteral feeding indications were a high risk of gastric aspiration (n = 90), gastric stasis (n = 27), pneumonia (n = 23), gastrointestinal bleeding (n = 12), and bowel rest (n = 3). Median enteral feeding durations were 14.5 days (IQR 8.0-30.7) for fluoroscopic placement, 20.0 days (IQR 8.0-40.0) for endoscopic placement, and 37.5 days (IQR 18.2-86.2) for transperitoneal jejunostomy. Times to establishment of oral feeding were 13.0 days (IQR 6.2-25.7) for fluoroscopic placement, 24.0 days (IQR 10.5-43.5) for endoscopic placement, and 37.0 days (IQR 17.0-64.2) for transperitoneal jejunostomy. After tube insertion, tube dislocation and blockage occurred in 34 patients (22%) and 16 patients (25%), respectively. Enteral feeding tube insertion in patients who can not maintain a nasogastric tube or start oral intake for a long time is important for nutritional support after LT. Proper feeding method selection according to patient condition can help patients by improving nutritional support after major operations such as LT. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Oxymetazoline is equivalent to ciprofloxacin in preventing postoperative otorrhea or tympanostomy tube obstruction.

    Science.gov (United States)

    Kumar, Veena V; Gaughan, John; Isaacson, Glenn; Szeremeta, Wasyl

    2005-02-01

    To compare the effectiveness of ciprofloxacin and oxymetazoline solutions instilled after tympanostomy tube placement in the prevention of postoperative otorrhea and tube occlusion. Prospective cross-sectional series. We reviewed all bilateral myringotomy and tube placement operations performed by two full-time attending pediatric otolaryngologists during a 9 month period. Data from 488 patients who underwent surgery for otitis media were collected. Demographic and clinical variables including age, sex, number of tube insertions in the past, previous adenoidectomy, type of effusion present at surgery, and type of drop prescribed postoperatively were recorded. All patients were evaluated in the office 2 to 4 weeks postoperatively. Multivariate logistic regression analysis was used to estimate the relationship of these variables with the occurrence of otorrhea and tube patency. Odds ratios were calculated. No significant differences in postoperative otorrhea or tube patency were found between ciprofloxacin (Ciloxan) and oxymetazoline solutions (Afrin, Visine LR). Oxymetazoline and ciprofloxacin solutions are equivalent in the prevention of postoperative otorrhea and tube occlusion after tympanostomy tube placement. The implications for medication cost and potential adverse reactions are discussed.

  3. 21 CFR 868.5800 - Tracheostomy tube and tube cuff.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Tracheostomy tube and tube cuff. 868.5800 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5800 Tracheostomy tube and tube cuff. (a) Identification. A tracheostomy tube and tube cuff is a device intended to be placed into a...

  4. Familial placement of Wightia (Lamiales)

    DEFF Research Database (Denmark)

    Zhou, Qing-Mei; Jensen, Søren Rosendal; Liu, Guo-Li

    2014-01-01

    The familial placement of Wightia has long been a problem. Here, we present a comprehensive phylogenetic inspection of Wightia based on noncoding chloroplast loci (the rps16 intron and the trnL–F region) and nuclear ribosomal internal transcribed spacer, and on chemical analysis. A total of 70 sa...

  5. NEI You Tube Videos: Amblyopia

    Medline Plus

    Full Text Available ... YouTube Videos >> NEI YouTube Videos: Amblyopia Listen NEI YouTube Videos YouTube Videos Home Age-Related Macular Degeneration ... Retinopathy of Prematurity Science Spanish Videos Webinars NEI YouTube Videos: Amblyopia Embedded video for NEI YouTube Videos: ...

  6. NEI You Tube Videos: Amblyopia

    Medline Plus

    Full Text Available ... YouTube Videos > NEI YouTube Videos: Amblyopia NEI YouTube Videos YouTube Videos Home Age-Related Macular Degeneration Amblyopia ... of Prematurity Science Spanish Videos Webinars NEI YouTube Videos: Amblyopia Embedded video for NEI YouTube Videos: Amblyopia ...

  7. NEI You Tube Videos: Amblyopia

    Medline Plus

    Full Text Available ... NEI YouTube Videos > NEI YouTube Videos: Amblyopia NEI YouTube Videos YouTube Videos Home Age-Related Macular Degeneration ... Retinopathy of Prematurity Science Spanish Videos Webinars NEI YouTube Videos: Amblyopia Embedded video for NEI YouTube Videos: ...

  8. Automated Fiber Placement of Advanced Materials (Preprint)

    National Research Council Canada - National Science Library

    Benson, Vernon M; Arnold, Jonahira

    2006-01-01

    .... ATK has been working with the Air Force Research Laboratory to foster improvements in the BMI materials and in the fiber placement processing techniques to achieve rates comparable to Epoxy placement rates...

  9. New innovative method relating guided surgery to dental implant placement.

    Science.gov (United States)

    Fauroux, M-A; De Boutray, M; Malthiéry, E; Torres, J-H

    2018-02-20

    Companies selling dental implant guided systems mostly offer similar surgical guides. The purpose of this paper is to present an innovative-guided surgery system which originality lies in its guidance device, and to report the author's experience in using this system for dental implant surgery. Two parallel tubes on either side of the drilling axis guide the successive drills and the implant placement. As a result of the lateral guidance, there is no friction of the drills on the surgical guide, which would damage it or contaminate the drilling hole with particles torn out from the guide. No radiological guide is needed during the radiographic examination stage. No successive diameter reduction tubes are requested. This guide can be used for all brands of implants. In our experience, 67 implants (31 titanium and 36 zircon implants) were placed in 35 patients with guided surgery system. Multiple clinical cases were treated with this system: 'one-stage' or a 'two-stage' surgical protocol, with flap and flapless surgical techniques, and with delayed or immediate loading. Clinical cases treated revealed good implant placement with planning. The widely open design of this guide allows irrigation and practitioner's sight control under conditions comparable to those of operations performed without surgical guide. This dental implant guided system appears to be a significant advance in the field of implant surgical guides. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  10. Usefulness of multifunctional gastrointestinal coil catheter for colorectal stent placement

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae-Hyung; Shin, Ji Hoon; Kim, Jin Hyoung; Lim, Jin-Oh; Kim, Kyung Rae [Asan Medical Center, Radiology and Research Institute of Radiology, Seoul (Korea); Song, Ho-Young [Asan Medical Center - Radiology, Songpa-gu, Seoul (Korea); Park, In Kook [Dongguk University, Life Science, Seoul (Korea); Choi, Eugene K. [Weill Medical College of Cornell University, New York, NY (United States)

    2008-11-15

    The purpose of this study was to evaluate the usefulness of a multifunctional gastrointestinal coil catheter for stent placement in 98 patients with colorectal strictures. The catheter was used in 98 consecutive patients for stent placement in the rectum (n = 24), recto-sigmoid (n = 13), sigmoid (n = 38), descending (n = 6), transverse (n = 11), splenic flexure (n = 3), hepatic flexure (n = 2), and ascending (n = 1) colon. The catheter was made of a stainless steel coil (1.3 mm in inner diameter), a 0.4-mm nitinol wire, a polyolefin tube, and a hemostasis valve. Usefulness of the catheter was evaluated depending on whether the catheter could pass a stricture over a guide wire and whether measurement of the stricture length was possible. The passage of the catheter over a guide wire beyond the stricture was technically successful and well tolerated in 93 (94.9%) of 98 patients. In the failed five patients, it was not possible to negotiate the guide wire due to presence of nearly complete small bowel obstruction. The average length of stricture was 6.15 cm (range, 3 cm to 20 cm) in patients with the colorectal stricture. There were no procedure-related complications. In conclusion, the multifunctional coil catheter seems to be useful in colorectal stent placement. (orig.)

  11. Small tube thoracostomy (20-22 Fr) in emergent management of chest trauma.

    Science.gov (United States)

    Tanizaki, Shinsuke; Maeda, Shigenobu; Sera, Makoto; Nagai, Hideya; Hayashi, Minoru; Azuma, Hiroyuki; Kano, Ken-Ichi; Watanabe, Hiroki; Ishida, Hiroshi

    2017-09-01

    The optimal tube size for an emergent thoracostomy for traumatic pneumothorax or hemothorax is unknown. Both small catheter tube thoracostomy and large-bore chest tube thoracostomy have been shown to work for the nonemergent management of patients with traumatic pneumothorax or hemothorax. This study was conducted to compare the efficacy of a small chest tube with that of a large tube in emergent thoracostomy due to chest trauma. Our hypothesis was that there would be no difference in clinical outcomes including tube-related complications, the need for additional tube placement, and thoracotomy, with the replacement of large tubes with small tubes. A retrospective review of all patients with chest trauma requiring tube thoracostomy within the first 2h from arrival at our emergency department over a 7-year period was conducted. Charts were reviewed for demographic data and outcomes including complications and initial drainage output. Small chest tubes (20-22 Fr) were compared with a large tube (28 Fr). Our primary outcome was tube-related complications. Secondary outcomes included additional invasive procedures, such as additional tube insertion and thoracotomy. There were 124 tube thoracostomies (small: 68, large: 56) performed in 116 patients. There were no significant differences between the small- and large-tube groups with regard to age, gender, injury mechanism, systolic blood pressure, heart rate, and injury severity score. Both groups were similar in the posterior direction of tube insertion, initial drainage output, and the duration of tube insertion. There was no significant difference in the primary outcomes of tube-related complications, including empyema (small: 1/68 vs. large: 1/56; p=1.000) or retained hemothorax (small: 2/68 vs. large: 2/56; p=1.000). Secondary outcomes, including the need for additional tube placement (small: 2/68 vs. large: 4/56; p=0.408) or thoracotomy (small: 2/68 vs. large: 1/56; p=1.000), were also similar. For patients with

  12. Nasogastric tube insertion in anaesthetized patients: a comprehensive review.

    Science.gov (United States)

    Sanaie, Sarvin; Mahmoodpoor, Ata; Najafi, Mahdi

    2017-01-01

    Nasogastric tubes (NGT) still remain the easiest and the best way for gastrointestinal tract access. There are various indications for the insertion of a nasogastric tube in anaesthetized and critically ill patients. Although many techniques have been introduced to facilitate nasogastric tube insertion using anatomic landmarks and a group of devices, there is no consensus on a standard method. Moreover, there are different methods for the assessment of the correct placement of a nasogastric tube. In addition to these challenges in insertion and assessment methods, there are varieties of major life-threatening and minor complications to be addressed. Thus, selecting the most appropriate approach requires enough knowledge in this area, considering patient condition and clinical factors, as well as the practitioners' sufficient education and experience, along with skill in performance. This is a comprehensive review of the literature evidence on different methods for nasogastric tube insertion, on the assessment of correct placement and the evaluation of complications, in addition to an approach to the effect of education on the quality of routine practice and patients' outcome.  .

  13. Lunar Lava Tube Sensing

    Science.gov (United States)

    York, Cheryl Lynn; Walden, Bryce; Billings, Thomas L.; Reeder, P. Douglas

    1992-01-01

    Large (greater than 300 m diameter) lava tube caverns appear to exist on the Moon and could provide substantial safety and cost benefits for lunar bases. Over 40 m of basalt and regolith constitute the lava tube roof and would protect both construction and operations. Constant temperatures of -20 C reduce thermal stress on structures and machines. Base designs need not incorporate heavy shielding, so lightweight materials can be used and construction can be expedited. Identification and characterization of lava tube caverns can be incorporated into current precursor lunar mission plans. Some searches can even be done from Earth. Specific recommendations for lunar lava tube search and exploration are (1) an Earth-based radar interferometer, (2) an Earth-penetrating radar (EPR) orbiter, (3) kinetic penetrators for lunar lava tube confirmation, (4) a 'Moon Bat' hovering rocket vehicle, and (5) the use of other proposed landers and orbiters to help find lunar lava tubes.

  14. Steam generator tube performance

    International Nuclear Information System (INIS)

    Tatone, O.S.; Pathania, R.S.

    1983-08-01

    A review of the performance of steam generator tubes in 110 water-cooled nuclear power reactors showed that tubes were plugged at 46 (42 percent) of the reactors. The number of tubes removed from service increased from 1900 (0.14 percent) in 1980 to 4692 (0.30 percent) in 1981. The leading causes of tube failures were stress corrosion cracking from the primary side, stress corrosion cracking (or intergranular attack) from the secondary side and pitting corrosion. The lowest incidence of corrosion-induced defects from the secondary side occurred in reactors that used all-volatile treatment since start-up. At one reactor a large number of degraded tubes were repaired by sleeving which is expected to become an important method of tube repair in the future

  15. Esophageal Perforation with Unilateral Fluidothorax Caused by Nasogastric Tube

    Directory of Open Access Journals (Sweden)

    Lukas P. Mileder

    2016-01-01

    Full Text Available Preterm infants are highly susceptible to injuries following necessary and often life-saving medical interventions. Esophageal perforation is a rare, yet serious complication that can be caused by aerodigestive tract suction, endotracheal intubation, or nasogastric tube placement. We present the case of a neonate born at 23 weeks plus three days of gestation with chest radiography showing malposition of the nasogastric feeding tube and massive right-sided effusion of Iopamidol in the pleural cavity due to esophageal perforation. In addition, the article summarizes common signs and symptoms associated with esophageal perforation in infants and discusses diagnostic approaches.

  16. Percutaneous transcholecystic approach for an experiment of biliary stent placement: an experimental study in dogs

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Tae Seok [Medical School of Gachon, Inchon (Korea, Republic of); Song, Ho Young; Lim, Jin Oh; Ko, Gi Young; Sung, Kyu Bo; Kim, Tae Hyung; Lee, Ho Jung [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)

    2002-06-01

    To determine, in an experimental study of biliary stent placement, the usefulness and safety of the percutaneous transcholecystic approach and the patency of a newly designed biliary stent. A stent made of 0.15-mm-thick nitinol wire, and 10 mm in diameter and 2 cm in length, was loaded in an introducer with an 8-F outer diameter. The gallbladders of seven mongrel dogs were punctured with a 16-G angiocath needle under sonographic guidance, and cholangiography was performed. After anchoring the anterior wall of the gallbladder to the abdominal wall using a T-fastener, the gallbladder body was punctured again under fluoroscopic guidance. The cystic and common bile ducts were selected using a 0.035-inch guide wire and a cobra catheter, and the stent was placed in the common bile duct. Post-stenting cholangiography was undertaken, and an 8.5-F drainage tube was inserted in the gallbladder. Two dogs were followed-up and sacrificed at 2,4 and 8 weeks after stent placement, respectively, and the other expired 2 days after stent placement. Follow-up cholangiograms were obtained before aninmal was sacrified, and a pathologic examination was performed. Stent placement was technically successful in all cases. One dog expired 2 days after placement because of bile peritonitis due to migration of the drainage tube into the peritoneal cavity, but the other six remained healthy during the follow-up period. Cholangiography performed before the sacrifice of each dog showed that the stents were patent. Pathologic examination revealed the proliferation of granulation tissue at 2 weeks, and complete endothelialization over the stents by granulation tissue at 8 weeks. Percutaneous transcholecystic biliary stent placement appears to be safe, easy and useful. After placement, the stent was patent during the follow-period.

  17. Percutaneous transcholecystic approach for an experiment of biliary stent placement: an experimental study in dogs

    International Nuclear Information System (INIS)

    Seo, Tae Seok; Song, Ho Young; Lim, Jin Oh; Ko, Gi Young; Sung, Kyu Bo; Kim, Tae Hyung; Lee, Ho Jung

    2002-01-01

    To determine, in an experimental study of biliary stent placement, the usefulness and safety of the percutaneous transcholecystic approach and the patency of a newly designed biliary stent. A stent made of 0.15-mm-thick nitinol wire, and 10 mm in diameter and 2 cm in length, was loaded in an introducer with an 8-F outer diameter. The gallbladders of seven mongrel dogs were punctured with a 16-G angiocath needle under sonographic guidance, and cholangiography was performed. After anchoring the anterior wall of the gallbladder to the abdominal wall using a T-fastener, the gallbladder body was punctured again under fluoroscopic guidance. The cystic and common bile ducts were selected using a 0.035-inch guide wire and a cobra catheter, and the stent was placed in the common bile duct. Post-stenting cholangiography was undertaken, and an 8.5-F drainage tube was inserted in the gallbladder. Two dogs were followed-up and sacrificed at 2,4 and 8 weeks after stent placement, respectively, and the other expired 2 days after stent placement. Follow-up cholangiograms were obtained before aninmal was sacrified, and a pathologic examination was performed. Stent placement was technically successful in all cases. One dog expired 2 days after placement because of bile peritonitis due to migration of the drainage tube into the peritoneal cavity, but the other six remained healthy during the follow-up period. Cholangiography performed before the sacrifice of each dog showed that the stents were patent. Pathologic examination revealed the proliferation of granulation tissue at 2 weeks, and complete endothelialization over the stents by granulation tissue at 8 weeks. Percutaneous transcholecystic biliary stent placement appears to be safe, easy and useful. After placement, the stent was patent during the follow-period

  18. Inadvertent insertion of a nasogastric tube into both main bronchi of an awake patient: a case report

    Science.gov (United States)

    2009-01-01

    The use of nasogastric tube is desirable for the short-term administration of calories when oral feeding is not possible. Although the insertion of nasogastric tubes has been described as being easy this is not without risks. An unusual case of malpositioning of a fine bore nasogastric tube into both main bronchi in a patient that was awake is reported. Respiratory complications of misplaced nasogastric tubes and the importance of a check chest x-ray following tube placement are discussed. PMID:19829883

  19. Manual tube welding torch

    International Nuclear Information System (INIS)

    Kiefer, J.H.; Smith, D.J.

    1981-01-01

    In a welding torch which fits over a tube intermediate the ends thereof for welding the juncture between the tube and a boss on the back side of a tube plate, a split housing encloses a tungsten electrode, a filler wire duct and a fiber optic bundle arranged to observe the welding process. A shielding gas duct is provided in the housing. A screw is provided for setting electrode/work distance. Difficult remote tube welding operations can be performed with the apparatus. (author)

  20. Steam generator tube performance

    International Nuclear Information System (INIS)

    Tatone, O.S.; Pathania, R.S.

    1984-10-01

    A review of the performance of steam generator tubes in 116 water-cooled nuclear power reactors showed that tubes were plugged at 54 (46 percent) of the reactors. The number of tubes removed from service decreased from 4 692 (0.30 percent) in 1981 to 3 222 (0.20 percent) in 1982. The leading causes of tube failures were stress corrosion cracking from the primary side, stress corrosion cracking (or intergranular attack) from the secondary side and pitting corrosion. The lowest incidence of corrosion-induced defects from the secondary side occurred in reactors that have used only volatile treatment, with or without condensate demineralization

  1. Wound tube heat exchanger

    Science.gov (United States)

    Ecker, Amir L.

    1983-01-01

    What is disclosed is a wound tube heat exchanger in which a plurality of tubes having flattened areas are held contiguous adjacent flattened areas of tubes by a plurality of windings to give a double walled heat exchanger. The plurality of windings serve as a plurality of effective force vectors holding the conduits contiguous heat conducting walls of another conduit and result in highly efficient heat transfer. The resulting heat exchange bundle is economical and can be coiled into the desired shape. Also disclosed are specific embodiments such as the one in which the tubes are expanded against their windings after being coiled to insure highly efficient heat transfer.

  2. Sapphire tube pressure vessel

    Science.gov (United States)

    Outwater, John O.

    2000-01-01

    A pressure vessel is provided for observing corrosive fluids at high temperatures and pressures. A transparent Teflon bag contains the corrosive fluid and provides an inert barrier. The Teflon bag is placed within a sapphire tube, which forms a pressure boundary. The tube is received within a pipe including a viewing window. The combination of the Teflon bag, sapphire tube and pipe provides a strong and inert pressure vessel. In an alternative embodiment, tie rods connect together compression fittings at opposite ends of the sapphire tube.

  3. Fuel nozzle tube retention

    Energy Technology Data Exchange (ETDEWEB)

    Cihlar, David William; Melton, Patrick Benedict

    2017-02-28

    A system for retaining a fuel nozzle premix tube includes a retention plate and a premix tube which extends downstream from an outlet of a premix passage defined along an aft side of a fuel plenum body. The premix tube includes an inlet end and a spring support feature which is disposed proximate to the inlet end. The premix tube extends through the retention plate. The spring retention feature is disposed between an aft side of the fuel plenum and the retention plate. The system further includes a spring which extends between the spring retention feature and the retention plate.

  4. ADVANCED DENTAL IMPLANT PLACEMENT TECHNIQUES

    Directory of Open Access Journals (Sweden)

    Alex M. GREENBERG

    2017-12-01

    Full Text Available The availability of in office Cone Beam CT (CBCT scanners, dental implant planning software, CAD CAM milling, and rapid printing technologies allow for the precise placement of dental implants and immediate prosthetic temporization. These technologies allow for flapless implant placement, or open flap bone reduction for “All on 4” techniques with improved preoperative planning and intraoperative performance. CBCT permits practitioners in an office setting with powerful diagnostic capabilities for the evaluation of bone quality and quantity, as well as dental and osseous pathology essential for better informed dental implant treatment. CBCT provides the convenience of in office imaging and decreased radiation exposure. Rapid printing technologies provide decreased time and high accuracy for bone model and surgical guide fabrication.

  5. placements des gouverneurs

    International Development Research Centre (IDRC) Digital Library (Canada)

    André Lavoie

    Transit. Tout endroit qui n'est pas considéré comme la destination où l'on se rend par affaires. Voyageur. Désigne un gouverneur dans le contexte du présent règlement. 5. Rôles et responsabilités. 5.1. Personnes participant au processus lié aux déplacements des gouverneurs. Toutes les personnes, dont les gouverneurs, ...

  6. Humanitarian engineering placements in our own communities

    Science.gov (United States)

    VanderSteen, J. D. J.; Hall, K. R.; Baillie, C. A.

    2010-05-01

    There is an increasing interest in the humanitarian engineering curriculum, and a service-learning placement could be an important component of such a curriculum. International placements offer some important pedagogical advantages, but also have some practical and ethical limitations. Local community-based placements have the potential to be transformative for both the student and the community, although this potential is not always seen. In order to investigate the role of local placements, qualitative research interviews were conducted. Thirty-two semi-structured research interviews were conducted and analysed, resulting in a distinct outcome space. It is concluded that local humanitarian engineering placements greatly complement international placements and are strongly recommended if international placements are conducted. More importantly it is seen that we are better suited to address the marginalised in our own community, although it is often easier to see the needs of an outside populace.

  7. Steam generator tube failures

    Energy Technology Data Exchange (ETDEWEB)

    MacDonald, P.E.; Shah, V.N.; Ward, L.W.; Ellison, P.G.

    1996-04-01

    A review and summary of the available information on steam generator tubing failures and the impact of these failures on plant safety is presented. The following topics are covered: pressurized water reactor (PWR), Canadian deuterium uranium (CANDU) reactor, and Russian water moderated, water cooled energy reactor (VVER) steam generator degradation, PWR steam generator tube ruptures, the thermal-hydraulic response of a PWR plant with a faulted steam generator, the risk significance of steam generator tube rupture accidents, tubing inspection requirements and fitness-for-service criteria in various countries, and defect detection reliability and sizing accuracy. A significant number of steam generator tubes are defective and are removed from service or repaired each year. This wide spread damage has been caused by many diverse degradation mechanisms, some of which are difficult to detect and predict. In addition, spontaneous tube ruptures have occurred at the rate of about one every 2 years over the last 20 years, and incipient tube ruptures (tube failures usually identified with leak detection monitors just before rupture) have been occurring at the rate of about one per year. These ruptures have caused complex plant transients which have not always been easy for the reactor operators to control. Our analysis shows that if more than 15 tubes rupture during a main steam line break, the system response could lead to core melting. Although spontaneous and induced steam generator tube ruptures are small contributors to the total core damage frequency calculated in probabilistic risk assessments, they are risk significant because the radionuclides are likely to bypass the reactor containment building. The frequency of steam generator tube ruptures can be significantly reduced through appropriate and timely inspections and repairs or removal from service.

  8. Steam generator tube failures

    International Nuclear Information System (INIS)

    MacDonald, P.E.; Shah, V.N.; Ward, L.W.; Ellison, P.G.

    1996-04-01

    A review and summary of the available information on steam generator tubing failures and the impact of these failures on plant safety is presented. The following topics are covered: pressurized water reactor (PWR), Canadian deuterium uranium (CANDU) reactor, and Russian water moderated, water cooled energy reactor (VVER) steam generator degradation, PWR steam generator tube ruptures, the thermal-hydraulic response of a PWR plant with a faulted steam generator, the risk significance of steam generator tube rupture accidents, tubing inspection requirements and fitness-for-service criteria in various countries, and defect detection reliability and sizing accuracy. A significant number of steam generator tubes are defective and are removed from service or repaired each year. This wide spread damage has been caused by many diverse degradation mechanisms, some of which are difficult to detect and predict. In addition, spontaneous tube ruptures have occurred at the rate of about one every 2 years over the last 20 years, and incipient tube ruptures (tube failures usually identified with leak detection monitors just before rupture) have been occurring at the rate of about one per year. These ruptures have caused complex plant transients which have not always been easy for the reactor operators to control. Our analysis shows that if more than 15 tubes rupture during a main steam line break, the system response could lead to core melting. Although spontaneous and induced steam generator tube ruptures are small contributors to the total core damage frequency calculated in probabilistic risk assessments, they are risk significant because the radionuclides are likely to bypass the reactor containment building. The frequency of steam generator tube ruptures can be significantly reduced through appropriate and timely inspections and repairs or removal from service

  9. Design of 3-D Printed Concentric Tube Robots.

    Science.gov (United States)

    Morimoto, Tania K; Okamura, Allison M

    2016-12-01

    Concentric tube surgical robots are minimally invasive devices with the advantages of snake-like reconfigurability, long and thin form factor, and placement of actuation outside the patient's body. These robots can also be designed and manufactured to acquire targets in specific patients for treating specific diseases in a manner that minimizes invasiveness. We propose that concentric tube robots can be manufactured using 3-D printing technology on a patient- and procedure-specific basis. In this paper, we define the design requirements and manufacturing constraints for 3-D printed concentric tube robots and experimentally demonstrate the capabilities of these robots. While numerous 3-D printing technologies and materials can be used to create such robots, one successful example uses selective laser sintering to make an outer tube with a polyether block amide and uses stereolithography to make an inner tube with a polypropylene-like material. This enables a tube pair with precurvatures of 0.0775 and 0.0455 mm -1 , which can withstand strains of 20% and 5.5% for the outer and inner tubes, respectively.

  10. Chest Tube Thoracostomy

    Science.gov (United States)

    ... in the space around the lungs (called a pleural effusion) . A chest tube may also be needed when a patient has ... or chest CT are also done to evaluate pleural fluid. If the X-ray shows a need for a chest tube to drain fluid or air, the procedure is ...

  11. Ventricular tachycardia following tube thoracotomy.

    Science.gov (United States)

    Hibbert, Benjamin; Lim, Toon Wei; Hibbert, Rebecca; Green, Martin; Gollob, Michael H; Davis, Darryl R

    2010-10-01

    Arrhythmias provoked by tube thoracotomy are a rare complication. We report a ventricular tachycardia after chest tube insertion for a device-related pneumothorax. Sinus rhythm was restored only by removal of the chest tube and insertion of a pliable pleural drain. Identification of the chest tube as an arrhythmic trigger following tube thoracotomy is essential in definitive management of refractory arrhythmias.

  12. [Project to Reduce the Incidence Rate of Nasogastric Tube Slippage in the Rehabilitation Ward].

    Science.gov (United States)

    Chen, Chiu-Chu; Su, Wei-Ling; Li, Ai-Cheng; Lin, Hsin-Yi

    2015-06-01

    Nasogastric (NG) tubes are used for providing nutrition to patients who have difficulties swallowing. However, the difficult process of repeatedly inserting NG tubes may lead to gastric erosions. The rehabilitation ward in this study had an NG tube slippage rate of 2.26% in 2012, significantly higher than the same rate in 2011. A proposal was developed to design better techniques for nurses to perform NG tube insertions in order to decrease the rate of NG tube slippage. The following were identified as the major causes of NG tube slippage: (1) caretaker is unfamiliar with NG tube care instructions, (2) caretaker disengages NG tube constraints, and (3) improper rotation of patients or carelessness when turning patients. Therefore, the following solutions were proposed: (1) establish an NG tube safety standard operating procedure, (2) publish bilingual (English and Bahasa Indonesia) pamphlets providing instructions on the correct method of securing and placing the NG tubes, (3) make bilingual (English and Bahasa Indonesia) instructional videos showing the correct method for securing and placing the NG tubes, (4) fabricate a novel tube constraint tool (the constraint ball) that is easy to use, (5) install creative bedside NG tube warning signs, and (6) reinforce the importance of NG tube constraint and placement among caretakers. The NG tube slippage rate was reduced from 2.26% to 0.77%, and was maintained at 0.75% during the follow-up period. The caretaker assessment further showed 100% understanding of the implemented NG tube safety procedures. This proposal was established using literature research, problem identification, and creative problem solving to achieve an effective reduction in NG tube slippage as well as to enhance nursing quality.

  13. Molybdenum Tube Characterization report

    Energy Technology Data Exchange (ETDEWEB)

    Beaux II, Miles Frank [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Usov, Igor Olegovich [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-02-07

    Chemical vapor deposition (CVD) techniques have been utilized to produce free-standing molybdenum tubes with the end goal of nuclear fuel clad applications. In order to produce tubes with properties desirable for this application, deposition rates were lowered requiring long deposition durations on the order of 50 hours. Standard CVD methods as well as fluidized-bed CVD (FBCVD) methods were applied towards these objectives. Characterization of the tubes produced in this manner revealed material suitable for fuel clad applications, but lacking necessary uniformity across the length of the tubes. The production of freestanding Mo tubes that possess the desired properties across their entire length represents an engineering challenge that can be overcome in a next iteration of the deposition system.

  14. Categorising YouTube

    DEFF Research Database (Denmark)

    Simonsen, Thomas Mosebo

    2011-01-01

    This article provides a genre analytical approach to creating a typology of the User Generated Content (UGC) of YouTube. The article investigates the construction of navigation processes on the YouTube website. It suggests a pragmatic genre approach that is expanded through a focus on YouTube’s...... technological affordances. Through an analysis of the different pragmatic contexts of YouTube, it is argued that a taxonomic understanding of YouTube must be analysed in regards to the vacillation of a user-driven bottom-up folksonomy and a hierarchical browsing system that emphasises a culture of competition...... and which favours the already popular content of YouTube. With this taxonomic approach, the UGC videos are registered and analysed in terms of empirically based observations. The article identifies various UGC categories and their principal characteristics. Furthermore, general tendencies of the UGC within...

  15. Virtual 3D planning of tracheostomy placement and clinical applicability of 3D cannula design : A three-step study

    NARCIS (Netherlands)

    de Kleijn, Bertram J; Kraeima, Joep; Wachters, Jasper E; van der Laan, Bernard F A M; Wedman, Jan; Witjes, M J H; Halmos, Gyorgy B

    AIM: We aimed to investigate the potential of 3D virtual planning of tracheostomy tube placement and 3D cannula design to prevent tracheostomy complications due to inadequate cannula position. MATERIALS AND METHODS: 3D models of commercially available cannula were positioned in 3D models of the

  16. The influence of chest tube size and position in primary spontaneous pneumothorax

    DEFF Research Database (Denmark)

    Riber, Sara S.; Riber, Lars P S; Olesen, Winnie H.

    2017-01-01

    patients admitted with PSP over a 5-year period. Traumatic, iatrogenic and secondary pneumothoraxes were excluded. Gender, age, smoking habits, type and size of chest tube used (pigtail catheter or surgical chest tube) were recorded from the patients' charts. All chest X-rays upon admittance......Background: Optimal chest tube position in the pleural cavity is largely unexplored for the treatment of primary spontaneous pneumothorax (PSP). We investigated whether type, size and position of chest tubes influenced duration of treatment for PSP. Methods: A retrospective follow-up study of all...... and immediately following chest tube placement were retrieved and re-evaluated for size of pneumothorax (categorized into five groups) and location of the chest tube tip (categorized as upper, middle or lower third of the pleural cavity). All data were analysed in a Cox proportional hazards regression model...

  17. Nasogastric tube knotting: a rare and potentially overlooked complication among healthcare professionals.

    Science.gov (United States)

    Chavda, Vijay; Alhammali, Tariq; Farrant, Joanna; Naidu, Leena; El-Rabaa, Saleem

    2017-09-07

    Nasogastric tube placement is a common procedure performed in surgical and medical specialities. The occurrence of knot formation is perhaps one of the least well-recognised complications associated with its usage. We present a case of nasogastric tube knotting to remind colleagues of this rare but important complication. A 75-year-old woman with adhesional bowel obstruction was admitted under the general surgery team. A wide bore nasogastric tube was inserted for drainage and decompression. Although placement of the tube was deemed to be successful, there was no drainage of gastric content evident. On removal of the 'non-functioning' tube a simple knot was seen at its proximal end. A further nasogastric tube was placed and the patient's symptoms resolved with conservative management. Nasogastric tube knotting is a rare and often overlooked complication with the potential to cause significant trauma on tube removal if unrecognised. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. Gastric Outlet and Duodenal Obstruction as a Complication of Migrated Gastrostomy Tube: Report of Two Cases and Literature Review.

    Science.gov (United States)

    Shah, Jamil; Sunkara, Tagore; Yarlagadda, Krishna Sowjanya; Rawla, Prashanth; Gaduputi, Vinaya

    2018-02-01

    Percutaneous endoscopic gastrostomy (PEG) is a well-recognized procedure for providing enteral feeding and long-term enteral nutritional support. Although it is mostly well tolerated, complications, sometimes mechanical in nature, do occur. Rare, and often initially unrecognized, late complications of PEG tube placement are gastric outlet obstruction and duodenal obstruction. Simple adjustment of the gastrostomy tube will lead to the improvement of the patient's clinical condition and prevent further complications. Physicians should be aware of and suspect gastric outlet and duodenal obstruction as rare late complications of PEG tube placement. Simple adjustment of the gastrostomy tube can resolve the problem without unnecessary medical tests and overly aggressive care. Here, we present two interesting cases of elderly women who developed mechanical obstruction after inadvertent migration of the gastrostomy tube.

  19. Isolated Fallopian Tube Torsion

    Directory of Open Access Journals (Sweden)

    S. Kardakis

    2013-01-01

    Full Text Available Isolated torsion of the Fallopian tube is a rare gynecological cause of acute lower abdominal pain, and diagnosis is difficult. There are no pathognomonic symptoms; clinical, imaging, or laboratory findings. A preoperative ultrasound showing tubular adnexal masses of heterogeneous echogenicity with cystic component is often present. Diagnosis can rarely be made before operation, and laparoscopy is necessary to establish the diagnosis. Unfortunately, surgery often is performed too late for tube conservation. Isolated Fallopian tube torsion should be suspected in case of acute pelvic pain, and prompt intervention is necessary.

  20. Nasogastric tube position and intragastric air collection in a neonatal intensive care population.

    Science.gov (United States)

    de Boer, Jacoba Coby; Smit, Bert J; Mainous, Rosalie O

    2009-12-01

    For neonates receiving intensive care, nasogastric tube feeding is essential. Since nasogastric tube placement techniques are not well standardized and common verification methods can be unreliable, placement errors may lead to unsafe situations. In mechanically ventilated neonates and neonates on continuous positive airway pressure, malpositioning of the nasogastric tube may prevent excess air within the stomach to escape. In this study, we aimed to relate tube position to amount of air. The hypothesis was: the better the position of the tube, the smaller the amount of air in the stomach. A 1-year cohort of neonates in a level IIIc neonatal intensive care unit with a nasogastric tube. We retrospectively reviewed 326 radiographs and classified nasogastric tube position and gastric air. Descriptive statistics were used to describe demographic data. Kendal's tau statistic was applied to explore the relationship between nasogastric tube position and amount of gastric air. A Mann-Whitney U test was performed to confirm the differences in gastric air in neonates with Ch5 and Ch6 gastric tubes and neonates with Ch8 gastric tubes. One or both orifices of nasogastric tubes were in the esophagus in 7.1% of cases, tubes were curled up in the stomach in 35.3% of cases, and tube tips were beyond the pyloric sphincter in 5.5% of cases. Substantial or excessive air was found in 37.7% of cases. Kendal's tau value indicated that there was no significant correlation between nasogastric tube position and gastric air. The Mann-Whitney U value indicated that children with Ch5 and Ch6 gastric tubes had significantly more gastric air than children with Ch8 gastric tubes. Nasogastric tubes were malpositioned in nearly half of cases, and substantial or excessive air was found in more than one-third of cases. The hypothesis-the better the position of the tube, the smaller the amount of gastric air-was not confirmed by the data. However, a significant relationship was found between tube

  1. Automation in tube finishing bay

    International Nuclear Information System (INIS)

    Bhatnagar, Prateek; Satyadev, B.; Raghuraman, S.; Syama Sundara Rao, B.

