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Sample records for db-wbmra initial experience

  1. Initial Egyptian ECMO experience

    Directory of Open Access Journals (Sweden)

    Akram Abdelbary

    2016-04-01

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

  2. EXPERIENCES WITH IDEA PROMOTING INITIATIVES

    DEFF Research Database (Denmark)

    Gish, Liv

    2011-01-01

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

  3. Energy efficiency initiatives: Indian experience

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-07-01

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

  4. Return to Experience and Initial Wage Level

    DEFF Research Database (Denmark)

    Sørensen, Kenneth Lykke; Vejlin, Rune Majlund

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

  5. Return to experience and initial wage level

    DEFF Research Database (Denmark)

    Sørensen, K.L.; Vejlin, R.

    2014-01-01

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

  6. Initial conditions of radiative shock experiments

    International Nuclear Information System (INIS)

    Kuranz, C. C.; Drake, R. P.; Krauland, C. M.; Marion, D. C.; Grosskopf, M. J.; Rutter, E.; Torralva, B.; Holloway, J. P.; Bingham, D.; Goh, J.; Boehly, T. R.; Sorce, A. T.

    2013-01-01

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

  7. Initial state radiation experiment at MAMI

    Energy Technology Data Exchange (ETDEWEB)

    Mihovilovič, M.; Merkel, H. [Institut für Kernphysik, Johannes Gutenberg-Universität Mainz, Johann-Joachim-Becher-Weg 45, 55128 Mainz (Germany); Collaboration: A1-Collaboration

    2013-11-07

    In an attempt to contribute further insight into the discrepancy between the Lamb shift and elastic scattering determinations of the proton charge radius, a new experiment at MAMI is underway, aimed at measuring proton form-factors at very low momentum transfers by using a new technique based on initial state radiation. This paper reports on first findings of the pilot measurement performed in 2010, whose main goal was to check the feasibility of the proposed experiment and to recognize and overcome potential obstacles before running the full experiment in 2013.

  8. Initial deuterium pellet experiments on FTU

    International Nuclear Information System (INIS)

    Snipes, J.A.

    1993-01-01

    Initial experiments have been performed with the Single Pellet INjector (SPIN) on FTU. SPIN is a two-stage cryogenic deuterium pellet injector capable of injection,a pellets with velocities up to 2.5 km/s. The nominal pellet mass for these experiments was approximately 1 x 10 20 atoms. These initial pellet experiments concentrated on studying pellet penetration under a variety of plasma conditions to compare with code predictions and to examine toroidal particle transport. The principal diagnostics used were two fast (∼1 μsec) photomultiplier tubes at nearly opposite toroidal locations with H α (D α ) interference filters (λ = 656 nm), a microwave cavity for pellet mass and velocity, a vertical array of soft x ray diodes without filters looking down onto the pellet, a DCN interferometer for electron density profiles, and a Michelson ECE system for electron temperature profiles. The time integral of the absolutely calibrated fast H α signal appears to give reasonable agreement with the expected pellet mass. Toroidal transport of deuterium ions from the pellet to nearly the opposite side of the tokamak agrees with calculated thermal deuterium velocities near the plasma edge. Comparison of the experimental results with code calculations using the Neutral Gas Shielding model show good agreement for the post-pellet electron temperature and density profiles and the H α profiles in some cases. Calculated penetration distances agree within 20%

  9. Barrier experiment: Shock initiation under complex loading

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-01-12

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

  10. Prostate brachytherapy in Ghana: our initial experience

    Directory of Open Access Journals (Sweden)

    James Edward Mensah

    2016-10-01

    Full Text Available Purpose: This study presents the experience of a brachytherapy team in Ghana with a focus on technology transfer and outcome. The team was initially proctored by experienced physicians from Europe and South Africa. Material and methods : A total of 90 consecutive patients underwent either brachytherapy alone or brachytherapy in combination with external beam radiotherapy for prostate carcinoma between July 2008 and February 2014 at Korle Bu Teaching Hospital, Accra, Ghana. Patients were classified as low-risk, intermediate, and high-risk according to the National Comprehensive Cancer Network (NCCN criteria. All low-risk and some intermediate risk group patients were treated with seed implantation alone. Some intermediate and all high-risk group patients received brachytherapy combined with external beam radiotherapy. Results: The median patient age was 64.0 years (range 46-78 years. The median follow-up was 58 months (range 18-74 months. Twelve patients experienced biochemical failure including one patient who had evidence of metastatic disease and died of prostate cancer. Freedom from biochemical failure rates for low, intermediate, and high-risk cases were 95.4%, 90.9%, and 70.8%, respectively. Clinical parameters predictive of biochemical outcome included: clinical stage, Gleason score, and risk group. Pre-treatment prostate specific antigen (PSA was not a statistically significant predictor of biochemical failure. Sixty-nine patients (76.6% experienced grade 1 urinary symptoms in the form of frequency, urgency, and poor stream. These symptoms were mostly self-limiting. Four patients needed catheterization for urinary retention (grade 2. One patient developed a recto urethral fistula (grade 3 following banding for hemorrhoids. Conclusions : Our results compare favorably with those reported by other institutions with more extensive experience. We believe therefore that, interstitial permanent brachytherapy can be safely and effectively

  11. Liver transplantations in Bulgaria--initial experience.

    Science.gov (United States)

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

    2014-01-01

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

  12. Initial TMX central-cell ICRH experiments

    International Nuclear Information System (INIS)

    Molvik, A.W.; Coffield, F.E.; Falabella, S.; Griffin, D.; McVey, B.; Pickles, W.; P.

    1980-01-01

    Four topics are discussed in this report: the feasibility of applying ion cyclotron resonance heating (ICRH) in the TMX central cell, some applications of heating, the results of preliminary experiments, and plans for further ICRH experiments

  13. Robotic repair of vesicovaginal fistula - initial experience

    Directory of Open Access Journals (Sweden)

    Ankush Jairath

    2016-02-01

    Full Text Available ABSTRACT Objective The most common acquired fistula of the urinary tract is Vesicovaginal fistulae (VVF (1 posing social stigmata for the patient as well as a surgical challenge for the urologist. Here we present our initial experience with Robotic assisted laparoscopic repair of VVF, its safety and efficacy. Materials and Methods Seven out of eight fistulas were post hysterectomy; five had undergone abdominal while two had laparoscopic hysterectomy while one was due to prolonged labour. Two had associated ureteric injury. All underwent robotic assisted laparoscopic trans abdominal extravesical approach. Three 8 mm ports for robotic arms, one 12 mm port for camera and another 12 mm for assistant were used in a fan shaped manner. All had preoperative ureteric catheter placed. Bladder was closed in two layers and vagina in one layer. Omental flap placed in all cases except two where it was not possible. Drain and per urethral catheter placed in all cases. Double J stents were placed in two cases requiring ureteric implantation additionally. Results The mean age of presentation was 39.25 years (26-47 range with mean BMI being 26.25 kg/m2 (21-32 range. Mean duration between insult and repair was 9.37 months (3-24 months. Only in single case there was history of previous repair attempt. On cystoscopy four had supratrigonal VVF and four were trigonal with mean size of 13.37 mm (7-20 mm. Mean operative time was 117.5 minutes (90-150. There were no intraoperative/postoperative complications or need for open conversion. Mean haemoglobin drop was 1.4 gm/dL (0.3-2 gm. Drain was removed once 24-48 hours output is negligible. One patient had post-operative urinary leak at 2 weeks which ceased with continuation of catheterisation for another 2 weeks. Catheter was removed after voiding cystourethrogram showed no leak at 2-3 weeks postoperatively. Mean duration of drain was 3.75 days (3-5 and per urethral catheterisation (which was removed after voiding

  14. Initial Encounters : The Lived Experiences of Buyers

    NARCIS (Netherlands)

    G. Wright; J.J. Dekker

    2012-01-01

    The initial encounter between a buyer and a seller has received much attention among practitioners. The first time a buyer interacts with a seller is thought to be highly influential. The premise is that buyers form an opinion during this first encounter, or even the first minutes of this encounter.

  15. Initial performance of the COSINE-100 experiment

    Energy Technology Data Exchange (ETDEWEB)

    Adhikari, G.; Adhikari, P. [Sejong University, Department of Physics, Seoul (Korea, Republic of); Souza, E.B. de; Jo, J.H.; Lim, K.E.; Maruyama, R.H.; Pierpoint, Z.P.; Thompson, W.G. [Yale University, Department of Physics, New Haven, CT (United States); Carlin, N. [University of Sao Paulo, Physics Institute, Sao Paulo (Brazil); Choi, S.; Joo, H.W.; Kim, S.K. [Seoul National University, Department of Physics and Astronomy, Seoul (Korea, Republic of); Choi, W.Q. [Korea Institute of Science and Technology Information, Daejeon (Korea, Republic of); Karlsruher Institut fuer Technologie (KIT), Institut fuer Experimentelle Kernphysik, Eggenstein-Leopoldshafen (Germany); Djamal, M.; Prihtiadi, H. [Bandung Institute of Technology, Department of Physics, Bandung (Indonesia); Ezeribe, A.C.; Kudryavtsev, V.A.; Lynch, W.A.; Mouton, F.; Spooner, N.J.C. [University of Sheffield, Department of Physics and Astronomy, Sheffield (United Kingdom); Ha, C.; Jeon, E.J.; Kang, W.G.; Kim, B.H.; Kim, H.; Kim, K.W.; Kim, N.Y.; Lee, H.S.; Lee, J.; Lee, M.H.; Leonard, D.S.; Olsen, S.L.; Park, H.K.; Park, K.S.; Ra, S.; Yong, S.H. [Institute for Basic Science (IBS), Center for Underground Physics, Daejeon (Korea, Republic of); Hahn, I.S. [Ewha Womans University, Department of Science Education, Seoul (Korea, Republic of); Hubbard, A.J.F. [Yale University, Department of Physics, New Haven, CT (United States); Northwestern University, Department of Physics and Astronomy, Evanston, IL (United States); Kang, W.; Rott, C. [Sungkyunkwan University, Department of Physics, Seoul (Korea, Republic of); Kauer, M. [University of Wisconsin-Madison, Department of Physics and Wisconsin IceCube Particle Astrophysics Center, Madison, WI (United States); Kim, H.J.; Lee, J.Y. [Kyungpook National University, Department of Physics, Daegu (Korea, Republic of); Kim, M.C. [Sungkyunkwan University, Department of Physics, Seoul (Korea, Republic of); Chiba University, Department of Physics, Chiba (Japan); Kim, Y.D. [Sejong University, Department of Physics, Seoul (Korea, Republic of); Institute for Basic Science (IBS), Center for Underground Physics, Daejeon (Korea, Republic of); Kim, Y.H. [Institute for Basic Science (IBS), Center for Underground Physics, Daejeon (Korea, Republic of); Korea Research Institute of Standards and Science, Daejeon (Korea, Republic of); Park, H.S. [Korea Research Institute of Standards and Science, Daejeon (Korea, Republic of); Park, J.S. [Institute for Basic Science (IBS), Center for Underground Physics, Daejeon (Korea, Republic of); High Energy Accelerator Research Organization (KEK), Ibaraki (Japan); Pettus, W. [Yale University, Department of Physics, New Haven, CT (United States); University of Washington, Department of Physics, Center for Experimental Nuclear Physics and Astrophysics, Seattle, WA (United States); Rogers, F.R. [Yale University, Department of Physics, New Haven, CT (United States); Massachusetts Institute of Technology, Department of Physics, Cambridge, MA (United States); Scarff, A. [University of Sheffield, Department of Physics and Astronomy, Sheffield (United Kingdom); University of British Columbia, Department of Physics and Astronomy, Vancouver, BC (Canada); Yang, L. [University of Illinois at Urbana-Champaign, Department of Physics, Urbana, IL (United States)

    2018-02-15

    COSINE is a dark matter search experiment based on an array of low background NaI(Tl) crystals located at the Yangyang underground laboratory. The assembly of COSINE-100 was completed in the summer of 2016 and the detector is currently collecting physics quality data aimed at reproducing the DAMA/LIBRA experiment that reported an annual modulation signal. Stable operation has been achieved and will continue for at least 2 years. Here, we describe the design of COSINE-100, including the shielding arrangement, the configuration of the NaI(Tl) crystal detection elements, the veto systems, and the associated operational systems, and we show the current performance of the experiment. (orig.)

  16. Initial experiments with Multiple Musical Gestures

    DEFF Research Database (Denmark)

    Jensen, Kristoffer; Graugaard, Lars

    2005-01-01

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

  17. SISCOM imaging : an initial South African experience

    International Nuclear Information System (INIS)

    Warwick, J.; Rubow, S.; Van Heerden, B.; Ghoorun, S.; Butler, J.

    2004-01-01

    Full text: Subtraction ictal SPECT co-registered with MRI (SISCOM) is a new technique utilized for the detection and localization of epileptogenic foci in patients with refractory focal epilepsy who are candidates for surgical resection. The technique requires many challenges to be overcome, in particular in relation to the administration of the radiopharmaceutical, acquisition of brain SPECT and the conversion, co-registration and fusion of brain SPECT and MRI studies. Furthermore the interpretation of the studies is complex and is ideally performed in a multidisciplinary context in cooperation with disciplines such as neurology, radiology, psychiatry and neurosurgery. Materials and methods: Two brain SPECT studies are performed using 99m Tc-ethylene cystinate dimer (ECD). An ictal study is performed after the administration of the 99m Tc-ECD during a seizure. An interictal SPECT, performed between seizures is then subtracted from the ictal SPECT, and the difference image fused with an MRI study to optimise localization of the epileptogenic focus. Image conversion, co-registration and fusion was performed using MRlcro and SPM software. Results: To date the Departments of Neurology and Nuclear Medicine have completed over 10 SISCOM studies. Conclusion: During this presentation this initial work will be presented. The methodology as well as the challenges involved in performing and interpreting these studies will be discussed. Individual cases will be used to illustrate the impact of this powerful technique on future patient management. (author)

  18. Initial clinical experience with the heartstring

    International Nuclear Information System (INIS)

    Kazui, Toshinobu; Doi, Hirosato; Suzuki, Masato; Okamoto, Takashi; Koshima, Ryuji; Sugiki, Kenji; Ohno, Takemi