    1997-01-01

    Automation concept in tube finishing bay, introduced after the final pass annealing of PHWR tubes resulted in integration of number of sub-systems in synchronisation with each other to produce final cut fuel tubes of specified length, tube finish etc. The tube finishing bay which was physically segregated into four distinct areas: 1. tube spreader and stacking area, 2. I.D. sand blasting area, 3. end conditioning, wad blowing, end capping and O.D. wet grinding area, 4. tube inspection, tube cutting and stacking area has been studied

  2. The Impact of Tympanostomy Tubes on Speech and Language Development in Children with Cleft Palate.

    Science.gov (United States)

    Shaffer, Amber D; Ford, Matthew D; Choi, Sukgi S; Jabbour, Noel

    2017-09-01

    Objective Describe the impact of hearing loss, tympanostomy tube placement before palatoplasty, and number of tubes received on speech outcomes in children with cleft palate. Study Design Case series with chart review. Setting Tertiary care children's hospital. Subjects and Methods Records from 737 children born between April 2005 and April 2015 who underwent palatoplasty at a tertiary children's hospital were reviewed. Exclusion criteria were cleft repair at an outside hospital, intact secondary palate, absence of postpalatoplasty speech evaluation, sensorineural or mixed hearing loss, no tubes, first tubes after palatoplasty, or first clinic after 12 months of age. Data from 152 patients with isolated cleft palate and 166 patients with cleft lip and palate were analyzed using Wilcoxon rank-sum, χ 2 , and Fisher exact test and logistic regression. Results Most patients (242, 76.1%) received tubes before palatoplasty. Hearing loss after tubes, but not before, was associated with speech/language delays at 24 months ( P = .005) and language delays ( P = .048) and speech sound production disorders (SSPDs, P = .040) at 5 years. Receiving tubes before palatoplasty was associated with failed newborn hearing screen ( P = .001) and younger age at first posttubes type B tympanogram with normal canal volume ( P = .015). Hearing loss after tubes ( P = .021), language delays ( P = .025), SSPDs ( P = .003), and velopharyngeal insufficiency ( P = .032) at 5 years and speech surgery ( P = .022) were associated with more tubes. Conclusion Continued middle ear disease, reflected by hearing loss and multiple tubes, may impair speech and language development. Inserting tubes before palatoplasty did not mitigate these impairments better than later tube placement.

  3. Product placement of computer games in cyberspace.

    Science.gov (United States)

    Yang, Heng-Li; Wang, Cheng-Shu

    2008-08-01

    Computer games are considered an emerging media and are even regarded as an advertising channel. By a three-phase experiment, this study investigated the advertising effectiveness of computer games for different product placement forms, product types, and their combinations. As the statistical results revealed, computer games are appropriate for placement advertising. Additionally, different product types and placement forms produced different advertising effectiveness. Optimum combinations of product types and placement forms existed. An advertisement design model is proposed for use in game design environments. Some suggestions are given for advertisers and game companies respectively.

  4. X-ray tube

    International Nuclear Information System (INIS)

    Webley, R.S.

    1975-01-01

    The object of the invention described is to provide an X-ray tube providing a scanned X-ray output which does not require a scanned electron beam. This is obtained by an X-ray tube including an anode which is rotatable about an axis, and a source of a beam of energy, for example an electron beam, arranged to impinge on a surface of the anode to generate X-radiation substantially at the region of incidence on the anode surface. The anode is rotatable about the axis to move the region of incidence over the surface. The anode is so shaped that the rotation causes the region of incidence to move in a predetermined manner relative to fixed parts of the tube so that the generated X-radiation is scanned in a predetermined manner relative to the tube. (UK)

  5. Tube Alinement for Machining

    Science.gov (United States)

    Garcia, J.

    1984-01-01

    Tool with stepped shoulders alines tubes for machining in preparation for welding. Alinement with machine tool axis accurate to within 5 mils (0.13mm) and completed much faster than visual setup by machinist.

  6. Steam generator tube performance

    International Nuclear Information System (INIS)

    Tatone, O.S.; Pathania, R.S.

    1982-04-01

    The performance of steam generator tubes in water-cooled nuclear power reactors has been reviewed for 1980. Tube defects occurred at 38% of the 97 reactors surveyed. This is a marginal improvement over 1979 when defects occurred at 41% of the reactors. The number of failed tubes was also lower, 0.14% of the tubes in service in 1980 compared with 0.20% of those in service in 1979. Analysis of the causes of these failures indicates that stress corrosion cracking was the leading failure mechanism. Reactors that used all-volatile treatment of secondary water, with or without full-flow condensate demineralization since start-up showed the lowest incidence of corrosion-related defects

  7. Ear tube insertion

    Science.gov (United States)

    ... mastoiditis) or the brain, or that damages nearby nerves Injury to the ear after sudden changes in ... does not heal after the tube falls out. Most of the time, these problems DO NOT last long. They also ...

  8. Tube Feeding Troubleshooting Guide

    Science.gov (United States)

    ... the diameter is measured in units known as French sizes, or “Fr”; a low profile tube also ... your quality of life. You are encouraged to speak with your physician, dietitian, home care company, or ...

  9. Realistic Chest Tube Simulator Using Pork Belly with Skin

    Directory of Open Access Journals (Sweden)

    Donald Patrick Mebust

    2017-07-01

    Full Text Available Audience: The pork belly chest tube simulator is designed to instruct Emergency Medicine residents and Emergency Medicine-bound students. Introduction: Chest tube insertion is an essential procedural skill that must be mastered by practicing emergency and surgical providers. It is a lifesaving procedure indicated in cases of pneumothorax, hemothorax, chylothorax, empyema, esophageal/gastric rupture into the pleural space, and traumatic arrest.1,2 These critical patients require immediate decompression and evacuation of pleural space pathology. Therefore, chest tube insertion must be performed competently and expeditiously to prevent further morbidity and mortality. Performed improperly, chest tube placement can lead to ineffective decompression as well as life threatening visceral and vascular injury. Overall complications rates have been quoted up to 37%.3,4 Simulation offers a safe and effective method to master such procedural techniques. Unfortunately, many chest tube simulators are expensive5 or do not offer a realistic simulation experience. Therefore, we have designed an economical device that has a life-like feel, very similar to human skin and tissue. Objective: The purpose of this model is to teach residents and students how to competently perform and properly secure a surgical chest tube. Methods: This chest tube simulator uses a piece of pork belly that includes skin with underlying muscle and fascia. This tissue is placed over wooden strips and foam tape which are a proxy for human ribs and pleura. This chest wall anatomy allows the learner to locate landmarks, palpate intercostal spaces on real skin, and perform blunt dissection with a realistic “pop” of pleural tissue. Finally, since chest tube dislodgment is a common and unfortunate cause of morbidity and mortality, this chest wall design allows the learner to practice the essential and various techniques of securing the chest tube to real skin.

  10. Magnesium tube hydroforming

    Energy Technology Data Exchange (ETDEWEB)

    Liewald, M.; Pop, R. [Institute for Metal Forming Technology (IFU), Stuttgart (Germany)

    2008-04-15

    Magnesium alloys reveal a good strength-to-weight ratio in the family of lightweight metals and gains potential to provide up to 30% mass savings compared to aluminium and up to 75 % compared to steel. The use of sheet magnesium alloys for auto body applications is however limited due to the relatively low formability at room temperature. Within the scope of this paper, extruded magnesium tubes, which are suitable for hydroforming applications, have been investigated. Results obtained at room temperature using magnesium AZ31 tubes show that circumferential strains are limited to a maximal value of 4%. In order to examine the influence of the forming temperature on tube formability, investigations have been carried out with a new die set for hot internal high pressure (IHP) forming at temperatures up to 400 C. Earlier investigations with magnesium AZ31 tubes have shown that fractures occur along the welding line at tubes extruded over a spider die, whereby a non-uniform expansion at bursting with an elongation value of 24% can be observed. A maximum circumferential strain of approx. 60% could be attained when seamless, mechanically pre-expanded and annealed tubes of the same alloy have been used. The effect of annealing time on materials forming properties shows a fine grained structure for sufficient annealing times as well as deterioration with a large increase at same time. Hence, seamless ZM21 tubes have been used in the current investigations. With these tubes, an increased tensile fracture strain of 116% at 350 C is observed as against 19% at 20 C, obtained by tensile testing of milled specimens from the extruded tubes. This behaviour is also seen under the condition of tool contact during the IHP forming process. To determine the maximum circumferential strain at different forming temperatures and strain rates, the tubes are initially bulged in a die with square cross-section under plane stress conditions. Thereafter, the tubes are calibrated by using an

  11. Power vacuum tubes handbook

    CERN Document Server

    Whitaker, Jerry

    2012-01-01

    Providing examples of applications, Power Vacuum Tubes Handbook, Third Edition examines the underlying technology of each type of power vacuum tube device in common use today. The author presents basic principles, reports on new development efforts, and discusses implementation and maintenance considerations. Supporting mathematical equations and extensive technical illustrations and schematic diagrams help readers understand the material. Translate Principles into Specific Applications This one-stop reference is a hands-on guide for engineering personnel involved in the design, specification,

  12. Dynamics of tubes in fluid with tube-baffle interaction

    International Nuclear Information System (INIS)

    Chen, S.S.; Jendrzejczyk, J.A.; Wambsganss, M.W.

    1983-09-01

    Three series of tests are performed to evaluate the effects of tube to tube-support-plate (TSP) clearance on tube dynamic characteristics and instability phenomena for tube arrays in crossflow. Test results show that, for relatively large clearances, tubes may possess TSP-inactive modes in which the tubes rattle inside some of the tube-support-plate holes, and that the natural frequencies of TSP-inactive modes are lower than those of TSP-active modes, in which the support plates provide knife-edge type support. Tube response characteristics associated with TSP-inactive modes are sensitive to tube-to-TSP clearance, TSP thickness, excitation amplitude, tube alignment, and the fluid inside the clearance. In addition, tube response is intrinsically nonlinear, with the dominance of TSP-inactive or TSP-active modes depending on the magnitudes of different system parameters. In general, such a system is difficult to model; only a full-scale test can provide all the necessary characteristics. A tube array supported by TSPs with relatively large clearances may be subjected to dynamic instability in some of the TSP-inactive modes; tube response characteristics and impact forces on TSPs for a tube row are studied in detail in this report. Tube displacements associated with the instability of a TSP-inactive mode are small; however, impacts of the tube against TSPs may result in significant damage in a relatively short time. 52 figures

  13. Pleural controversy: optimal chest tube size for drainage.

    Science.gov (United States)

    Light, Richard W

    2011-02-01

    In recent years, a higher and higher percentage of patients with pleural effusions or pneumothorax are being treated with small-bore (10-14 F) chest tubes rather than large-bore (>20 F). However, there are very few randomized controlled studies comparing the efficacy and complication rates with the small- and large-bore catheters. Moreover, the randomized trials that are available have flaws in their design. The advantages of the small-bore catheters are that they are easier to insert and there is less pain with their insertion while they are in place. The placement of the small-bore catheters is probably more optimal when placement is done with ultrasound guidance. Small-bore chest tubes are recommended when pleurodesis is performed. The success of the small-bore indwelling tunnelled catheters that are left in place for weeks documents that the small-bore tubes do not commonly become obstructed with fibrin. Patients with complicated parapneumonic effusions are probably best managed with small-bore catheters even when the pleural fluid is purulent. Patients with haemothorax are best managed with large-bore catheters because of blood clots and the high volume of pleural fluid. Most patients with pneumothorax can be managed with aspiration or small-bore chest tubes. If these fail, a large-bore chest tube may be necessary. Patients on mechanical ventilation with barotrauma induced pneumothoraces are best managed with large-bore chest tubes. © 2011 The Author. Respirology © 2011 Asian Pacific Society of Respirology.

  14. Gastrostomy feeding tube - pump - child

    Science.gov (United States)

    ... tube feeding; PEG tube care; Feeding - gastrostomy tube - pump; G-tube - pump; Gastrostomy button - pump; Bard Button - pump; MIC-KEY - pump ... Gather supplies: Feeding pump (electronic or battery powered) Feeding ... pump (includes a feeding bag, drip chamber, roller clamp, ...

  15. NEI You Tube Videos: Amblyopia

    Medline Plus

    Full Text Available ... search for current job openings visit HHS USAJobs Home >> NEI YouTube Videos >> NEI YouTube Videos: Amblyopia Listen NEI YouTube Videos YouTube Videos Home Age-Related Macular Degeneration Amblyopia Animations Blindness Cataract ...

  16. Use of guiding sheaths in peroral fluoroscopic gastroduodenal stent placement

    International Nuclear Information System (INIS)

    Bae, Jae-Ik; Shin, Ji Hoon; Song, Ho-Young; Yoon, Chang Jin; Nam, Deok Ho; Choi, Won-Chan; Lim, Jin-Oh

    2005-01-01

    Our purpose was to assess the safety and usefulness of guiding sheaths in peroral fluoroscopic gastroduodenal stent placement. Two types of guiding sheath were made from straight polytetrafluoroethylene tubes. Type A was 80 cm in length, 4 mm in outer diameter and 3 mm in inner diameter. Type B was 70 cm in length, 6 mm in outer diameter and 5 mm in inner diameter. The type A sheath was used in 18 patients in whom a catheter-guide wire combination failed to pass through a stricture. The type B sheath was used in 22 patients in whom a stent delivery system failed to pass through the stricture due to loop formation within the gastric lumen. The overall success rate for guiding a catheter-guide wire through a stricture after using the type A sheath was 89%. The overall success rate for passing a stent delivery system through a stricture after using the type B sheath was 100%. All procedures were tolerated by the patients without any significant complications. The guiding sheaths were safe and useful in peroral fluoroscopic gastroduodenal stent placement. (orig.)

  17. Understanding Successful Sandwich Placements: A Bourdieusian Approach

    Science.gov (United States)

    Clark, Martyn; Zukas, Miriam

    2016-01-01

    Sandwich placements and other integrated work and study schemes are increasingly advocated as a key means by which universities can promote students' employability. However, there is little understanding of how successful placements work in terms of facilitating learning and development. Drawing on three longitudinal case studies of students who…

  18. Percutaneous Placement of Peritoneal Dialysis Catheters in ...

    African Journals Online (AJOL)

    Background: The percutaneous placement of peritoneal dialysis (PD) catheters using conscious sedation with ultrasound and fluoroscopic guidance is underutilised and hasseveral advantages over the open surgical and laparoscopic placement methods, especially in the resource-limited developing world. Objectives: To ...

  19. Clitoral Pain Following Retropubic Midurethral Sling Placement

    Directory of Open Access Journals (Sweden)

    Melanie Christofferson, DO

    2015-12-01

    Conclusion: Clitoral pain symptoms following placement of a retropubic midurethral sling should be evaluated and promptly addressed, given the potential negative impact on the patient's sexual function. Christofferson M, Barnard J, and Montoya TI. Clitoral pain following retropubic midurethral sling placement. Sex Med 2015;3:346–348.

  20. Private Placement Debt Financing for Public Entities

    Science.gov (United States)

    Holman, Lance S.

    2010-01-01

    Private placement financing is a debt or capital lease obligation arranged between a municipality or a 501(c) (3) not-for-profit organization and a single sophisticated institutional investor. The investor can be a bank, insurance company, finance company, hedge fund, or high-net worth individual. Private placement financing is similar to…

  1. 32 CFR 1656.10 - Job placement.

    Science.gov (United States)

    2010-07-01

    ... will be reassigned in accordance with § 1656.12. (c) In making job interview referrals and in making... 32 National Defense 6 2010-07-01 2010-07-01 false Job placement. 1656.10 Section 1656.10 National....10 Job placement. (a) Selective Service will maintain a job bank for the exclusive purpose of placing...

  2. Artificial Intelligence based technique for BTS placement

    International Nuclear Information System (INIS)

    Alenoghena, C O; Emagbetere, J O; 1 Minna (Nigeria))" data-affiliation=" (Department of Telecommunications Engineering, Federal University of Techn.1 Minna (Nigeria))" >Aibinu, A M

    2013-01-01

    The increase of the base transceiver station (BTS) in most urban areas can be traced to the drive by network providers to meet demand for coverage and capacity. In traditional network planning, the final decision of BTS placement is taken by a team of radio planners, this decision is not fool proof against regulatory requirements. In this paper, an intelligent based algorithm for optimal BTS site placement has been proposed. The proposed technique takes into consideration neighbour and regulation considerations objectively while determining cell site. The application will lead to a quantitatively unbiased evaluated decision making process in BTS placement. An experimental data of a 2km by 3km territory was simulated for testing the new algorithm, results obtained show a 100% performance of the neighbour constrained algorithm in BTS placement optimization. Results on the application of GA with neighbourhood constraint indicate that the choices of location can be unbiased and optimization of facility placement for network design can be carried out

  3. Genetic Algorithm Approaches for Actuator Placement

    Science.gov (United States)

    Crossley, William A.

    2000-01-01

    This research investigated genetic algorithm approaches for smart actuator placement to provide aircraft maneuverability without requiring hinged flaps or other control surfaces. The effort supported goals of the Multidisciplinary Design Optimization focus efforts in NASA's Aircraft au program. This work helped to properly identify various aspects of the genetic algorithm operators and parameters that allow for placement of discrete control actuators/effectors. An improved problem definition, including better definition of the objective function and constraints, resulted from this research effort. The work conducted for this research used a geometrically simple wing model; however, an increasing number of potential actuator placement locations were incorporated to illustrate the ability of the GA to determine promising actuator placement arrangements. This effort's major result is a useful genetic algorithm-based approach to assist in the discrete actuator/effector placement problem.

  4. Do X-rays after chest tube removal change patient management?

    Science.gov (United States)

    Johnson, Bret; Rylander, Michele; Beres, Alana L

    2017-05-01

    A link between childhood radiation and future cancer risks exists, and reduction of unnecessary radiation in childhood has been recommended. Pneumothoraces, pleural effusions, and many surgical procedures require placement of a chest tube/pigtail catheter. Traditional management is daily x-rays, with an x-ray after tube removal. Our hypothesis is the "post pull" x-ray rarely results in changing clinical management of the patient. With IRB approval, a 5-year retrospective chart review was performed. Inclusion criteria were chest tube or pigtail placed for any reason with complete records. Data collected were demographics, reason for and duration of placement, number of x-rays done prior to and after removal. Primary outcome was whether the "post pull" x-ray changed clinical management. A total of 179 episodes were evaluated. Seventeen were excluded for incomplete data, or death/transfer of the patient with the tube in situ. Forty-nine tubes/pigtails were placed for pneumothorax, 48 for pleural effusion/empyema, 9 for hemothorax, and 51 during operative procedure. A median of 5 x-rays was done post insertion. 99% of the patients (160/162) had a "post pull" x-ray performed after tube removal. In 9 cases the x-ray changed patient management. X-ray after chest tube/pigtail removal rarely changes patient management. We recommend considering imaging if there are clinical symptoms. Prognosis study, level II (retrospective cohort). Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Categorising YouTube

    Directory of Open Access Journals (Sweden)

    Thomas Mosebo Simonsen

    2011-09-01

    Full Text Available This article provides a genre analytical approach to creating a typology of the User Generated Content (UGC of YouTube. The article investigates the construction of navigationprocesses on the YouTube website. It suggests a pragmatic genre approach that is expanded through a focus on YouTube’s technological affordances. Through an analysis of the different pragmatic contexts of YouTube, it is argued that a taxonomic understanding of YouTube must be analysed in regards to the vacillation of a user-driven bottom-up folksonomy and a hierarchical browsing system that emphasises a culture of competition and which favours the already popular content of YouTube. With this taxonomic approach, the UGC videos are registered and analysed in terms of empirically based observations. The article identifies various UGC categories and their principal characteristics. Furthermore, general tendencies of the UGC within the interacting relationship of new and old genres are discussed. It is argued that the utility of a conventional categorical system is primarily of analytical and theoretical interest rather than as a practical instrument.

  6. Risks of Using Bedside Tests to Verify Nasogastric Tube Position in Adult Patients

    Directory of Open Access Journals (Sweden)

    Melody Ni

    2014-12-01

    Full Text Available Nasogastric (NG tubes are commonly used for enteral feeding. Complications of feeding tube misplacement include malnutrition, pulmonary aspiration, and even death. We built a Bayesian network (BN to analyse the risks associated with available bedside tests to verify tube position. Evidence on test validity (sensitivity and specificity was retrieved from a systematic review. Likelihood ratios were used to select the best tests for detecting tubes misplaced in the lung or oesophagus. Five bedside tests were analysed including magnetic guidance, aspirate pH, auscultation, aspirate appearance, and capnography/colourimetry. Among these, auscultation and appearance are non-diagnostic towards lung or oesophagus placements. Capnography/ colourimetry can confirm but cannot rule out lung placement. Magnetic guidance can rule out both lung and oesophageal placement. However, as a relatively new technology, further validation studies are needed. The pH test with a cut-off at 5.5 or lower can rule out lung intubation. Lowering the cut-off to 4 not only minimises oesophageal intubation but also provides extra safety as the sensitivity of pH measurement is reduced by feeding, antacid medication, or the use of less accurate pH paper. BN is an effective tool for representing and analysing multi-layered uncertainties in test validity and reliability for the verification of NG tube position. Aspirate pH with a cut-off of 4 is the safest bedside method to minimise lung and oesophageal misplacement.

  7. Fill tube fitted spheres

    International Nuclear Information System (INIS)

    Ives, B.H.

    1981-01-01

    The high temperature diffusion technique for fuel filling of some future direct drive cryogenic ICF targets may be unacceptable. The following describes a technique of fitting a 1 mm diameter x 6 μm thick glass microsphere with an approx. 50 μm O.D. glass fill tube. The process of laser drilling a 50 μm diameter hole in the microsphere wall, technique for making the epoxy joint between the sphere and fill tube, as well as the assembly procedure are also discussed

  8. Steam generator tube vibration study

    International Nuclear Information System (INIS)

    Enderlin, W.I.

    1986-01-01

    Chemical cleaning has been proposed to remove magnetite buildup in some pressurized water reactor steam generators. The US Nuclear Regulatory Commission (NRC) has expressed concern that such cleaning would combine with the tube denting caused by magnetite formation to enlarge tube/tube support plate clearances, increasing the level of flow-induced vibrations that could lead to unacceptably high tube wear and failure rates. In support of NRC, the Pacific Northwest Laboratory investigated whether such increased clearances would exacerbate tube fretting wear. Using a full-length scale model of a steam generator tube bundle, flow tests were conducted at an instrumented location through clearances representing as-built and post-cleaned tube conditions. Test results indicated little potential for increased tube wear as a result of chemical cleaning, under normal operating conditions at tube support locations similar to that tested

  9. Investigation of bacteremia after separator placement

    Directory of Open Access Journals (Sweden)

    Anjuman Preet Kaur Dua

    2016-01-01

    Full Text Available Background: Simple orthodontic procedure such as separator placement can be associated with the occurrence of transient bacteraemia. Use of clorhexidine before separator placement has been recommended as a measure to decrease the bacteraemia. Aim: The purpose of this study was to detect the presence of transient bacteremia after separator placement following use of 0.2% chlorhexidine gluconate mouthwash. Methodology: The study group consisted of 27 adult patients who reported for orthodontic treatment (18 males and 9 females. The patients were asked to rinse their mouth for 60 sec with 15 mL of 0.2% chlorhexidine gluconate mouthwash before the separator placement. An aseptic technique was used to draw out 5 ml of blood was from either the left or right antecubital fossa immediately before orthodontic separator placement (as control group, and the second 5 ml sample was taken 1–2 min after the placement of separators mesial and distal to all the first molars. All the blood samples were inoculated into culture bottles containing Brain Heart Infusion and incubated aerobically for 7 days. Media used for bacterial growth is chocolate agar and MacConkey agar. Results: From a total of 27 patients and 54 samples, none of the sample was found positive for bacteremia. Conclusion: This study demonstrated that there is no bacteremia after the placement of separators following the use of chlorhexidine mouthwash.

  10. Use of Gastrostomy Tube to Prevent Maternal PKU Syndrome.

    Science.gov (United States)

    Schwoerer, Jessica A Scott; Obernolte, Lisa; Van Calcar, Sandra; Heighway, Susan; Bankowski, Heather; Williams, Phillip; Rice, Gregory

    2012-01-01

    Maternal Phenylketonuria Syndrome (MPKU) can occur in infants born to mothers with PKU with poor metabolic control during pregnancy. Elevated phenylalanine (phe) acts as a teratogen to the developing fetus with consequences including intellectual disability, microcephaly, facial dysmorphism, growth retardation, and congenital heart disease. MPKU can be prevented if metabolic control is achieved by 8-10 weeks gestation. If control is not achieved, there is a significant risk for MPKU. Therefore, in women with poor metabolic control at time of pregnancy, establishing metabolic control quickly is important.Clinically, establishing metabolic control in women with PKU can present challenges. Social issues, psychological issues, and insufficient education about PKU play an important role in a patient's inability to reinstitute this challenging diet. Maintaining phe levels within a range to allow for infant growth, while preventing toxicity, is challenging, particularly for those women who no longer follow the PKU diet. Gastrostomy tube placement is an option to deliver medical formula to women who are unable to restart diet due to severe nausea or palatability issues.Here we discuss two pregnancies in which a gastrostomy tube was placed to achieve metabolic control after other measures failed to reduce phe concentrations into the recommended range. For these two pregnancies, placement of the gastrostomy tube led to improvement in phe levels with normal infant outcomes including normal growth, head circumference, and heart structure.

  11. Are success and survival rates of early implant placement higher than immediate implant placement?

    Science.gov (United States)

    Soydan, S S; Cubuk, S; Oguz, Y; Uckan, S

    2013-04-01

    Immediate placement refers to the placement of an implant into a tooth socket at the time of extraction; early placement refers to the placement of an implant after substantial gingival healing, but before any clinically significant bone fill occurs within the socket. This study evaluated the success and survival rates of implants following immediate and early placement. 50 implants were placed in 36 patients. 26 immediate (group I) and 24 early placements (group II) were performed. Pain or tenderness with function, mobility, radiographic bone loss from initial surgery and exudate history were evaluated. Mean vertical bone loss in the immediate placement group was 0.55 mm and 0.80 mm in the early placement group. The survival rate for the immediate placement group was 96.16% with 51.6 months follow-up and in the early placement group was 100% with 61.9 months follow-up. The results of this study suggest that although the success and survival rates of early placed implants were a little higher and the follow up period was longer than immediately placed implants, the difference was not remarkable. In conclusion, both implant insertion techniques are safe and reliable procedures with considerably high survival rates. Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  12. Misdirected minitracheostomy tube

    Directory of Open Access Journals (Sweden)

    Ajmer Singh

    2017-01-01

    Full Text Available We report a patient who after an uneventful coronary artery bypass graft surgery and left ventricular aneurysmorrhaphy developed intracerebral hemorrhage and subsequently required minitracheostomy. Chest X-ray showed misdirected minitracheostomy tube facing upward toward the laryngeal opening which was repositioned using bronchoscope.

  13. A New Resonance Tube

    Science.gov (United States)

    Bates, Alan

    2017-01-01

    The measurement of the speed of sound in air with the resonance tube is a popular experiment that often yields accurate results. One approach is to hold a vibrating tuning fork over an air column that is partially immersed in water. The column is raised and lowered in the water until the generated standing wave produces resonance: this occurs at…

  14. Thoughts of accelerator tubes

    International Nuclear Information System (INIS)

    Larson, J.D.

    1977-01-01

    A brief, subjective review is given of mechanisms that may be limiting electrostatic accelerator tubes to present levels of performance. Suggestions are made for attacking these limitations with the purpose of stimulating the thinking of designers and users of electrostatic accelerators

  15. Thoughts of accelerator tubes

    Energy Technology Data Exchange (ETDEWEB)

    Larson, J D

    1977-01-01

    A brief, subjective review is given of mechanisms that may be limiting electrostatic accelerator tubes to present levels of performance. Suggestions are made for attacking these limitations with the purpose of stimulating the thinking of designers and users of electrostatic accelerators.

  16. Eustachian Tube Dysfunction

    Science.gov (United States)

    ... When it is inflated, the balloon opens a pathway for mucus and air to flow through the tube. This can help it function properly. FDA warning The U.S. Food and Drug Administration (FDA) advises against the use of ear candles. ...

  17. Tube-dwelling invertebrates

    NARCIS (Netherlands)

    Hölker, Franz; Vanni, Michael J.; Kuiper, Jan J.; Meile, Christof; Grossart, Hans Peter; Stief, Peter; Adrian, Rita; Lorke, Andreas; Dellwig, Olaf; Brand, Andreas; Hupfer, Michael; Mooij, Wolf M.; Nützmann, Gunnar; Lewandowski, Jörg

    2015-01-01

    There is ample evidence that tube-dwelling invertebrates such as chironomids significantly alter multiple important ecosystem functions, particularly in shallow lakes. Chironomids pump large water volumes, and associated suspended and dissolved substances, through the sediment and thereby compete

  18. Chest tube insertion

    Science.gov (United States)

    ... of your chest cavity. This is called the pleural space. It is done to allow your lungs to fully expand. ... pneumothorax ) Fluid buildup in the chest (called a pleural ... in the esophagus (the tube that allows food to go from the mouth ...

  19. Precordial electrode placement in women.

    Science.gov (United States)

    Macfarlane, P W; Colaco, R; Stevens, K; Reay, P; Beckett, C; Aitchison, T

    2003-03-01

    Precordial ECG electrode positioning was standardised in the early 1940s. However, it has been customary for the V 3 to V 6 electrodes to be placed under the left breast in women rather than in the correct anatomical positions relating to the 4th and 5th interspaces. For this reason, a comparison between the two approaches to chest electrode positioning in women was undertaken. In total 84 women were recruited and ECGs recorded with electrodes in the correct anatomical position and also in the more commonly used positions under the breast. As a separate study, 299 healthy women were recruited to study normal limits of leads V 3 to V 6 recorded with electrodes in the correct anatomical positions and compare them with published normal limits with electrodes in the more commonly used locations. It was shown that there was less variability with electrodes in the correct anatomical positions and that there were significant differences between the new limits of normality compared with the old established limits. Expansion of the database and further analysis of the data is required to make a definitive recommendation with respect to precordial electrode placement in women.

  20. Sensor Placement Optimization using Chama

    Energy Technology Data Exchange (ETDEWEB)

    Klise, Katherine A. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Geotechnology and Engineering Dept.; Nicholson, Bethany L. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Discrete Math and Optimization Dept.; Laird, Carl Damon [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Discrete Math and Optimization Dept.

    2017-10-01

    Continuous or regularly scheduled monitoring has the potential to quickly identify changes in the environment. However, even with low - cost sensors, only a limited number of sensors can be deployed. The physical placement of these sensors, along with the sensor technology and operating conditions, can have a large impact on the performance of a monitoring strategy. Chama is an open source Python package which includes mixed - integer, stochastic programming formulations to determine sensor locations and technology that maximize monitoring effectiveness. The methods in Chama are general and can be applied to a wide range of applications. Chama is currently being used to design sensor networks to monitor airborne pollutants and to monitor water quality in water distribution systems. The following documentation includes installation instructions and examples, description of software features, and software license. The software is intended to be used by regulatory agencies, industry, and the research community. It is assumed that the reader is familiar with the Python Programming Language. References are included for addit ional background on software components. Online documentation, hosted at http://chama.readthedocs.io/, will be updated as new features are added. The online version includes API documentation .

  1. Traumatic tibialis anterior tendon rupture: treatment with a two-stage silicone tube and an interposition hamstring tendons graft protocol.

    Science.gov (United States)

    Kontogeorgakos, Vasileios; Koutalos, Antonios; Hantes, Michael; Manoudis, Gregory; Badras, Leonidas; Malizos, Konstantinos

    2015-03-01

    A novel technique for managing ruptured tibialis anterior tendon complicated by infection and tendon substance loss in a young adult is described. A two-stage reconstruction technique with a silicon tube and tendon autograft was performed. At first, after local control of the infection, scar excision and placement of a silicone tube was performed. Ten weeks later, ipsilateral hamstrings tendons were harvested and bridged the 7 cm tendon gap. Eighteen months later, the patient has excellent clinical and functional outcome.

  2. Selective Placement Program Coordinator (SPPC) Directory

    Data.gov (United States)

    Office of Personnel Management — List of the Selective Placement Program Coordinators (SPPC) in Federal agencies, updated as needed. Users can filter the list by choosing a state and/or agency name.

  3. Drift tubes of Linac 2

    CERN Multimedia

    Photographic Service

    1977-01-01

    Being redied for installation, those at the right are for tank 1, those on the left for tank 2. Contrary to Linac 1, which had drift-tubes supported on stems, here the tubes are suspended, for better mechanical stability.

  4. Rubens Flame-Tube Demonstration.

    Science.gov (United States)

    Ficken, George W.; Stephenson, Francis C.

    1979-01-01

    Investigates and explains the phenomenon associated with Rubens flame-tube demonstration, specifically the persistance of flames at regular intervals along the tube for few minutes after the gas is turned off. (GA)

  5. Prospects for stronger calandria tubes

    International Nuclear Information System (INIS)

    Ells, C.E.; Coleman, C.E.; Hosbons, R.R.; Ibrahim, E.F.; Doubt, G.L.

    1990-12-01

    The CANDU calandria tubes, made of seam welded and annealed Zircaloy-2, have given exemplary service in-reactor. Although not designed as a system pressure containment, calandria tubes may remain intact even in the face of pressure tube rupture. One such incident at Pickering Unit 2 demonstrated the economic advantage of such an outcome, and a case can be made for increasing the probability that other calandria tubes would perform in a similar fashion. Various methods of obtaining stronger calandria tubes are available, and reviewed here. When the tubes are internally pressurized, the weld is the weak section of the tube. Increasing the oxygen concentration in the starting sheet, and thickening the weld, are promising routes to a stronger tube

  6. Disclosing brand placement to young children

    OpenAIRE

    De Pauw, Pieter; Hudders, Liselot; Cauberghe, Veroline; De Kuysscher, Charlotte

    2015-01-01

    Purpose – This article examines whether a television brand placement warning cue can alter young children’s susceptibility for advertising effects (i.e., brand attitude) through activating their advertising literacy. The proposed model also puts forward an important moderating role for children’s skeptical attitude toward the brand placement format. Design/methodology/approach – The data were collected among 63 children between 7 and 9 years old (Mage = 8.49; 51% girls) through a single...

  7. Pregnancy Outcomes After Myomectomy With Polytetrafluoroethylene Placement

    OpenAIRE

    Eaton, Jennifer L.; Milad, Magdy P.

    2014-01-01

    Background and Objectives: The aim of this study was to report preliminary data on pregnancy outcomes after myomectomy with placement of an expanded polytetrafluoroethylene adhesion barrier membrane. Methods: In this retrospective case series, 68 women who underwent myomectomy with expanded polytetrafluoroethylene membrane placement between January 1, 2003, and December 31, 2009, were identified. Of these women, 15 subsequently had documented pregnancies and were included in the final dataset...

  8. Règlement institutionnel Déplacements

    International Development Research Centre (IDRC) Digital Library (Canada)

    Julie Pépin

    placements et toutes les réservations connexes conformément au présent règlement. Toutes les personnes qui voyagent pour le Centre doivent avoir recours aux services de cette agence pour l'obtention de conseils, de réservations et de titres de transport aux fins de tous les déplacements payés par le CRDI (transport ...