    2006-01-01

    The Heartstring is one of the devices that enable proximal anastomosis without clamping the aorta. We have applied the device not only to low-risk patients with normal aortas but also to high-risk patients with diseased aortas. The purpose of this study was to investigate the initial outcomes of using this device. The Heartstring was used on 87 patients between January and December 2004. The patients comprised 62 men and 25 women 48-86 years old (mean 68.4±8.4 years). The ascending aorta was evaluated by computed tomography (CT) scanning before surgery. If a patient's aorta was severely calcified, epiaortic echocardiography was performed. The aortas were ranked into four grades, and the preoperative patient's status were evaluated by the EuroSCORE. Angiography was performed on the third postoperative day. CT scanning revealed that 74 patients had no calcification in the ascending aorta, 10 patients had scattered calcification, and 3 patients had plate-like calcification. The EuroSCORE was 6.86±1.03. We performed 93 proximal anastomoses and 149 distal anastomoses. The average distal anastomosis was 1.6±0.6 sites per graft. Of the distal anastomoses, 74.2% were to the circumflex artery territory. Postoperative coronary angiography revealed that all grafts were patent. The Heartstring facilitates safe proximal anastomosis, even in high-risk patients. Their short-term outcome was good. The device assists in bypassing circumflex artery territory. Long-term follow-up is necessary. (author)

  19. Initial Educational Experiences of Tertiary Students. LSAY Briefing Number 14

    Science.gov (United States)

    Hillman, Kylie

    2008-01-01

    This "Briefing" presents information about the initial tertiary education experiences, such as satisfaction with aspects of student life and changes to initial enrolments, of two groups of young people, based on two recent Longitudinal Surveys of Australian Youth (LSAY) research reports. One study focused on the first year experiences of…

  20. Laparoscopic nephrectomy: initial experience with 120 cases.

    LENUS (Irish Health Repository)

    Cheema, I A

    2012-02-01

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

  1. Laparoscopic nephrectomy: initial experience with 120 cases.

    LENUS (Irish Health Repository)

    Cheema, I A

    2010-02-01

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

  2. Initial performance of the CUORE-0 experiment

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-08-15

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

  3. VIM: Initial ENDF/B-VI experience

    International Nuclear Information System (INIS)

    Blomquist, R.N.

    1997-01-01

    The VIM Monte Carlo particle transport code uses detailed continuous-energy cross sections produced from ENDF/B data by a set of specialized codes developed or adapted for use at Argonne National Laboratory. ENDF/B-IV data were used until about 1979, and Version V data since then. These VIM libraries were extensively benchmarked against the MC 2 -2 code and against ZPR and ZPPR criticals for fast spectrum calculations, as well as other fast and thermal experiments and calculations. Recently, the cross section processing codes have been upgraded to accommodate ENDF/B-VI files, and a small library has been tested. Several fundamental tasks comprise the construction of a faithful representation of ENDF data for VIM calculations: (1) The resolved resonance parameters are converted to Doppler-broadened continuous-energy cross sections with energy grids suitable for linear-linear interpolation. (2) The unresolved resonance parameter distributions are sampled to produce many (40-400) resonance ladders in each energy band. These are converted to Doppler-broadened continuous energy resonance cross sections that are then binned by cross section, accumulating ladders until statistical convergence, the result being probability tables of total cross sections and conditional mean scattering and fission cross sections. VIM samples these tables at run time, and File 3 back ground cross sections are added. (3) Anisotropic angular distribution data are converted to angular probability tables. All other ENDF data are unmodified, except for format

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

    KAUST Repository

    Saghir, Shahid; Bellaredj, Mohammed Lamine Faycal; Ramini, Abdallah; Younis, Mohammad I.

    2016-01-01

    Microplates are the building blocks of many micro-electro-mechanical systems. It is common for them to experience initial curvature imperfection due to residual stresses caused by the micro fabrication process. Such plates are essentially different

  5. Initial Results from Coaxial Helicity Injection Experiments in NSTX

    International Nuclear Information System (INIS)

    Raman, R.; Jarboe, T.R.; Mueller, D.; Schaffer, M.J.; Maqueda, R.; Nelson, B.A.; Sabbagh, S.; Bell, M.; Ewig, R.; Fredrickson, E.; Gates, D.; Hosea, J.; Ji, H.; Kaita, R.; Kaye, S.M.; Kugel, H.; Maingi, R.; Menard, J.; Ono, M.; Orvis, D.; Paolette, F.; Paul, S.; Peng, M.; Skinner, C.H.; Wilgen, W.; Zweben, S.

    2001-01-01

    Coaxial Helicity Injection (CHI) has been investigated on the National Spherical Torus Experiment (NSTX). Initial experiments produced 130 kA of toroidal current without the use of the central solenoid. The corresponding injector current was 20 kA. Discharges with pulse lengths up to 130 ms have been produced

  6. British Isles Field Experience: An Initiative in International Education.

    Science.gov (United States)

    Martin, William J.

    The British Isles Field Experience (BIFE) program was initiated at Williamsport Area Community College (WACC) to provide a group of WACC faculty and staff members with individual and group activities of a personal, professional, and cultural nature in order to promote an international perspective that can be infused into student, collegiate, and…

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

    Energy Technology Data Exchange (ETDEWEB)

    Foster, John T.

    2009-10-01

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

  8. Preliminary results from initial in-pile debris bed experiments

    International Nuclear Information System (INIS)

    Rivard, J.B.

    1977-01-01

    An accident in a liquid metal fast breeder reactor (LMFBR) in which molten core material is suddenly quenched with subcooled liquid sodium could result in extensive fragmentation and dispersal of fuel as subcritical beds of frozen particulate debris within the reactor vessel. Since this debris will continue to generate power due to decay of retained fission products, containment of the debris is threatened if the generated heat is not removed. Therefore, the initial safety question is the capacity which debris beds may have for transfer of the decay heat to overlying liquid sodium by natural processes--i.e., without the aid of forced circulation of the coolant. Up to the present time, all experiments on debris bed behavior either have used substitute materials (e.g., sand and water) or have employed actual materials, but atypical heating methods. Increased confidence in the applicability of debris bed simulations is afforded if the heat is generated within the fuel component of the appropriate fast reactor materials. The initial series of in-pile tests reported on herein constitutes the first experiments in which the internal heating mode has been produced in particulate oxide fuel immersed in liquid sodium. Fission heating of the fully-enriched UO 2 in the experiment while it is contained within Sandia Laboratories Annular Core Pulse Reactor (ACPR), operating in its steady-state mode, approximates the decay heating of debris. Preliminary results are discussed

  9. Initial experience of tritium exposure control at JET

    International Nuclear Information System (INIS)

    Patel, B.; Campling, D.C.; Schofield, P.A.; Macheta, P.; Sandland, K.

    1998-01-01

    Some of the safety procedures and controls in place for work with tritium are described, and initial operational experience of handling tritium is discussed. A description is given of work to rectify a water leak in a JET neutral beam heating component, which involved man-access to a confined volume to perform repairs, at tritium levels about 100 DAC (80 MBq/m 3 . HTO). Control measures involving use of purge and extract ventilation, and of personal protection using air-fed pressurized suits are described. Results are given of the internal doses to project staff and of atmospheric discharges of tritium during the repair outage. (P.A.)

  10. Experimental test accelerator: description and results of initial experiments

    International Nuclear Information System (INIS)

    Fessenden, T.; Birx, D.; Briggs, R.

    1980-01-01

    The ETA is a high current (10,000 Amp) linear induction accelerator that produces short (30 ns) pulses of electrons at 5 MeV twice per second or in bursts of 5 pulses separated by as little as one millisecond. At this time the machine has operated at 65% of its design current and 90% of the design voltage. This report contains a description of the accelerator and its diagnostics; the results of the initial year of operation; a comparison of design codes with experiments on beam transport; and a discussion of some of the special problems and their status

  11. Initial acceptance test experience with FFTF plant equipment

    International Nuclear Information System (INIS)

    Brown, R.K.; Coleman, K.A.; Mahaffey, M.K.; McCargar, C.G.; Young, M.W.

    1978-09-01

    The purpose of this paper is to examine the initial acceptance test experience of certain pieces of auxiliary equipment of the Fast Flux Test Facility (FFTF). The scope focuses on the DHX blowers and drive train, inert gas blowers, H and V containment isolation valves, and the Surveillance and In-service Inspection (SISI) transporter and trolley. For each type of equipment, the discussion includes a summary of the design and system function, installation history, preoperational acceptance testing procedures and results, and unusual events and resolutions

  12. Initial experience with the NRC significance determination process

    Energy Technology Data Exchange (ETDEWEB)

    Madison, A.L. [Office of Nuclear Reactor Regulation, US Nuclear Regulatory Commission (United States)

    2001-07-01

    The U.S. Nuclear Regulatory Commission (NRC) has revamped its inspection, assessment, and enforcement programs for commercial nuclear power plants. The new oversight process uses more objective, timely, and safety-significant criteria in assessing performance, while seeking to more effectively and efficiently regulate the industry. The NRC tested the new process at thirteen reactors at nine sites across the country on a pilot basis in 1999 to identify what things worked well and what improvements were called for before beginning Initial Implementation at all US nuclear power plants on April 2, 2000. After a year of experience has been gained with the new oversight process at all US plants, the NRC anticipates making further improvements based on this wider experience. (author)

  13. Initial experience with the NRC significance determination process

    International Nuclear Information System (INIS)

    Madison, A.L.

    2001-01-01

    The U.S. Nuclear Regulatory Commission (NRC) has revamped its inspection, assessment, and enforcement programs for commercial nuclear power plants. The new oversight process uses more objective, timely, and safety-significant criteria in assessing performance, while seeking to more effectively and efficiently regulate the industry. The NRC tested the new process at thirteen reactors at nine sites across the country on a pilot basis in 1999 to identify what things worked well and what improvements were called for before beginning Initial Implementation at all US nuclear power plants on April 2, 2000. After a year of experience has been gained with the new oversight process at all US plants, the NRC anticipates making further improvements based on this wider experience. (author)

  14. Initiation process of a thrust fault revealed by analog experiments

    Science.gov (United States)

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

    2016-04-01

    We conducted 2D (cross-sectional) analog experiments with dry sand using a high resolution digital image correlation (DIC) technique to reveal initiation process of a thrust fault in detail, and identified a number of "weak shear bands" and minor uplift prior to the thrust initiation. The observations suggest that the process can be divided into three stages. Stage 1: characterized by a series of abrupt and short-lived weak shear bands at the location where the thrust will be generated later. Before initiation of the fault, the area to be the hanging wall starts to uplift. Stage 2: defined by the generation of the new thrust and its active displacement. The location of the new thrust seems to be constrained by its associated back-thrust, produced at the foot of the surface slope (by the previous thrust). The activity of the previous thrust turns to zero once the new thrust is generated, but the timing of these two events is not the same. Stage 3: characterized by a constant displacement along the (new) thrust. Similar minor shear bands can be seen in the toe area of the Nankai accretionary prism, SW Japan and we can correlate the along-strike variations in seismic profiles to the model results that show the characteristic features in each thrust development stage.

  15. LWR aerosol containment experiments (LACE) program and initial test results

    International Nuclear Information System (INIS)

    Muhlestein, L.D.; Hilliard, R.K.; Bloom, G.R.; McCormack, J.D.; Rahn, F.J.

    1985-01-01

    The LWR aerosol containment experiments (LACE) program is described. The LACE program is being performed at the Hanford Engineer Development Laboratory (operated by Westinghouse Hanford Company) and the initial tests are sponsored by EPRI. The objectives of the LACE program are: to demonstrate, at large-scale, inherent radioactive aerosol retention behavior for postulated high consequence LWR accident situations; and to provide a data base to be used for aerosol behavior . Test results from the first phase of the LACE program are presented and discussed. Three large-scale scoping tests, simulating a containment bypass accident sequence, demonstrated the extent of agglomeration and deposition of aerosols occurring in the pipe pathway and vented auxiliary building under realistic accident conditions. Parameters varied during the scoping tests were aerosol type and steam condensation

  16. Discharge initiation experiments in the Tokapole II tokamak

    International Nuclear Information System (INIS)

    Shepard, D.A.

    1984-01-01

    Experiments in the Tokapole II tokamak demonstrate the benefits of high density (n/sub e//n/sub o/ greater than or equal to 0.01) preionization by reducing four quantities at startup: necessary toroidal loop voltage (V 1 ) (50%), volt-second consumption (40-50%), impurity radiation (25-50%), and runaway electron production (approx. 80-100%). A zero-dimensional code models the loop voltage reduction dependence on preionization density and predicts a similar result for reactor scale devices. The code shows low initial resistivity and a high resistivity time derivative contribute to loop voltage reduction. Microwaves at the electron cyclotron resonance (ECR) frequency and plasma gun injection produce high density preionization, which reduces the initial V 1 , volt-second consumption, and runaways. The ECR preionization also reduces impurity radiation by shortening the time from voltage application to current channel formation. This, evidently, reduces the total plasma-wall interaction at startup. The power balance of the ECR plasma in a toroidal-field-only case was studied using Langmuir probes and impurity doping. The vertical electric field and current, which result from curvature drift, were measured as approx. 10 V/cm and 50 amps, respectively, and exceeded expected values for the bulk electron temperature (approx. 10 eV)

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

    KAUST Repository

    Saghir, Shahid

    2016-07-01

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

  18. [Characterization of photochemical smog chamber and initial experiments].

    Science.gov (United States)

    Jia, Long; Xu, Yong-Fu; Shi, Yu-Zhen

    2011-02-01

    A self-made new indoor environmental chamber facility for the study of atmospheric processes leading to the formation of ozone and secondary organic aerosols has been introduced and characterized. The characterization experiments include the measurements of wall effects for reactive species and the determination of chamber dependent * OH radical sources by CO-NO(x) irradiation experiments. Preliminary ethene-NO(x) and benzene-NO(x) experiments were conducted as well. The results of characterization experiments show that the wall effects for O3 and NO2 in a new reactor are not obvious. Relative humidity has a great effect on the wall losses in the old reactor, especially for O3. In the old reactor, the rate constant for O3 wall losses is obtained to be 1.0 x 10(-5) s(-1) (RH = 5%) and 4.0 x10(-5) s(-1) (RH = 91%), whereas for NO2, it is 1.0 x 10(-6) s(-1) (RH = 5%) and 0.6 x 10(-6) s(-1) (RH = 75%). The value for k(NO2 --> HONO) determined by CO-NO(x) irradiation experiments is (4.2-5.2) x 10(-5) s(-1) and (2.3-2.5) x 10(-5) s(-1) at RH = 5% and RH 75% -77%, respectively. The average *OH concentration is estimated to be (2.1 +/- 0.4) x 10(6) molecules/cm3 by using a reaction rate coefficient of CO and * OH. The sensitivity of chamber dependent auxiliary reactions to the O3 formation is discussed. Results show that NO2 --> HONO has the greatest impact on the O3 formation during the initial stage, N2O5 + H2O --> 2HNO3 has a minus effect to maximum O3 concentration, and that the wall losses of both O3 and NO2 have little impact on the O3 formation. The results from the ethene-NO(x) and benzene-NO(x) experiments are in good agreement with those from the MCM simulation, which reflects that the facility for the study of the formation of secondary pollution of ozone and secondary organic aerosols is reliable. This demonstrates that our facility can be further used in the deep-going study of chemical processes in the atmosphere.