  9. Multiple immediate implants placement with immediate loading

    OpenAIRE

    Narang, Sumit; Narang, Anu; Jain, Kapil; Bhatia, Vineet

    2014-01-01

    The replacement of missing teeth with implant-borne restorations has become a treatment modality accepted by the scientific community for fully and partially edentulous patients. Recent reports have demonstrated the successful placement of dental implants into the fresh extraction socket in the anterior as well as in molar regions, which is made possible due to modification in implant surface. The present case report highlights the placement of three bicortical screw (BCS) implants into the f...

  10. Immediate Implant Placement: Report of Case Series

    Directory of Open Access Journals (Sweden)

    Koray M.

    2015-07-01

    Full Text Available Objective: The aim of this study was to evaluate the outcome of immediate postextraction implant placement. Immediate placement of dental implants have been claimed of the potential advantages such as reductions in the number of surgical interventions, a shorter treatment time, an ideal 3-dimensional implant positioning, the presumptive preservation of alveolar bone at the site of the tooth extraction and soft tissue aesthetics.

  11. Expansion lyre-shaped tube

    International Nuclear Information System (INIS)

    Andro, Jean.

    1973-01-01

    The invention relates the expansion lyre-shaped tube portions formed in dudgeoned tubular bundles between two bottom plates. An expansion lyre comprises at least two sets of tubes of unequal lengths coplanar and symmetrical with respect to the main tube axis, with connecting portions between the tubes forming said sets. The invention applies to apparatus such as heat exchangers, heaters, superheaters or breeders [fr

  12. A Heuristic Force Model for Haptic Simulation of Nasogastric Tube Insertion Using Fuzzy Logic.

    Science.gov (United States)

    Choi, Kup-Sze; He, Xue-Jian; Chiang, Vico C L; Deng, Zhaohong; Qin, Jing

    2016-01-01

    Nasogastric tube (NGT) placement is an essential clinical skill. The training is conventionally performed on rubber mannequins albeit practical limitations. Computer simulation with haptic feedback can potentially offer a more realistic and accessible training method. However, the complex interactions between the tube and the nasogastric passage make it difficult to model the haptic feedback during NGT placement. In this paper, a fuzzy-logic-based approach is proposed to directly transfer the experience of clinicians in NGT placement into the simulation system. Based on their perception of the varying tactile sensation and the conditions during NGT placement, the membership functions and fuzzy rules are defined to develop the force model. Forces created using the model are then combined with friction forces to drive the haptic device and render the insertion forces in real time. A prototype simulator is developed based on the proposed force model and the implementation details are presented. The usability of the prototype is also evaluated by clinical teachers. The proposed methodology has the potential for developing computerized NGT placement training methods for clinical education. It is also applicable for simulation systems involving complicated force interactions or computation-expensive models.

  13. Effectiveness of Tympanostomy Tubes for Otitis Media: A Meta-analysis.

    Science.gov (United States)

    Steele, Dale W; Adam, Gaelen P; Di, Mengyang; Halladay, Christopher H; Balk, Ethan M; Trikalinos, Thomas A

    2017-06-01

    Tympanostomy tube placement is the most common ambulatory surgery performed on children in the United States. The goal of this study was to synthesize evidence for the effectiveness of tympanostomy tubes in children with chronic otitis media with effusion and recurrent acute otitis media. Searches were conducted in Medline, the Cochrane Central Trials Registry and Cochrane Database of Systematic Reviews, Embase, and the Cumulative Index to Nursing and Allied Health Literature. Abstracts and full-text articles were independently screened by 2 investigators. A total of 147 articles were included. When feasible, random effects network meta-analyses were performed. Children with chronic otitis media with effusion treated with tympanostomy tubes compared with watchful waiting had a net decrease in mean hearing threshold of 9.1 dB (95% credible interval: -14.0 to -3.4) at 1 to 3 months and 0.0 (95% credible interval: -4.0 to 3.4) by 12 to 24 months. Children with recurrent acute otitis media may have fewer episodes after placement of tympanostomy tubes. Associated adverse events are poorly defined and reported. Sparse evidence is available, applicable only to otherwise healthy children. Tympanostomy tubes improve hearing at 1 to 3 months compared with watchful waiting, with no evidence of benefit by 12 to 24 months. Children with recurrent acute otitis media may have fewer episodes after tympanostomy tube placement, but the evidence base is severely limited. The benefits of tympanostomy tubes must be weighed against a variety of associated adverse events. Copyright © 2017 by the American Academy of Pediatrics.

  14. The Placement History Chart: A Tool for Understanding the Longitudinal Pattern of Foster Children's Placements.

    Science.gov (United States)

    Kim, Hyoun K; Pears, Katherine C; Fisher, Philip A

    2012-08-01

    Despite growing concerns about foster placement instability, little information is available regarding the longitudinal patterns of placement histories among foster children. The purpose of the present study was to develop a charting system using child welfare records to facilitate a better understanding of longitudinal patterns of placement history for 117 foster children. The resulting Placement History Chart included all placements that occurred during the observed time period and accounted for various dimensions: number, length, type, and sequence of placements; timing of transitions; and total time in out-of-home care. The Placement History Chart is an effective tool for placing foster care experiences within a broader developmental context. As such, the Placement History Chart can be a valuable research tool for understanding various dimensions and variations of placement transitions among foster children by capturing sequences and cumulative risks over time. Furthermore, this chart can facilitate the development of intervention programs that are developmentally sensitive and effectively address particularly vulnerable subpopulations of foster children.

  15. NEI You Tube Videos: Amblyopia

    Science.gov (United States)

    ... NEI YouTube Videos: Amblyopia Listen NEI YouTube Videos YouTube Videos Home Age-Related Macular Degeneration Amblyopia Animations Blindness Cataract Convergence Insufficiency Diabetic Eye Disease Dilated Eye Exam Dry Eye For Kids Glaucoma Healthy Vision Tips Leber Congenital Amaurosis Low ...

  16. NEI You Tube Videos: Amblyopia

    Medline Plus

    Full Text Available ... NEI YouTube Videos: Amblyopia Listen NEI YouTube Videos YouTube Videos Home Age-Related Macular Degeneration Amblyopia Animations Blindness Cataract Convergence Insufficiency Diabetic Eye Disease Dilated Eye Exam Dry Eye For Kids Glaucoma Healthy Vision Tips Leber Congenital Amaurosis Low ...

  17. Neutron image intensifier tubes

    International Nuclear Information System (INIS)

    Verat, M.; Rougeot, H.; Driard, B.

    1983-01-01

    The most frequently used techniques in neutron radiography employ a neutron converter consisting of either a scintillator or a thin metal sheet. The radiation created by the neutrons exposes a photographic film that is in contact with the converter: in the direct method, the film is exposed during the time that the object is irradiated with neutrons; in the transfer method, the film is exposed after the irradiation of the object with neutrons. In industrial non-destructive testing, when many identical objects have to be checked, these techniques have several disadvantages. Non-destructive testing systems without these disadvantages can be constructed around neutron-image intensifier tubes. A description and the operating characteristics of neutron-image intensifier tubes are given. (Auth.)

  18. Neural tube defects

    Directory of Open Access Journals (Sweden)

    M.E. Marshall

    1981-09-01

    Full Text Available Neural tube defects refer to any defect in the morphogenesis of the neural tube, the most common types being spina bifida and anencephaly. Spina bifida has been recognised in skeletons found in north-eastern Morocco and estimated to have an age of almost 12 000 years. It was also known to the ancient Greek and Arabian physicians who thought that the bony defect was due to the tumour. The term spina bifida was first used by Professor Nicolai Tulp of Amsterdam in 1652. Many other terms have been used to describe this defect, but spina bifida remains the most useful general term, as it describes the separation of the vertebral elements in the midline.

  19. CRL X-ray tube

    International Nuclear Information System (INIS)

    Kolchevsky, N.N.; Petrov, P.V.

    2015-01-01

    A novel types of X-ray tubes with refractive lenses are proposed. CRL-R X-ray tube consists of Compound Refractive Lens- CRL and Reflection X-ray tube. CRL acts as X-ray window. CRL-T X-ray consists of CRL and Transmission X-ray tube. CRL acts as target for electron beam. CRL refractive lens acts as filter, collimator, waveguide and focusing lens. Properties and construction of the CRL X-ray tube are discussed. (authors)

  20. CRL X-RAY TUBE

    OpenAIRE

    Kolchevsky, N. N.; Petrov, P. V.

    2015-01-01

    A novel types of X-ray tubes with refractive lenses are proposed. CRL-R X-ray tube consists of Compound Refractive Lens- CRL and Reflection X-ray tube. CRL acts as X-ray window. CRL-T X-ray consists of CRL and Transmission X-ray tube. CRL acts as target for electron beam. CRL refractive lens acts as filter, collimator, waveguide and focusing lens. Properties and construction of the CRL X-ray tube are discussed.

  1. Nasogastric tube depth: the 'NEX' guideline is incorrect.

    Science.gov (United States)

    Taylor, Stephen J; Allan, Kaylee; McWilliam, Helen; Toher, Deirdre

    Misplacing 17-23% of nasogastric (NG) tubes above the stomach ( Rollins et al, 2012 ; Rayner, 2013 ) represents a serious risk in terms of aspiration, further invasive (tube) procedures, irradiation from failed X-ray confirmation, delay to feed and medication. One causal factor is that in the National Patient Safety Agency (NPSA) guidance to place a tube, length is measured from nose to ear to xiphisternum (NEX) ( NSPA, 2011 ); NEX is incorrect because it only approximates the nose to gastro-oesophageal junction (GOJ) distance and is therefore too short. To overcome this and because the xiphisternum is more difficult to locate, local policy is to measure in the opposite direction; xiphisternum to ear to nose (XEN), then add 10 cm. The authors determined whether external body measurements can be used to estimate the NG tube length to safely reach the gastric body. This involved testing the statistical association of body length, age, sex and XEN in consecutive critically ill patients against internal anatomical landmarks determined from an electromagnetic (EM) trace of the tube path. XEN averaged 50 cm in 71 critically ill patients aged 53±20 years. Tube marking and the EM trace were used to determine mean insertion distances at pre-gastro-oesophageal junction (GOJ) (48 cm), where the tube first turns left towards the stomach and becomes shallow on the trace; gastric body (62 cm), where the tube reaches the left-most part of the stomach; and gastric antrum (73 cm) at the midline on the EM trace. Using body length, age, sex and XEN in a linear regression model, only 25% of variability was predicted, showing that external measurements cannot reliably predict the length of tube required to reach the stomach. A tube length of XEN (or NEX) is too short to guarantee gastric placement and is unsafe. XEN+10 cm or more complex measurements will reach the gastric body (mid-stomach) in most patients, but because of wide variation, external measurements often fail to predict a

  2. Manchester Clinical Placement Index (MCPI): Conditions for medical students’ learning in hospital and community placements

    NARCIS (Netherlands)

    Dornan, Tim; Muijtjens, Arno; Graham, Jennifer; Scherpbier, Albert; Boshuizen, Els

    2012-01-01

    Dornan, T., Muijtjens, A., Graham, J., Scherpbier, A., & Boshuizen, H. P. A. (2012). Manchester Clinical Placement Index (MCPI): Conditions for medical students’ learning in hospital and community placements. Advances in Health Sciences Education, 17, 703-716. doi:10.1007/s10459-10011-19344-x

  3. [Determinants of urgency of nursing home placement].

    Science.gov (United States)

    Kishida, Kensaku; Tanizaki, Shizuko

    2008-05-01

    The aim of this paper was to identify factors affecting the urgency of nursing home placement after introduction of public long-term care insurance. The subjects were families including at least one disabled elderly person and one another family member in two cities in Chugoku Prefecture. The measure of the urgency of placement was 0 if the family did not submit any application for placement, 1 if the care managers judged that the elderly person should enter in the future when she/he really needs placement, 2 if the care managers judged that she/he might be able to wait for a short while, and 3 if the care managers judged that she/he should enter as early as possible. Our estimation method was by ordered logit model. The dependent variable was the measure of the urgency and the independent variables were several attributes of the families. In the estimation, we considered the possibility that the coefficients depend on categories of dependent variable. We obtained data for 146 waiting families and 494 others (total 640). There were differences in the urgency of placement among waiting elderly as follows "she/he should enter as early as possible" (28.8%); "she/he can wait for a while" (32.2%), "she/he should enter in the future when she/he really needs placement" (39.0%). The results of multivariate analyses showed that the urgency of placement correlated significantly with the severity of the elderly persons disabilities, the number of primary caregivers' self-symptoms, the family members' negative attitude toward caregiving, residing in city A, not having one's own house and limited use of short-stay facilities due to the circumstances of the providers. When judging the urgency of placement, we should consider not only whether the applicant has submitted a request for a nursing home or not, but also differences among the waiting families. The urgency of placement correlates significantly with severity of disability of the elderly person, the number of primary

  4. Novel Visual Nasogastric Tube Insertion System: A Feasibility and Efficiency Study in a Manikin.

    Science.gov (United States)

    Li, Qiaoya; Xie, Juan; Wu, Jinxing; Guo, Rui; Ma, Wenwen; Xu, Gang; Yang, Min; Deng, Huisheng

    2016-01-01

    Background . Conventional nasogastric tube placement is an essential clinical procedure; however, complications may arise from blind manipulation. We tested the feasibility and efficiency of a visual nasogastric tube insertion system (VNGS) using a manikin. Methods . A microimaging fiber (0.8 mm) was integrated into the nasogastric tube to create the VNGS. Twenty inexperienced physicians were enrolled and assigned to the visual or conventional group. Each physician performed 10 repeated nasogastric tube insertions with visual guidance or the conventional method; another 20 inexperienced medical students received nasogastric tube insertion training using visual guidance or the conventional method. Results . The nasogastric tube successfully reached the stomach and the narrow anatomic structures were visualized with the VNGS. Time required for insertion was significantly shorter in the visual group compared to the conventional group (22.56 ± 3.08 versus 37.30 ± 4.12 seconds, P Tube misplacement was observed in 19/100 cases (19%) in the conventional group; no misplacement was observed in the visual group. Less mucosal damage was noted in the visual group (3.43 ± 1.63 versus 9.86 ± 2.31 cm 2 ). Medical students performed better NGT insertions (shorter insertion time and less procedure-related complications) after undergoing the visual guidance training. Conclusions . The VNGS may provide a new technique for nasogastric tube insertion applicable to clinical use or simulation training.

  5. Administering Polyethylene Glycol Electrolyte Solution Via a Nasogastric Tube: Pulmonary Complications.

    Science.gov (United States)

    Metheny, Norma A; Meert, Kathleen L

    2017-03-01

    Patients sometimes require insertion of a nasogastric tube for the administration of a large volume of a polyethylene glycol electrolyte solution. If the tube is malpositioned, the risk for direct instillation of the solution into the lung increases. The risk for aspiration also increases if the infusion rate exceeds gastrointestinal tolerance. To review published cases of patients' experiencing adverse pulmonary events after administration of polyethylene glycol electrolyte solution via a nasogastric tube and to offer suggestions to prevent these outcomes. A search of the literature from 1993 through 2014 was performed by using the PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Scopus databases. In the 12 case reports located, none of the patients had radiographs to verify tube location before infusion of polyethylene glycol electrolyte solution. After symptoms developed in 3 children (ages 8-11 years), radiographs showed their tubes incorrectly positioned in the bronchus, lung, or esophagus; ports of a fourth child's tube were in the oropharynx. The remaining 8 patients (ages 5-86 years) never had radiographs to determine tube placement. Pulmonary complications from the infusions of polyethylene glycol electrolyte solution contributed to the death of 5 of the patients. Relatively simple maneuvers to reduce the likelihood of adverse pulmonary events following the administration of large volumes of polyethylene glycol electrolyte solution via a nasogastric tube are well worth the cost and effort to protect patients from potential serious injury. ©2017 American Association of Critical-Care Nurses.

  6. Fine Control of Local Whitespace in Placement

    Directory of Open Access Journals (Sweden)

    Jarrod A. Roy

    2008-01-01

    Full Text Available In modern design methodologies, a large fraction of chip area during placement is left unused by standard cells and allocated as “whitespace.” This is done for a variety of reasons including the need for subsequent buffer insertion, as a means to ensure routability, signal integrity, and low coupling capacitance between wires, and to improve yield through DFM optimizations. To this end, layout constraints often require a certain minimum fraction of whitespace in each region of the chip. Our work introduces several techniques for allocation of whitespace in global, detail, and incremental placement. Our experiments show how to efficiently improve wirelength by reallocating whitespace in legal placements at the large scale. Additionally, for the first time in the literature, we empirically demonstrate high-precision control of whitespace in designs with macros and obstacles. Our techniques consistently improve the quality of whitespace allocation of top-down as well as analytical placement methods and achieve low penalties on designs from the ISPD 2006 placement contest with minimal interconnect increase.

  7. Page placement policies for NUMA multiprocessors

    Energy Technology Data Exchange (ETDEWEB)

    LaRowe, R.P. Jr.; Ellis, C.S. (Dept. of Computer Science, Duke Univ., Durham, NC (US))

    1991-02-01

    In many parallel applications, the size of the program's data exceeds even the very large amount of main memory available on large-scale multiprocessors. Virtual memory, in the sense of a transparent management of the main/secondary memory hierarchy, is a natural solution. The replacement, fetch, and placement policies used in uniprocessor paging systems need to be reexamined in light of the differences in the behavior of parallel computations and in the memory architectures of multiprocessors. In this paper the authors investigate the impact of page placement in nonuniform memory access time (NUMA) shared memory MIMD machines. The authors experimentally evaluate several paging algorithms that incorporate different approaches to the placement issue. Under certain workload assumptions, the results show that placement algorithms that are strongly biased toward local frame allocations but are able to borrow remote frames can reduce the number of page faults over strictly local allocation. The increased cost of memory operations due to the extra remote accesses is more than compensated for by the savings resulting from the reduction in demand fetches, effectively reducing the computation completion time for these programs without having adverse effects on the performance of typical NUMA programs. The authors also discuss some early results obtained from an actual kernel implementation of one of the page placement algorithms.

  8. Changes in the distance between carina and orotracheal tube during open or videolaparoscopic bariatric surgery.

    Science.gov (United States)

    de Figueiredo Locks, Giovani; Simões de Almeida, Maria Cristina; Sperotto Ceccon, Maurício; Campos Pastório, Karen Adriana

    2015-01-01

    To examine whether there are changes in the distance between the orotracheal tube and carina induced by orthostatic retractor placement or by pneumoperitoneum insufflation in obese patients undergoing gastroplasty. 60 patients undergoing bariatric surgery by two techniques: open (G1) or videolaparoscopic (G2) gastroplasty were studied. After tracheal intubation, adequate ventilation of both hemitoraxes was confirmed by lung auscultation. The distance orotracheal tube-carina was estimated with the use of a fiber bronchoscope before and after installation of orthostatic retractors in G1 or before and after insufflation of pneumoperitoneum in patients in G2. G1 was composed of 22 and G2 of 38 patients. No cases of endobronchial intubation were detected in either group. The mean orotracheal tube-carina distance variation was estimated in -0.03cm (95% CI 0.06 to -0.13) in the group of patients undergoing open gastroplasty and in -0.42cm (95% CI -0.56 to -1.4) in the group of patients undergoing videolaparoscopic gastroplasty. The extremes of variation in each group were: 0.5cm to -1.6cm in patients undergoing open surgery and 0.1cm to -2.2cm in patients undergoing videolaparoscopic surgery. There was no significant change in orotracheal tube-CA distance after placement of orthostatic retractors in patients undergoing open gastroplasty. There was a reduction in orotracheal tube-CA distance after insufflation of pneumoperitoneum in patients undergoing videolaparoscopic gastroplasty. We recommend attention to lung auscultation and to signals of ventilation monitoring and reevaluation of orotracheal tube placement after peritoneal insufflation. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  9. Changes in the distance between carina and orotracheal tube during open or videolaparoscopic bariatric surgery

    Directory of Open Access Journals (Sweden)

    Giovani de Figueiredo Locks

    2015-10-01

    Full Text Available ABSTRACTOBJECTIVE: To examine whether there are changes in the distance between the orotracheal tube and carina induced by orthostatic retractor placement or by pneumoperitoneum insufflation in obese patients undergoing gastroplasty.METHODS: 60 patients undergoing bariatric surgery by two techniques: open (G1 or videolaparoscopic (G2 gastroplasty were studied. After tracheal intubation, adequate ventilation of both hemitoraxes was confirmed by lung auscultation. The distance orotracheal tube-carina was estimated with the use of a fiber bronchoscope before and after installation of orthostatic retractors in G1 or before and after insufflation of pneumoperitoneum in patients in G2.RESULTS: G1 was composed of 22 and G2 of 38 patients. No cases of endobronchial intubation were detected in either group. The mean orotracheal tube-carina distance variation was estimated in -0.03 cm (95% CI 0.06 to -0.13 in the group of patients undergoing open gastroplasty and in -0.42 cm (95% CI -0.56 to -1.4 in the group of patients undergoing videolaparoscopic gastroplasty. The extremes of variation in each group were: 0.5 cm to -1.6 cm in patients undergoing open surgery and 0.1 cm to -2.2 cm in patients undergoing videolaparoscopic surgery.CONCLUSIONS: There was no significant change in orotracheal tube-CA distance after placement of orthostatic retractors in patients undergoing open gastroplasty. There was a reduction in orotracheal tube-CA distance after insufflation of pneumoperitoneum in patients undergoing videolaparoscopic gastroplasty. We recommend attention to lung auscultation and to signals of ventilation monitoring and reevaluation of orotracheal tube placement after peritoneal insufflation.

  10. Free compression tube. Applications

    Science.gov (United States)

    Rusu, Ioan

    2012-11-01

    During the flight of vehicles, their propulsion energy must overcome gravity, to ensure the displacement of air masses on vehicle trajectory, to cover both energy losses from the friction between a solid surface and the air and also the kinetic energy of reflected air masses due to the impact with the flying vehicle. The flight optimization by increasing speed and reducing fuel consumption has directed research in the aerodynamics field. The flying vehicles shapes obtained through studies in the wind tunnel provide the optimization of the impact with the air masses and the airflow along the vehicle. By energy balance studies for vehicles in flight, the author Ioan Rusu directed his research in reducing the energy lost at vehicle impact with air masses. In this respect as compared to classical solutions for building flight vehicles aerodynamic surfaces which reduce the impact and friction with air masses, Ioan Rusu has invented a device which he named free compression tube for rockets, registered with the State Office for Inventions and Trademarks of Romania, OSIM, deposit f 2011 0352. Mounted in front of flight vehicles it eliminates significantly the impact and friction of air masses with the vehicle solid. The air masses come into contact with the air inside the free compression tube and the air-solid friction is eliminated and replaced by air to air friction.

  11. Shock tube Multiphase Experiments

    Science.gov (United States)

    Middlebrooks, John; Allen, Roy; Paudel, Manoj; Young, Calvin; Musick, Ben; McFarland, Jacob

    2017-11-01

    Shock driven multiphase instabilities (SDMI) are unique physical phenomena that have far-reaching practical applications in engineering and science. The instability is present in high energy explosions, scramjet combustors, and supernovae events. The SDMI arises when a multiphase interface is impulsively accelerated by the passage of a shockwave. It is similar in development to the Richtmyer-Meshkov (RM) instability however, particle-to-gas coupling is the driving mechanism of the SDMI. As particle effects such as lag and phase change become more prominent, the SDMI's development begins to significantly deviate from the RM instability. We have developed an experiment for studying the SDMI in our shock tube facility. In our experiments, a multiphase interface is created using a laminar jet and flowed into the shock tube where it is accelerated by the passage of a planar shockwave. The interface development is captured using CCD cameras synchronized with planar laser illumination. This talk will give an overview of new experiments conducted to examine the development of a shocked cylindrical multiphase interface. The effects of Atwood number, particle size, and a second acceleration (reshock) of the interface will be discussed.

  12. German causative events with placement verbs

    Directory of Open Access Journals (Sweden)

    De Knop Sabine

    2016-06-01

    Full Text Available Several studies have described the semantic uses of German posture verbs, but only few have dealt with German placement verbs. The present study wants to make up for this gap. Starting from a collection of examples from the core corpora of the Digitales Wörterbuch der Deutschen Sprache (DWDS and some former studies on posture verbs, it first describes the variety of the most common German placement verbs stellen (‘to put upright’, legen (‘to lay down’, setzen (‘to set’ and stecken (‘to stick’.

  13. Multiple immediate implants placement with immediate loading.

    Science.gov (United States)

    Narang, Sumit; Narang, Anu; Jain, Kapil; Bhatia, Vineet

    2014-09-01

    The replacement of missing teeth with implant-borne restorations has become a treatment modality accepted by the scientific community for fully and partially edentulous patients. Recent reports have demonstrated the successful placement of dental implants into the fresh extraction socket in the anterior as well as in molar regions, which is made possible due to modification in implant surface. The present case report highlights the placement of three bicortical screw (BCS) implants into the fresh extraction sockets and one KOS implant in edentulous area with flapless technique. All the implants were immediately loaded and followed up for a period of 6 months.

  14. Multiple immediate implants placement with immediate loading

    Directory of Open Access Journals (Sweden)

    Sumit Narang

    2014-01-01

    Full Text Available The replacement of missing teeth with implant-borne restorations has become a treatment modality accepted by the scientific community for fully and partially edentulous patients. Recent reports have demonstrated the successful placement of dental implants into the fresh extraction socket in the anterior as well as in molar regions, which is made possible due to modification in implant surface. The present case report highlights the placement of three bicortical screw (BCS implants into the fresh extraction sockets and one  KOS implant in edentulous area with flapless technique. All the implants were immediately loaded and followed up for a period of 6 months.

  15. Current updates in catheters, tubes and drains in the pediatric chest: A practical evaluation approach.

    Science.gov (United States)

    Concepcion, Nathan David P; Laya, Bernard F; Lee, Edward Y

    2017-10-01

    Chest radiographs are very helpful tool not only in the evaluation of respiratory and/or cardiac pathologies, but also to help clinicians in the assessment of various tubes and catheters inserted in pediatric patients. This review article focuses on the indications, contraindications, ideal locations of the tips of these tubes and catheters, as well as the consequences of malpositioning. Clinical outcomes of pediatric patients can be affected by the placement of these medical devices. The radiologist therefore has a critical role in detecting and relaying such malpositioned devices for prompt revisions or removal. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. A Novel and Innovative Way of Nasogastric Tube Insertion in Anesthetized Intubated Patient.

    Science.gov (United States)

    Sahu, Sandeep; Kishore, Kamal; Sachan, Vertika; Chatterjee, Arnidam

    2017-01-01

    Nasogastric tube (NGT) placement in anesthetized and intubated is sometimes very challenging with more than 50% failure rate in the first attempt. We describe a newer innovative Sahu's three in one, technique with use of GlideScope and forward placement of intubated trachea by external laryngeal maneuver, these both techniques lead to separation of trachea from esophagus so that endoscopic jejunal feeding tube guide wire strengthen NGT can be guided and manipulated to esophagus under direct vision. After informed consent, we used Sahu's three in one combo technique to insert NGT in adult anesthetized and intubated patients of both the sexes with high success in the first attempt. We found this technique easy, helpful, less time consuming with high success rate.

  17. COMPLICATIONS NASOGASTRIC TUBE INSERTION AND TREATMENT

    Directory of Open Access Journals (Sweden)

    Dwi Kresnawati

    2013-12-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 Insertion of a nasogastric tube (NGT is an invasive procedure that is often done by increasing medical emergency. There are two indications of this procedure,the indications are for diagnostic and therapeutic interest mainly to access and evaluate the nutritional content of the stomach for patients with suspected gastrointestinal bleeding. Although nasogastric tube insertion simpler, easier and safer than with a pipe orogastrik, but complications can occur during installation such as malposition of NGT, epistaxis, mucosal trauma, aspiration pneumonia, hypoxemia and pneumothorak. So the importance of knowledge, skills, and how treatment for complications arising prevents one way to ensure the proper placement of NGT. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  18. Usability study of pH strips for nasogastric tube placement

    NARCIS (Netherlands)

    Borsci, Simone; Buckle, Peter; Huddy, Jeremy; Alaestante, Zenia; Ni, Zhifang; Hanna, George B.

    2017-01-01

    © 2017 Borsci et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Aims: (1) To model the process of use and

  19. Pre- and Postoperative Vomiting in Children Undergoing Video-Assisted Gastrostomy Tube Placement

    Directory of Open Access Journals (Sweden)

    Torbjörn Backman

    2014-01-01

    Full Text Available Background. The aim of this study was to determine the incidence of pre- and postoperative vomiting in children undergoing a Video-Assisted Gastrostomy (VAG operation. Patients and Methods. 180 children underwent a VAG operation and were subdivided into groups based on their underlying diagnosis. An anamnesis with respect to vomiting was taken from each of the children’s parents before the operation. After the VAG operation, all patients were followed prospectively at one and six months after surgery. All complications including vomiting were documented according to a standardized protocol. Results. Vomiting occurred preoperatively in 51 children (28%. One month after surgery the incidence was 43 (24% in the same group of children and six months after it was found in 40 (22%. There was a difference in vomiting frequency both pre- and postoperatively between the children in the groups with different diagnoses included in the study. No difference was noted in pre- and postoperative vomiting frequency within each specific diagnosis group. Conclusion. The preoperative vomiting symptoms persisted after the VAG operation. Neurologically impaired children had a higher incidence of vomiting than patients with other diagnoses, a well-known fact, probably due to their underlying diagnosis and not the VAG operation. This information is useful in preoperative counselling.

  20. Paramedic Intubation Experience Is Associated With Successful Tube Placement but Not Cardiac Arrest Survival.

    Science.gov (United States)

    Dyson, Kylie; Bray, Janet E; Smith, Karen; Bernard, Stephen; Straney, Lahn; Nair, Resmi; Finn, Judith

    2017-09-01

    Paramedic experience with intubation may be an important factor in skill performance and patient outcomes. Our objective is to examine the association between previous intubation experience and successful intubation. In a subcohort of out-of-hospital cardiac arrest cases, we also measure the association between patient survival and previous paramedic intubation experience. We analyzed data from Ambulance Victoria electronic patient care records and the Victorian Ambulance Cardiac Arrest Registry for January 1, 2008, to September 26, 2014. For each patient case, we defined intubation experience as the number of intubations attempted by each paramedic in the previous 3 years. Using logistic regression, we estimated the association between intubation experience and (1) successful intubation and (2) first-pass success. In the out-of-hospital cardiac arrest cohort, we determined the association between previous intubation experience and patient survival. During the 6.7-year study period, 769 paramedics attempted intubation in 14,857 patients. Paramedics typically performed 3 intubations per year (interquartile range 1 to 6). Most intubations were successful (95%), including 80% on the first attempt. Previous intubation experience was associated with intubation success (odds ratio 1.04; 95% confidence interval 1.03 to 1.05) and intubation first-pass success (odds ratio 1.02; 95% confidence interval 1.01 to 1.03). In the out-of-hospital cardiac arrest subcohort (n=9,751), paramedic intubation experience was not associated with patient survival. Paramedics in this Australian cohort performed few intubations. Previous experience was associated with successful intubation. Among out-of-hospital cardiac arrest patients for whom intubation was attempted, previous paramedic intubation experience was not associated with patient survival. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  1. Long-term management of a dog with idiopathic megaesophagus and recurrent aspiration pneumonia by use of an indwelling esophagostomy tube for suction of esophageal content and esophagogastric tube feeding.

    Science.gov (United States)

    Kanemoto, Yuka; Fukushima, Kenjiro; Kanemoto, Hideyuki; Ohno, Koichi; Tsujimoto, Hajime

    2017-01-24

    A 10-year-old neutered male Labrador Retriever dog was diagnosed with idiopathic megaesophagus. Despite receiving conventional treatments including elevated feeding, the dog showed repeated regurgitation and aspiration pneumonia, consequently developing weight loss and severe malnutrition. For the purpose of controlling regurgitation, an esophagostomy tube was placed for draining the esophageal fluid. Additionally, an esophagogastric tube was placed for nutritional support. After tube placement, the average frequency of regurgitation was reduced from 2.4 times a day to 0.1 times a day. The nutritional state of the dog improved gradually, and the body weight increased from 18.5 to 27.9 kg. The dog died on day 951, and necropsy revealed a gastric ulcer (2.5 cm in diameter), presumably esophagostomy tube-induced injury. This case report suggests that patients with idiopathic megaesophagus and persistent regurgitation might benefit from esophageal drainage through an esophagostomy tube.

  2. Bacterial Biofilms in Jones Tubes.

    Science.gov (United States)

    Ahn, Eric S; Hauck, Matthew J; Kirk Harris, Jonathan; Robertson, Charles E; Dailey, Roger A

    To investigate the presence and microbiology of bacterial biofilms on Jones tubes (JTs) by direct visualization with scanning electron microscopy and polymerase chain reaction (PCR) of representative JTs, and to correlate these findings with inflammation and/or infection related to the JT. In this study, prospective case series were performed. JTs were recovered from consecutive patients presenting to clinic for routine cleaning or recurrent irritation/infection. Four tubes were processed for scanning electron microscopy alone to visualize evidence of biofilms. Two tubes underwent PCR alone for bacterial quantification. One tube was divided in half and sent for scanning electron microscopy and PCR. Symptoms related to the JTs were recorded at the time of recovery. Seven tubes were obtained. Five underwent SEM, and 3 out of 5 showed evidence of biofilms (60%). Two of the 3 biofilms demonstrated cocci and the third revealed rods. Three tubes underwent PCR. The predominant bacteria identified were Pseudomonadales (39%), Pseudomonas (16%), and Staphylococcus (14%). Three of the 7 patients (43%) reported irritation and discharge at presentation. Two symptomatic patients, whose tubes were imaged only, revealed biofilms. The third symptomatic patient's tube underwent PCR only, showing predominantly Staphylococcus (56%) and Haemophilus (36%) species. Two of the 4 asymptomatic patients also showed biofilms. All symptomatic patients improved rapidly after tube exchange and steroid antibiotic drops. Bacterial biofilms were variably present on JTs, and did not always correlate with patients' symptoms. Nevertheless, routine JT cleaning is recommended to treat and possibly prevent inflammation caused by biofilms.

  3. Failure analysis of boiler tube

    International Nuclear Information System (INIS)

    Mehmood, K.; Siddiqui, A.R.

    2007-01-01

    Boiler tubes are energy conversion components where heat energy is used to convert water into high pressure superheated steam, which is then delivered to a turbine for electric power generation in thermal power plants or to run plant and machineries in a process or manufacturing industry. It was reported that one of the tubes of a fire-tube boiler used in a local industry had leakage after the formation of pits at the external surface of the tube. The inner side of the fire tube was working with hot flue gasses with a pressure of 10 Kg/cm/sup 2/ and temperature 225 degree C. The outside of the tube was surrounded by feed water. The purpose of this study was to determine the cause of pits developed at the external surface of the failed boiler tube sample. In the present work boiler tube samples of steel grade ASTM AI61/ASTM A192 were analyzed using metallographic analysis, chemical analysis, and mechanical testing. It was concluded that the appearance of defects on the boiler tube sample indicates cavitation type corrosion failure. Cavitation damage superficially resembled pitting, but surface appeared considerably rougher and had many closely spaced pits. (author)

  4. YouTube and 'psychiatry'.

    Science.gov (United States)

    Gordon, Robert; Miller, John; Collins, Noel

    2015-12-01

    YouTube is a video-sharing website that is increasingly used to share and disseminate health-related information, particularly among younger people. There are reports that social media sites, such as YouTube, are being used to communicate an anti-psychiatry message but this has never been confirmed in any published analysis of YouTube clip content. This descriptive study revealed that the representation of 'psychiatry' during summer 2012 was predominantly negative. A subsequent smaller re-analysis suggests that the negative portrayal of 'psychiatry' on YouTube is a stable phenomenon. The significance of this and how it could be addressed are discussed.

  5. Radiation-resistant camera tube

    International Nuclear Information System (INIS)

    Kuwahata, Takao; Manabe, Sohei; Makishima, Yasuhiro

    1982-01-01

    It was a long time ago that Toshiba launched on manufacturing black-and-white radiation-resistant camera tubes employing nonbrowning face-plate glass for ITV cameras used in nuclear power plants. Now in compliance with the increasing demand in nuclear power field, the Company is at grips with the development of radiation-resistant single color-camera tubes incorporating a color-stripe filter for color ITV cameras used under radiation environment. Herein represented are the results of experiments on characteristics of materials for single color-camera tubes and prospects for commercialization of the tubes. (author)

  6. The interventional treatment for biliary recurrent obstruction after palliative T tube drainage in patients with obstruction due to cholangiocarcinoma

    International Nuclear Information System (INIS)

    Han Xinwei; Li Yongdong; Guan Sheng; Wu Gang; Xing Gusheng; Ma Bo

    2002-01-01

    Objective: To explore the interventional method to treat biliary recurrent jaundice after T tube drainage in patients with malignant obstructive jaundice due to cholangiocarcinoma. Methods: 7 biliary metallic stents were placed in 7 patients with recurrent jaundice after T-tube drainage in cholangiocarcinoma cases. Results: Stent placement was once successful in all 7 cases with successful rate of 100%. For all cases, TBIL, ALT, GTP and AKP values 7 days postoperatively were significantly lower than that of preoperation together with subsidence of jaundice satisfactorily for 100% after the treatment. Conclusions: Percutaneous placement of biliary metallic stents was effective economic, minimal invasive and safe for palliation of biliary recurrent jaundice after T tube drainage in cholangiocarcinoma-induced obstructive jaundice

  7. Learning from YouTube [Video Book

    Science.gov (United States)

    Juhasz, Alexandra

    2011-01-01

    YouTube is a mess. YouTube is for amateurs. YouTube dissolves the real. YouTube is host to inconceivable combos. YouTube is best for corporate-made community. YouTube is badly baked. These are a few of the things Media Studies professor Alexandra Juhasz (and her class) learned about YouTube when she set out to investigate what actually happens…

  8. Laryngeal tube suction for airway management during in-hospital emergencies.

    Science.gov (United States)

    Mutlak, Haitham; Weber, Christian Friedrich; Meininger, Dirk; Cuca, Colleen; Zacharowski, Kai; Byhahn, Christian; Schalk, Richard

    2017-07-01

    The role of supraglottic airway devices in emergency airway management is highlighted in international airway management guidelines. We evaluated the application of the new generation laryngeal tube suction (LTS-II/LTS-D) in the management of in-hospital unexpected difficult airway and cardiopulmonary resuscitation. During a seven-year period, patients treated with a laryngeal tube who received routine anesthesia and had an unexpected difficult airway (Cormack Lehane Grade 3-4), who underwent cardiopulmonary resuscitation, or who underwent cardiopulmonary resuscitation outside the operating room and had a difficult airway were evaluated. Successful placement of the LTS II/LTS-D, sufficient ventilation, time to placement, number of placement attempts, stomach content, peripheral oxygen saturation/end-tidal carbon dioxide development (SpO2/etCO2) over 5 minutes, subjective overall assessment and complications were recorded. In total, 106 adult patients were treated using an LTS-II/LTS-D. The main indication for placement was a difficult airway (75%, n=80), followed by cardiopulmonary resuscitation (25%, n=26) or an overlap between both (18%, n=19). In 94% of patients (n=100), users placed the laryngeal tube during the first attempt. In 93% of patients (n=98), the tube was placed within 30 seconds. A significant increase in SpO2 from 97% (0-100) to 99% (5-100) was observed in the whole population and in cardiopulmonary resuscitation patients. The average initial etCO2 of 39.5 mmHg (0-100 mmHg) decreased significantly to an average of 38.4 mmHg (10-62 mmHg) after 5 minutes. A comparison of cardiopulmonary resuscitation patients with non-cardiopulmonary resuscitation patients regarding gastric contents showed no significant difference. LTS-D/LTS-II use for in-hospital unexpected difficult airway management provides a secure method for primary airway management until other options such as video laryngoscopy or fiber optic intubation become available.

  9. Predicting success on the Advanced Placement Biology Examination

    Science.gov (United States)

    Shepherd, Lesa Hanlin

    Four hundred sixty students in four public high schools were used as subjects to determine which of eleven academic and demographic factors studied were significant predictors of success for the Advanced Placement Biology Examination. Factors studied were attendance, class rank, gender, grade level at the time of the examination, grade point average, level of prerequisite biology course, number of Advanced Placement Examinations taken in the year prior to the Advanced Placement Biology Examination, number of Advanced Placement Examinations taken in the same year as the Advanced Placement Biology Examination, proposed major in college, race, and SAT mathematics, verbal, and combined score. Significant relationships were found to exist between the Advanced Placement Biology Examination score and attendance, class rank, gender, grade level at the time of the Advanced Placement Biology Examination, grade point average, number of Advanced Placement Examinations taken in the year prior to the Advanced Placement Biology Examination, number of Advanced Placement Examinations taken in the same year as the Advanced Placement Biology Examination, race, and SAT scores. Significant relationships were not found to exist between Advanced Placement Biology Examination score and level prerequisite biology course and Advanced Placement Biology Examination score and proposed major in college. A multiple regression showed the best combination of predictors to be attendance, SAT verbal score, and SAT mathematics score. Discriminant analysis showed the variables in this study to be good predictors of whether the student would pass the Advanced Placement Biology Examination (score a 3, 4, or 5) or fail the Advanced Placement Biology Examination (score a 1 or 2). These results demonstrated that significant predictors for the Advanced Placement Biology Examination do exist and can be used to assist in the prediction of scores, prediction of passing or failing, the identification of

  10. Tube to tube excursive instability - sensitivities and transients

    International Nuclear Information System (INIS)

    Brown, M.; Layland, M.W.

    1980-01-01

    A simple basic analysis of excursive instability in a boiler tube shows how it depends upon operating conditions and physical properties. A detailed mathematical model of an AGR boiler is used to conduct a steady state parameter sensitivity survey. It is possible from this basis to anticipate the effects of changes in operating conditions and changes in design parameters upon tube to tube stability. Dynamic responses of tubes operating near the stability threshold are examined using a mathematical model. Simulated excursions are triggered by imparting small abrupt pressure changes on the boiler inlet pressure. The influences of the magnitude of the pressure change, waterside friction factor and gas side coupling between tubes are examined. (author)

  11. Nasogastric tube syndrome induced by an indwelling long intestinal tube.

    Science.gov (United States)

    Sano, Naoki; Yamamoto, Masayoshi; Nagai, Kentaro; Yamada, Keiichi; Ohkohchi, Nobuhiro

    2016-04-21

    The nasogastric tube (NGT) has become a frequently used device to alleviate gastrointestinal symptoms. Nasogastric tube syndrome (NTS) is an uncommon but potentially life-threatening complication of an indwelling NGT. NTS is characterized by acute upper airway obstruction due to bilateral vocal cord paralysis. We report a case of a 76-year-old man with NTS, induced by an indwelling long intestinal tube. He was admitted to our hospital for treatment of sigmoid colon cancer. He underwent sigmoidectomy to release a bowel obstruction, and had a long intestinal tube inserted to decompress the intestinal tract. He presented acute dyspnea following prolonged intestinal intubation, and bronchoscopy showed bilateral vocal cord paralysis. The NGT was removed immediately, and tracheotomy was performed. The patient was finally discharged in a fully recovered state. NTS be considered in patients complaining of acute upper airway obstruction, not only with a NGT inserted but also with a long intestinal tube.

  12. Source placement for equalization in small enclosures

    DEFF Research Database (Denmark)

    Stefanakis, Nick; Sarris, J.; Cambourakis, G.

    2008-01-01

    ) but not with those that will deteriorate it (the "undesired" modes). Simulation results in rectangular rooms and in a car cavity show the benefits of source placement in terms of reduced overall error and increased spatial robustness in the equalization process. Additional benefits, which can be derived by proper...

  13. Endoscopic stent placement throughout the gastrointestinal tract

    NARCIS (Netherlands)

    van den Berg, M.W.

    2014-01-01

    In this thesis we focussed our research on stent placement throughout the GI tract. In search for ideal stents for treatment of malignant oesophageal stenosis and gastric outlet obstruction we evaluated new stent designs in prospective cohort studies. Smaller research projects mainly aimed to

  14. Simple, quick, and efficient implant placement jig

    Directory of Open Access Journals (Sweden)

    Nikhil Narayan Pai

    2015-01-01

    Full Text Available Implants have become an inherent part of everyday orthodontic practice, but unlike prosthodontic implants, their placement and insertion into narrow interradicular spaces for orthodontic purposes remain a tricky and challenging part to most clinicians. An innovative and clinically useful method has been described here for safe and easy insertion of mini-implants.

  15. Weld Strength Assessment for Tape Placement

    NARCIS (Netherlands)

    Grouve, Wouter Johannes Bernardus; Warnet, Laurent; Akkerman, Remko; Wijskamp, Sebastiaan; Kok, J.S.M.

    2010-01-01

    A mandrel peel set-up is developed to assess the peel fracture toughness of fibre reinforced thermoplastic tapes welded on a woven laminate using a laser-assisted tape placement robot. A comprehensive experimental programme was designed to investigate the influence of nip point temperature and

  16. Suboccipital neuropathy after bone conduction device placement

    NARCIS (Netherlands)

    Faber, H.T.; Ru, J.A. de

    2013-01-01

    OBJECTIVE: To describe the clinical characteristics of a 70-year-old female with occipital neuropathy following bone conduction device surgery. DESCRIPTION: A 65-year-old woman underwent bone conduction device placement surgery on the left temporal bone. Postoperatively she progressively developed

  17. Photoelectron Spectroscopy in Advanced Placement Chemistry

    Science.gov (United States)

    Benigna, James

    2014-01-01

    Photoelectron spectroscopy (PES) is a new addition to the Advanced Placement (AP) Chemistry curriculum. This article explains the rationale for its inclusion, an overview of how the PES instrument records data, how the data can be analyzed, and how to include PES data in the course. Sample assessment items and analysis are included, as well as…

  18. BIBLIOGRAPHIC GUIDE FOR ADVANCED PLACEMENT, LATIN.

    Science.gov (United States)

    BARRON, ROBERT; ROSELLE, LEONE

    LITERARY AND CRITICAL WORKS, REFERENCE BOOKS, PERIODICALS, RECORDS, FILMS, AND FILMSTRIPS DEALING WITH ROMAN LITERATURE, HISTORY, CIVILIZATION, MYTHOLOGY, AND LANGUAGE ARE INCLUDED IN THIS BIBLIOGRAPHY OF RECOMMENDED READING IN ENGLISH FOR ADVANCED PLACEMENT PROGRAMS IN LATIN. THE LIST IS DIVIDED INTO TWO $500 GROUPS, SO THAT FOR CONVENIENCE IN…

  19. 34 CFR 300.116 - Placements.

    Science.gov (United States)

    2010-07-01

    ... educational placement of a child with a disability, including a preschool child with a disability, each public... with a disability requires some other arrangement, the child is educated in the school that he or she... modifications in the general education curriculum. (Approved by the Office of Management and Budget under...

  20. Realistic Approach for Phasor Measurement Unit Placement

    DEFF Research Database (Denmark)

    Rather, Zakir Hussain; Chen, Zhe; Thøgersen, Paul

    2015-01-01

    This paper presents a realistic cost-effectivemodel for optimal placement of phasor measurement units (PMUs) for complete observability of a power system considering practical cost implications. The proposed model considers hidden or otherwise unaccounted practical costs involved in PMU installat...

  1. Literary Archetypes. Advanced Placement English Curriculum Guide.

    Science.gov (United States)

    Anne Arundel County Public Schools, Annapolis, MD.

    Providing students with the opportunity to earn college credit while still in high school, the Advanced Placement English course described in this guide is designed to help students (1) want to choose from a wide range of literature for independent reading; (2) develop a critical awareness about literature; (3) recognize connections among works of…

  2. 5 CFR 359.702 - Placement rights.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Placement rights. 359.702 Section 359.702 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS REMOVAL FROM THE SENIOR... rights. (a) An appointee covered by this subpart is entitled to be placed in a vacant civil service...

  3. Flapless single-tooth immediate implant placement.

    Science.gov (United States)

    de Carvalho, Breno Carnevalli Franco; de Carvalho, Elaine Manso Oliveira Franco; Consani, Rafael Leonardo Xediek

    2013-01-01

    This 15-year prospective study evaluated the success rate and preservation of the gingival margin of single implants placed in a flapless procedure loaded immediately after extraction or after a healing period. Immediate flapless implant placement was performed in patients who fulfilled specified inclusion criteria. Implants were either immediately restored with a provisional crown or left unloaded (received healing abutment only). Implant success and gingival margin levels were evaluated after implant placement and after 1 to 15 years. A total of 305 healthy nonsmoking subjects (90 men, 215 women) were treated with 430 immediate implants during a 15-year period (December 1994 to December 2009) and monitored for 1 to 15 years. Two hundred seventy-five implants received an immediate provisional crown, and 155 received a healing abutment. The implant survival rate was 93.03% (± 3.74%). The immediate provisional helped to maintain the original gingival margin, although the implant survival rate was higher for implants that were not immediately restored (96.78%) than for the implants that were immediately restored with a provisional (90.9%). This 15-year prospective study showed a favorable implant success rate related to the flapless immediate implant placement protocol with healing abutment placement or an immediate provisional crown to replace a single missing tooth.

  4. Optimization of portal placement for endoscopic calcaneoplasty

    NARCIS (Netherlands)

    van Sterkenburg, Maayke N.; Groot, Minke; Sierevelt, Inger N.; Spennacchio, Pietro A.; Kerkhoffs, Gino M. M. J.; van Dijk, C. Niek

    2011-01-01

    The purpose of our study was to determine an anatomic landmark to help locate portals in endoscopic calcaneoplasty. The device for optimal portal placement (DOPP) was developed to measure the distance from the distal fibula tip to the calcaneus (DFC) in 28 volunteers to determine the location of the

  5. Delayed bracket placement in orthodontic treatment

    Directory of Open Access Journals (Sweden)

    Chandra Wigati

    2008-12-01

    Full Text Available Background: Beside bracket position, the timing of bracket placement is one of the most essential in orthodontic treatment with fixed appliances. Even it seems simple the timing of bracket placement can be crucial and significantly influence the result of orthodontic treatment. However it is often found brackets are placed without complete understanding of its purpose and effects, which could be useless and even detrimental for the case. Purpose: The aim of this case report is to show that the timing of bracket placement could be different depending on the cases. Case: Five different cases are presented here with different timing of bracket placement. Case management: On these cases, brackets were placed on the upper arch first, on the lower arch first, or even only on some teeth first. Good and efficient orthodontic treatment results were achieved. Conclusion: For every orthodontic case, from the very beginning of treatment, bracket should be placed with the end result in mind. If brackets are correctly placed at a correct time, better treatment result could be achieved without unnecessary round tripping tooth movement.

  6. Safety of pull-type and introducer percutaneous endoscopic gastrostomy tubes in oncology patients: a retrospective analysis

    Directory of Open Access Journals (Sweden)

    Pelckmans Paul A

    2011-03-01

    Full Text Available Abstract Background Percutaneous endoscopic gastrostomy (PEG allows long-term tube feeding. Safety of pull-type and introducer PEG placement in oncology patients with head/neck or oesophageal malignancies is unknown. Methods Retrospective analysis of 299 patients undergoing PEG tube placement between January 2006 and December 2008 revealed 57 oncology patients. All patients with head/neck or oesophageal malignancy were treated with chemo- and radiotherapy. In case of high-grade stenosis introducer Freka® Pexact PEG tube was placed (n = 24 and in all other patients (n = 33 conventional pull-type PEG tube. Short-term complications and mortality rates were compared. Results Patients' characteristics and clinical status were comparable in both groups. Short-term complications were encountered in 11/24 (48% introducer PEG patients as compared to only 4/33 (12% pull-type PEG patients (P vs. 0/33 (0%, P vs. 3/33 (9%, NS. Finally, 3/24 gastrointestinal perforations (12% resulted from a difficult placement procedure vs. 1/33 (3%, leading to urgent surgical intervention and admission to ICU. Two introducer PEG patients died at ICU, resulting in an overall mortality rate of 8% vs. 0% (P = 0.091. Conclusion The introducer Freka® Pexact PEG procedure for long-term tube feeding may lead to significantly higher complication and mortality rates in patients with head/neck or oesophageal malignancies treated with chemo- and radiotherapy. It is suggested to use the conventional pull-type PEG tube placement in this group of patients, if possible.

  7. A New Resonance Tube

    Science.gov (United States)

    Bates, Alan

    2017-12-01

    The measurement of the speed of sound in air with the resonance tube is a popular experiment that often yields accurate results. One approach is to hold a vibrating tuning fork over an air column that is partially immersed in water. The column is raised and lowered in the water until the generated standing wave produces resonance: this occurs at the point where sound is perceived to have maximum loudness, or at the point where the amplitude of the standing wave has maximum value, namely an antinode. An antinode coincides with the position of the tuning fork, beyond the end of the air column, which consequently introduces an end correction. One way to minimize this end correction is to measure the distance between consecutive antinodes.

  8. Piezoelectric Rotary Tube Motor

    Science.gov (United States)

    Fisher, Charles D.; Badescu, Mircea; Braun, David F.; Culhane, Robert

    2011-01-01

    A custom rotary SQUIGGLE(Registered TradeMark) motor has been developed that sets new benchmarks for small motor size, high position resolution, and high torque without gear reduction. Its capabilities cannot be achieved with conventional electromagnetic motors. It consists of piezoelectric plates mounted on a square flexible tube. The plates are actuated via voltage waveforms 90 out of phase at the resonant frequency of the device to create rotary motion. The motors were incorporated into a two-axis postioner that was designed for fiber-fed spectroscopy for ground-based and space-based projects. The positioner enables large-scale celestial object surveys to take place in a practical amount of time.

  9. Pressure tube reactor

    International Nuclear Information System (INIS)

    Matsumoto, Tomoyuki; Fujino, Michihira.

    1980-01-01

    Purpose: To equalize heavy water flow distribution by providing a nozzle for externally injecting heavy water from a vibration preventive plate to the upper portion to feed the heavy water in a pressure tube reactor and swallowing up heavy water in a calandria tank to supply the heavy water to the reactor core above the vibration preventive plate. Constitution: A moderator injection nozzle is mounted on the inner wall of a calandria tank. Heavy water is externally injected above the vibration preventive plate, and heavy water in the calandria tank is swallowed up to supply the heavy water to the core reactor above the vibration preventive plate. Therefore, the heavy water flow distribution can be equalized over the entire reactor core, and the distribution of neutron absorber dissolved in the heavy water is equalized. (Yoshihara, H.)

  10. Primary Fallopian Tube Carcinoma

    Directory of Open Access Journals (Sweden)

    Prasad K Shetty

    2011-01-01

    Full Text Available Primary Fallopian Tube Carcinoma (PFTC is rare and accounts for about 0.3% of all gynecologic cancers. Less than 1500 cases have been reported in the literature. It arises in postmenopausal women and typically presents with abdominal pelvic pain, vaginal bleeding and watery discharge. However, a correct diagnosis is rarely achieved preoperative, and in many cases, the diagnosis is made after incidental surgery for unrelated conditions commonly being ovarian carcinoma . Compared with ovarian carcinoma, PFTC more often presents at early stages, but it has a worse prognosis. PFTC is usually managed in the same manner as ovarian cancer. We report a case of Left PFTC that presented as Left ovarian mass, and we briefly review the literature.

  11. Prognostic factors for tube feeding dependence after curative (chemo-) radiation in head and neck cancer: A systematic review of literature.

    Science.gov (United States)

    Wopken, Kim; Bijl, Hendrik P; Langendijk, Johannes A

    2018-01-01

    Tube feeding dependence is a commonly observed debilitating side-effect of curative (chemo-) radiation in head and neck cancer patients that severely affects quality of life. Prevention of this side-effect can be obtained using advanced radiation techniques, such as IMRT. For radiotherapy treatment plan optimization, it has become increasingly important to develop prediction models that enable clinicians to predict the risk of tube feeding dependence for individual patients. To develop such a tool, information regarding the most relevant prognostic factors for tube feeding dependence is necessary. The primary aim of this systematic review, conducted according to PRISMA guidelines, was to identify prognostic factors that are consistently found to be associated with tube feeding dependence at ≥6months after treatment. The secondary aim was to identify prognostic factors found to be associated with tube feeding placement and use at factors for tube feeding dependence at ≥6months. The studies reported on patient and disease variables, treatment variables and DVH parameters. Two of these studies reported on a model for tube feeding dependence, one including DVH parameters. Additionally, 18 studies were identified that reported on prognostic factors for tube feeding placement and use at factors that were consistently associated with the risk of tube feeding dependence at ≥6months for head and neck cancer patients treated with (chemo-) radiotherapy were DVH parameters, including dose to the larynx, the pharyngeal constrictor muscle inferior and superior, and the dose to the contralateral parotid gland. Furthermore, advanced tumor and nodal stage, pretreatment weight loss, (concomitant) chemotherapy and prophylactic gastrostomy policy were prognostic for tube feeding dependence ≥6months. For tube feeding use at less than 6months, prognostic DVH parameters included dose and volume to the oral mucosa, dose to the contralateral submandibular gland, and also dose to

  12. Angioplasty and stent placement - peripheral arteries

    Science.gov (United States)

    ... blood flow. A stent is a small, metal mesh tube that keeps the artery open. Angioplasty and ... Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical ...

  13. Angioplasty and stent placement - carotid artery - discharge

    Science.gov (United States)

    ... have also had a stent (a tiny wire mesh tube) placed in the blocked area to keep ... Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical ...

  14. Reliability of pH measurement and the auscultatory method to confirm the position of a nasogastric tube.

    Science.gov (United States)

    Boeykens, Kurt; Steeman, Els; Duysburgh, Ivo

    2014-11-01

    Blind placement of a nasogastric feeding tube is a common nursing procedure. Confirmation of the correct position in the stomach is warranted to avoid serious complications such as misplacement in the lung. Testing pH of aspirate from a tube is one of the techniques to confirm the tip position. The purpose of this study was to evaluate the auscultatory method and pH measurement with a pH cut-off point of 5.5 after tube insertion and to compare this with the 'gold standard': an abdominal X-ray. Also the feasibility of the pH method was evaluated. Large prospective observational study in a general hospital. In adult hospitalised patients, the positioning of 331 feeding tubes was tested using two different methods to predict tube position in the stomach. In 98.9% (n=178) of aspirate samples with a pH ≤ 5.5, the tube was located in the stomach. If an aspirate could be obtained, the results of pH measurements showed a sensitivity of 78.4% and a specificity of 85.7%. Obtaining aspirate initially after placement was possible in approximately half of cases but after taking additional measures (including administration of air into the tube, side-positioning of the patient and re-aspiration after one hour) this increased to 81.6%. The sensitivity of the auscultatory method was 79% while the specificity was 61%. A pH of ≤ 5.5 from tube aspirate is adequate to check the position of the tube in the stomach. Additional measures improve the success to obtain an aspirate from the tube. The auscultatory method is unreliable. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Familial link of otitis media requiring tympanostomy tubes.

    Science.gov (United States)

    Padia, Reema; Alt, Jeremiah A; Curtin, Karen; Muntz, Harlan R; Orlandi, Richard R; Berger, Justin; Meier, Jeremy D

    2017-04-01

    Placement of tympanostomy tubes for recurrent or chronic otitis media is the most commonly performed ambulatory procedure in the United States. Etiologies have been speculated to be environmentally based, and studies have suggested a genetic component to the disease. However, no large-scale studies have attempted to define a familial component. The objective of this study was to determine the familial risk of otitis media requiring tympanostomy tubes (OMwTT) in a statewide population. Retrospective observational cohort study with population-based matched controls. Using an extensive genealogical database linked to medical records, the familial risk of OMwTT was calculated for relatives of probands (46,249 patients diagnosed with OMwTT from 1996-2013) compared to random population controls matched 5:1 on sex and birth year from logistic regression models. The median age at time of tympanostomy tube placement was 1 year (interquartile range, 0-2 years). First-degree relatives of patients with OMwTT, primarily siblings, had a 5-fold increased risk of OMwTT (P media may have a significant genetic component given the increased risk found in close as well as distant relatives. This could be influenced by shared environments given a five-times risk observed in siblings. Further understanding the genetic basis of OMwTT and its interplay with environmental factors may clarify the etiology and lead to better detection of disease and treatments. 3b. Laryngoscope, 127:962-966, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  16. Factors influencing decision regret regarding placement of a PEG among substitute decision-makers of older persons in Japan: a prospective study.

    Science.gov (United States)

    Kuraoka, Yumiko; Nakayama, Kazuhiro

    2017-06-28

    A tube feeding decision aid designed at the Ottawa Health Research Institute was specifically created for substitute decision-makers who must decide whether to allow placement of a percutaneous endoscopic gastrostomy (PEG) tube in a cognitively impaired older person. We developed a Japanese version and found that the decision aid promoted the decision-making process of substitute decision-makers to decrease decisional conflict and increase knowledge. However, the factors that influence decision regret among substitute decision-makers were not measured after the decision was made. The objective of this study was to explore the factors that influence decision regret among substitute decision-makers 6 months after using a decision aid for PEG placement. In this prospective study, participants comprised substitute decision-makers for 45 inpatients aged 65 years and older who were being considered for placement of a PEG tube in hospitals, nursing homes and patients' homes in Japan. The Decisional Conflict Scale (DCS) was used to evaluate decisional conflict among substitute decision-makers immediately after deciding whether to introduce tube feeding and the Decision Regret Scale (DRS) was used to evaluate decisional regret among substitute decision-makers 6 months after they made their decision. Normalized scores were evaluated and analysis of variance was used to compare groups. The results of the multiple regression analysis suggest that PEG placement (P conflict (P conflict immediately after deciding whether to allow PEG placement have an influence on decision regret among substitute decision-makers after 6 months.

  17. Characterization of tube support alloys

    International Nuclear Information System (INIS)

    Vaia, A.R.

    1985-01-01

    The involvement and relationship of carbon steel corrosion products in the tube denting phenomenon promoted an intensive research effort to: 1) understand, reproduce, and arrest the denting process, and 2) evaluate alternative tube support materials to provide additional corrosion resistance. The paper summarizes a corrosion testing program for the verification of type 405 stainless steel under acid or all volatile treatment conditions

  18. Flaming on YouTube

    NARCIS (Netherlands)

    Moor, Peter J.; Heuvelman, A.; Verleur, R.

    2010-01-01

    In this explorative study, flaming on YouTube was studied using surveys of YouTube users. Flaming is defined as displaying hostility by insulting, swearing or using otherwise offensive language. Three general conclusions were drawn. First, although many users said that they themselves do not flame,

  19. NEI You Tube Videos: Amblyopia

    Medline Plus

    Full Text Available ... Amaurosis Low Vision Refractive Errors Retinopathy of Prematurity Science Spanish Videos Webinars NEI YouTube Videos: Amblyopia Embedded video for NEI YouTube Videos: Amblyopia NEI Home Contact Us A-Z Site Map NEI on Social Media Information in Spanish (Información en español) Website, ...

  20. 27 CFR 40.352 - Cigarette tubes.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Cigarette tubes. 40.352... OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND PROCESSED TOBACCO Manufacture of Cigarette Papers and Tubes Taxes § 40.352 Cigarette tubes. Cigarette tubes...

  1. External ear canal cholesteatoma after ventilation tube insertion and mastoidectomy

    Directory of Open Access Journals (Sweden)

    Đerić Dragoslava

    2012-01-01

    Full Text Available Introduction. Etiopathogenetically, there are two types of chollesteatomas: congenital, and acquired. Numerous theories in the literature try to explain the nature of the disease, however, the question about cholesteatomas remain still unanswered. The aim of the study was to present a case of external ear canal cholesteatoma (EEC developed following microsurgery (ventilation tube insertion and mastoidectomy, as well as to point ant possible mechanisms if its development. Case report. A 16-yearold boy presented a 4-month sense of fullness in the ear and otalgia on the left side. A year before, mastoidectomy and posterior atticotomy were performed with ventilation tube placement due to acute purulent mastoiditis. Diagnosis was based on otoscopy examination, audiology and computed tomography (CT findings. CT showed an obliterative soft-tissue mass completely filled the external ear canal with associated erosion of subjacent the bone. There were squamous epithelial links between the canal cholesteatoma and lateral tympanic membrane surface. They originated from the margins of tympanic membrane incision made for a ventilation tube (VT insertion. The position of VT was good as well as the aeration of the middle ear cavity. The tympanic membrane was intact and of normal appearance without middle ear extension or mastoid involvement of cholesteatoma. Cholesteatoma and ventilation tube were both removed. The patient recovered without complications and shortly audiology revealed hearing improving. Follow-up 2 years later, however, showed no signs of the disease. Conclusion. There could be more than one potential delicate mechanism of developing EEC in the ear with VT insertion and mastoidectomy. It is necessary to perform routine otologic surveillance in all patients with tubes. Affected ear CT scan is very helpful in showing the extent of cholesteatoma and bony defects, which could not be assessed by otoscopic examination alone.

  2. Immediate placement of endosseous implants into the extraction sockets

    OpenAIRE

    Vijay Ebenezer; K Balakrishnan; R Vigil Dev Asir; Banu Sragunar

    2015-01-01

    Implant by definition ?means any object or material, such as an alloplastic substance or other tissue, which is partial or completely inserted into the body for therapeutic, diagnostic, prosthetic, or experimental purpose.? The placement of a dental implant in an extraction socket at the time of extraction or explantation is known as immediate implant placement whereas delayed placement of implant signifies the implant placement in edentulous areas where healing has completed with new bone fo...

  3. The Pharyngostomy Tube: Indications, Technique, Efficacy, and Safety in Modern Surgical Practice.

    Science.gov (United States)

    Garza-Castillon, Rafael; Berger, Jonathan; Andrade, Rafael; Podgaetz, Eitan

    2016-11-17

    Background  Long-term nasogastric tubes are uncomfortable and associated with complications such as impairment with speech and swallowing, septum trauma, epistaxis, alar necrosis, and intubation of the trachea among others. Pharyngostomy tubes (PTs) are an alternative for prolonged enteral feeding, transluminal drainage of collections, and gastric decompression in patients with an intestinal obstruction and an inoperable abdomen. Patients and Methods  This is a retrospective analysis of patients who had a PT placed at our institution from May 2005 to March 2015. The primary end point of the study was to establish the type and rate of complications and aspiration events related to PT use. Results  During the specified period, a total of 84 PTs were placed. The most common indication for PT placement was enteric decompression in 65 (77.4%), followed by transluminal collection drainage in 12 (14.3%), and enteral access for nutrition in 7 (8.3%) patients. The mean time to tube removal was 17.8 days ± 17.1 (range, 2-119). We encountered 10 (11.2%) complications related to PT placement, including 7 cases of cellulitis, 2 superficial abscesses, and 1 patient with pharyngeal hemorrhage. Conclusion  PTs are a relatively simple, safe, and straightforward approach to achieve long-term enteral decompression, access for feeding or transluminal drainage, avoiding the complications associated with prolonged nasogastric tube placement. The complication rate is low and patient satisfaction and compliance appear to be higher than with nasogastric tubes. Modern surgeons should be familiar with the procedure and technique. PTs should be part of every surgeon's armamentarium. Georg Thieme Verlag KG Stuttgart · New York.

  4. HF electronic tubes. Technologies, grid tubes and klystrons

    International Nuclear Information System (INIS)

    Lemoine, Th.

    2009-01-01

    This article gives an overview of the basic technologies of electronic tubes: cathodes, electronic optics, vacuum and high voltage. Then the grid tubes, klystrons and inductive output tubes (IOT) are introduced. Content: 1 - context and classification; 2 - electronic tube technologies: cathodes, electronic optics, magnetic confinement (linear tubes), periodic permanent magnet (PPM) focussing, collectors, depressed collectors; 3 - vacuum technologies: vacuum quality, surface effects and interaction with electrostatic and RF fields, secondary emission, multipactor effect, thermo-electronic emission; 4 - grid tubes: operation of a triode, tetrodes, dynamic operation and classes of use, 'common grid' and 'common cathode' operation, ranges of utilisation and limitations, operation of a tetrode on unadjusted load, lifetime of a tetrode, uses of grid tubes; 5 - klystrons: operation, impact of space charge, multi-cavity klystrons, interaction efficiency, extended interaction klystrons, relation between interaction efficiency, perveance and efficiency, ranges of utilization and power limitations, multi-beam klystrons and sheet beam klystrons, operation on unadjusted load, klystron band pass and lifetime, uses; 6 - IOT: principle of operation, ranges of utilisation and limitations, interaction efficiency and depressed collector IOT, IOT lifetime and uses. (J.S.)

  5. Determining the brand awareness of product placement in video games

    OpenAIRE

    Král, Marek

    2015-01-01

    This bachelor thesis focusses on the determination of the brand awareness of product placement in video games. The theoretical part includes information about marketing, product placement and video games. The practical part consists of evaluation of the market research about product placements in video games. Conclusion suggests the most important factors influencing the level brand awareness.

  6. Brand Placement and Consumer Choice: An in-Store Experiment

    Science.gov (United States)

    Sigurdsson, Valdimar; Saevarsson, Hugi; Foxall, Gordon

    2009-01-01

    An in-store experiment was performed to investigate the effects of shelf placement (high, middle, low) on consumers' purchases of potato chips. Placement of potato chips on the middle shelf was associated with the highest percentage of purchases. The results confirm the importance of item placement as a factor in consumers' buying behavior.…

  7. Optimal capacitor sizing and placement based on real time analysis ...

    African Journals Online (AJOL)

    In this paper, optimal capacitor sizing and placement method was used to improve energy efficiency. It involves the placement of capacitors in a specific location with suitable sizing based on the current load of the electrical system. The optimization is done in real time scenario where the sizing and placement of the ...

  8. 20 CFR 638.409 - Placement and job development.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Placement and job development. 638.409 Section 638.409 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR JOB CORPS... Placements in the Job Corps § 638.409 Placement and job development. The overall objective of all Job Corps...

  9. A retrospective matched cohort study evaluating the effects of percutaneous endoscopic gastrostomy feeding tubes on nutritional status and survival in patients with advanced gastroesophageal malignancies undergoing systemic anti-cancer therapy.

    Science.gov (United States)

    Mitchell, Scott; Williams, John P; Bhatti, Harsimrandeep; Kachaamy, Toufic; Weber, Jeffrey; Weiss, Glen J

    2017-01-01

    Many patients with cancer or other systemic illnesses can experience malnutrition. One way to mitigate malnutrition is by insertion of a percutaneous endoscopic gastrostomy feeding tube (PEG tube). The goal of this retrospective matched cohort study is to evaluate if PEG tube placement improved nutritional status and overall survival (OS) in advanced gastroesophageal (GE) cancer patients who are undergoing anti-neoplastic therapy. GE cancer patients who were treated and evaluated by a nutritionist and had at least 2 nutritionist follow-up visits were identified. Patients with PEG tube were matched to patients that did not undergo PEG placement (non-PEG). Clinical characteristics, GE symptoms reported at nutrition follow-up visits, and OS were recorded. 20 PEG and 18 non-PEG cases met criteria for further analyses. After correction for multiple testing, there were no OS differences between PEG and non-PEG, treatment naive and previously treated. However, PEG esophageal carcinoma has statistically significant inferior OS compared with non-PEG esophageal carcinoma. PEG placement did not significantly reduce the proportion of patients with weight loss between the initial nutrition assessment and 12-week follow-up. In this small study, PEG placement had inferior OS outcome for GE esophageal carcinoma, no improvement in OS for other evaluated groups, and did not reduce weight loss between baseline and 12-week follow-up. Unless there is prospective randomized trial that can show superiority of PEG placement in this population, PEG placement in this group cannot be endorsed.

  10. Pulsed Drift Tube Accelerator

    International Nuclear Information System (INIS)

    Faltens, A.