  19. Shock initiation experiments on ratchet grown PBX 9502

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-01-01

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

  20. Discharge initiation experiments in the Tokapole II tokamak

    International Nuclear Information System (INIS)

    Shepard, D.A.

    1984-06-01

    Experiments in the Tokapole II tokamak demonstrate the benefits of high density (n/sub e//n 0 greater than or equal to 0.01) preionization by reducing four quantities at startup: necessary toroidal loop voltage (V 1 ) (50%), volt-second consumption (40 to 50%), impurity radiation (25 to 50%), and runaway electron production (approx. 80 to 100%). A zero-dimensional code models the loop voltage reduction dependence on preionization density and predicts a similar result for reactor scale devices. The code shows low initial resistivity and a high resistivity time derivative contribute to loop voltage reduction. The power balance of the ECR plasma in a toroidal-field-only case was studied. Langmuir probes and impurity doping were used. The vertical electric field (E/sub v/) and current (I/sub v/), which result from curvature drift, were measured (E/sub v/ approx. 10 V/cm and I/sub v/ approx. 50 Amps) and exceeded expected values for the bulk electron temperature (approx. 10 eV). A series of experiments with external windings to simulate field errors perpendicular to the toroidal field was done. The results imply that an error field of 0.1% of the toroidal field is deleterious to ECR plasma density

  1. Medical student perceptions of an initial collaborative immersion experience.

    Science.gov (United States)

    House, Joseph B; Cedarbaum, Jacob; Haque, Fatema; Wheaton, Michael; Vredeveld, Jennifer; Purkiss, Joel; Moore, Laurel; Santen, Sally A; Daniel, Michelle

    2018-03-01

    Recent reviews of interprofessional education (IPE) highlight the need for innovative curricula focused on longitudinal clinical learning. We describe the development and early outcomes of the initial clinical experience (ICE), a longitudinal practice-based course for first-year medical students. While IPE courses focus on student-to-student interaction, ICE focuses on introducing students to interprofessional collaboration. Students attend 14 sessions at one of 18 different clinical sites. They work directly with different health professionals from among 17 possible professions, including nurses, pharmacists, social workers, and respiratory, occupational, and physical therapists. Between 2015 and 2016, 167 students completed the course, and 81 completed the end-of-course evaluation. Students agreed or strongly agreed that ICE meaningfully contributed to their understanding of healthcare teams and different professional roles (86%), improved their understanding of healthcare systems (84%), improved their ability to communicate with healthcare professionals (61%), and improved their ability to work on interprofessional teams (65%). Select themes from narrative comments suggest that clinical immersion improves understanding of professional roles, helps students understand their own future roles in healthcare teams, and increases awareness of and respect for other professionals, with the potential to change future practice. ICE may be a template for other schools wishing to expand their current educational offerings, by engaging learners in more authentic, longitudinal clinical experiences with practicing healthcare professionals.

  2. [Initiation, promotion, initiation experiments with radon and cigarette smoke: Lung tumors in rats]. Progress report

    International Nuclear Information System (INIS)

    Moolgavkar, S.H.

    1994-01-01

    During the past several years, the authors have made considerable progress in modeling carcinogenesis in general, and in modeling radiation carcinogenesis, in particular. They present an overview of their progress in developing stochastic carcinogenesis models and applying them to experimental and epidemiologic data sets. Traditionally, cancer models have been used for the analysis of incidence (or prevalence) data in epidemiology and time to tumor data in experimental studies. The relevant quantities for the analysis of these data are the hazard function and the probability of tumor. The derivation of these quantities is briefly described here. More recently, the authors began to use these models for the analysis of data on intermediate lesions on the pathway to cancer. Such data are available in experimental carcinogenesis studies, in particular in initiation and promotion studies on the mouse skin and the rat liver. If however, quantitative information on intermediate lesions on the pathway to lung cancer were to be come available at some future date, the methods that they have developed for the analysis of initiation-promotion experiments could easily be applied to the analysis of these lesions. The mathematical derivations here are couched in terms of a particular two-mutation model of carcinogenesis. Extension to models postulating more than two mutations is not always straightforward

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

    Science.gov (United States)

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

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

  4. Cardiac 82rubidium PET/CT: initial European experience

    International Nuclear Information System (INIS)

    Groves, Ashley M.; Dickson, John C.; Kayani, Irfan; Endozo, Raymondo; Blanchard, Patty; Shastry, Manu; Prvulovich, Elizabeth; Waddington, Wendy A.; Ben-Haim, Simona; Bomanji, Jamshed B.; Ell, Peter J.; Speechly-Dick, Marie-Elsya; McEwan, Jean R.

    2007-01-01

    Myocardial perfusion with PET/CT has advantages over conventional SPECT. We describe our initial European experience using 82 Rubidium-PET/CT, as part of a clinical myocardial perfusion service. We studied the first 100 patients (64 male; 36 female, mean age = 60: SD +/-12.5y, mean body mass index = 30: SD +/-6.9kg/m 2 ) who underwent 82 Rubidium cardiac PET/CT in our institution. Thirty patients had recently undergone coronary angiography. Patients underwent imaging during adenosine infusion and at rest. Images were acquired over 5 minutes using a GE-PET/CT instrument. Image quality was described as good, adequate or inadequate. Images were reported patient-by-patient by a minimum of five nuclear medicine physicians. A segment-by-segment analysis (17-segment model) was also performed. Image quality was good in 77%, adequate 23% and inadequate 0%. There was no statistical difference in image quality between obese and non-obese patients (Fisher's exact test, p = 0.2864). 59% had normal perfusion studies, 29% had inducible ischaemia, 12% had myocardial infarction (11% with super added ischaemia). There was reduced 82 Rubidium uptake in 132/1700 segments during stress. There was reduced 82 Rubidium uptake at rest in 42/1700 segments. The 82 Rubidium PET/CT findings were consistent with the angiographic findings in 28/30 cases. We show that, even from initial use of 82 Rubidium, it is possible to perform myocardial perfusion studies quickly with good image quality, even in the obese. The PET findings correlated well in the third of the cases where angiography was available. As such, 82 Rubidium cardiac PET/CT is likely to be an exciting addition to the European nuclear physician/ cardiologist's radionuclide imaging arsenal. (orig.)

  5. The PIOTRON: initial performance, preparation and experience with pion therapy

    International Nuclear Information System (INIS)

    Von Essen, C.F.; Blattmann, H.; Crawford, J.F.; Fessenden, P.; Pedroni, E.; Perret, C.; Salzmann, M.; Shortt, K.; Walder, E.