    2004-01-01

    The pulsed drift-tube accelerator (DTA) concept was revived by Joe Kwan and John Staples and is being considered for the HEDP/WDM application. It could be used to reach the full energy or as an intermediate accelerator between the diode and a high gradient accelerator such as multi-beam r.f. In the earliest LBNL HIF proposals and conceptual drivers it was used as an extended injector to reach energies where an induction linac with magnetic quadrupoles is the best choice. For HEDP, because of the very short pulse duration, the DTA could provide an acceleration rate of about 1MV/m. This note is divided into two parts: the first, a design based on existing experience; the second, an optimistic extrapolation. The first accelerates 16 parallel K + beams at a constant line charge density of 0.25(micro) C/m per beam to 10 MeV; the second uses a stripper and charge selector at around 4MeV followed by further acceleration to reach 40 MeV. Both benefit from more compact sources than the present 2MV injector source, although that beam is the basis of the first design and is a viable option. A pulsed drift-tube accelerator was the first major HIF experiment at LBNL. It was designed to produce a 2(micro)s rectangular 1 Ampere C s + beam at 2MeV. It ran comfortably at 1.6MeV for several years, then at lower voltages and currents for other experiments, and remnants of that experiment are in use in present experiments, still running 25 years later. The 1A current, completely equivalent to 1.8A K + , was chosen to be intermediate between the beamlets appropriate for a multi-beam accelerator, and a single beam of, say, 10A, at injection energies. The original driver scenarios using one large beam on each side of the reactor rapidly fell out of favor because of the very high transverse and longitudinal fields from the beam space charge, circa 1MV/cm and 250 kV/cm respectively, near the chamber and because of aberrations in focusing a large diameter beam down to a 1mm radius spot at a

  11. Water-storage-tube systems. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Hemker, P.

    1981-12-24

    Passive solar collection/storage/distribution systems were surveyed, designed, fabricated, and mechanically and thermally tested. The types studied were clear and opaque fiberglass tubes, metal tubes with plastic liners, and thermosyphoning tubes. (MHR)

  12. Conditioning and breakdown phenomena in accelerator tubes

    International Nuclear Information System (INIS)

    Skorka, S.J.

    1979-01-01

    Important breakdown mechanisms in accelerator tubes are reviewed, and discharge phenomena in NEC tubes are deduced from the surface appearance of the electrodes and insulators of a used tube. Microphotos of these surfaces are shown

  13. Eddy current signal comparison for tube identification

    Science.gov (United States)

    Glass, S. W.; Vojvodic, R.

    2015-03-01

    Inspection of nuclear power plant steam generator tubes is required to justify continued safe plant operation. The steam generators consist of thousands of tubes with nominal diameters of 15 to 22mm, approximately 1mm wall thickness, and 20 to 30m in length. The tubes are inspected by passing an eddy current probe through the tubes from tube end to tube end. It is critical to know exactly which tube identification (row and column) is associated with each tube's data. This is controlled by a precision manipulator that provides the tube ID to the eddy current system. Historically there have been some instances where the manipulator incorrectly reported the tube ID. This can have serious consequences including lack of inspection of a tube, or if a pluggable indication is detected, the tube is likely to be mis-plugged thereby risking a primary to secondary leak.

  14. Diagnostic accuracy of methods used to verify nasogastric tube position in mechanically ventilated adult patients: a systematic review.

    Science.gov (United States)

    Bennetzen, Linda Vad; Håkonsen, Sasja Jul; Svenningsen, Helle; Larsen, Palle

    2015-01-01

    Nasogastric tubes are widely used in hospitals, e.g. for the administration of nutrients. However, nasogastric tubes can be inserted accidently into the airways leading to complications like pneumonia, pneumothorax and even death. Mechanically ventilated patients are at high risk of having a nasogastric tube misplaced, since they often have reduced consciousness and weak cough reflex. A variety of methods have been used for determination of nasogastric tube placement, but with varying success. The present systematic review was carried out to evaluate the diagnostic accuracy of methods used to determine nasogastric tube placement in mechanically ventilated adult patients. Studies including mechanically ventilated adult patients with a nasogastric tube were considered for inclusion, regardless of the type of nasogastric tube.All methods (index tests) used to verify nasogastric tubes placed in the airways and in the gastrointestinal tract were included. As a reference standard, X-ray was used to verify the accuracy of each index test.The studies that were included in the present systematic review were designed based on diagnostic test accuracy studies.The outcome was the accuracy (sensitivity and specificity) of the methods to discriminate between respiratory and gastrointestinal placement of the nasogastric tube. The search strategy aimed to find both published and unpublished studies before September 2013. Eleven electronic databases were searched including CINAHL, PubMed, Scopus and Embase. Methodological quality was assessed independently by two reviewers using QUADAS as a critical appraisal tool. Data were extracted by two reviewers independently using a modified Joanna Briggs Institute data extraction form including specific details such as: population, setting, index test, sensitivity and specificity. Sensitivity and specificity were extracted from the studies and presented in tables. When these were not written in the studies, calculations were performed based

  15. Planned and unplanned terminations of foster care placements in the Netherlands: Relationships with characteristics of foster children and foster placements

    NARCIS (Netherlands)

    van Rooij, F.; Maaskant, A.; Weijers, I.; Weijers, D.; Hermanns, J.

    2015-01-01

    This study examined the role of placement and child characteristics in the unplanned termination of foster placements. Data were used from 169 foster children aged 0 to 20. Results showed that 35% of all foster placement terminations were unplanned. Outcomes of logistic regression analyses

  16. mouseTube

    Science.gov (United States)

    Torquet, Nicolas; de Chaumont, Fabrice; Faure, Philippe; Bourgeron, Thomas; Ey, Elodie

    2016-01-01

    Ultrasonic vocalisation is a broadly used proxy to evaluate social communication in mouse models of neuropsychiatric disorders. The efficacy and robustness of testing these models suffer from limited knowledge of the structure and functions of these vocalisations as well as of the way to analyse the data. We created mouseTube , an open database with a web interface, to facilitate sharing and comparison of ultrasonic vocalisations data and metadata attached to a recording file. Metadata describe 1) the acquisition procedure, e.g ., hardware, software, sampling frequency, bit depth; 2) the biological protocol used to elicit ultrasonic vocalisations; 3) the characteristics of the individual emitting ultrasonic vocalisations ( e.g. , strain, sex, age). To promote open science and enable reproducibility, data are made freely available. The website provides searching functions to facilitate the retrieval of recording files of interest. It is designed to enable comparisons of ultrasonic vocalisation emission between strains, protocols or laboratories, as well as to test different analysis algorithms and to search for protocols established to elicit mouse ultrasonic vocalisations. Over the long term, users will be able to download and compare different analysis results for each data file. Such application will boost the knowledge on mouse ultrasonic communication and stimulate sharing and comparison of automatic analysis methods to refine phenotyping techniques in mouse models of neuropsychiatric disorders.

  17. X-ray tube

    International Nuclear Information System (INIS)

    Mayo, B.J.

    1980-01-01

    An x-ray tube in which the x-ray origin is scanned on a circle around the patient, comprises a ring-shaped anode, an electron beam travelling along a circular path being deflected onto the anode at the desired positions. The electron beam path may be in a plane parallel to the anode and perhaps at the same radius. It may be in the same plane as a transmission target/anode and at a greater radius. The anode should extend over at least 180 0 although it may extend to 360 0 . Electrostatic means may be provided to constrain the beam to the circular path and further electrostatic means deflect it to the anode of the beam and ensure it is focused at the point of incidence. Collimators provide a planar fan-shaped beam and the anode may be shaped to attenuate side lobes of the radiation. Electrode collects electrons not deflected. The focal regions may be adjacent or otherwise. Coils may provide periodic focusing to overcome space charge dispersion and dynamic adjustment of the focusing before deflection ensures focusing at target incidence. Focusing may be absent near the deflection region, and current in the coil section near the focal region should be zero. (author)

  18. Flux tubes at finite temperature

    Energy Technology Data Exchange (ETDEWEB)

    Cea, Paolo [INFN, Sezione di Bari,Via G. Amendola 173, I-70126 Bari (Italy); Dipartimento di Fisica dell’Università di Bari,Via G. Amendola 173, I-70126 Bari (Italy); Cosmai, Leonardo [INFN, Sezione di Bari,Via G. Amendola 173, I-70126 Bari (Italy); Cuteri, Francesca; Papa, Alessandro [Dipartimento di Fisica, Università della Calabria & INFN-Cosenza,Ponte Bucci, cubo 31C, I-87036 Rende (Cosenza) (Italy)

    2016-06-07

    The chromoelectric field generated by a static quark-antiquark pair, with its peculiar tube-like shape, can be nicely described, at zero temperature, within the dual superconductor scenario for the QCD confining vacuum. In this work we investigate, by lattice Monte Carlo simulations of the SU(3) pure gauge theory, the fate of chromoelectric flux tubes across the deconfinement transition. We find that, if the distance between the static sources is kept fixed at about 0.76 fm ≃1.6/√σ and the temperature is increased towards and above the deconfinement temperature T{sub c}, the amplitude of the field inside the flux tube gets smaller, while the shape of the flux tube does not vary appreciably across deconfinement. This scenario with flux-tube “evaporation” above T{sub c} has no correspondence in ordinary (type-II) superconductivity, where instead the transition to the phase with normal conductivity is characterized by a divergent fattening of flux tubes as the transition temperature is approached from below. We present also some evidence about the existence of flux-tube structures in the magnetic sector of the theory in the deconfined phase.

  19. Stent graft placement for dysfunctional arteriovenous grafts

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Gyeong Sik [Dept. of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam (Korea, Republic of); Shin, Byung Seok; Ohm, Joon Young; Ahn, Moon Sang [Chungnam National University Hospital, Daejeon (Korea, Republic of)

    2015-07-15

    This study aimed to evaluate the usefulness and outcomes of stent graft use in dysfunctional arteriovenous grafts. Eleven patients who underwent stent graft placement for a dysfunctional hemodialysis graft were included in this retrospective study. Expanded polytetrafluoroethylene covered stent grafts were placed at the venous anastomosis site in case of pseudoaneurysm, venous laceration, elastic recoil or residual restenosis despite the repeated angioplasty. The patency of the arteriovenous graft was evaluated using Kaplan-Meier analysis. Primary and secondary mean patency was 363 days and 741 days. Primary patency at 3, 6, and 12 months was 82%, 73%, and 32%, respectively. Secondary patency at the 3, 6, 12, 24, and 36 months was improved to 91%, 82%, 82%, 50%, and 25%, respectively. Fractures of the stent graft were observed in 2 patients, but had no effect on the patency. Stent graft placement in dysfunctional arteriovenous graft is useful and effective in prolonging graft patency.

  20. PEG tubes: dealing with complications.

    Science.gov (United States)

    Malhi, Hardip; Thompson, Rosie

    A percutaneous endoscopic gastronomy tube can be used to deliver nutrition, hydration and medicines directly into the patient's stomach. Patients will require a tube if they are unable to swallow safely, putting them at risk of aspiration of food, drink and medicines into their lungs. It is vital that nurses are aware of the complications that may arise when caring for a patient with a PEG tube. It is equally important that nurses know how to deal with these complications or from where tc seek advice. This article provides a quick troubleshooting guide to help nurses deal with complications that can arise with PEG feeding.

  1. Rigid inflatable gastrostomy tube malposition

    Directory of Open Access Journals (Sweden)

    Timothy E. Murray, MB, MCh, MRCS, FFR

    2017-12-01

    Full Text Available Rigid inflatable gastrostomy (RIG tubes are widely used in contemporary clinical practice for a variety of indications. Insertion of RIG tubes is associated with a high technical success rate and low incidence of mortality. In this case report, a procedural pitfall associated with intraperitoneal-extragastric malposition is described. Rigorous assessment of abdominal radiographs, as well as awareness of the expected appearance of the RIG tube and gastropexy T-fasteners, allows the abdominal radiologist to detect early RIG position in the early postprocedural period. Abdominal radiography is a widely available and inexpensive technique. The high spatial resolution it provides makes it a valuable tool in determining hardware position.

  2. Expansion tube test time predictions

    Science.gov (United States)

    Gourlay, Christopher M.

    1988-01-01

    The interaction of an interface between two gases and strong expansion is investigated and the effect on flow in an expansion tube is examined. Two mechanisms for the unsteady Pitot-pressure fluctuations found in the test section of an expansion tube are proposed. The first mechanism depends on the Rayleigh-Taylor instability of the driver-test gas interface in the presence of a strong expansion. The second mechanism depends on the reflection of the strong expansion from the interface. Predictions compare favorably with experimental results. The theory is expected to be independent of the absolute values of the initial expansion tube filling pressures.

  3. VLSI Cells Placement Using the Neural Networks

    International Nuclear Information System (INIS)

    Azizi, Hacene; Zouaoui, Lamri; Mokhnache, Salah

    2008-01-01

    The artificial neural networks have been studied for several years. Their effectiveness makes it possible to expect high performances. The privileged fields of these techniques remain the recognition and classification. Various applications of optimization are also studied under the angle of the artificial neural networks. They make it possible to apply distributed heuristic algorithms. In this article, a solution to placement problem of the various cells at the time of the realization of an integrated circuit is proposed by using the KOHONEN network

  4. Placement Strategies of World's Top Business Schools

    OpenAIRE

    Varun Shenoy; Aithal P. S .

    2017-01-01

    Institutional Ranking in higher education space has become a very important practice and management institutions across the world are greatly profited by the published global rankings based on various criterions. The ranking is usually publicized depending upon Institutional infrastructure, their employment &placements, teaching pedagogy, research output, faculty-student ratio, international linkage, application of technology in teaching –learning process etc. In this study, we have chosen to...

  5. A Placement Model for Flight Simulators.

    Science.gov (United States)

    1982-09-01

    simulator basing strategies. Captains David R. VanDenburg and Jon D. Veith developed a mathematical model to assist in the placement analysis of A-7...Institute for Defense Analysis, Arlington VA, August 1977. AD A049979. 23. Sugarman , Robert C., Steven L. Johnson, and William F. H. Ring. "B-I Systems...USAF Cost and Plan- nin& Factors. AFR 173-13. Washington: Govern- ment Printing Office, I February 1982. * 30. Van Denburg, Captain David R., USAF

  6. FPGA Congestion-Driven Placement Refinement

    Energy Technology Data Exchange (ETDEWEB)

    Vicente de, J.

    2005-07-01

    The routing congestion usually limits the complete proficiency of the FPGA logic resources. A key question can be formulated regarding the benefits of estimating the congestion at placement stage. In the last years, it is gaining acceptance the idea of a detailed placement taking into account congestion. In this paper, we resort to the Thermodynamic Simulated Annealing (TSA) algorithm to perform a congestion-driven placement refinement on the top of the common Bounding-Box pre optimized solution. The adaptive properties of TSA allow the search to preserve the solution quality of the pre optimized solution while improving other fine-grain objectives. Regarding the cost function two approaches have been considered. In the first one Expected Occupation (EO), a detailed probabilistic model to account for channel congestion is evaluated. We show that in spite of the minute detail of EO, the inherent uncertainty of this probabilistic model impedes to relieve congestion beyond the sole application of the Bounding-Box cost function. In the second approach we resort to the fast Rectilinear Steiner Regions algorithm to perform not an estimation but a measurement of the global routing congestion. This second strategy allows us to successfully reduce the requested channel width for a set of benchmark circuits with respect to the widespread Versatile Place and Route (VPR) tool. (Author) 31 refs.

  7. Experiences of Supervision at Practice Placement Sites

    Directory of Open Access Journals (Sweden)

    Lesley Diack

    2014-01-01

    Full Text Available Background. Whilst placement supervision and clinical education programmes are of significant value in shaping the behaviours of undergraduate healthcare students, appropriate provisions which are efficacious to the learner are somewhat lacking, particularly for students studying on UK MPharm programmes. Objectives. To explore and explain the value of placement supervision to the personal development and employability of undergraduate pharmacy students. Methods. Students participated in a week long community pharmacy pilot programme, a result of a collaborative effort between the School of Pharmacy and Life Sciences and a small consortium of community pharmacies. Students and stakeholders were asked to evaluate their experiences via separate questionnaires which had been developed to elicit views and attitudes. Key Findings. Feedback from students and stakeholders towards the experience was overwhelmingly positive with multiple benefits being reported. Of particular prominence was the emphasis in student feedback on the value of placement supervision to their professional and personal development. Findings were indicative of a development in clinical practice proficiencies, core skills, and improvement in decision-making practice. Conclusions. The benefits of clinical supervision to the professional and personal development of MPharm students are well documented, although attracting professional pharmacy supervisors is proving a problematic task for educational providers in the UK.

  8. Can donated media placements reach intended audiences?

    Science.gov (United States)

    Cooper, Crystale Purvis; Gelb, Cynthia A; Chu, Jennifer; Polonec, Lindsey

    2013-09-01

    Donated media placements for public service announcements (PSAs) can be difficult to secure, and may not always reach intended audiences. Strategies used by the Centers for Disease Control and Prevention's (CDC) Screen for Life: National Colorectal Cancer Action Campaign (SFL) to obtain donated media placements include producing a diverse mix of high-quality PSAs, co-branding with state and tribal health agencies, securing celebrity involvement, monitoring media trends to identify new distribution opportunities, and strategically timing the release of PSAs. To investigate open-ended recall of PSAs promoting colorectal cancer screening, CDC conducted 12 focus groups in three U.S. cities with men and women either nearing age 50 years, when screening is recommended to begin, or aged 50-75 years who were not in compliance with screening guidelines. In most focus groups, multiple participants recalled exposure to PSAs promoting colorectal cancer screening, and most of these individuals reported having seen SFL PSAs on television, in transit stations, or on the sides of public buses. Some participants reported exposure to SFL PSAs without prompting from the moderator, as they explained how they learned about the disease. Several participants reported learning key campaign messages from PSAs, including that colorectal cancer screening should begin at age 50 years and screening can find polyps so they can be removed before becoming cancerous. Donated media placements can reach and educate mass audiences, including millions of U.S. adults who have not been screened appropriately for colorectal cancer.

  9. Paving the Way for Implant Placement for an Auricular Prosthesis

    Directory of Open Access Journals (Sweden)

    Dipti S Shah

    2013-01-01

    Full Text Available Background: Ideal placement of bone integrated implants to retain a prosthesis is critical for a successful final prosthetic restoration. Several sources have described the importance and use of surgical templates for the optimal placement of extraoral implants. The literature is replete with information explaining the use of surgic al templates for intraoral implant placement. Indeed, correct placement of implants facilitates creating a prosthesis that functions well and looks natural. To ensure proper implant placement, considerable effort should go into pre-surgical planning. It is clear that extraoral surgical templates aid in proper implant placement, yet the literature describing fabrication is limited. This article describes different methods for fabrication of surgical template for placement of implants for an auricular prosthesis.

  10. Nurse and patient factors that influence nursing time in chest tube management early after open heart surgery: A descriptive, correlational study.

    Science.gov (United States)

    Cook, Myra; Idzior, Laura; Bena, James F; Albert, Nancy M

    2017-10-01

    Determine nurse characteristics and patient factors that affect nurses' time in managing chest tubes in the first 24-hours of critical-care stay. Prospective, descriptive. Cardiovascular critical-care nurses and post-operative heart surgery patients with chest tubes were enrolled from a single center in Ohio. Nurses completed case report forms about themselves, comfort and time in managing chest tubes, chest tube placement and management factors. Analysis included correlational and comparative statistics; Bonferroni corrections were applied, as appropriate. Of 29 nurses, 86.2% were very comfortable managing chest tubes and oozing/non-secure dressings, but only 41.4% were very comfortable managing clogged chest tubes. Of 364 patients, mean age was 63.1 (±12.3) years and 36% had previous heart surgery. Total minutes of chest tube management was higher with≥3 chest tubes, tube size cardiac surgeries (p≤0.002), heart failure (pNurse comfort with chest tube-related tasks affected time spent on chest tube management. Published by Elsevier Ltd.

  11. Comparison of digital and traditional thoracic drainage systems for postoperative chest tube management after pulmonary resection: A prospective randomized trial.

    Science.gov (United States)

    Takamochi, Kazuya; Nojiri, Shuko; Oh, Shiaki; Matsunaga, Takeshi; Imashimizu, Kota; Fukui, Mariko; Suzuki, Kenji

    2017-11-13

    The objective of this study was to evaluate whether a digital thoracic drainage system (group D) is clinically useful compared with a traditional thoracic drainage system (group T) in chest tube management following anatomic lung resection. Patients scheduled to undergo segmentectomy or lobectomy were prospectively randomized before surgery to group D or T. A stratification randomization was performed according to the following air leak risk factors: age, sex, smoking status, and presence of emphysema and/or chronic obstructive pulmonary disease. The primary end point was the duration of chest tube placement. No statistically significant differences were found between groups D (n = 135) and T (n = 164) with regard to the duration of chest tube placement (median, 2.0 vs 3.0 days; P = .149), duration of hospitalization (median, 6.0 vs 7.0 days; P = .548), or frequency of postoperative adverse events (25.1% vs 20.7%; P = .361). In subgroup analyses of the 64 patients with postoperative air leak (20 in group D and 44 in group T), the duration of chest tube placement (median, 4.5 vs 4.0 days; P = .225) and duration of postoperative air leak (median, 3.0 vs 3.0 days; P = .226) were not significantly different between subgroups. The use of a digital thoracic drainage system did not shorten the duration of chest tube placement in comparison to a traditional thoracic drainage system after anatomic lung resection. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  12. NEI You Tube Videos: Amblyopia

    Medline Plus

    Full Text Available ... and Aging Program African American Program Training and Jobs Fellowships NEI Summer Intern Program Diversity In Vision ... DIVRO) Student Training Programs To search for current job openings visit HHS USAJobs Home >> NEI YouTube Videos >> ...

  13. Tube-wave seismic imaging

    Science.gov (United States)

    Korneev, Valeri A [LaFayette, CA

    2009-05-05

    The detailed analysis of cross well seismic data for a gas reservoir in Texas revealed two newly detected seismic wave effects, recorded approximately 2000 feet above the reservoir. A tube-wave (150) is initiated in a source well (110) by a source (111), travels in the source well (110), is coupled to a geological feature (140), propagates (151) through the geological feature (140), is coupled back to a tube-wave (152) at a receiver well (120), and is and received by receiver(s) (121) in either the same (110) or a different receiving well (120). The tube-wave has been shown to be extremely sensitive to changes in reservoir characteristics. Tube-waves appear to couple most effectively to reservoirs where the well casing is perforated, allowing direct fluid contact from the interior of a well case to the reservoir.

  14. NEI You Tube Videos: Amblyopia

    Medline Plus

    Full Text Available ... and Aging Program African American Program Training and Jobs Fellowships NEI Summer Intern Program Diversity In Vision ... DIVRO) Student Training Programs To search for current job openings visit HHS USAJobs Home > NEI YouTube Videos > ...

  15. Lunar Core Drive Tubes Summary

    Data.gov (United States)

    National Aeronautics and Space Administration — Contains a brief summary and high resolution imagery from various lunar rock and core drive tubes collected from the Apollo and Luna missions to the moon.

  16. NEI You Tube Videos: Amblyopia

    Medline Plus

    Full Text Available ... questions Clinical Studies Publications Catalog Photos and Images Spanish Language Information Grants and Funding Extramural Research Division ... Low Vision Refractive Errors Retinopathy of Prematurity Science Spanish Videos Webinars NEI YouTube Videos: Amblyopia Embedded video ...

  17. Conditioning of NEC accelerator tubes

    International Nuclear Information System (INIS)

    Yntema, J.L.

    1979-01-01

    The conditioning process of NEC tubes was investigated by recording the fluctuations observed with a residual gas analyzer for a fixed mass and a simultaneous recording of the current fluctuations in background pressure

  18. NEI You Tube Videos: Amblyopia

    Medline Plus

    Full Text Available ... Disease Education Program Glaucoma Education Program Low Vision Education Program Hispanic/Latino ... To search for current job openings visit HHS USAJobs Home » NEI YouTube ...

  19. Replacement of Dislodged Gastrostomy Tubes After Stoma Dilation in the Pediatric Emergency Department

    Directory of Open Access Journals (Sweden)

    Shiloni Bhambani

    2017-04-01

    Full Text Available Introduction: A dislodged gastrostomy tube (GT is a common complaint that requires evaluation in the pediatric emergency department (ED and, on occasion, will require stoma dilation to successfully replace the GT. The objective of this study was to describe the frequency that stoma dilation is required, the success rate of replacement, complications encountered, and the techniques used to confirm placement of the GT after dilation. Methods: We conducted a retrospective medical record review of children 0–18 years who presented to the pediatric ED from February 2013 through February 2015 with a dislodged GT that required stoma dilation by pediatric emergency physicians with serially increasing Foley catheter sizes prior to successful placement of the GT. Results: We reviewed a total of 302 encounters in 215 patients, with 97 (32% of the encounters requiring stoma dilation prior to replacing a GT. The median amount of dilation was 2 French between the initial Foley catheter size and the final GT size. There was a single complication of a mal-positioned balloon that was identified at the index visit. No delayed complications were encountered. We performed confirmation of placement in all patients. The two most common forms of confirmation were aspiration of gastric contents (56/97 [58%] followed by contrast radiograph in 39 (40%. Conclusion: The practice of serial dilation of a gastrostomy stoma site to allow successful replacement of a gastrostomy tube in pediatric patients who present to the ED with a dislodged gastrostomy tube is generally successful and without increased complication. All patients received at least one form of confirmation for appropriate GT placement with the most common being aspiration of gastric contents.

  20. Eddy current tube testing unit

    International Nuclear Information System (INIS)

    Dufayet, J.P.; Duret, G.

    1975-01-01

    The unit described can check a wide variety of tubes in quick succession and its modular design gives it a high degree of versability. Suitably defined working conditions and specific fittings enable most of the faults encountered in the manufacture of a tube to be detected. By appropriate means of selection based on signal amplitude, phase and frequency analyses it is possible to adapt selection criteria to the seriousness of the different categories of defect [fr

  1. Electronics for proportional drift tubes

    International Nuclear Information System (INIS)

    Fremont, G.; Friend, B.; Mess, K.H.; Schmidt-Parzefall, W.; Tarle, J.C.; Verweij, H.; CERN-Hamburg-Amsterdam-Rome-Moscow Collaboration); Geske, K.; Riege, H.; Schuett, J.; CERN-Hamburg-Amsterdam-Rome-Moscow Collaboration); Semenov, Y.; CERN-Hamburg-Amsterdam-Rome-Moscow Collaboration)

    1980-01-01

    An electronic system for the read-out of a large number of proportional drift tubes (16,000) has been designed. This system measures deposited charge and drift-time of the charge of a particle traversing a proportional drift tube. A second event can be accepted during the read-out of the system. Up to 40 typical events can be collected and buffered before a data transfer to a computer is necessary. (orig.)

  2. The YouTube reader

    OpenAIRE

    Snickars, Pelle; Vonderau, Patrick

    2009-01-01

    YouTube has come to epitomize the possibilities of digital culture. With more than seventy million unique users a month and approximately eighty million videos online, this brand-name video distribution platform holds the richest repository of popular culture on the Internet. As the fastest growing site in the history of the Web, YouTube promises endless new opportunities for amateur video, political campaigning, entertainment formats, and viral marketing—a clip culture that has seemed to out...

  3. Colonic transendoscopic enteral tubing: A novel way of transplanting fecal microbiota

    Science.gov (United States)

    Peng, Zhaoyuan; Xiang, Jie; He, Zhi; Zhang, Ting; Xu, Lijuan; Cui, Bota; Li, Pan; Huang, Guangming; Ji, Guozhong; Nie, Yongzhan; Wu, Kaichun; Fan, Daiming; Zhang, Faming

    2016-01-01

    Background and study aims: Placement of a tube through the anus into the cecum has not yet been established as a method of administering whole-colonic treatment. The aim of this study was to evaluate the safety, feasibility, and value of transendoscopic enteral tubing (TET) for fecal microbiota transplantation (FMT) through the colon. Patients and methods: A prospective observational study was performed of FMT using a new colonic TET technique. Under endoscopic guidance, a TET tube was affixed to the cecum with clips. The safety, value, and satisfaction with the FMT by TET were evaluated. Results: A total of 54 patients underwent TET. The success rate of the TET procedure was 100 % (54/54). Duration of the TET procedures was 14.8 ± 5.8 min. During the TET tube retention period, 98.1 % (53/54) of patients were satisfied with TET. The retention time for whole-colon delivery of the fecal microbiota suspension was 12.4 ± 2.3 days. In 88.4 % (49/54) of cases, no discomfort was reported during injection through the TET tube of the microbiota suspension. No adverse events were see in patients who required tube extubation after FMT. Conclusions: Colonic TET is a novel, safe, convenient, and reliable procedure for FMT that results in a high degree of patient satisfaction. PMID:27556065

  4. Dermatology on YouTube.

    Science.gov (United States)

    Boyers, Lindsay N; Quest, Tyler; Karimkhani, Chante; Connett, Jessica; Dellavalle, Robert P

    2014-06-15

    YouTube, reaches upwards of six billion users on a monthly basis and is a unique source of information distribution and communication. Although the influence of YouTube on personal health decision-making is well established, this study assessed the type of content and viewership on a broad scope of dermatology related content on YouTube. Select terms (i.e. dermatology, sun protection, skin cancer, skin cancer awareness, and skin conditions) were searched on YouTube. Overall, the results included 100 videos with over 47 million viewers. Advocacy was the most prevalent content type at 24% of the total search results. These 100 videos were "shared" a total of 101,173 times and have driven 6,325 subscriptions to distinct YouTube user pages. Of the total videos, 35% were uploaded by or featured an MD/DO/PhD in dermatology or other specialty/field, 2% FNP/PA, 1% RN, and 62% other. As one of the most trafficked global sites on the Internet, YouTube is a valuable resource for dermatologists, physicians in other specialties, and the general public to share their dermatology-related content and gain subscribers. However, challenges of accessing and determining evidence-based data remain an issue.

  5. Preperitoneal placement of an inflatable penile prosthesis reservoir for postoperative erectile dysfunction after radical cystoprostatectomy with orthotopic neobladder

    Directory of Open Access Journals (Sweden)

    Jung Kwon Kim

    2016-09-01

    Full Text Available Purpose: To describe a case of safe placement of an inflatable penile prosthesis reservoir for postoperative erectile dysfunction (ED with a history of radical cystoprostatectomy with an orthotopic Studer neobladder. Materials and Methods: A 55-year-old bladder cancer patient, who underwent radical cystoprostatectomy with orthotopic Studer neobladder 2 years prior, suffered from postoperative ED. A 3-piece inflatable penile prosthesis was implanted via a penoscrotal incision. The alternative reservoir placement began with a longitudinal 4-cm incision, which was 2 finger-breaths to the left and lateral to the umbilicus. Thereafter, the anterior and posterior rectus sheaths were dissected and incised. Then, the transversalis fascia entering into the preperitoneal space was incised, followed by circumferential sweeping using the forefinger, and, finally, placement of a 100 mL ‘flat’ reservoir. The reservoir was filled with 65 mL saline and then evaluated for back pressure. The reservoir tubing exited through the defect of the rectus sheaths and tunneled through the abdominal fat into the penoscrotal wound. Results: Total operative time was 105 minutes, and the estimated blood loss was minimal. The patient was discharged at postoperative day 1 and experienced no perioperative complications. At the 6-month follow-up, there was no abdominal bulging from the preperitoneal reservoir, and the reservoir was not palpable. Conclusions: The preperitoneal placement of the flat reservoir at the level of the umbilicus is a safe and acceptable surgical technique for postoperative ED after radical cystoprostatectomy with orthotopic neobladder.

  6. Stent placement for esophageal strictures : an update

    NARCIS (Netherlands)

    Hirdes, Meike Madeleine Catharine; Vleggaar, Frank Paul; Siersema, Peter Derk

    2011-01-01

    The use of stents for esophageal strictures has evolved rapidly over the past 10 years, from rigid plastic tubes to flexible self-expanding metal (SEMS), plastic (SEPS) and biodegradable stents. For the palliative treatment of malignant dysphagia both SEMS and SEPS effectively provide a rapid relief

  7. FROM BRAND PLACEMENT TO TOURISM PRODUCT PLACEMENT. FICTION SERIES AS PROMOTIONAL SUPPORT OF SPANISH TOURISM DESTINATIONS

    Directory of Open Access Journals (Sweden)

    Noelia Araújo-Vila

    2011-12-01

    Full Text Available Every day more consumers spend much of their free time to the consumption of audiovisual series, which is reflected in the notable increase in downloads and audiences. Therefore, many sectors have decided to use audiovisual series as advertising (brand placement, being one of them the tourism sector (tourism product placement. There are many worldwide destinations that have decided to set in a fiction series, thus being viewed by thousands of spectators, which has resulted in increases in visitors. In the Spanish case is not so clear the use of this strategy, as it is analysed in this article.

  8. Multi-anode wire straw tube tracker

    International Nuclear Information System (INIS)

    Oh, S.H.; Ebenstein, W.L.; Wang, C.W.

    2011-01-01

    We report on a test of a straw tube detector design having several anode (sense) wires inside a straw tube. The anode wires form a circle inside the tube and are read out independently. This design could solve several shortcomings of the traditional single wire straw tube design such as double hit capability and stereo configuration.

  9. 21 CFR 872.6570 - Impression tube.

    Science.gov (United States)

    2010-04-01

    ... DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6570 Impression tube. (a) Identification. An impression tube is a device consisting of a hollow copper tube intended to take an impression of a single tooth... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Impression tube. 872.6570 Section 872.6570 Food...

  10. 27 CFR 41.35 - Cigarette tubes.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Cigarette tubes. 41.35... OF THE TREASURY (CONTINUED) TOBACCO IMPORTATION OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND PROCESSED TOBACCO Taxes Tax Rates § 41.35 Cigarette tubes. Cigarette tubes are taxed at the following rates...

  11. Tubing vs. buckets: a cost comparison

    Science.gov (United States)

    Neil K. Huyler

    1975-01-01

    Equipment investment for tubing-vacuum systems was significantly less than that for bucket systems. Tubing-vacuum systems required about 22 percent less labor input, the major labor input being completed before sap-flow periods. Annual cost of operation was less for tubing-vacuum than the bucket system. Small tubing-vacuum operations showed more profit potential than...

  12. Effective conflict resolution strategies for SRAF placement

    Science.gov (United States)

    Ganjugunte, Shashidhara K.; Strecker, Norbert; Jayaram, Srividya; LaCour, Pat; Torunoglu, Ilhami

    2015-07-01

    Sub-Resolution Assist Features (SRAFs) have emerged as a key technology to enable semiconductor manufacturing for advanced technology nodes. SRAF placement is required to adhere to manufacturability constraints (MRC). MRC specifications are distance and size constraints specified by the user to ensure SRAFs are not detrimental to the final target shapes being printed. Conceptually, SRAF placement can be divided into two steps - SRAF candidate generation and SRAF candidate cleanup or conflict resolution. SRAFs generated as candidates may not adhere to MRC constraints. It is during the cleanup/conflict resolution process that the MRC constraints are enforced. In this paper we focus on the latter phase - cleanup. The goal of the cleanup phase is to retain as much of the initial candidates as possible, and, if necessary, transform them to adhere to MRC conditions. An SRAF is said to be in conflict with another shape if it violates the distance MRC constraint. One can model these conflicts using a conflict graph G=(V,E), whose vertices V correspond to geometric shapes involved in a conflict and an edge is present in E, between two vertices if the corresponding shapes are involved in a conflict. A weight is associated with each vertex that could, for example, correspond to area of the corresponding shape. The goal of conflict resolution then, is to find a transformation of the vertices so that the resulting graph is conflict free while maximizing the weight of vertices retained. This can be viewed as a generalization of the computationally hard problem of finding the largest independent set of candidates, albeit allowing for transformation. The transformations we allow include deletion, splitting, resizing, merge, and bounded translation. In this paper, we describe an approach which classifies the conflicts and apply appropriate transformations to achieve effective SRAF placement. Further, we demonstrate that such a strategy reduces the number of rules to be specified by

  13. Post-placement temperature reduction techniques

    DEFF Research Database (Denmark)

    Liu, Wei; Nannarelli, Alberto

    2010-01-01

    With technology scaled to deep submicron era, temperature and temperature gradient have emerged as important design criteria. We propose two post-placement techniques to reduce peak temperature by intelligently allocating whitespace in the hotspots. Both methods are fully compliant with commercial...... technologies, and can be easily integrated with state-of-the-art thermal-aware design flow. Experiments in a set of tests on circuits implemented in STM 65nm technologies show that our methods achieve better peak temperature reduction than directly increasing circuit's area....

  14. New strategy for optimizing wavelength converter placement

    Science.gov (United States)

    Foo, Y. C.; Chien, S. F.; Low, Andy L. Y.; Teo, C. F.; Lee, Youngseok

    2005-01-01

    This paper proposes a new strategic alternate-path routing to be combined with the particle swarm optimization (PSO) algorithm to better solve the wavelength converters placement problem. The strategic search heuristic is designed to provide network connectivity topologies for the converters to be placed more effectively. The new strategy is applied to the 14-node NSFNET to examine its efficiency in reducing the blocking probability in sparse wavelength conversion network. Computed results show that, when applied to the identical optimization framework, our search method outperforms both the equal-cost multipath routing and traffic-engineering-aware shortest-path routing.

  15. Preoperative short hookwire placement for small pulmonary lesions: evaluation of technical success and risk factors for initial placement failure.

    Science.gov (United States)

    Iguchi, Toshihiro; Hiraki, Takao; Matsui, Yusuke; Fujiwara, Hiroyasu; Masaoka, Yoshihisa; Tanaka, Takashi; Sato, Takuya; Gobara, Hideo; Toyooka, Shinichi; Kanazawa, Susumu

    2018-05-01

    To retrospectively evaluate the technical success of computed tomography fluoroscopy-guided short hookwire placement before video-assisted thoracoscopic surgery and to identify the risk factors for initial placement failure. In total, 401 short hookwire placements for 401 lesions (mean diameter 9.3 mm) were reviewed. Technical success was defined as correct positioning of the hookwire. Possible risk factors for initial placement failure (i.e., requirement for placement of an additional hookwire or to abort the attempt) were evaluated using logistic regression analysis for all procedures, and for procedures performed via the conventional route separately. Of the 401 initial placements, 383 were successful and 18 failed. Short hookwires were finally placed for 399 of 401 lesions (99.5%). Univariate logistic regression analyses revealed that in all 401 procedures only the transfissural approach was a significant independent predictor of initial placement failure (odds ratio, OR, 15.326; 95% confidence interval, CI, 5.429-43.267; p failure (OR 0.793, 95% CI 0.631-0.996; p = 0.046). The technical success of preoperative short hookwire placement was extremely high. The transfissural approach was a predictor initial placement failure for all procedures and small lesion size was a predictor of initial placement failure for procedures performed via the conventional route. • Technical success of preoperative short hookwire placement was extremely high. • The transfissural approach was a significant independent predictor of initial placement failure for all procedures. • Small lesion size was a significant independent predictor of initial placement failure for procedures performed via the conventional route.

  16. Analysis of forming limit in tube hydroforming

    International Nuclear Information System (INIS)

    Kim, Chan Il; Yang, Seung Hang; Kim, Young Suk

    2013-01-01

    The automotive industry has shown increasing interest in tube hydroforming. Despite many automobile structural parts being produced from cylindrical tubes, failures frequently occur during tube hydroforming under improper forming conditions. These problems include wrinkling, buckling, folding back, and bursting. We perform analytical studies to determine forming limits in tube hydroforming and demonstrate how these forming limits are influenced by the loading path. Theoretical results for the forming limits of wrinkling and bursting are compared with experimental results for an aluminum tube.

  17. Immediate placement of endosseous implants into the extraction sockets

    Directory of Open Access Journals (Sweden)

    Vijay Ebenezer

    2015-01-01

    Full Text Available Implant by definition "means any object or material, such as an alloplastic substance or other tissue, which is partial or completely inserted into the body for therapeutic, diagnostic, prosthetic, or experimental purpose." The placement of a dental implant in an extraction socket at the time of extraction or explantation is known as immediate implant placement whereas delayed placement of implant signifies the implant placement in edentulous areas where healing has completed with new bone formation after the loss of tooth/teeth. Recent idea goes by "why late when it can be done immediately." There are several advantages of immediate placement of implants, and lots of studies have been done. In this article, the advantages and disadvantages of immediate versus delayed placement of implants have been reviewed.

  18. Immediate placement of endosseous implants into the extraction sockets.

    Science.gov (United States)

    Ebenezer, Vijay; Balakrishnan, K; Asir, R Vigil Dev; Sragunar, Banu

    2015-04-01

    Implant by definition "means any object or material, such as an alloplastic substance or other tissue, which is partial or completely inserted into the body for therapeutic, diagnostic, prosthetic, or experimental purpose." The placement of a dental implant in an extraction socket at the time of extraction or explantation is known as immediate implant placement whereas delayed placement of implant signifies the implant placement in edentulous areas where healing has completed with new bone formation after the loss of tooth/teeth. Recent idea goes by "why late when it can be done immediately." There are several advantages of immediate placement of implants, and lots of studies have been done. In this article, the advantages and disadvantages of immediate versus delayed placement of implants have been reviewed.

  19. Physics of magnetic flux tubes

    CERN Document Server

    Ryutova, Margarita

    2015-01-01

    This book is the first account of the physics of magnetic flux tubes from their fundamental properties to collective phenomena in an ensembles of flux tubes. The physics of magnetic flux tubes is absolutely vital for understanding fundamental physical processes in the solar atmosphere shaped and governed by magnetic fields. High-resolution and high cadence observations from recent space and  ground-based instruments taken simultaneously at different heights and temperatures not only show the ubiquity of filamentary structure formation but also allow to study how various events are interconnected by system of magnetic flux tubes. The book covers both theory and observations. Theoretical models presented in analytical and phenomenological forms are tailored for practical applications. These are welded with state-of-the-art observations from early decisive ones to the most recent data that open a new phase-space for exploring the Sun and sun-like stars. Concept of magnetic flux tubes is central to various magn...

  20. Comparison of proseal laryngeal mask and endotracheal tube for airway safety in pediatric strabismus surgery.

    Science.gov (United States)

    Gul, Rauf; Goksu, Sitki; Ugur, Berna K; Sahin, Levent; Koruk, Senem; Okumus, Seydi; Erbagci, Ibrahim

    2012-04-01

    To compare proseal laryngeal mask airway (PLMA) with an endotracheal tube (ET) for airway safety, maintained ease of insertion, and hemodynamic stability in pediatric strabismus surgery (PSS). This prospective-randomized clinical study was carried out in the Department of Anesthesiology, Faculty of Medicine, Gaziantep University, Turkey between April 2008 and July 2009. Eighty American Society of Anesthesiology (ASA) I-II children, weight 10-30 kg, aged between 1-12 years undergoing PSS were selected. The anesthesia was induced with 8% sevoflurane, 50% nitrous oxide/oxygen mixture, and a neuromuscular blockade with 0.5 mg/kg atracurium in both groups. After a sufficient dosage of anesthesia, the patients were randomized into 2 groups (Group P: PLMA, n= 40, Group T: ET, n=40) and an airway management device; either a PLMA or ET was inserted. The number of placement attempts, placement success or failure, success or failure of a gastric suction tube placement during the procedures and perioperative complications were assessed. Thirty-eight patients (95%) in the PLMA group, 39 (97.5%) patients in the ET group were successfully placed with a PLMA and ET on the first attempt (p>0.05). There were no statistically significant differences in the hemodynamic parameters, end-tidal carbon dioxide, and complications. This study revealed that PLMA may offer an alternative airway to ET wherein positive pressure ventilation was the preferred choice for children undergoing PSS.

  1. The Re-Placement Test: Using TOEFL for Purposes of Placement

    Science.gov (United States)

    Moglen, Daniel

    2015-01-01

    This article will consider using TOEFL scores for purposes of placement and advising for international graduate students at a northern California research university. As the number of international students is on the rise and the funds for the graduate ESL program are diminishing, the way in which the university is handling the influx of…

  2. Placement suitability criteria of composite tape for mould surface in automated tape placement

    Directory of Open Access Journals (Sweden)

    Zhang Peng

    2015-10-01

    Full Text Available Automated tape placement is an important automated process used for fabrication of large composite structures in aeronautical industry. The carbon fiber composite parts realized with this process tend to replace the aluminum parts produced by high-speed machining. It is difficult to determine the appropriate width of the composite tape in automated tape placement. Wrinkling will appear in the tape if it does not suit for the mould surface. Thus, this paper deals with establishing placement suitability criteria of the composite tape for the mould surface. With the assumptions for ideal mapping and by applying some principles and theorems of differential geometry, the centerline trajectory of the composite tape is identified to follow the geodesic. The placement suitability of the composite tape is examined on three different types of non-developable mould surfaces and four criteria are derived. The developed criteria have been used to test the deposition process over several mould surfaces and the appropriate width for each mould surface is obtained by referring to these criteria.

  3. Placement Design of Changeable Message Signs on Curved Roadways

    Directory of Open Access Journals (Sweden)

    Zhongren Wang, Ph.D. P.E. T.E.

    2015-01-01

    Full Text Available This paper presented a fundamental framework for Changeable Message Sign (CMS placement design along roadways with horizontal curves. This analytical framework determines the available distance for motorists to read and react to CMS messages based on CMS character height, driver's cone of vision, CMS pixel's cone of legibility, roadway horizontal curve radius, and CMS lateral and vertical placement. Sample design charts were developed to illustrate how the analytical framework may facilitate CMS placement design.

  4. Nursing administration of medication via enteral tubes in adults: a systematic review.

    Science.gov (United States)

    Phillips, Nicole M; Nay, Rhonda

    2007-09-01

    Background  Enteral tubes are frequently inserted as part of medical treatment in a wide range of patient situations. Patients with an enteral tube are cared for by nurses in a variety of settings, including general and specialised acute care areas, aged care facilities and at home. Regardless of the setting, nurses have the primary responsibility for administering medication through enteral tubes. Medication administration via an enteral tube is a reasonably common nursing intervention that entails a number of skills, including preparing the medication, verifying the tube position, flushing the tube and assessing for potential complications. If medications are not given effectively through an enteral tube, harmful consequences may result leading to increased morbidity, for example, tube occlusion, diarrhoea and aspiration pneumonia. There are resultant costs for the health-care system related to possible increased length of stay and increased use of equipment. Presently what is considered to be best practice to give medications through enteral tubes is unknown. Objectives  The objective of this systematic review was to determine the best available evidence on which nursing interventions are effective in minimising the complications associated with the administration of medications via enteral tubes in adults. Nursing interventions and considerations related to medication administration included form of medication, verifying tube placement before administration, methods used to give medication, methods used to flush tubes, maintenance of tube patency and specific practices to prevent possible complications related to the administration of enteral medications. Search strategy  The following databases were searched for literature reported in English only: CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO. There was no date restriction applied. In addition, the reference lists of all included

  5. Advancement of a Job- and Personal- Characteristics Placement Model

    National Research Council Canada - National Science Library

    Frink, Dwight

    2001-01-01

    Research toward validation of a comprehensive model mapping personal characteristics onto differentiated job characteristics for effective placement, development, and retention of Navy personnel is described...

  6. Analyzing block placement errors in SADP patterning

    Science.gov (United States)

    Kobayashi, Shinji; Okada, Soichiro; Shimura, Satoru; Nafus, Kathleen; Fonseca, Carlos; Demand, Marc; Biesemans, Serge; Versluijs, Janko; Ercken, Monique; Foubert, Philippe; Miyazaki, Shinobu

    2016-03-01

    We discuss edge placement errors (EPE) for multi-patterning of Mx critical layers using ArF lithography. Specific focus is placed on the block formation part of the process. While plenty of literature characterization data exist on spacer formation, only limited published data is available on block processes. We analyze the accuracy of placing blocks relative to narrow spacers. Many publications calculate EPE assuming Gaussian distributions for key process variations contributing to EPE. For practical reasons, each contributor is measured on dedicated test structures. In this work, we complement such analysis and directly measure the EPE in product. We perform high density sampling of blocks using CDSEM images and analyze all feature edges of interest. We find that block placement errors can be very different depending on their local design context. Specifically we report on 2 block populations (further called block A and B) which have a 4x different standard deviation. We attribute this to differences in local topography (spacer shape) and interaction with the plasma-etch process design. Block A (on top of the `core space' S1) has excellent EPE uniformity of ~1 nm while block B (on top of `gap space' S2) has degraded EPE control of ~4 nm. Finally, we suggest that the SOC etch process is at the origin on positioning blocks accurately on slim spacers, helping the manufacturability of spacer-based patterning techniques, and helping its extension toward the 5nm node.

  7. On hydraulics of capillary tubes

    Directory of Open Access Journals (Sweden)

    N.G. Aloyan

    2016-03-01

    Full Text Available The article considers the laws of motion of water in the capillary tubes, taken as a model for flowing well, on the analogical net count device. For capillary tube the lower limit value of flow rate is empirically determined above which the total hydraulic resistance of the capillary is practically constant. The specificity of the phenomenon is that the regime of motion, by a Reynolds number, for a given flow rate still remains laminar. This circumstance can perplex the specialists, so the author invites them to the scientific debate on the subject of study. Obviously, to identify the resulting puzzle it is necessary to conduct a series of experiments using capillaries of different lengths and diameters and with different values of overpressure. The article states that in tubes with very small diameter the preliminary magnitude of capillary rise of water in the presence of flow plays no role and can be neglected.

  8. Patient identification and tube labelling

    DEFF Research Database (Denmark)

    van Dongen-Lases, Edmée C; Cornes, Michael P; Grankvist, Kjell

    2016-01-01

    of phlebotomy procedures with the CLSI H3-A6 guideline was unacceptably low, and that patient identification and tube labelling are amongst the most critical steps in need of immediate attention and improvement. The process of patient identification and tube labelling is an essential safety barrier to prevent......Venous blood sampling (phlebotomy) is the most common invasive procedure performed in patient care. Guidelines on the correct practice of phlebotomy are available, including the H3-A6 guideline issued by the Clinical Laboratory Standards Institute (CLSI). As the quality of practices and procedures...... patient identity mix-up. Therefore, the EFLM Working Group aims to encourage and support worldwide harmonisation of patient identification and tube labelling procedures in order to reduce the risk of preanalytical errors and improve patient safety. With this Position paper we wish to raise awareness...

  9. Drift tubes of Linac 2

    CERN Multimedia

    CERN PhotoLab

    1977-01-01

    With the advent of the 800 MeV PS Booster in 1972, the original injector of the PS, a 50 MeV Alvarez-type proton linac, had reached its limits, in terms of intensity and stability. In 1973 one therefore decided to build a new linac (Linac 2), also with a drift-tube Alvarez structure and an energy of 50 MeV. It had a new Cockcroft-Walton preinjector with 750 keV, instead of the previous one with 500 keV. Linac 2 was put into service in 1980. The old Linac 1 was then used for the study of, and later operation with, various types of ions. This picture shows Linac 2 drift-tubes, suspended on stems coming from the top, in contrast to Linac 1, where the drift-tubes stood on stems coming from the bottom.

  10. Miniature X-Ray Tubes

    Science.gov (United States)

    Bearman, Gregory H.

    1995-01-01

    Miniature x-ray tubes proposed for use in portable instruments used to analyze minerals. Electrons from field emitter (instead of thermionic emitter) accelerated to target to generate x-rays. Fabricated from silicon wafers, micromachined field emitters (MFEs) not subject to breakage or restrictions on lifetimes, and tolerate vacuums that filaments cannot. Miniature x-ray tubes very robust, immune to shock and vibration, and permanently sealed with getter for continued pumping. Combined with solid-state x-ray detectors for analysis of x-ray fluorescence.

  11. Working session 3: Tubing integrity

    International Nuclear Information System (INIS)

    Cueto-Felgueroso, C.; Strosnider, J.

    1997-01-01

    Twenty-three individuals representing nine countries (Belgium, Canada, the Czech Republic, France, Japan, the Slovak Republic, Spain, the UK, and the US) participated in the session on tube integrity. These individuals represented utilities, vendors, consultants and regulatory authorities. The major subjects discussed by the group included overall objectives of managing steam generator tube degradation, necessary elements of a steam generator degradation management program, the concept of degradation specific management, structural integrity evaluations, leakage evaluations, and specific degradation mechanisms. The group's discussions on these subjects, including conclusions and recommendations, are summarized in this article

  12. Opposed slant tube diabatic sorber

    Science.gov (United States)

    Erickson, Donald C.

    2004-01-20

    A sorber comprised of at least three concentric coils of tubing contained in a shell with a flow path for liquid sorbent in one direction, a flow path for heat transfer fluid which is in counter-current heat exchange relationship with sorbent flow, a sorbate vapor port in communication with at least one of sorbent inlet or exit ports, wherein each coil is coiled in opposite direction to those coils adjoining it, whereby the opposed slant tube configuration is achieved, with structure for flow modification in the core space inside the innermost coil.

  13. YouTube and Facebook

    DEFF Research Database (Denmark)

    Robertson, Scott P.; Vatrapu, Ravi; Medina, Richard

    This paper examines the links to YouTube from the Facebook “walls” of Barack Obama, Hillary Clinton, and John McCain over two years prior to the 2008 U.S. Presidential election. User-generated linkage patterns show how participants in these politically-related social networking dialogues used...... online video to make their points. We show a strong integration of the Web 2.0 and new media technologies of social networking and online video. We argue that political discussion in social networking environments can no longer be viewed as primarily textual, and that neither Facebook nor YouTube can...

  14. Faculty staff and rural placement supervisors' pre- and post-placement perceptions of a clinical rural placement programme in NSW Australia.

    Science.gov (United States)

    Johnson, G; Blinkhorn, A

    2013-02-01

    Staff views on a rural clinical placement involving 4th year dental undergraduates from the University of Sydney (Australia) were collected in order to monitor whether the programme was feasible and acceptable to the academic Faculty Staff and the rural clinical supervisors. An evaluation of the rural placement programme was undertaken in 2009 at three rural sites in New South Wales (Australia). Semi-structured pre- and post-placement in person interviews recorded the views of three University Faculty Staff whilst similar data were collected by telephone interviews for three supervising clinicians at the rural clinical sites. Interviews gathered opinions on the organisation, implementation and outcomes of the rural placement programme. Eight qualitative analysis identified themes were specified and included communication, programme duration, effect on students and staff, benefits of the programme, rural intentions, programme sustainability and the success of the programme. Positive pre-placement aspects were potentially good clinical experience, new environment, sharing of knowledge and interaction with a rural community. Negative issues were anxieties about students' clinical ability to offer a service, missing lectures and maintaining clinical training quotas. The post-placement themes were generally positive; staff reported that the students enjoyed the rural community experience, their communication and clinical skills improved. According to the staff, the placement programme was feasible and provided acceptable positive clinical and personal development for the students. This research will help educators planning to incorporate a rural clinical programme into a University curriculum. © 2012 John Wiley & Sons A/S.

  15. Pump element for a tube pump

    DEFF Research Database (Denmark)

    2011-01-01

    The invention relates to a tube pump comprising a tube and a pump element inserted in the tube, where the pump element comprises a rod element and a first and a second non-return valve member positioned a distance apart on the rod element. The valve members are oriented in the same direction...... portion acts to alternately close and open the valve members thereby generating a fluid flow through the tube. The invention further relates to a pump element comprising at least two non-return valve members connected by a rod element, and for insertion in an at least partly flexible tube in such tube...... pump as mentioned above, thereby acting to generate a fluid flow through the tube upon repeated deformation of the tube between the two valve members. The pump element may comprise a connecting part for coupling to another tube and may comprise a sealing part establishing a fluid tight connection...

  16. The Placement History Chart: A Tool for Understanding the Longitudinal Pattern of Foster Children’s Placements

    Science.gov (United States)

    Kim, Hyoun K.; Pears, Katherine C.; Fisher, Philip A.

    2012-01-01

    Despite growing concerns about foster placement instability, little information is available regarding the longitudinal patterns of placement histories among foster children. The purpose of the present study was to develop a charting system using child welfare records to facilitate a better understanding of longitudinal patterns of placement history for 117 foster children. The resulting Placement History Chart included all placements that occurred during the observed time period and accounted for various dimensions: number, length, type, and sequence of placements; timing of transitions; and total time in out-of-home care. The Placement History Chart is an effective tool for placing foster care experiences within a broader developmental context. As such, the Placement History Chart can be a valuable research tool for understanding various dimensions and variations of placement transitions among foster children by capturing sequences and cumulative risks over time. Furthermore, this chart can facilitate the development of intervention programs that are developmentally sensitive and effectively address particularly vulnerable subpopulations of foster children. PMID:22754080

  17. [Changes in the distance between carina and orotracheal tube during open or videolaparoscopic bariatric surgery].

    Science.gov (United States)

    de Figueiredo Locks, Giovani; Simões de Almeida, Maria Cristina; Sperotto Ceccon, Maurício; Campos Pastório, Karen Adriana

    2015-01-01

    To examine whether there are changes in the distance between the orotracheal tubeand carina induced by orthostatic retractor placement or by pneumoperitoneum insufflation in obese patients undergoing gastroplasty. 60 patients undergoing bariatric surgery by two techniques: open (G1) or videola-paroscopic (G2) gastroplasty were studied. After tracheal intubation, adequate ventilation of both hemitoraxes was confirmed by lung auscultation. The distance orotracheal tube-carina was estimated with the use of a fiber bronchoscope before and after installation of orthostatic retractors in G1 or before and after insufflation of pneumoperitoneum in patients in G2. G1 was composed of 22 and G2 of 38 patients. No cases of endobronchial intubationwere detected in either group. The mean orotracheal tube-carina distance variation was estimated in -0.03 cm (95% CI 0.06 to -0.13) in the group of patients undergoing open gastroplastyand in -0.42 cm (95% CI -0.56 to -1.4) in the group of patients undergoing videolaparoscopic gastroplasty. The extremes of variation in each group were: 0.5 cm to -1.6 cm in patients under-going open surgery and 0.1 cm to -2.2 cm in patients undergoing videolaparoscopic surgery. There was no significant change in orotracheal tube-CA distance after placementof orthostatic retractors in patients undergoing open gastroplasty. There was a reduction inorotracheal tube-CA distance after insufflation of pneumoperitoneum in patients undergoing videolaparoscopic gastroplasty. We recommend attention to lung auscultation and to signals of ventilation monitoring and reevaluation of orotracheal tube placement after peritoneal insufflation. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  18. Intrapleural fibrinolytics combined with image-guided chest tube drainage for pleural infection.

    Science.gov (United States)

    Levinson, Gary M; Pennington, Daniel W

    2007-04-01

    To present our method of treating pleural infection by using a combination of image-guided chest tube drainage and intrapleural fibrinolytics. We retrospectively reviewed the medical charts and radiographs of 30 consecutive patients with pleural infection who were seen at our institution from December 15, 1995, to July 1, 2006, 27 of whom received intrapleural urokinase or tissue-type plasminogen activator. End points were death, length of stay in the hospital, and percentage of patients who needed surgery. Placement of chest tubes required image guidance 45.7% of the time. Three patients (10%; 95% confidence interval, 2.1%-26.5%) died of complications from pleural infection. None of the 30 patients (0%; 95% confidence interval, 0%-9.5%) required surgery for treatment of pleural infection. The median hospital length of stay was 11 days. In the treatment of pleural infection, intrapleural urokinase or tissue-type plasminogen activator in combination with careful image-guided placement of chest tubes is highly effective in resolving the effusion and curing the infection.

  19. Gastrostomy Tube Feeding in Children With Developmental or Acquired Disorders: A Longitudinal Comparison on Healthcare Provision and Eating Outcomes 4 Years After Gastrostomy.

    Science.gov (United States)

    Backman, Ellen; Karlsson, Ann-Kristin; Sjögreen, Lotta

    2018-03-30

    Studies on long-term feeding and eating outcomes in children requiring gastrostomy tube feeding (GT) are scarce. The aim of this study was to describe children with developmental or acquired disorders receiving GT and to compare longitudinal eating and feeding outcomes. A secondary aim was to explore healthcare provision related to eating and feeding. This retrospective cohort study reviewed medical records of children in 1 administrative region of Sweden with GT placement between 2005 and 2012. Patient demographics, primary diagnoses, age at GT placement, and professional healthcare contacts prior to and after GT placement were recorded and compared. Feeding and eating outcomes were assessed 4 years after GT placement. The medical records of 51 children, 28 boys and 23 girls, were analyzed and grouped according to "acquired" (n = 13) or "developmental" (n = 38) primary diagnoses. At 4 years after GT placement, 67% were still using GT. Only 6 of 37 (16%) children with developmental disorders transferred to eating all orally, as opposed to 10 of 11 (91%) children with acquired disorders. Children with developmental disorders were younger at the time of GT placement and displayed a longer duration of GT activity when compared with children with acquired disorders. This study demonstrates a clear difference between children with developmental or acquired disorders in duration of GT activity and age at GT placement. The study further shows that healthcare provided to children with GT is in some cases multidisciplinary, but primarily focuses on feeding rather than eating. © 2018 American Society for Parenteral and Enteral Nutrition.

  20. Diagnostic value of pleural fluid obtained from a chest tube collection system.

    Science.gov (United States)

    Reed, Robert M; Eberlein, Michael; Netzer, Giora; Pickering, Edward; Shanholtz, Carl; Verceles, Avelino C; McCurdy, Michael T

    2015-02-01

    Pleural fluid is typically drawn directly from the pleural space for diagnostic studies, but occasionally analyses are desired when a chest tube is already in place and a traditional approach is not feasible. The diagnostic value of analyzing fluid samples obtained from the pleural fluid collection system after chest tube insertion is unknown. We performed a prospective observational study of patients in whom chest tube placement was planned for clinical indications. Diagnostic studies were performed on fluid obtained from the pleural space at the time of tube insertion and then repeated 2, 6, and 24 h later on samples obtained from the fluid collection system. Fifty-five percent of the 23 effusions studied met light's criteria for exudate at baseline. Lactate dehydrogenase (LDH) varied considerably over time from baseline measures with only 25 % of measures at 24 h falling within 25 % of baseline levels. The sensitivity for exudate by LDH remained 100 % with poor specificity ranging 50-69 % with repeat measures. Total protein exhibited less variability with 85 % of measures at 24 h falling within 25 % of baseline measure. Sensitivity and specificity at 24 h were 88 and 82 %, respectively. Repeat measures of cholesterol, albumin, and triglycerides generally correlated well (Spearman's rho > 0.90) with baseline values. Measures of glucose and cell counts varied considerably from baseline. Analysis of pleural fluid from a chest tube collection system is feasible and can provide useful diagnostic information. Practitioners should consider the test characteristics of each measure when interpreting samples obtained.

  1. Laparoscopic common bile duct exploration and antegrade biliary stenting: Leaving behind the Kehr tube

    Directory of Open Access Journals (Sweden)

    Darío Martínez-Baena

    2013-03-01

    Full Text Available Introduction: single-stage laparoscopic surgery of cholelithiasis and associated common bile duct stones (CL-CBDS has shown similar results when compared to laparoscopic cholecystectomy combined with ERCP. Classically, choledochorrhaphy has been protected by a T-tube drain to allow external bypass of bile flow. However, its removal is associated with a significant complication rate. Use of antegrade biliary stents avoids T-tube removal associated morbidity. The aim of this study is to compare the results of choledochorrhaphy plus T-tube drainage versus antegrade biliary stenting in our series of laparoscopic common bile duct explorations (LCBDE. Material and methods: between 2004 and 2011, 75 patients underwent a LCBDE. Choledochorrhaphy was performed following Kehr tube placements in 47 cases and transpapillary biliary stenting was conducted in the remaining 28 patients. Results: postoperative hospital stay was shorter in the stent group (5 ± 10.26 days than in the Kehr group (12 ± 10.6 days, with a statistically significant difference. There was a greater trend to grade B complications in the stent group (10.7 vs. 4.3 % and to grade C complications in the Kehr group (6.4 vs. 3.6 %. There were 3 cases of residual common bile duct stones in the Kehr group (6.4 % and none in the stent group. Conclusions: antegrade biliary stenting following laparoscopic common bile duct exploration for CL-CBDS is an effective and safe technique that prevents T-tube related morbidity.

  2. Prospective evaluation of an indwelling esophageal balloon dilatation feeding tube for treatment of benign esophageal strictures in dogs and cats.

    Science.gov (United States)

    Tan, Desmond K; Weisse, Chick; Berent, Allyson; Lamb, Kenneth E

    2018-03-01

    Despite multiple dilatation procedures, benign esophageal strictures (BES) remain a recurring cause of morbidity and mortality in dogs and cats. Investigate the use of an indwelling Balloon Dilatation esophagostomy tube (B-Tube) for treatment of BES in dogs and cats. Nine dogs and 3 cats. Animals with BES were recruited for our prospective study. Endoscopic and fluoroscopic evaluation of the esophagus and balloon dilatation were performed under general anesthesia, followed by placement of an indwelling B-Tube. The animals' owners performed twice daily at-home inflations for approximately 6 weeks. Repeat endoscopy was performed before B-Tube removal. Animals were reevaluated for changes in modified dysphagia score (MDS) after B-Tube removal. The B-Tube management was relatively well tolerated and effective in maintaining dilatation of a BES while in place. These animals underwent a median of 2 anesthetic episodes and were monitored for a median of 472 days (range, 358-1736 days). The mean MDS before treatment was 3.1 ± 0.5/4.0 and final follow-up MDS were significantly (P dog died. The B-Tube offers an effective, and more economical method, and often decreased anesthetic time to repeated balloon dilatation procedures for the treatment of BES in dogs and cats. Copyright © 2018 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  3. Study on antioxidant experiment on forged steel tube sheet and tube hole for steam generator

    International Nuclear Information System (INIS)

    Zong Hai; Wang Detai; Ding Yang

    2012-01-01

    Antioxidant experiment on forged steel tube sheet and tube hole for steam generator was studied and the influence of different simulated heat treatments on the antioxidant performance of tube sheet and tube hole was made. The influence of different antioxidant methods on the size of tube hole was drawn. Furthermore, the change of size and weight of 18MnD5 forged steel tube sheet on the condition of different simulated heat treatments was also studied. The analytical results have proved reference information for the use of 18MnD5 material and for key processes of processing tube hole and wearing and expanding U-style tube. (authors)

  4. Mechanical support for straw tubes

    International Nuclear Information System (INIS)

    Joestlein, H.

    1990-01-01

    A design is proposed for mounting a large number of straw tubes to form an SSC central tracking chamber. The assembly is precise and of very low mass. The fabrication is modular and can be carried out with a minimum of tooling and instrumentation. Testing of modules is possible prior to the final assembly. 4 figs

  5. OurTube / David Talbot

    Index Scriptorium Estoniae

    Talbot, David

    2009-01-01

    USA California Ülikooli töötajate Abram Stern'i ja Michael Dale'i poolt 2005. a. algatatud USA kongressis peetud kõnede videoremiksidest ja nende poolt loodud veebisaidist Metavid.org. Ka YouTube keskkonnast ja wikipedia katsetustest muuta oma keskkond multimeedialisemaks

  6. NEI You Tube Videos: Amblyopia

    Medline Plus

    Full Text Available ... Program Vision and Aging Program African American Program Training and Jobs Fellowships NEI Summer Intern Program Diversity In Vision Research & Ophthalmology (DIVRO) Student Training Programs To search for current job openings visit HHS USAJobs Home >> NEI YouTube Videos >> ...

  7. Working session 1: Tubing degradation

    International Nuclear Information System (INIS)

    Kharshafdjian, G.; Turluer, G.

    1997-01-01

    A general introductory overview of the purpose of the group and the general subject area of SG tubing degradation was given by the facilitator. The purpose of the session was described as to open-quotes develop conclusions and proposals on regulatory and technical needs required to deal with the issues of SG tubing degradation.close quotes Types, locations and characteristics of tubing degradation in steam generators were briefly reviewed. The well-known synergistic effects of materials, environment, and stress and strain/strain rate, subsequently referred to by the acronym open-quotes MESSclose quotes by some of the group members, were noted. The element of time (i.e., evolution of these variables with time) was emphasized. It was also suggested that the group might want to consider the related topics of inspection capabilities, operational variables, degradation remedies, and validity of test data, and some background information in these areas was provided. The presentation given by Peter Millet during the Plenary Session was reviewed; Specifically, the chemical aspects and the degradation from the secondary side of the steam generator were noted. The main issues discussed during the October 1995 EPRI meeting on secondary side corrosion were reported, and a listing of the potential SG tube degradations was provided and discussed

  8. Case of nasogastric tube dysfunction.

    Science.gov (United States)

    Rainer, Florian; Prenner, Guenther; Binder, Lukas Peter; Fickert, Peter; Plank, Johannes

    2018-01-05

    An elderly female patient was admitted to intensive care for prolonged vasopressor therapy and mechanical ventilation after cardiac arrest and acute percutaneous coronary intervention. Antiplatelet, thyroid hormone replacement and statin therapies were administered through a 14-French nasogastric tube (Nestlé Health Science) and enteral feeding was initiated. Correct position of the nasogastric tube was confirmed radiologically. On the seventh day in the intensive care, our patient was seen to regurgitate soft crumbs into her mouth. The blocked nasogastric tube was removed, but attempts to reinsert another tube failed.Upper GI endoscopy revealed an obstruction of the oesophagus with a milky-yellowish caseous substance 20 cm from the incisors (figure 1). The proximal part of the mass showed a central hole and ring-shaped layers resembling the cut face of a tree trunk.gutjnl;gutjnl-2017-315619v1/F1F1F1Figure 1Obstruction of the oesophagus with a milky-yellowish caseous substance. What caused the obstruction?How should we manage such a problem? © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  9. Kundt's Tube Experiment Using Smartphones

    Science.gov (United States)

    Parolin, Sara Orsola; Pezzi, Giovanni

    2015-01-01

    This article deals with a modern version of Kundt's tube experiment. Using economic instruments and a couple of smartphones, it is possible to "see" nodes and antinodes of standing acoustic waves in a column of vibrating air and to measure the speed of sound.

  10. Steam generator tube integrity program

    International Nuclear Information System (INIS)

    Diercks, D.R.; Shack, W.J.

    1996-01-01

    The degradation of steam generator tubes in pressurized water nuclear reactors continues to be a serious problem, and the US Nuclear Regulatory Commission (NRC) is developing a performance-based rule and regulatory guide for steam generator tube integrity. To support the evaluation of industry-proposed implementation of these performance-based criteria, the NRC is sponsoring a new research program at Argonne National Laboratory on steam generator tubing degradation. The objective of the new program is to provide the necessary experimental data and predictive correlations and models that will permit the NRC to independently evaluate the integrity of steam generator tubes. The technical work in the program is divided into four tasks, (1) assessment of inspection reliability, (2) research on in-service inspection technology, (3) research on degradation modes and integrity, and (4) development of methodology and technical assessments for current and emerging regulatory issues. The objectives of and planned research activities under each of these four tasks are described here. (orig.)

  11. Tube in shell heat exchangers

    International Nuclear Information System (INIS)

    Hayden, O.; Willby, C.R.; Sheward, G.E.; Ormrod, D.T.; Firth, G.F.

    1980-01-01

    An improved tube-in-shell heat exchanger to be used between liquid metal and water is described for use in the liquid metal coolant system of fast breeder reactors. It is stated that this design is less prone to failures which could result in sodium water reactions than previous exchangers. (UK)

  12. Tubing with high corrosion resistance

    Science.gov (United States)

    Ioffe, A. V.; Tetyueva, T. V.; Vyboyshchik, M. A.; Trifonova, E. A.; Lutsenko, E. S.

    2010-07-01

    The optimum chemical composition and the regime for heat treatment of heat-resistant steel 15Kh5M are determined for the production of tubing with strength of group L80 (API 5CT) and high cold resistance and resistance to carbon dioxide and sulfurated hydrogen corrosion at low alloying additives of chromium and molybdenum.

  13. NEI You Tube Videos: Amblyopia

    Medline Plus

    Full Text Available ... Macular Degeneration Amblyopia Animations Blindness Cataract Convergence Insufficiency Diabetic Eye Disease Dilated Eye Exam Dry Eye For Kids Glaucoma Healthy Vision Tips Leber Congenital Amaurosis Low Vision Refractive Errors Retinopathy of Prematurity Science Spanish Videos Webinars NEI YouTube ...

  14. Welding the CNGS decay tube

    CERN Multimedia

    Maximilien Brice

    2004-01-01

    3.6 km of welds were required for the 1 km long CERN Neutrinos to Gran Sasso (CNGS) decay tube, in which particles produced in the collision with a proton and a graphite target will decay into muons and muon neutrinos. Four highly skilled welders performed this delicate task.

  15. NEI You Tube Videos: Amblyopia

    Medline Plus

    Full Text Available ... and Aging Program African American Program Training and Jobs Fellowships NEI Summer Intern Program Diversity In Vision ... DIVRO) Student Training Programs To search for current job openings visit HHS USAJobs Home » NEI YouTube Videos » ...