    1982-01-01

    The PIOTRON is a large solid angle superconducting channel built for the use of negative pi-mesons in radiotherapy. The pions are produced by protons of 590 MeV striking a target of molybdenum or beryllium. The pions are divided into 60 channels and deflected twice to enter the treatment volume radially. The momentum and the momentum band for all 60 channels can be chosen and the beam spot of Bragg peak pions at the isocenter of the applicator is a few centimeters in each direction. Dynamic scanning can thus achieve 3-dimensionally shaped treatment volumes. Two different methods are available: the ring scan, using changes of pion range; and the spot scan, involving translation of the patient through the fixed beam spot. Dose distributions of individual and multiple beams were plotted in a cylindrical water phantom. Radiobiological experiments with mammalian cells in gel and with mouse feet were performed. A special beam geometry using a sector of 15 beams was selected for the first treatments of patients with metastatic skin nodules. Six patients were treated. Acute skin reactions were scored and compared with those from orthovoltage therapy with comparable beam geometry. The RBE for 10 fractions is between 1.4 and 1.5. The next step involved treatment of patients inside water-bolus rings in preparation for dynamic therapy. Patients were then treated with the spot scan dynamic mode in the water bolus. The initial responses and reactions are favorable and confirm the feasibility and accuracy of dynamic pion therapy

  6. Initial Experience with ABO-incompatible Live Donor Renal Transplantation

    Directory of Open Access Journals (Sweden)

    Meng-Kun Tsai

    2006-01-01

    Full Text Available The serious shortage of cadaveric organs has prompted the development of ABO-incompatible live donor renal transplantation. We report our experience of the initial two live donor ABO incompatible renal transplants at our hospital. The first patient was a 55-year-old type A female who received a kidney from her AB type husband. The second patient was a 27-year-old type O male who received renal transplantation from his type A father. Preconditioning immunosuppressive therapy in the two patients with tacrolimus, mycophenolate mofetil and methylprednisolone was started 7 days before transplantation. During the period of preconditioning, double filtration plasmapheresis (DFPP was employed to remove anti-A and -B antibodies. Laparoscopic splenectomy and renal transplantation were performed after the anti-donor ABO antibodies were reduced to a titer of 1:4. Rituximab, a humanized monoclonal anti-CD20 antibody, was administered to the second patient due to a rebound in the anti-A antibody titer during the preconditioning period. Under a tacrolimus-based immunosuppressive regimen, both patients recovered very well without any evidence of rejection. Serum creatinine levels were 1.0 and 1.4 mg/dL at 6 and 3 months after transplantation, respectively. These cases illustrate that with new immunosuppressive agents, DFPP and splenectomy, ABO-incompatible renal transplantation can be successfully conducted in end-stage renal disease patients whose only available live donors are blood group incompatible.

  7. Initial Experience with the Machine Protection System for LHC

    CERN Document Server

    Schmidt, Ruediger; Dehning, Bernd; Ferro-Luzzi, Massimiliano; Goddard, Brennan; Lamont, Mike; Siemko, Andrzej; Uythoven, Jan; Wenninger, Jorg; Zerlauth, Markus

    2010-01-01

    For nominal beam parameters at 7 TeV/c each proton beam with a stored energy of 362 MJ threatens to damage accelerator equipment in case of uncontrolled beam loss. These parameters will only be reached after some years of operation, however, a small fraction of this energy is already sufficient to damage accelerator equipment or experiments. The correct functioning of the machine protection systems is vital during the different operational phases already for initial operation. When operating the complex magnet system, with and without beam, safe operation relies on the protection and interlock systems for the superconducting circuits. For safe injection and transfer of the beams from SPS to LHC, transfer line parameters are monitored, beam absorbers must be in the correct position and the LHC must be ready to accept beam. At the end of a fill and in case of failures beams must be properly extracted onto the dump blocks, for some types of failure within less than few hundred microseconds. Safe operation requir...

  8. [Aortic valve preservation in Marfan syndrome. Initial experience].

    Science.gov (United States)

    Forteza, Alberto; Cortina, Jose M; Sánchez, Violeta; Centeno, Jorge; López, M Jesús; Pérez de la Sota, Enrique; Rufilanchas, Juan J

    2007-05-01

    Preservation of the aortic valve using the technique described by David has been shown to be as effective as the Bentall-De Bono procedure. It avoids both the need for long-term anticoagulation and the complications associated with mechanical prostheses. We report our initial experience using this technique in patients with Marfan syndrome. Between April 2004 and April 2006, we used the David reimplantation technique in 40 patients with an aortic root aneurysm. Eighteen patients had Marfan syndrome. Their median age was 29 years (13-55 years). Echocardiography showed that the median diameter of the aortic sinus was 53 mm (46-59 mm). In 17 patients, aortic valve preservation was possible. No patient died during hospitalization and there were no significant complications. On echocardiography at discharge, no patient had greater than grade-II aortic regurgitation. During a median follow-up period of 8 months (1-24 months), one patient died due to rupture of an abdominal aneurysm. The others are all in New York Heart Association class I. Preservation of the aortic valve by means of valve reimplantation produced excellent results. It avoided both the thromboembolic and hemorrhagic complications associated with prostheses and the need for long-term anticoagulation. If reimplanted valves continue to function adequately over the long term, this technique should become the treatment of choice for aneurysms of the ascending aorta in patients with Marfan syndrome.

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

    International Nuclear Information System (INIS)

    Gangi, Afshin; Tsoumakidou, Georgia; Abdelli, Omar; Buy, Xavier; Mathelin, Michel de; Jacqmin, Didier; Lang, Herve

    2012-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-08-15

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

  11. Initial experience with AcQsim CT simulator

    International Nuclear Information System (INIS)

    Michalski, Jeff M.; Gerber, Russell; Bosch, Walter R.; Harms, William; Matthews, John W.; Purdy, James A.; Perez, Carlos A.

    1995-01-01

    Purpose: We recently replaced our university developed CT simulator prototype with a commercial grade spiral CT simulator (Picker AcQsim) that is networked with three independent virtual simulation workstations and our 3D radiation therapy planning (3D-RTP) system multiple workstations. This presentation will report our initial experience with this CT simulation device and define criteria for optimum clinical use as well as describe some potential drawbacks of the current system. Methods and Materials: Over a 10 month period, 210 patients underwent CT simulation using the AcQsim. An additional 127 patients had a volumetric CT scan done on the device with their CT data and target and normal tissue contours ultimately transferred to our 3D-RTP system. We currently perform the initial patient localization and immobilization in the CT simulation suite by using CT topograms and a fiducial laser marking system. Immobilization devices, required for all patients undergoing CT simulation, are constructed and registered to a device that defines the treatment table coordinates. Orthogonal anterior and lateral CT topograms document patient alignment and the position of a reference coordinate center. The volumetric CT scan with appropriate CT contrast materials administered is obtained while the patient is in the immobilization device. On average, more than 100 CT slices are obtained per study. Contours defining tumor, target, and normal tissues are drawn on a slice by slice basis. Isocenter definition can be automatically defined within the target volume and marked on the patient and immobilization device before leaving the initial CT simulation session. Virtual simulation is then performed on the patient data set with the assistance of predefined target volumes and normal tissue contours displayed on rapidly computed digital reconstructed radiographs (DRRs) in a manner similar to a conventional fluoroscopic radiotherapy simulator. Lastly, a verification simulation is

  12. Radiolysis of Fricke solution: initial experiments with the pelletron facility

    International Nuclear Information System (INIS)

    Sharma, S.B.; Rao, B.S.M.