  16. 21 CFR 876.5980 - Gastrointestinal tube and accessories.

    Science.gov (United States)

    2010-04-01

    ... intubation, feeding tube, gastroenterostomy tube, Levine tube, nasogastric tube, single lumen tube with... § 876.9. (2) Class I (general controls) for the dissolvable nasogastric feed tube guide for the nasogastric tube. The class I device is exempt from the premarket notification procedures in subpart E of part...

  17. Sensor Placement for Modal Parameter Subset Estimation

    DEFF Research Database (Denmark)

    Ulriksen, Martin Dalgaard; Bernal, Dionisio; Damkilde, Lars

    2016-01-01

    ). It is shown that the widely used Effective Independence (EI) method, which uses the modal amplitudes as surrogates for the parameters of interest, provides sensor configurations yielding theoretical lower bound variances whose maxima are up to 30 % larger than those obtained by use of the max-min approach.......The present paper proposes an approach for deciding on sensor placements in the context of modal parameter estimation from vibration measurements. The approach is based on placing sensors, of which the amount is determined a priori, such that the minimum Fisher information that the frequency...... responses carry on the selected modal parameter subset is, in some sense, maximized. The approach is validated in the context of a simple 10-DOF mass-spring-damper system by computing the variance of a set of identified modal parameters in a Monte Carlo setting for a set of sensor configurations, whose...

  18. Brocade: Optimal flow placement in SDN networks

    CERN Multimedia

    CERN. Geneva

    2015-01-01

    Today' network poses several challanges to network providers. These challanges fall in to a variety of areas ranging from determining efficient utilization of network bandwidth to finding out which user applications consume majority of network resources. Also, how to protect a given network from volumetric and botnet attacks. Optimal placement of flows deal with identifying network issues and addressing them in a real-time. The overall solution helps in building new services where a network is more secure and more efficient. Benefits derived as a result are increased network efficiency due to better capacity and resource planning, better security with real-time threat mitigation, and improved user experience as a result of increased service velocity.

  19. Suboccipital neuropathy after bone conduction device placement.

    Science.gov (United States)

    Faber, H T; de Ru, J A

    2013-01-01

    To describe the clinical characteristics of a 70-year-old female with occipital neuropathy following bone conduction device surgery. A 65-year-old woman underwent bone conduction device placement surgery on the left temporal bone. Postoperatively she progressively developed chronic pain at the implantation site. The pain led to minimal neck movement, which resulted in complaints of the shoulder and arm on the left side. She was treated by an orthopaedic surgeon for a frozen shoulder. Pain medication and occipital nerve blocking had no sustained effect on the pain. Occipital neuropathy is a syndrome with continuous aching involving the occipital and parietal scalp caused by trauma or peripheral compression of the occipital nerves. The most common causes of occipital neuropathy are probably direct trauma to the nerve and hypertrophic fibrosis of subcutaneous tissue surrounding the nerve. Scar formation after surgery may therefore cause entrapment of the nerve. We describe a case of occipital neuropathy as a complication of BAHA surgery.

  20. Optimal PMU placement using Iterated Local Search

    Energy Technology Data Exchange (ETDEWEB)

    Hurtgen, M.; Maun, J.-C. [Universite Libre de Bruxelles, Avenue F. Roosevelt 50, B-1050 Brussels (Belgium)

    2010-10-15

    An essential tool for power system monitoring is state estimation. Using PMUs can greatly improve the state estimation process. However, for state estimation, the PMUs should be placed appropriately in the network. The problem of optimal PMU placement for full observability is analysed in this paper. The objective of the paper is to minimise the size of the PMU configuration while allowing full observability of the network. The method proposed initially suggests a PMU distribution which makes the network observable. The Iterated Local Search (ILS) metaheuristic is then used to minimise the size of the PMU configuration needed to observe the network. The algorithm is tested on IEEE test networks with 14, 57 and 118 nodes and compared to the results obtained in previous publications. (author)

  1. Pre-radiotherapy feeding tube identifies a poor prognostic subset of postoperative p16 positive oropharyngeal carcinoma patients

    International Nuclear Information System (INIS)

    Verma, Vivek; Liu, Jingxia; Eschen, Laura; Danieley, Jonathan; Spencer, Christopher; Lewis, James S Jr; Diaz, Jason; Piccirillo, Jay F; Adkins, Douglas R; Nussenbaum, Brian; Thorstad, Wade L; Gay, Hiram A

    2015-01-01

    This study explores variables associated with poor prognosis in postoperative p16 positive oropharyngeal squamous cell carcinoma (OPSCC) patients undergoing adjuvant radiotherapy or chemoradiotherapy. Specifically, analysis was done related to timing of feeding tube insertion relative to radiotherapy. From 1997–2009, of 376 consecutive patients with OPSCC, 220 received adjuvant IMRT, and 97 were p16 positive and eligible. Of these, 23 had feeding tube placement before IMRT (B-FT), 32 during/after IMRT (DA-FT), and 42 had no feeding tube (NO-FT). Feeding tubes were not placed prophylactically. These three groups were analyzed for differential tumor, patient, treatment, and feeding tube characteristics, as well as differences in overall survival (OS), disease free survival (DFS), and distant metastasis free survival (DMFS). Pre-RT FT insertion was associated with higher tumor size and depth, T (but not N) and overall stage, comorbidities, presence of chemotherapy, and less use of transoral laser microsurgery/transoral bovie. Additionally, time from surgery to IMRT completion was also statistically longer in the B-FT group. The feeding tube was permanent in 52% of patients in the B-FT group versus 16% in the DA-FT group (p = 0.0075). The 5-year OS for the NO-FT, DA-FT, and B-FT groups was 90%, 86%, and 50%, respectively. The 5-year DFS for the NO-FT, DA-FT, and B-FT groups was 87.6%, 83.6%, and 42.7%, respectively. Multivariate analysis showed that for OS and DFS, feeding tube placement timing and smoking history were statistically significant. Due to the poor prognosis of early FT insertion, the presence of FTs at time of radiotherapy consultation can be used as an alternate marker to identify a subset of p16 positive OPSCC patients that have a poor prognosis

  2. Critical Factors in the Placement of Community College Mathematics Students.

    Science.gov (United States)

    Robinson, Shawn H.; Kubala, Thomas S.

    1999-01-01

    Describes a study undertaken to increase the effectiveness of student-placement systems in community colleges. Found that the use of student characteristics, such as gender, ethnicity, prior exposure to course work, and enrollment in a study-skills course, was more useful than the SAT, ACT, and College Placement Test in predicting student…

  3. Rationales provided for placement decisions by Dutch professionals and students

    NARCIS (Netherlands)

    Bartelink, Cora; Knorth, Erik J.; Koopmans, A. Carien; López López, Mónica; Witteman, Cilia L.M.; Ten Berge, Ingrid J.; Van Yperen, Tom A.

    2017-01-01

    Objectives - Out-of-home placement is a major occurrence in a child’s life. It can have both positive and negative effects on a child’s development and should therefore always be based on careful decision making. Repeatedly, researchers show that professionals make different placement decisions.

  4. Consumers with Major Depressive Disorder: Factors Influencing Job Placement

    Science.gov (United States)

    Hergenrather, Kenneth C.; Haase, Eileen; Zeglin, Robert J.; Rhodes, Scott D.

    2013-01-01

    The theory of planned behavior (TPB) was applied to study the factors that influence the intention of public rehabilitation placement professionals to place consumers with major depressive disorder (MDD) in jobs. A sample of 108 public rehabilitation placement professionals in the Mid-Atlantic region of the United States completed the MDD…

  5. Experiences of health science students during clinical placements at ...

    African Journals Online (AJOL)

    Background: Clinical placement is an essential component of training in health sciences because it is where theory and practice interface. Objective: To explore experiences of health sciences students during clinical placement in terms of supervision, challenges and coping strategies. Design: It was a cross sectional survey ...

  6. Student Transcript-Enhanced Placement Study (STEPS). Technical Report

    Science.gov (United States)

    Willett, Terrence

    2013-01-01

    Prior research suggests that using high school transcripts may improve English and math placement accuracy at colleges. Between 2012 and 2013, the Research and Planning Group for California Community Colleges (RP Group) conducted the Student Transcript Enhanced Placement Study (STEPS) in partnership with the California Community Colleges…

  7. Dental hygiene student experiences in external placements in Australia.

    Science.gov (United States)

    Taylor, Jane A; Hayes, Melanie J; Wallace, Linda

    2012-05-01

    While placements in external locations are being increasingly used in dental education globally, few studies have explored the student learning experience at such placements. The purpose of this study was to investigate student experiences while on external placement in a baccalaureate dental hygiene program. A self-reporting questionnaire was distributed to final-year dental hygiene students (n=77) at the University of Newcastle, Australia, in 2010. The questionnaire included questions regarding the type of placement, experiences offered, supervision, resources available, and lasting impressions. Responding students were generally positive about their external placement experience and indicated that the majority of facilities provided them with the opportunity to provide direct patient care and perform clinical tasks typical of a practicing hygienist. However, there was a statistically significant difference in their opinions about discipline-focused and community placements. Students indicated that their external placement experience provided opportunities to learn more about time and patient management, including hands-on experience with specific clinical tasks. Ongoing evaluations are necessary to ensure that external placements meet both student needs and intended learning outcomes within dental hygiene programs.

  8. 12 CFR 339.7 - Forced placement of flood insurance.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Forced placement of flood insurance. 339.7... GENERAL POLICY LOANS IN AREAS HAVING SPECIAL FLOOD HAZARDS § 339.7 Forced placement of flood insurance. If... not covered by flood insurance or is covered by flood insurance in an amount less than the amount...

  9. 12 CFR 614.4945 - Forced placement of flood insurance.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Forced placement of flood insurance. 614.4945... OPERATIONS Flood Insurance Requirements § 614.4945 Forced placement of flood insurance. If a System... not covered by flood insurance or are covered by flood insurance in an amount less than the amount...

  10. 38 CFR 36.4706 - Forced placement of flood insurance.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Forced placement of flood... (CONTINUED) LOAN GUARANTY Sale of Loans, Guarantee of Payment, and Flood Insurance § 36.4706 Forced placement of flood insurance. If the Secretary, or a servicer acting on behalf of the Secretary, determines at...

  11. 12 CFR 572.7 - Forced placement of flood insurance.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Forced placement of flood insurance. 572.7... HAVING SPECIAL FLOOD HAZARDS § 572.7 Forced placement of flood insurance. If a savings association, or a... not covered by flood insurance or is covered by flood insurance in an amount less than the amount...

  12. 12 CFR 22.7 - Forced placement of flood insurance.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Forced placement of flood insurance. 22.7... HAVING SPECIAL FLOOD HAZARDS § 22.7 Forced placement of flood insurance. If a bank, or a servicer acting... or mobile home and any personal property securing the designated loan is not covered by flood...

  13. Product Category Layout and Organization: Retail Placement of Food Products

    NARCIS (Netherlands)

    Herpen, van E.

    2016-01-01

    This article discusses the placement of food products in retail stores, in particular how the placement of food products can influence how consumers perceive the store in general and these products in particular. It reviews the overall layout of the store, assortment organization, and shelf

  14. Compositional Syntactic Placement and Simple Concept Learning in Female Adults.

    Science.gov (United States)

    Hart, Russ A.

    A media attribute approach was used in a study which hypothesized that compositional syntactic placement may bridge the processing link between the learner's cognitive capacity and the demands of a simple concept attainment task. Compositional syntactic placement refers to the relative horizontal position of the primary symbol or object within a…

  15. Community placement and reintegration of service users from long ...

    African Journals Online (AJOL)

    Objective: To ascertain community placement and reintegration of service users from long-term mental health care facilities. Method: This study reviewed the progress during 2003 with the alternative placement of a selected candidate group of 27 service users in some of Lifecare's long-term mental health care facilities in ...

  16. Distinguishing implicit from explicit brand attitudes in brand placement research

    NARCIS (Netherlands)

    Wennekers, A.M.; Vandeberg, L.; Zoon, K.; van Reijmersdal, E.A.; Verlegh, P.; Voorveld, H.; Eisend, M.

    2016-01-01

    Brand placement is a popular topic, both in business and academia. Brands are placed in a wide-ranging array of media, including television programs, movies, radio shows, magazines, games, music videos, and websites. Expenditures on brand placement are still growing (PQ Media, 2013), as well as the

  17. Private Placements as Sources of Long Term Funds for publicly ...

    African Journals Online (AJOL)

    Private Placements as Sources of Long Term Funds for publicly quoted firms in the Nigerian Capital Market. ... AFRREV IJAH: An International Journal of Arts and Humanities ... Abstract. Private placements are gradually becoming means of raising long-term funds in the Nigerian capital market by publicly quoted companies.

  18. 28 CFR 541.49 - Review of control unit placement.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Review of control unit placement. 541.49... INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Control Unit Programs § 541.49 Review of control unit placement. (a) Unit staff shall evaluate informally and daily an inmate's adjustment within the control unit...

  19. 33 CFR 183.566 - Fuel pumps: Placement.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Fuel pumps: Placement. 183.566...) BOATING SAFETY BOATS AND ASSOCIATED EQUIPMENT Fuel Systems Manufacturer Requirements § 183.566 Fuel pumps: Placement. Each fuel pump must be on the engine it serves or within 12 inches of the engine, unless it is a...

  20. Computer-Assisted Placement: Effective Aid or Paper Albatross?

    Science.gov (United States)

    Sampson, James P.

    1978-01-01

    A short time ago, the computer was a concept of the future which scared many and amazed even more. Now a reality, the computer has become as common on the placement front as the interview. The computer's value to placement is discussed. (Author)

  1. Work Placements at 14-15 Years and Employability Skills

    Science.gov (United States)

    Messer, David

    2018-01-01

    Purpose: In the UK, concern frequently has been voiced that young people lack appropriate employability skills. One way to address this is to provide work based placements. In general, previous research findings have indicated that young people find such placements useful because of help with career choice and relevant skills. However, most…

  2. Adverbial Placement in Ewe: A Role and Reference Grammar ...

    African Journals Online (AJOL)

    This article looks at adverbial placement and interpretation in Ewe. It takes from English adverbial placement in which several positions are possible. Implicitly, it looks at what is the same compared to English and what is different when we look at adverbials in Ewe. The study looks at Ewe adverbials from a Role and ...

  3. Structural challenges of holiday placement programmes for children ...

    African Journals Online (AJOL)

    Structural challenges of holiday placement programmes for children in SOS's Children Village, Zimbabwe. ... African Journal of Social Work ... Response to child protection crisis has essentially seen the placement of orphans and other vulnerable children in residential care institutions, particularly children' homes modelled ...

  4. 46 CFR 130.460 - Placement of machinery alarms.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Placement of machinery alarms. 130.460 Section 130.460 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) OFFSHORE SUPPLY VESSELS VESSEL CONTROL, AND MISCELLANEOUS EQUIPMENT AND SYSTEMS Automation of Unattended Machinery Spaces § 130.460 Placement of machinery alarms. (a) Visible and...

  5. Ambulatory estimation of foot placement during walking using inertial sensors

    NARCIS (Netherlands)

    Schepers, H. Martin; van Asseldonk, Edwin H.F.; Baten, Christian T.M.; Veltink, Petrus H.

    This study proposes a method to assess foot placement during walking using an ambulatory measurement system consisting of orthopaedic sandals equipped with force/moment sensors and inertial sensors (accelerometers and gyroscopes). Two parameters, lateral foot placement (LFP) and stride length (SL),

  6. Understanding the Heritage Language Student: Proficiency and Placement

    Science.gov (United States)

    Thompson, Gregory L.

    2015-01-01

    Given the ever-growing number of Spanish heritage learners in both universities and colleges, the need has continued to grow for the development of placement exams that accurately measure language ability, are simple to evaluate, and are easy to administer to large numbers of students. This article analyzes the implementation of a placement exam…

  7. 45 CFR 605.35 - Evaluation and placement.

    Science.gov (United States)

    2010-10-01

    ... Preschool, Elementary, and Secondary Education § 605.35 Evaluation and placement. (a) Preplacement evaluation. A recipient that operates a public elementary or secondary education program or activity shall... evaluation data and in making placement decisions, a recipient shall (1) draw upon information from a variety...

  8. 34 CFR 104.35 - Evaluation and placement.

    Science.gov (United States)

    2010-07-01

    ... ASSISTANCE Preschool, Elementary, and Secondary Education § 104.35 Evaluation and placement. (a) Preplacement evaluation. A recipient that operates a public elementary or secondary education program or activity shall... evaluation data and in making placement decisions, a recipient shall (1) draw upon information from a variety...

  9. AP: A Critical Examination of the Advanced Placement Program

    Science.gov (United States)

    Sadler, Philip M.; Sonnert, Gerhard; Tai, Robert; Klopfenstein, Kirstin

    2016-01-01

    The Advanced Placement (AP) program was created to enhance the experience of gifted students as they transition from high school to college. "AP: A Critical Examination of the Advanced Placement Program," edited by Philip M. Sadler, Gerhard Sonnert, Robert Tai, and Kirstin Klopfenstein (2010, Harvard Education Press), questions the…

  10. Network placement optimization for large-scale distributed system

    Science.gov (United States)

    Ren, Yu; Liu, Fangfang; Fu, Yunxia; Zhou, Zheng

    2018-01-01

    The network geometry strongly influences the performance of the distributed system, i.e., the coverage capability, measurement accuracy and overall cost. Therefore the network placement optimization represents an urgent issue in the distributed measurement, even in large-scale metrology. This paper presents an effective computer-assisted network placement optimization procedure for the large-scale distributed system and illustrates it with the example of the multi-tracker system. To get an optimal placement, the coverage capability and the coordinate uncertainty of the network are quantified. Then a placement optimization objective function is developed in terms of coverage capabilities, measurement accuracy and overall cost. And a novel grid-based encoding approach for Genetic algorithm is proposed. So the network placement is optimized by a global rough search and a local detailed search. Its obvious advantage is that there is no need for a specific initial placement. At last, a specific application illustrates this placement optimization procedure can simulate the measurement results of a specific network and design the optimal placement efficiently.

  11. Schizophrenia on YouTube.

    Science.gov (United States)

    Nour, Matthew M; Nour, Murraih H; Tsatalou, Olga-Maria; Barrera, Alvaro

    2017-01-01

    YouTube ( www.youtube.com ) is the most popular video-sharing Web site on the Internet and is used by medical students as a source of information regarding mental health conditions, including schizophrenia. The accuracy and educational utility of schizophrenia presentations on YouTube are unknown. The purpose of this study was to analyze the accuracy of depictions of psychosis in the context of a diagnosis of schizophrenia (referred to in this article as "acute schizophrenia") on YouTube and to assess the utility of these videos as educational tools for teaching medical students to recognize the clinical features of acute schizophrenia. YouTube was searched for videos purporting to show acute schizophrenia. Eligible videos were independently rated by two consultant psychiatrists on two separate occasions 22 days apart for diagnostic accuracy, psychopathology, and educational utility. Videos (N=4,200) were assessed against predefined inclusion and exclusion criteria. The majority were not eligible for further analysis, mostly because they did not claim to show a patient with schizophrenia (74%) or contained duplicated content (11%). Of 35 videos that met the eligibility and adequacy criteria, only 12 accurately depicted acute schizophrenia. Accurate videos were characterized by persecutory delusions (83%), inappropriate affect (75%), and negative symptoms (83%). Despite the fact that 83% of accurate videos were deemed to have good educational utility compared with 15% of inaccurate videos, accurate and inaccurate videos had similar view counts (290,048 versus 186,124). Schizophrenia presentations on YouTube offer a distorted picture of the condition.

  12. Preparation of metallic uranium tubes

    International Nuclear Information System (INIS)

    Lerouge, G.; Decours, J.

    1964-01-01

    The production furnace is an induction heated vacuum furnace having a capacity at the moment of 250 kg. Previously the crucible was heated by the inductor, the mould being outside the inductor. The tubes thus produced contained cavities, the alloy structure was fine; this was cold-mould casting, At the moment the top of the moulds are pre-heated, this is the so called hot-mould casting. This method has the advantage of eliminating the cavities but leads to a less fine microstructure. The alloy used for the 18 x 40 mm and 23 x 43 mm tubes is U-Mo (1.1 per cent). Since the moulds are now heated at the top, the solidification of the metal is very slow in this zone leading to a pronounced γ grain, whereas towards the base the faster cooling leads to a smaller γ grain. The γ structure depends essentially on the solidification rate and on the time spent in this zone. In order to obtain a fine and homogeneous grain along the whole length of the tube, a controlled cooling treatment is effected. It consists in heating the uranium tubes in the γ place and then in cooling them at a rate of between 20 and 50 deg C/mm down to 400 deg C. The 77 x 95 mm and 54 x 70 mm annular elements are at the moment being produced for research purposes. Their preparation is similar to that of 18 x 40 mm and 23 x 43 mm elements. The 77 x 95 mm tubes are at the moment made from U-Cr alloy (0.1 per cent); because of their size, their preparation is carried out in 600 mm diameter furnaces. (authors) [fr

  13. Rejection index for pressure tubes

    International Nuclear Information System (INIS)

    Mitchell, A.B.; Meneley, D.

    1989-10-01

    The objective of the present study was to establish a set of criteria (or Rejection Index) which could be used to decide whether a zirconium-2 1/2 w/o niobium pressure tube in a CANDU reactor should be removed from service due to in-service degradation. A critique of key issues associated with establishing a realistic rejection index was prepared. Areas of uncertainty in available information were identified and recommendations for further analysis and laboratory testing made. A Rejection Index based on the following limits has been recommended: 1) Limits related to design intent and normal operation: any garter spring must remain within the tolerance band specified for its design location; the annulus gas system must normally be operated in a circulating mode with a procedure in place for purging to prevent accumulation of deuterium. It must remain sensitive to leaks into any part of the systems; and pressure tube dimensions and distortions must be limited to maintain the fuel channels within the original design intent; 2) Limits related to defect tolerance: adequate time margins between occurrence of a leaking crack and unstable failure must be demonstrated for all fuel channels; long lap-type flaws are unacceptable; crack-like defects of any size are unacceptable; and score marks, frat marks and other defects with contoured profiles must fall below certain depth, length and stress intensity limits; and 3) Limits related to property degradation: at operating temperature each pressure tube must be demonstrated to have a critical length in excess of a stipulated value; the maximum equivalent hydrogen level in any pressure tube should not exceed a limit which should be defined taking into account the known history of that tube; the maximum equivalent hydrogen level in any rolled joint should not exceed a limit which is presently recommended as 200 ppm equivalent hydrogen; and the maximum diametral creep strain should be limited to less than 5%

  14. Improving the calandria tubes for CANDU reactors

    International Nuclear Information System (INIS)

    Coleman, C.E.; Fong, R.W.L.; Doubt, G.L.

    1997-01-01

    CANDU calandria tubes are made from annealed Zircaloy-2 sheet formed into a cylinder and welded along its length to make the tube. The current calandria tubes have given exemplary service for many years. With more stringent regulations and the need to accommodate warm cooling water in tropical countries, we started a development program to increase the margins for failure during postulated accidents. These improvements involve increasing the tube strength and optimising the heat-transfer from an excessively hot fuel channel to the cool moderator. If the postulated accident involves a pressure tube break, it would be desirable if the calandria tube withstood the full pressure of the heat-transport system. The weakest link in current calandria tubes is the weld. Thickening the weld can increase the strength by 20% while seamless tubes can be 45% stronger than current tubes. The latter tubes can hold full system pressure for many hours without failure. If during the postulated accident the fuel and pressure tube become excessively hot but do not touch the calandria tube, the radiant heat loss must be maximised. Current calandria tubes have an absorptivity (emissivity) of about 0.2. To protect the fuel and the fuel channel we have devised a finish to the inside surface of the calandria tube that increases the emissivity to 0.7. If during the postulated accident the hot pressure tube touches the cool calandria tube, the contact conductance and the critical heat flux must be optimised to ensure nucleate boiling of the moderator at the outside surface of the calandria tube and therefore efficient exploitation of the moderator as a heat sink. In laboratory tests small ridges on the inside surface and roughening of the outside surface have been shown to increase the margins against failure and increase the possible moderator temperatures thus providing the opportunity to decrease the cost of the moderator heat-exchange system and remove restrictions on reactor operation in

  15. A case of a 'lost' nasogastric tube.

    Science.gov (United States)

    Sankar, V; Shakeel, M; Keh, S; Ah-See, K W

    2012-12-01

    To present the case of a 'lost' nasogastric tube and to highlight the importance of imaging and/or chest X-ray after nasogastric tube insertion, especially in unreliable patients. A 50-year-old man, undergoing radiotherapy treatment for squamous cell carcinoma of the tongue base, was admitted for pain control and nasogastric tube feeding. This patient required multiple nasogastric tubes over a two-week period. The patient repeatedly denied pulling the nasogastric tube out and we were unable to establish the exact mode of nasogastric tube removal. On one such occasion another tube was inserted and a check X-ray showed two feeding tubes; the latest one was lying in the left main bronchus and the old nasogastric tube was observed in the oesophagus, with its upper end jutting above the hypopharynx. It was apparent that the patient had somehow cut the tube and swallowed it. This case not only illustrates the importance of flexible nasendoscopy and/or chest X-ray for checking the position of the nasogastric tube, but also highlights that some patients are not tolerant of nasogastric tubes. The use of nasogastric tubes should be avoided in these patients to prevent any self-inflicted injury.

  16. Optimal caliper placement: manual vs automated methods.

    Science.gov (United States)

    Yazdi, B; Zanker, P; Wanger, P; Sonek, J; Pintoffl, K; Hoopmann, M; Kagan, K O

    2014-02-01

    To examine the inter- and intra-operator repeatability of manual placement of callipers in the assessment of basic biometric measurements and to compare the results to an automated calliper placement system. Stored ultrasound images of 95 normal fetuses between 19 and 25 weeks' gestation were used. Five operators (two experts, one resident and two students) were asked to measure the BPD, OFD and FL two times manually and automatically. For each operator, intra-operator repeatability of the manual and automated measurements was assessed by within operator standard deviation. For the assessment of the interoperator repeatability, the mean of the four manual measurements by the two experts was used as the gold standard.The relative bias of the manual measurement of the three non-expert operators and the operator-independent automated measurement were compared with the gold standard measurement by means and 95% confidence interval. In 88.4% of the 95 cases, the automated measurement algorithm was able to obtain appropriate measurements of the BPD, OFD, AC and FL. Within operator standard deviations of the manual measurements ranged between 0.15 and 1.56, irrespective of the experience of the operator.Using the automated biometric measurement system, there was no difference between the measurements of each operator. As far as the inter-operator repeatability is concerned, the difference between the manual measurements of the two students, the resident, and the gold standard was between -0.10 and 2.53 mm. The automated measurements tended to be closer to the gold standard but did not reach statistical significance. In about 90% of the cases, it was possible to obtain basic biometric measurements with an automated system. The use of automated measurements resulted in a significant improvement of the intra-operator but not of the inter-operator repeatability, but measurements were not significantly closer to the gold standard of expert examiners. This article is protected

  17. Novel Split Chest Tube Improves Post-Surgical Thoracic Drainage

    Science.gov (United States)

    Olivencia-Yurvati, Albert H; Cherry, Brandon H; Gurji, Hunaid A; White, Daniel W; Newton, J Tyler; Scott, Gary F; Hoxha, Besim; Gourlay, Terence; Mallet, Robert T

    2014-01-01

    Objective Conventional, separate mediastinal and pleural tubes are often inefficient at draining thoracic effusions. Description We developed a Y-shaped chest tube with split ends that divide within the thoracic cavity, permitting separate intrathoracic placement and requiring a single exit port. In this study, thoracic drainage by the split drain vs. that of separate drains was tested. Methods After sternotomy, pericardiotomy, and left pleurotomy, pigs were fitted with separate chest drains (n=10) or a split tube prototype (n=9) with internal openings positioned in the mediastinum and in the costo-diaphragmatic recess. Separate series of experiments were conducted to test drainage of D5W or 0.58 M sucrose, an aqueous solution with viscosity approximating that of plasma. One litre of fluid was infused into the thorax, and suction was applied at −20 cm H2O for 30 min. Results When D5W was infused, the split drain left a residual volume of 53 ± 99 ml (mean value ± SD) vs. 148 ± 120 for the separate drain (P=0.007), representing a drainage efficiency (i.e. drained vol/[drained + residual vol]) of 95 ± 10% vs. 86 ± 12% for the separate drains (P = 0.011). In the second series, the split drain evacuated more 0.58 M sucrose in the first minute (967 ± 129 ml) than the separate drains (680 ± 192 ml, P<0.001). By 30 min, the split drain evacuated a similar volume of sucrose vs. the conventional drain (1089 ± 72 vs. 1056 ± 78 ml; P = 0.5). Residual volume tended to be lower (25 ± 10 vs. 62 ± 72 ml; P = 0.128) and drainage efficiency tended to be higher (98 ± 1 vs. 95 ± 6%; P = 0.111) with the split drain vs. conventional separate drains. Conclusion The split chest tube drained the thoracic cavity at least as effectively as conventional separate tubes. This new device could potentially alleviate postoperative complications. PMID:25478289

  18. Evaluation of jejunostomy tube feeding after abdominal surgery in dogs.

    Science.gov (United States)

    Tsuruta, Kaoru; Mann, F A; Backus, Robert C

    2016-07-01

    To describe the use of postoperative intrajejunal feeding and to evaluate the association of preoperative plasma albumin concentrations with intrajejunal feeding-related complications and clinical outcome. Prospective, observational study. University veterinary teaching hospital. Sixty-four dogs. Jejunostomy tube placement during abdominal surgery. Most dogs (81%) survived. The median intrajejunal feeding period was 2.1 days (range: 1-16 days; n = 64). Only 3 (5%) dogs received their estimated resting energy requirement by intrajejunal feeding. Of dogs that were fed intrajejunally (58 out of 64), most (55 out of 58) received intrajejunal feeding within 24 hours after surgery. Energy provision via the jejunal feeding tube did not differ between dogs with and without complications (P = 0.592), or between nonsurvivors and survivors (P = 0.298). Thirty-five dogs ate voluntarily concurrently with intrajejunal feeding. Of dogs that ate voluntarily concurrently with intrajejunal feeding for ≤50% of the postoperative period, most (74%) survived to discharge. Complications were seen in 22% of dogs, and none were life-threatening; gastrointestinal signs were most common. There was no difference in preoperative plasma albumin concentration between dogs with and without complications (P = 0.432) and between nonsurvivors and survivors (P = 0.727). Fecal score was not significantly different between the 2 liquid diets studied (FormulaV Enteral Care HLP and CliniCare Canine/Feline; P = 0.927). A jejunostomy tube placed during abdominal surgery was likely to be used at the study institution. Few complications were seen and none were life-threatening. Intrajejunal feeding was initiated early after surgery and did not interfere with the initiation of voluntary oral intake. Fecal scores were high and were useful for an objective assessment of fecal consistency in dogs with intrajejunal feeding. © Veterinary Emergency and Critical Care Society 2016.

  19. Comparison of esophageal placement of Bravo capsule system under direct endoscopic guidance with conventional placement method

    Directory of Open Access Journals (Sweden)

    Aijaz A Sofi

    2010-10-01

    Full Text Available Aijaz A Sofi, Charles Filipiak, Thomas Sodeman, Usman Ahmad, Ali Nawras, Isam DaboulDepartment of Medicine, Division of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio, USABackground: Conventional placement of a wireless esophageal pH monitoring device in the esophagus requires initial endoscopy to determine the distance to the gastroesophageal junction. Blind placement of the capsule by the Bravo delivery system is followed by repeat endoscopy to confirm placement. Alternatively, the capsule can be placed under direct vision during endoscopy. Currently there are no published data comparing the efficiency of one method over the other. The objective of this study was to compare the method of Bravo wireless pH deviceplacement under direct visualization with the conventional method.Methods: A retrospective study involving 58 patients (29 patients with indirect and 29 patients with direct visualization who had Bravo capsule placement. The physician endoscopy procedure notes, nurse’s notes, postprocedure notes, recovery notes, and pH monitoring results were reviewed. The safety of the procedures, length of the procedures, and patient tolerability were evaluated.Results: None of the 58 patients had early detachment of the device and had no immediate procedure-related complications. The overall incidence of complications in both the groups was similar. No failures due to the technique were noted in either group. Average amount of time taken for the procedure was similar in both groups.Conclusion: The technique of placing a Bravo pH device under direct visualization is as safe and effective as the conventional method. In addition, there is an added advantage of avoiding a second endoscopic intubation in the direct visualization technique.Keywords: Bravo capsule, technique, esophageal pH monitoring

  20. [Tracheal intubation with Parker Flex-Tip tubes assisted by tube-guiding devices].

    Science.gov (United States)

    Mizuno, Ju; Morita, Shigeho; Suzuki, Maya; Arita, Hideko; Hanaoka, Kazuo

    2010-04-01

    In tracheal intubation assisted by tube-guiding devices passing through the tube, such as fiberoptic scopes, bougies, tracheal tube exchange catheters, and light wands, passage of the tube-guiding device, by itself, is often easy. But advancing a tracheal tube with a conventional distal tip over these tube-guiding devices is frequently difficult or impossible, because its rigid, side-beveled tip frequently catches on anatomical features of the airway. A novel tracheal tube, the Parker Flex-Tip tube (Parker Medical, Colorado, USA) has a centered, curved, tapered and flexible distal tip that passes through the airway faster and easier than conventional tracheal tubes. As it is advanced along a tube-guiding device, the tip of the Parker tube travels along the midline of the airway, without the gap that usually exists between the distal edge of a conventional tracheal tube and the tube-guiding device. The gapless, midline travel of the Parker tube leads to a greater incidence of first-attempt intubation success with tube-guiding devices, because there is less risk of tube tip hang-ups on the arytenoids and the vocal cords. Clinically, use of the Parker tube is helpful for oral and nasal intubations, especially in patients with difficult airways.

  1. Outcomes of Infants with Home Tube Feeding: Comparing Nasogastric Versus Gastrostomy Tubes

    Science.gov (United States)

    Khalil, Syed Tariq; Uhing, Michael R.; Duesing, Lori; Visotcky, Alexis; Tarima, Sergey; Nghiem-Rao, T. Hang

    2017-01-01

    Background Determine the tube-related complications and feeding outcomes of infants discharged home from the NICU with nasogastric (NG) tube feeding or gastrostomy (G-tube) feeding. Material & Methods We performed a chart review of 335 infants discharged from our NICU with home NG tube or G-tube feeding between January 2009 – December 2013. The primary outcome was the incidence of feeding tube-related complications requiring emergency department (ED) visits, hospitalizations, or deaths. Secondary outcome was feeding status at 6 months post-discharge. Univariate and multivariate analyses were conducted. Results There were 322 infants discharged with home enteral tube feeding, 84 NG tube and 238 G-tube, with available out-patient data for the 6 month post-discharge period. A total of 115 ED visits, 28 hospitalizations, and 2 deaths were due to a tube-related complication. The incidence of tube-related complications requiring an ED visit was significantly higher in the G-tube group compared to the NG tube group (33.6% vs 9.5%, p tube related complication. By 6 months post-discharge, full oral feeding was achieved in 71.4% of infants in the NG tube group compared to 19.3% in the G-tube group (p tube and percentage of oral feeding at discharge were significantly associated with continued tube feeding at 6 months post-discharge. Conclusion Home NG tube feeding is associated with fewer ED visits for tube-related complications compared to home G-tube feeding. There may be some infants who could benefit from a trial home NG tube feeding. PMID:27647478

  2. Outcomes of Infants With Home Tube Feeding: Comparing Nasogastric vs Gastrostomy Tubes.

    Science.gov (United States)

    Khalil, Syed Tariq; Uhing, Michael R; Duesing, Lori; Visotcky, Alexis; Tarima, Sergey; Nghiem-Rao, T Hang

    2017-11-01

    The aim of this study was to determine the tube-related complications and feeding outcomes of infants discharged home from the neonatal intensive care unit (NICU) with nasogastric (NG) tube feeding or gastrostomy (G-tube) feeding. We performed a chart review of 335 infants discharged from our NICU with home NG tube or G-tube feeding between January 2009 and December 2013. The primary outcome was the incidence of feeding tube-related complications requiring emergency department (ED) visits, hospitalizations, or deaths. Secondary outcome was feeding status at 6 months postdischarge. Univariate and multivariate analyses were conducted. There were 322 infants discharged with home enteral tube feeding (NG tube, n = 84; G-tube, n = 238), with available outpatient data for the 6-month postdischarge period. A total of 115 ED visits, 28 hospitalizations, and 2 deaths were due to a tube-related complication. The incidence of tube-related complications requiring an ED visit was significantly higher in the G-tube group compared with the NG tube group (33.6% vs 9.5%, P tube-related complication. By 6 months postdischarge, full oral feeding was achieved in 71.4% of infants in the NG tube group compared with 19.3% in the G-tube group ( P tube and percentage of oral feeding at discharge were significantly associated with continued tube feeding at 6 months postdischarge. Home NG tube feeding is associated with fewer ED visits for tube-related complications compared with home G-tube feeding. Some infants could benefit from a trial home NG tube feeding.