    1994-01-01

    Experimental details of heavy ion irradiation of aqueous solutions using the Nuclear Science Centre (NSC) pelletron facility and the initial results from the radiolysis of Fricke solution using oxygen-16 ions are reported. (author). 4 refs., 1 fig

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

    Science.gov (United States)

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

    2016-01-01

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

  14. Hawadith Street Initiative: A unique Sudanese childhood charity experience.

    Science.gov (United States)

    Ahmed, Awad Mohamed; A-Rahman, Nada Hassan Ahmed

    2015-01-01

    Due to escalating conflicts and resultant economic constraints, different social services in low income and low-middle income countries have witnessed a decline in its standards, and increase in the costs. This situation has led to emergence of large numbers of patients and their families who cannot afford the costs of health services provided by public hospitals. On this background, and the old heritage of the Sudanese to help the needy, the Hawadith Street Initiative (HSI) was established. Named after the street on which it was founded - which translates indirectly to "Accidents Lane", HSI was established in 2012 by a group of youths, most of them in their twenties of age, and recently graduated. The main activity of the initiative is helping the needy hospital patients, especially with regards to their treatment costs, in Khartoum and other cities in Sudan. Starting with recreational programs for cancer patients, and public campaigns for donation of blood, the initiative's youths changed their activities. Using the social media, Facebook, they adopted the strategy of communication with potential donors, after sending posts containing brief anonymous presentations and call of help for needy cases. Currently HSI includes more than 2000 volunteers in Khartoum and 17 other cities. The most important achievement of HSI is the establishment of an intensive care unit at a children hospital in Omdurman city costing 435,880 US dollars. HSI demonstrates the possibility of delivering great services with minimum resources, and constitutes a unique organization, worldwide, in a new wave of Internet-based initiatives.

  15. Initial experience with robotic pancreatic surgery in Singapore: single institution experience with 30 consecutive cases.

    Science.gov (United States)

    Goh, Brian K P; Low, Tze-Yi; Lee, Ser-Yee; Chan, Chung-Yip; Chung, Alexander Y F; Ooi, London L P J

    2018-05-24

    Presently, the worldwide experience with robotic pancreatic surgery (RPS) is increasing although widespread adoption remains limited. In this study, we report our initial experience with RPS. This is a retrospective review of a single institution prospective database of 72 consecutive robotic hepatopancreatobiliary surgeries performed between 2013 and 2017. Of these, 30 patients who underwent RPS were included in this study of which 25 were performed by a single surgeon. The most common procedure was robotic distal pancreatectomy (RDP) which was performed in 20 patients. This included eight subtotal pancreatectomies, two extended pancreatecto-splenectomies (en bloc gastric resection) and 10 spleen-saving-RDP. Splenic preservation was successful in 10/11 attempted spleen-saving-RDP. Eight patients underwent pancreaticoduodenectomies (five hybrid with open reconstruction), one patient underwent a modified Puestow procedure and one enucleation of uncinate tumour. Four patients had extended resections including two RDP with gastric resection and two pancreaticoduodenectomies with vascular resection. There was one (3.3%) open conversion and seven (23.3%) major (>Grade II) morbidities. Overall, there were four (13.3%) clinically significant (Grade B) pancreatic fistulas of which three required percutaneous drainage. These occurred after three RDP and one robotic enucleation. There was one reoperation for port-site hernia and no 30-day/in-hospital mortalities. The median post-operative stay was 6.5 (range: 3-36) days and there were six (20%) 30-day readmissions. Our initial experience showed that RPS can be adopted safely with a low open conversion rate for a wide variety of procedures including pancreaticoduodenectomy. © 2018 Royal Australasian College of Surgeons.

  16. Multi-detector CT knee arthrography - initial experience

    International Nuclear Information System (INIS)

    Thomson, J.M.Z.; Fallon, M.; Breidahl, W.H.

    2002-01-01

    Full text: Traditional plain film arthrography can achieve reasonable accuracy and is an accepted method of investigation of patients with knee pain and possible meniscal tear. Multi-detector CT can potentially provide a more detailed and accurate examination due to its high-resolution crosssectional and multi-planar capabilities. The aim of this study was to assess the accuracy of our technique. All patients who underwent a multi-detector CT knee arthrogram in an initial 8 month period were identified. Initially the referring clinician was contacted. If the patient was referred to an orthopaedic surgeon the outcome of orthopaedic review was recorded using clinical, arthroscopic and / or MRI follow-up of the patient population. One hundred and twelve patients had a Multi-detector CT knee arthrogram performed within and 8 month period. Follow-up information was received in 69.7% of patients. Of these 68.9% had orthopaedic assessment - of which 69.2% underwent a knee arthroscopy.There was total agreement of findings in 67%, agreement of meniscal findings in 67% and chondral findings in 100%. Overall, orthopaedic opinion agreed with CT findings in 76.9%. At this stage, all meniscal tears not described in the initial CT arthrogram report have in retrospect been visible. Multi-detector CT knee arthrography is an accurate and elegant technique for investigation of knee pain, providing information in a format familiar to those reporting knee MRI. There is an initial learning curve. The technique is particularly useful in chondral assessment. It is accurate for meniscal pathology, although caution and recognition of potential pitfalls is required. Copyright (2002) Blackwell Science Pty Ltd

  17. European Community initiatives and experience in scientific and technical information

    Energy Technology Data Exchange (ETDEWEB)

    Steven, G [Commission of the European Communities, Luxembourg (Luxembourg)

    1990-05-01

    Scientific and technical information (STI) is an increasingly important resource for R and D and industrial development. The rapid development of the market for electronic information and the increasing potential offered through new information technologies require new approaches for the collection and dissemination of STI. Activities of the Commission of the European Communities (CEC) in this area are reviewed. More recent CEC initiatives in the areas of biotechnology information and factual materials data banks have proved the need for international collaboration and for the implementation of infrastructural measures as a basis for such collaboration. The implementation of the EC Demonstrator Programme on materials property data systems has evaluated the potential of eleven European materials data banks against the market requirements and has helped to launch wide international collaboration. The concluding European workshop on materials data systems has developed a set of recommendations for future initiatives. These are shortly reviewed together with initial findings of a study aimed at developing a business plan for the establishment of a biotechnology information infrastructure for the bio-industries and research base in Europe. (author). 3 refs.

  18. European Community initiatives and experience in scientific and technical information

    International Nuclear Information System (INIS)

    Steven, G.

    1990-05-01

    Scientific and technical information (STI) is an increasingly important resource for R and D and industrial development. The rapid development of the market for electronic information and the increasing potential offered through new information technologies require new approaches for the collection and dissemination of STI. Activities of the Commission of the European Communities (CEC) in this area are reviewed. More recent CEC initiatives in the areas of biotechnology information and factual materials data banks have proved the need for international collaboration and for the implementation of infrastructural measures as a basis for such collaboration. The implementation of the EC Demonstrator Programme on materials property data systems has evaluated the potential of eleven European materials data banks against the market requirements and has helped to launch wide international collaboration. The concluding European workshop on materials data systems has developed a set of recommendations for future initiatives. These are shortly reviewed together with initial findings of a study aimed at developing a business plan for the establishment of a biotechnology information infrastructure for the bio-industries and research base in Europe. (author). 3 refs

  19. CT guided percutaneous needle biopsy of the chest: initial experience

    African Journals Online (AJOL)

    The objective of this article is to report our first experience of CT guided percutaneous thoracic biopsy and to demonstrate the accuracy and safety of this procedure. This was a retrospective study of 28 CT-Guided Percutaneous Needle Biopsies of the Chest performed on 24 patients between November 2014 and April 2015.