  3. In service inspection for steam generator tubes

    International Nuclear Information System (INIS)

    Comby, R.; Eyrolles, Ph.

    1988-01-01

    In this paper the authors show the means putting in place for examination of steam generators tubes. These means (eddy current probes, ultrasonic testing) associated with a knowledge on degradation phenomena allow mapping controlled tubes and limiting undesirable obturations [fr

  4. X-ray tube current control

    International Nuclear Information System (INIS)

    Dupuis, W.A.; Resnick, T.A.

    1982-01-01

    A closed loop feedback system for controlling the current output of an x-ray tube. The system has circuitry for improving the transient response and stability of the x-ray tube current over a substantial nonlinear portion of the tube current production characteristic. The system includes a reference generator for applying adjustable step function reference signals representing desired tube currents. The system also includes means for instantaneous sensing of actual tube current. An error detector compares the value of actual and reference tube current and produces an error signal as a function of their difference. The system feedback loop includes amplification circuitry for controlling x-ray tube filament dc voltage to regulate tube current as a function of the error signal value. The system also includes compensation circuitry, between the reference generator and the amplification circuitry, to vary the loop gain of the feedback control system as a function of the reference magnitude

  5. The accessory fallopian tube: A rare anomaly

    Directory of Open Access Journals (Sweden)

    Kusum R Gandhi

    2012-01-01

    Full Text Available This paper presents a rare anatomical variation in the form of accessory fallopian tube on right side. The duplication of fallopian tube was observed in a 34-year-old female during routine undergraduate dissection in our department. Fallopian tube is the part of uterus that carries the ovum from the ovary to the uterus. Accessory fallopian tube is the congenital anomaly attached to the ampullary part of main tube. This accessory tube is common site of pyosalpinx, hydrosalpinx, cystic swelling and torsion. The ovum released by the ovary may also be captured by the blind accessory tube leading to infertility or ectopic pregnancy. Hence, all patients of infertility or pelvic inflammatory disease should be screened to rule out the presence of accessory fallopian tube and if encountered should be removed.

  6. Chemical cleaning specification: few tube test model

    International Nuclear Information System (INIS)

    Hampton, L.V.; Simpson, J.L.

    1979-09-01

    The specification is for the waterside chemical cleaning of the 2 1/4 Cr - 1 Mo steel steam generator tubes. It describes the reagents and conditions for post-chemical cleaning passivation of the evaporator tubes

  7. Prestressed Carbon Fiber Composite Overwrapped Gun Tube

    National Research Council Canada - National Science Library

    Littlefield, Andrew; Hyland, Edward

    2006-01-01

    .... Using composite materials not only directly removes weight from the gun tube but, by better balancing the tube, allows the use of smaller drive systems, thus further enhancing the system weight loss...

  8. Placement History of Foster Children : A Study of Placement History and Outcomes in Long-Term Family Foster Care

    NARCIS (Netherlands)

    Strijker, Johan; Knorth, Erik J.; Knot-Dickscheit, Jana

    2008-01-01

    The files of 419 children in family foster care and kinship foster care were used in a retrospective longitudinal design study that examined their placement histories in child welfare. Significant associations were found between the number of placements on one hand, and the prevalence of attachment

  9. Placement History of Foster Children: A Study of Placement History and Outcomes in Long-Term Family Foster Care

    Science.gov (United States)

    Strijker, Johan; Knorth, Erik J.; Knot-Dickscheit, Jana

    2008-01-01

    The files of 419 children in family foster care and kinship foster care were used in a retrospective longitudinal design study that examined their placement histories in child welfare. Significant associations were found between the number of placements on one hand, and the prevalence of attachment disorders, severity of behavioral problems, and…

  10. Placement Disruption and Negative Placement Outcomes among Adolescents in Long-Term Foster Care: The Role of Behavior Problems

    Science.gov (United States)

    Leathers, Sonya J.

    2006-01-01

    Objective: This study examined risk of placement disruption and negative placement outcomes (e.g., residential treatment and incarceration) among adolescents placed in traditional family foster care for a year or longer. A foster parent's report of externalizing behavior problems was expected to be a stronger predictor of disruption and negative…

  11. Do Work Placements Improve Final Year Academic Performance or Do High-Calibre Students Choose to Do Work Placements?

    Science.gov (United States)

    Jones, C. M.; Green, J. P.; Higson, H. E.

    2017-01-01

    This study investigates whether the completion of an optional sandwich work placement enhances student performance in final year examinations. Using Propensity Score Matching, our analysis departs from the literature by controlling for self-selection. Previous studies may have overestimated the impact of sandwich work placements on performance…

  12. Ceramic vacuum tubes for geothermal well logging

    Energy Technology Data Exchange (ETDEWEB)

    Kelly, R.D.

    1977-01-01

    Useful design data acquired in the evaluation of ceramic vacuum tubes for the development of a 500/sup 0/C instrumentation amplifier are presented. The general requirements for ceramic vacuum tubes are discussed for application to the development of high temperature well logs. Commercially available tubes are described and future contract activities that specifically relate to ceramic vacuum tubes are detailed. Supplemental data are presented in the appendix.

  13. Laryngeal tube suction for airway management during in-hospital emergencies

    Directory of Open Access Journals (Sweden)

    Haitham Mutlak

    Full Text Available OBJECTIVE: The role of supraglottic airway devices in emergency airway management is highlighted in international airway management guidelines. We evaluated the application of the new generation laryngeal tube suction (LTS-II/LTS-D in the management of in-hospital unexpected difficult airway and cardiopulmonary resuscitation. METHODS: During a seven-year period, patients treated with a laryngeal tube who received routine anesthesia and had an unexpected difficult airway (Cormack Lehane Grade 3-4, who underwent cardiopulmonary resuscitation, or who underwent cardiopulmonary resuscitation outside the operating room and had a difficult airway were evaluated. Successful placement of the LTS II/LTS-D, sufficient ventilation, time to placement, number of placement attempts, stomach content, peripheral oxygen saturation/end-tidal carbon dioxide development (SpO2/etCO2 over 5 minutes, subjective overall assessment and complications were recorded. RESULTS: In total, 106 adult patients were treated using an LTS-II/LTS-D. The main indication for placement was a difficult airway (75%, n=80, followed by cardiopulmonary resuscitation (25%, n=26 or an overlap between both (18%, n=19. In 94% of patients (n=100, users placed the laryngeal tube during the first attempt. In 93% of patients (n=98, the tube was placed within 30 seconds. A significant increase in SpO2 from 97% (0-100 to 99% (5-100 was observed in the whole population and in cardiopulmonary resuscitation patients. The average initial etCO2 of 39.5 mmHg (0-100 mmHg decreased significantly to an average of 38.4 mmHg (10-62 mmHg after 5 minutes. A comparison of cardiopulmonary resuscitation patients with non-cardiopulmonary resuscitation patients regarding gastric contents showed no significant difference. CONCLUSIONS: LTS-D/LTS-II use for in-hospital unexpected difficult airway management provides a secure method for primary airway management until other options such as video laryngoscopy or fiber optic

  14. Spring/dimple instrument tube restraint

    Science.gov (United States)

    DeMario, E.E.; Lawson, C.N.

    1993-11-23

    A nuclear fuel assembly for a pressurized water nuclear reactor has a spring and dimple structure formed in a non-radioactive insert tube placed in the top of a sensor receiving instrumentation tube thimble disposed in the fuel assembly and attached at a top nozzle, a bottom nozzle, and intermediate grids. The instrumentation tube thimble is open at the top, where the sensor or its connection extends through the cooling water for coupling to a sensor signal processor. The spring and dimple insert tube is mounted within the instrumentation tube thimble and extends downwardly adjacent the top. The springs and dimples restrain the sensor and its connections against lateral displacement causing impact with the instrumentation tube thimble due to the strong axial flow of cooling water. The instrumentation tube has a stainless steel outer sleeve and a zirconium alloy inner sleeve below the insert tube adjacent the top. The insert tube is relatively non-radioactivated inconel alloy. The opposed springs and dimples are formed on diametrically opposite inner walls of the insert tube, the springs being formed as spaced axial cuts in the insert tube, with a web of the insert tube between the cuts bowed radially inwardly for forming the spring, and the dimples being formed as radially inward protrusions opposed to the springs. 7 figures.

  15. Manual tube-to-tubesheet welding torch

    Science.gov (United States)

    Kiefer, Joseph H.; Smith, Danny J.

    1982-01-01

    A welding torch made of a high temperature plastic which fits over a tube intermediate the ends thereof for welding the juncture between the tube and the back side of a tube plate and has a ballooned end in which an electrode, filler wire guide, fiber optic bundle, and blanketing gas duct are disposed.

  16. Heat exchanger with a removable tube section

    Science.gov (United States)

    Wolowodiuk, W.; Anelli, J.

    1975-07-29

    A heat exchanger is described in which the tube sheet is secured against primary liquid pressure, but which allows for easy removal of the tube section. The tube section is supported by a flange which is secured by a number of shear blocks, each of which extends into a slot which is immovable with respect to the outer shell of the heat exchanger. (auth)

  17. The Fuge Tube Diode Array Spectrophotometer

    Science.gov (United States)

    Arneson, B. T.; Long, S. R.; Stewart, K. K.; Lagowski, J. J.

    2008-01-01

    We present the details for adapting a diode array UV-vis spectrophotometer to incorporate the use of polypropylene microcentrifuge tubes--fuge tubes--as cuvettes. Optical data are presented validating that the polyethylene fuge tubes are equivalent to the standard square cross section polystyrene or glass cuvettes generally used in…

  18. Numerical and experimental study of an annular pulse tube used in the pulse tube cooler

    Science.gov (United States)

    Pang, Xiaomin; Chen, Yanyan; Wang, Xiaotao; Dai, Wei; Luo, Ercang

    2017-12-01

    Multi-stage pulse tube coolers normally use a U-type configuration. For compactness, it is attractive to build a completely co-axial multi-stage pulse tube cooler. In this way, an annular shape pulse tube is inevitable. Although there are a few reports about previous annular pulse tubes, a detailed study and comparison with a circular pulse tube is lacking. In this paper, a numeric model based on CFD software is carried out to compare the annular pulse tube and circular pulse tube used in a single stage in-line type pulse tube cooler with about 10 W of cooling power at 77 K. The length and cross sectional area of the two pulse tubes are kept the same. Simulation results show that the enthalpy flow in the annular pulse tube is lower by 1.6 W (about 11% of the enthalpy flow) compared to that in circular pulse tube. Flow and temperature distribution characteristics are also analyzed in detail. Experiments are then conducted for comparison with an in-line type pulse tube cooler. With the same acoustic power input, the pulse tube cooler with a circular pulse tube obtains 7.88 W of cooling power at 77 K, while using an annular pulse tube leads to a cooling power of 7.01 W, a decrease of 0.9 W (11.4%) on the cooling performance. The study sets the basis for building a completely co-axial two-stage pulse tube cooler.

  19. Morphomechanics: transforming tubes into organs.

    Science.gov (United States)

    Taber, Larry A

    2014-08-01

    After decades focusing on the molecular and genetic aspects of organogenesis, researchers are showing renewed interest in the physical mechanisms that create organs. This review deals with the mechanical processes involved in constructing the heart and brain, concentrating primarily on cardiac looping, shaping of the primitive brain tube, and folding of the cerebral cortex. Recent studies suggest that differential growth drives large-scale shape changes in all three problems, causing the heart and brain tubes to bend and the cerebral cortex to buckle. Relatively local changes in form involve other mechanisms such as differential contraction. Understanding the mechanics of organogenesis is central to determining the link between genetics and the biophysical creation of form and structure. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Microwave discharges in capillary tubes

    International Nuclear Information System (INIS)

    Dervisevic, Emil

    1984-01-01

    This research thesis aims at being a contribution to the study of microwave discharge by a surface wave, and more precisely focusses on the discharge in capillary tubes filled with argon. The author first present theoretical models which describe, on the one hand, the propagation of the surface wave along the plasma column, and, on the other hand, longitudinal and radial profiles of the main discharge characteristics. The second part addresses the study of the influence of parameters (gas pressure and tube radius) on discharge operation and characteristics. Laws of similitude as well as empirical relationships between argon I and argon II emission line intensities, electron density, and electric field in the plasma have been established [fr

  1. Scintillation counter: photomultiplier tube alignment

    International Nuclear Information System (INIS)

    Olson, R.E.

    1975-01-01

    A scintillation counter, particularly for counting gamma ray photons, includes a massive lead radiation shield surrounding a sample-receiving zone. The shield is disassembleable into a plurality of segments to allow facile installation and removal of a photomultiplier tube assembly, the segments being so constructed as to prevent straight-line access of external radiation through the shield into the sample receiving zone. Provisions are made for accurately aligning the photomultiplier tube with respect to one or more sample-transmitting bores extending through the shield to the sample receiving zone. A sample elevator, used in transporting samples into the zone, is designed to provide a maximum gamma-receiving aspect to maximize the gamma detecting efficiency. (auth)

  2. Ionization tube simmer current circuit

    Science.gov (United States)

    Steinkraus, R.F. Jr.

    1994-12-13

    A highly efficient flash lamp simmer current circuit utilizes a fifty percent duty cycle square wave pulse generator to pass a current over a current limiting inductor to a full wave rectifier. The DC output of the rectifier is then passed over a voltage smoothing capacitor through a reverse current blocking diode to a flash lamp tube to sustain ionization in the tube between discharges via a small simmer current. An alternate embodiment of the circuit combines the pulse generator and inductor in the form of an FET off line square wave generator with an impedance limited step up output transformer which is then applied to the full wave rectifier as before to yield a similar simmer current. 6 figures.

  3. ATLAS Muon Drift Tube Electronics

    Energy Technology Data Exchange (ETDEWEB)

    Arai, Y [KEK, High Energy Accelerator Research Organisation, Tsukuba (Japan); Ball, B; Chapman, J W; Dai, T; Ferretti, C; Gregory, J [University of Michigan, Department of Physics, Ann Arbor, MI (United States); Beretta, M [INFN Laboratori Nazionali di Frascati, Frascati (Italy); Boterenbrood, H; Jansweijer, P P M [Nikhef National Institute for Subatomic Physics, Amsterdam (Netherlands); Brandenburg, G W; Fries, T; Costa, J Guimaraes da; Harder, S; Huth, J [Harvard University, Laboratory for Particle Physics and Cosmology, Cambridge, MA (United States); Ceradini, F [INFN Roma Tre and Universita Roma Tre, Dipartimento di Fisica, Roma (Italy); Hazen, E [Boston University, Physics Department, Boston, MA (United States); Kirsch, L E [Brandeis University, Department of Physics, Waltham, MA (United States); Koenig, A C [Radboud University Nijmegen/Nikhef, Dept. of Exp. High Energy Physics, Nijmegen (Netherlands); Lanza, A [INFN Pavia, Pavia (Italy); Mikenberg, G [Weizmann Institute of Science, Department of Particle Physics, Rehovot (Israel)], E-mail: brandenburg@physics.harvard.edu (and others)

    2008-09-15

    This paper describes the electronics used for the ATLAS monitored drift tube (MDT) chambers. These chambers are the main component of the precision tracking system in the ATLAS muon spectrometer. The MDT detector system consists of 1,150 chambers containing a total of 354,000 drift tubes. It is capable of measuring the sagitta of muon tracks to an accuracy of 60 {mu}m, which corresponds to a momentum accuracy of about 10% at p{sub T}= 1 TeV. The design and performance of the MDT readout electronics as well as the electronics for controlling, monitoring and powering the detector will be discussed. These electronics have been extensively tested under simulated running conditions and have undergone radiation testing certifying them for more than 10 years of LHC operation. They are now installed on the ATLAS detector and are operating during cosmic ray commissioning runs.

  4. ATLAS Muon Drift Tube Electronics

    CERN Document Server

    Arai, Y; Beretta, M; Boterenbrood, H; Brandenburg, G W; Ceradini, F; Chapman, J W; Dai, T; Ferretti, C; Fries, T; Gregory, J; Guimarães da Costa, J; Harder, S; Hazen, E; Huth, J; Jansweijer, P P M; Kirsch, L E; König, A C; Lanza, A; Mikenberg, G; Oliver, J; Posch, C; Richter, R; Riegler, W; Spiriti, E; Taylor, F E; Vermeulen, J; Wadsworth, B; Wijnen, T A M

    2008-01-01

    This paper describes the electronics used for the ATLAS monitored drift tube (MDT) chambers. These chambers are the main component of the precision tracking system in the ATLAS muon spectrometer. The MDT detector system consists of 1,150 chambers containing a total of 354,000 drift tubes. It is capable of measuring the sagitta of muon tracks to an accuracy of 60 microns, which corresponds to a momentum accuracy of about 10% at pT = 1 TeV. The design and performance of the MDT readout electronics as well as the electronics for controlling, monitoring and powering the detector will be discussed. These electronics have been extensively tested under simulated running conditions and have undergone radiation testing certifying them for more than 10 years of LHC operation. They are now installed on the ATLAS detector and are operating during cosmic ray commissioning runs.

  5. Origami interleaved tube cellular materials

    International Nuclear Information System (INIS)

    Cheung, Kenneth C; Tachi, Tomohiro; Calisch, Sam; Miura, Koryo

    2014-01-01

    A novel origami cellular material based on a deployable cellular origami structure is described. The structure is bi-directionally flat-foldable in two orthogonal (x and y) directions and is relatively stiff in the third orthogonal (z) direction. While such mechanical orthotropicity is well known in cellular materials with extruded two dimensional geometry, the interleaved tube geometry presented here consists of two orthogonal axes of interleaved tubes with high interfacial surface area and relative volume that changes with fold-state. In addition, the foldability still allows for fabrication by a flat lamination process, similar to methods used for conventional expanded two dimensional cellular materials. This article presents the geometric characteristics of the structure together with corresponding kinematic and mechanical modeling, explaining the orthotropic elastic behavior of the structure with classical dimensional scaling analysis. (paper)

  6. Stereotaxic implantation of dispersed cell suspensions into brain. A systematic appraisal of cell placement and survival

    International Nuclear Information System (INIS)

    Plunkett, R.J.; Weber, R.J.; Oldfield, E.H.

    1988-01-01

    The application of several recent advances in cell biology, brain implantation, and cell-mediated tumor immunotherapy requires successful and reproducible placement of viable cell suspensions into brain. Stereotaxic implantation is being used to inject cytotoxic lymphocytes into gliomas and to replace dopaminergic cells in parkinsonian models. Systematic assessment of the factors that influence success in implantation of cell suspensions into solid tissues is needed. A model was developed for investigation of stereotaxic implantation using radiolabeled rat lymphokine-activated killer (LAK) cells. Anesthetized rats received microliter injections of cell suspension into the right caudate nucleus. The injection volume, cell concentration, infusion rate, and needle size were varied systematically. The animals were sacrificed 1 hour after injection; the brain was removed and sectioned, and the radioactivity was counted. Three aliquots of the suspension were injected into counting tubes for control analysis. Recovery of radioactivity was expressed as the percent of mean counts per minute (cpm) in the right frontal lobe/mean cpm in the three control tubes. To assess the viability of implanted cells, the right frontal region was mechanically dissociated in media and centrifuged, and the pellet and supernatant were counted. By using small needles and slow infusion of volumes of 10 microliters or less, 85% to 90% of the radioactivity was recovered in the caudate nucleus. At least half of the implanted cells were viable. Consistent, accurate implantation of dispersed cells into brain over a range of volumes, cell concentrations, infusion rates, and needle sizes was achieved

  7. X-ray tube target

    International Nuclear Information System (INIS)

    Weber, R.G.

    1980-01-01

    A target with an improved heat emissive surface for use in a rotating anode type x-ray tube is described. The target consists of a body having a first surface portion made of x-ray emissive material and a second surface portion made of a heat emissive material comprising at least one of hafnium boride, hafnium oxide, hafnium nitride, hafnium silicide, and hafnium aluminide. (U.K.)

  8. The comparison of corrosion resistance between Baosteel's alloy 690 tube and foreign alloy 690 tube

    International Nuclear Information System (INIS)

    Ma Mingjuan; Zhang Lefu; Li Yan

    2012-01-01

    Alloy 690 having excellent corrosion resistance is widely used for SG tubes. The intergranular corrosion and pitting corrosion resistance of Baosteel's alloy 690 tube, Country A alloy 690 tube and Country B alloy 690 tube have been analysed by comparison. It shows that: The intergranular corrosion of Baosteel's alloy 690 tube tested complied with ASTM G28 Standard could satisfy the technical requirement. However.some of Baosteel's alloy 690 tube in intergranular corrosion resistance had less performance than Country A. In addition, pitting corrosion tested with ASTM G48 Standard shown the Baosteel's alloy 690 tube better than Country B. (authors)

  9. Dynamic characteristics of heat exchanger tubes vibrating in a tube support plate inactive mode

    International Nuclear Information System (INIS)

    Jendrzejczyk, J.A.

    1985-01-01

    Tubes in shell-and-tube heat exchangers, including nuclear plant steam generators, derive their support from longitudinally positioned tube support plates (TSPs). Typically there is a clearance between the tube and TSP hole. Depending on design and fabrication tolerances, the tube may or may not contact all of the TSPs. Noncontact results in an inactive TSP which can lead to detrimental flow induced tube vibrations under certain conditions dependent on the resulting tube-TSP interaction dynamics and the fluid excitation forces. The purpose of this study is to investigate the tube-TSP interaction dynamics. Results of an experimental study of damping and natural frequency as functions of tube-TSP diametral clearance and TSP thickness are reported. Calculated values of damping ratio and frequency of a tube vibrating within an inactive TSP are also presented together with a comparison of calculated and experimetnal quantities

  10. Advanced pressure tube sampling tools

    International Nuclear Information System (INIS)

    Wittich, K.C.; King, J.M.

    2002-01-01

    Deuterium concentration is an important parameter that must be assessed to evaluate the Fitness for service of CANDU pressure tubes. In-reactor pressure tube sampling allows accurate deuterium concentration assessment to be made without the expenses associated with fuel channel removal. This technology, which AECL has developed over the past fifteen years, has become the standard method for deuterium concentration assessment. AECL is developing a multi-head tool that would reduce in-reactor handling overhead by allowing one tool to sequentially sample at all four axial pressure tube locations before removal from the reactor. Four sets of independent cutting heads, like those on the existing sampling tools, facilitate this incorporating proven technology demonstrated in over 1400 in-reactor samples taken to date. The multi-head tool is delivered by AECL's Advanced Delivery Machine or other similar delivery machines. Further, AECL has developed an automated sample handling system that receives and processes the tool once out of the reactor. This system retrieves samples from the tool, dries, weighs and places them in labelled vials which are then directed into shielded shipping flasks. The multi-head wet sampling tool and the automated sample handling system are based on proven technology and offer continued savings and dose reduction to utilities in a competitive electricity market. (author)

  11. The periumbilical approach in ventriculoperitoneal shunt placement: technique and long-term results.

    Science.gov (United States)

    Recinos, Pablo F; Pindrik, Jonathan A; Bedri, Mazen I; Ahn, Edward S; Jallo, George I; Recinos, Violette Renard

    2013-05-01

    The aim of this study was to examine the feasibility and safety of ventriculoperitoneal (VP) shunt placement using a periumbilical approach for distal peritoneal access. By using this minimally invasive approach, the authors hypothesized that the cosmetic outcomes would be better than could be achieved by using a traditional minilaparotomy and that clinical results would be comparable. A periumbilical approach was used for distal catheter insertion during a first-time VP shunt placement in 20 patients (8 males and 12 females). Median age at time of surgery was 3.0 months (range 7 days-11.9 years) and mean follow-up time was 17.8 months (range 1.2-28.0 months). The median weight of the patients was 3.99 kg (range 1.95-57.0 kg). A single incision was made along the natural crease inferior to the umbilicus. The linea alba was exposed and a 1-mm incision made while the patient was temporarily held in a Valsalva maneuver. A peritoneal trocar was then inserted through the fascial incision and the distal catheter was passed into the peritoneal space. The incision line in all patients healed well, did not require operative revision, and was described as minimally visible by the patients' families. Mean operative time was 35 minutes. Eight patients required revision surgery. One distal failure occurred when the distal shunt tubing retracted and became coiled in the neck; this was repaired by conversion to a minilaparotomy for distal replacement. There was 1 shunt infection (5%) requiring shunt removal and replacement. One patient had significant skin thinning around the valve and proximal catheter, which required replacement of the entire shunt system, and another patient underwent a conversion to a ventriculoatrial shunt due to poor peritoneal absorption. In the remaining 4 patients who required operative revision, the peritoneal portion of the shunt was not involved. The periumbilical approach for peritoneal access during VP shunt placement is technically feasible, has

  12. Tube entrance lens focus control

    Science.gov (United States)

    Weisser, D. C.; Fifield, L. K.; Kitchen, T. F. G.; Tunningley, T. B.; Lobanov, N. R.; Muirhead, A. G.

    2013-02-01

    The entrance of the accelerator tube in a large electrostatic accelerator imposes a strong lens that dominates the beam optics. The magnification of the lens is large because of the low injection energy, the high voltage gradient of the acceleration tube and the long distance to the terminal. In the absence of the acceleration, the magnification would produce an unacceptably large beam spot at the terminal. The tyranny of the lens is especially irksome when the accelerator is required to operate at a lower terminal voltage than the one corresponding to the nominal gradient at high voltage. One way around the difficulty, used in NEC Pelletron accelerators, is to insert a series of nylon and steel rods that short together units of the acceleration structure at the terminal leaving the ones near the entrance close to the nominal gradient for optimum transmission. This operation takes time and risks the loss of insulating gas. Another alternative used in the 25URC at Oak Ridge National Laboratory, is to focus the beam at the tube entrance, substantially diluting the effect of the entrance lens. The beam then diverges and so requires an additional lens part way to the terminal. This solution is only partially effective and still necessitates use of shorting rods for low voltage operation. The fact that these elaborate strategies are used is evidence that the alternative of lowering the injection energy as the terminal voltage is lowered imposes enough problems that it is not used in practice. We have modeled a solution that controls the voltage gradient at the tube entrance using an external power supply. This not only maintains the focusing effect of the lens but provides the opportunity to tune the beam by adjusting the entrance lens. A 150 kV power supply outside the pressure vessel feeds a controllable voltage through a high voltage feed-through to the fifth electrode of the accelerator tube. Thus 150 kV on this electrode creates the nominal gradient of 30 kV per

  13. Transracial adoption and foster care placement: worker perception and attitude.

    Science.gov (United States)

    Carter-Black, Jan

    2002-01-01

    This study explores black child welfare workers' perceptions of transracial adoption (TRA) and foster care placement (FCP). Informants were asked to discuss their attitudes toward the placement of black children with white families, as well as their perception of the Multiethnic Placement Act of 1994 and the supplemental Interethnic Adoption Provision of 1996. This study expands existing research regarding the viability of TRA and FCP by incorporating the previously ignored perceptions of social service professionals who are charged with the responsibility of providing child and family services. Findings illuminate the significant role that prioritization of client need plays in the perceptions of workers.

  14. Development boiling to sprinkled tube bundle

    Science.gov (United States)

    Kracík, Petr; Pospíšil, Jiří

    2016-03-01

    This paper presents results of a studied heat transfer coefficient at the surface of a sprinkled tube bundle where boiling occurs. Research in the area of sprinkled exchangers can be divided into two major parts. The first part is research on heat transfer and determination of the heat transfer coefficient at sprinkled tube bundles for various liquids, whether boiling or not. The second part is testing of sprinkle modes for various tube diameters, tube pitches and tube materials and determination of individual modes' interface. All results published so far for water as the falling film liquid apply to one to three tubes for which the mentioned relations studied are determined in rigid laboratory conditions defined strictly in advance. The sprinkled tubes were not viewed from the operational perspective where there are more tubes and various modes may occur in different parts with various heat transfer values. The article focuses on these processes. The tube is located in a low-pressure chamber where vacuum is generated using an exhauster via ejector. The tube consists of smooth copper tubes of 12 mm diameter placed horizontally one above another.

  15. Development boiling to sprinkled tube bundle

    Directory of Open Access Journals (Sweden)

    Kracík Petr

    2016-01-01

    Full Text Available This paper presents results of a studied heat transfer coefficient at the surface of a sprinkled tube bundle where boiling occurs. Research in the area of sprinkled exchangers can be divided into two major parts. The first part is research on heat transfer and determination of the heat transfer coefficient at sprinkled tube bundles for various liquids, whether boiling or not. The second part is testing of sprinkle modes for various tube diameters, tube pitches and tube materials and determination of individual modes’ interface. All results published so far for water as the falling film liquid apply to one to three tubes for which the mentioned relations studied are determined in rigid laboratory conditions defined strictly in advance. The sprinkled tubes were not viewed from the operational perspective where there are more tubes and various modes may occur in different parts with various heat transfer values. The article focuses on these processes. The tube is located in a low-pressure chamber where vacuum is generated using an exhauster via ejector. The tube consists of smooth copper tubes of 12 mm diameter placed horizontally one above another.

  16. A Risk-Based Sensor Placement Methodology

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ronald W [ORNL; Kulesz, James J [ORNL

    2006-08-01

    A sensor placement methodology is proposed to solve the problem of optimal location of sensors or detectors to protect population against the exposure to and effects of known and/or postulated chemical, biological, and/or radiological threats. Historical meteorological data are used to characterize weather conditions as wind speed and direction pairs with the percentage of occurrence of the pairs over the historical period. The meteorological data drive atmospheric transport and dispersion modeling of the threats, the results of which are used to calculate population at risk against standard exposure levels. Sensor locations are determined via a dynamic programming algorithm where threats captured or detected by sensors placed in prior stages are removed from consideration in subsequent stages. Moreover, the proposed methodology provides a quantification of the marginal utility of each additional sensor or detector. Thus, the criterion for halting the iterative process can be the number of detectors available, a threshold marginal utility value, or the cumulative detection of a minimum factor of the total risk value represented by all threats.

  17. Proactive PICC placement: evaluating the patient experience.

    Science.gov (United States)

    Harrold, Karen; Martin, Annette; Scarlett, Clare

    to evaluate patient experience following the proactive placement of a peripherally inserted central catheter (PICC). all patients with a PICC in situ who had attended the chemotherapy day unit over a period of 15 weeks were invited to complete a self-administered questionnaire. Questions related to: information giving, the degree of pain on insertion and any complications experienced by the patient while the device was in situ. There was also space to allow for free-text comments after each question. the majority of patients felt they received enough information and that the procedure was fully explained. Pain on insertion was largely reported as being minimal, with the few patients who did report the procedure as painful also reporting there being difficulty with the insertion. Complication rates were low, the main complication reported was mechanical owing to difficulty with blood withdrawal. irrespective of how uncomfortable the patient found the procedure, the majority of patients would recommend proactive PICC insertion to other patients as 'it made the whole process much easier'.

  18. 4-Point ultrasonography to confirm the correct position of the nasogastric tube in 114 critically ill patients.

    Science.gov (United States)

    Zatelli, Marianna; Vezzali, Norberto

    2017-03-01

    Nasogastric feeding tube is routinely positioned in intensive care units. The complications of misplacement are rare but very dangerous for the patients. The aim of this study is to estimate the diagnostic accuracy of this new technique, 4-point ultrasonography to confirm nasogastric tube placement in intensive care. One hundred fourteen critical ill patients monitored in ICU were included. The intensivist provided in real time to perform the exam in four steps: sonography from either the right or left side of the patient's neck to visualize the esophagus, sonography of epigastrium to confirm the passage through the esophagogastric junction and the positioning in antrum, sonography of the fundus. Finally, gastric placement of the nasogastric feeding tube was confirmed with thorax radiograph. One hundred fourteen of the gastric tubes were visualized by sonography in the digestive tract and all were confirmed by radiography (sensitivity 100%). The entire sonographic procedure, including the longitudinal and transversal scan of the esophagus, the esophagogastric junction, the antrum and the fundus, took 10 min. Our pilot study demonstrated that not weighted-tip gastric tube routinely used in Intensive Care is visible with the sonography. The pilot study confirmed the high sensitivity of the sonography in the verify correct positioning of gastric tube in the adult ICU patients. The ultrasound examination seems to be easy and rapid even when performed by a intensivist whit a sonographic training of only 40 h. The sonographic exam at the bedside was performed in a shorter time than the acquisition and reporting of the X-ray.

  19. Placement Stability, Cumulative Time in Care, and Permanency: Using Administrative Data from CPS to Track Placement Trajectories.

    Science.gov (United States)

    Hélie, Sonia; Poirier, Marie-Andrée; Esposito, Tonino; Turcotte, Daniel

    2017-11-17

    Objectives : The Quebec Youth Protection Act was amended in 2007. The main goal of this reform was to improve placement stability for children who are removed from their home for their protection. Among several legal provisions introduced was the establishment of maximum age-specific durations of out-of-home care, after which a plan must be established to provide stability for children placed in substitute care by finding permanent homes for them. The purpose of this study is (1) to examine trends in placement use and placement stability since the reform and (2) to document the current frequency of each type of placement setting, the cumulative time in care before the exit to permanency, and the sustainability of the permanency outcome. Methods: The study relies on 3 entry cohorts of all children investigated who received protection measures in the province of Quebec during 3 specific time frames before and after the reform ( n = 9620, 8676, 8425). Cohorts were observed for a period varying from 3 to 4 years. Administrative data from all 16 child protection agencies were used to track placement trajectory indicators and to compare cohorts. Results : There has been a decrease in the proportion of children receiving protection measures who were placed in care since the reform, and placement in kinship care has become more frequent among children placed. Placement stability improved slightly after the reform. Overall, for infants, the most frequent type of permanency attained is adoption, while reunification is the option most often indicated for older children. Some children are at a greater risk of experiencing unstable placement trajectories: young children have a high rate of reunification breakdown, some wait a long time to be adopted, and adolescents are frequently removed from the substitute care setting where they were supposed to stay until the age of 18. Conclusions : The results suggest interesting avenues for policy makers and service providers to improve

  20. Placement Stability, Cumulative Time in Care, and Permanency: Using Administrative Data from CPS to Track Placement Trajectories

    Directory of Open Access Journals (Sweden)

    Sonia Hélie

    2017-11-01

    Full Text Available Objectives: The Quebec Youth Protection Act was amended in 2007. The main goal of this reform was to improve placement stability for children who are removed from their home for their protection. Among several legal provisions introduced was the establishment of maximum age-specific durations of out-of-home care, after which a plan must be established to provide stability for children placed in substitute care by finding permanent homes for them. The purpose of this study is (1 to examine trends in placement use and placement stability since the reform and (2 to document the current frequency of each type of placement setting, the cumulative time in care before the exit to permanency, and the sustainability of the permanency outcome. Methods: The study relies on 3 entry cohorts of all children investigated who received protection measures in the province of Quebec during 3 specific time frames before and after the reform (n = 9620, 8676, 8425. Cohorts were observed for a period varying from 3 to 4 years. Administrative data from all 16 child protection agencies were used to track placement trajectory indicators and to compare cohorts. Results: There has been a decrease in the proportion of children receiving protection measures who were placed in care since the reform, and placement in kinship care has become more frequent among children placed. Placement stability improved slightly after the reform. Overall, for infants, the most frequent type of permanency attained is adoption, while reunification is the option most often indicated for older children. Some children are at a greater risk of experiencing unstable placement trajectories: young children have a high rate of reunification breakdown, some wait a long time to be adopted, and adolescents are frequently removed from the substitute care setting where they were supposed to stay until the age of 18. Conclusions: The results suggest interesting avenues for policy makers and service