  20. Young Asian Women Experiences of the Summer Activities Initiative.

    Science.gov (United States)

    Kirby, Laura

    2002-01-01

    Interviews and observations focused on experiences of 15 young Asian women at a 5-day summer adventure program in southern England. Participants seemed bored with presentations about future career options, activities lost their challenge through repetition, and debriefing was weak. However, the women connected with the transferable skills of trust…

  1. An Initial Approach for Learning Objects from Experience

    Science.gov (United States)

    2018-05-02

    algorithm to delineate objects which are then fed to a simple feed-forward neural network without any other processes in the pipeline. Our neural network...These are the basic requirements for the pipeline and are discussed in more detail below. Additionally, we are interested in testing various parts...that continuously learning objects from experience requires mechanisms to do the following: 1) Focus attention on things and stuff of interest . 2

  2. Negative Interest Rates: Central Banks Initiated an Experiment

    OpenAIRE

    Aleksey N. Burenin

    2016-01-01

    Negative interest rates appeared as a consequence of economic problems that countries with market economy came across after the crises of2007-2008. The attempts of monetary authorities to stimulate economies with the help of quantitative easing didn't bring the desired result. That's why the central banks once again resorted to a traditional tool of their monetary policy of changing interest rates. But this time they launched an experiment, they used negative interest rates. The European Cent...

  3. Cardiac biplane strain imaging: initial in vivo experience

    Science.gov (United States)

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

    2010-02-01

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

  4. Cardiac biplane strain imaging: initial in vivo experience

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-02-21

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

  5. Cardiac biplane strain imaging: initial in vivo experience

    International Nuclear Information System (INIS)

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

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Mario Spremić

    2003-01-01

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

  7. The Planeterrella experiment: from individual initiative to networking

    Directory of Open Access Journals (Sweden)

    Garnier Pierre

    2013-02-01

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

  8. The Planeterrella experiment: from individual initiative to networking

    Science.gov (United States)

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

    2013-12-01

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

  9. Paediatric magnetic resonance enteroclysis under general anaesthesia - initial experience

    International Nuclear Information System (INIS)

    Sadigh, Sophie; Chopra, Mark; Olsen, Oeystein E.; Watson, Tom A.; Sury, Michael R.; Shah, Neil

    2017-01-01

    MR enterography is the accepted imaging reference standard for small bowel assessment in inflammatory bowel disease. There is an increasing cohort of children with inflammatory bowel disease presenting at an early age (<5 years) with severe disease. Younger children present a technical challenge for enterography because of the need for sedation/general anaesthesia to allow image optimisation and the need for oral contrast to allow adequate luminal assessment. Through our experiences, MR enteroclysis under general anaesthesia has proven to be a successful imaging technique for the work-up of these patients. In this paper, we present our institutional practice for performing MR enteroclysis under general anaesthesia. (orig.)

  10. Paediatric magnetic resonance enteroclysis under general anaesthesia - initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Sadigh, Sophie; Chopra, Mark; Olsen, Oeystein E.; Watson, Tom A. [Great Ormond Street Hospital NHS Foundation Trust, Department of Paediatric Radiology, London (United Kingdom); Sury, Michael R. [Great Ormond Street Hospital NHS Foundation Trust, Department of Paediatric Anaesthetics, London (United Kingdom); Shah, Neil [Great Ormond Street Hospital NHS Foundation Trust, Department of Paediatric Gastroenterology, London (United Kingdom)

    2017-06-15

    MR enterography is the accepted imaging reference standard for small bowel assessment in inflammatory bowel disease. There is an increasing cohort of children with inflammatory bowel disease presenting at an early age (<5 years) with severe disease. Younger children present a technical challenge for enterography because of the need for sedation/general anaesthesia to allow image optimisation and the need for oral contrast to allow adequate luminal assessment. Through our experiences, MR enteroclysis under general anaesthesia has proven to be a successful imaging technique for the work-up of these patients. In this paper, we present our institutional practice for performing MR enteroclysis under general anaesthesia. (orig.)

  11. Complications in paediatric craniofacial surgery: an initial four year experience.

    Science.gov (United States)

    Jones, B M; Jani, P; Bingham, R M; Mackersie, A M; Hayward, R

    1992-04-01

    107 children undergoing transcranial craniofacial surgery in a paediatric hospital have been reviewed to assess the incidence and type of complications which arose. This represents the first 4 years' experience of the craniofacial team. There were no deaths or permanent adverse sequelae of surgery. A total of 53 complications were seen in 42 patients. In 9.3% of patients they were potentially life-threatening, serious in 12.1% and of a minor nature in 28%. The more serious complications were related either to haemorrhage and/or vasovagal shock at operation or to infection post-operatively. Infants undergoing monoblock frontofacial advancements and those with tracheostomies were at particular risk.

  12. Laparoscopic hand-assisted pancreaticoduodenectomy: initial UK experience.

    Science.gov (United States)

    Ammori, B J

    2004-04-01

    By and large, the limited world experience with laparoscopic pancreaticoduodenectomy (PD) has been unfavorable, but the laparoscopic hand-assisted approach to PD has recently shown promising results. We report the first successful UK experience with laparoscopic hand-assisted PD (LHAPD). A 62-year-old man who presented with painless obstructive jaundice was found at endoscopy, to have an ampullary tumor. Preoperative biopsy specimens confirmed the diagnosis of an adenocarcinoma, and CT showed no evidence of either vascular involvement or metastatic disease. A staging laparoscopy showed no intraabdominal metastases, and an LHAPD was performed using a Gelport. The intraoperative course was uneventful. Two units of blood were transfused intraoperatively, but no postoperative blood transfusion was required. The operative time was 11 h (plus a 30-min break). The patients postoperative recovery was uneventful except for superficial pressure sores over the buttocks and elbows. The patient resumed oral fluid and dietary intake on the 1st and 3rd postoperative days, respectively, and was discharged from hospital on the 9th postoperative day. Histology demonstrated an ampullary adenocarcinoma with clear resection margins and involvement of two of the 13 lymph nodes examined. At 2-month follow-up, the patient remains well and is receiving adjuvant chemotherapy. LHAPD achieves good oncological clearance and can be performed safely in selected patients. The early promising results with this approach will undoubtedly encourage wider adoption of this procedure and are likely to widen the selection criteria.

  13. Commissioning and initial experience with the ALICE on-line

    International Nuclear Information System (INIS)

    Altini, V; Anticic, T; Carena, F; Carena, W; Chapeland, S; Barroso, V Chibante; Costa, F; Divia, R; Fuchs, U; Makhlyueva, I; Roukoutakis, F; Schossmaier, K; Soos, C; Vyvre, P Vande; Haller, B von; Denes, E; Kiss, T

    2010-01-01

    ALICE (A Large Ion Collider Experiment) is the heavy-ion detector designed to study the physics of strongly interacting matter and the quark-gluon plasma at the CERN Large Hadron Collider (LHC). A large bandwidth and flexible Data Acquisition System (DAQ) has been designed and deployed to collect sufficient statistics in the short running time available per year for heavy ions and to accommodate very different requirements originated from the 18 sub-detectors. This paper will present the large scale tests conducted to assess the standalone DAQ performances, the interfaces with the other online systems and the extensive commissioning performed in order to be fully prepared for physics data taking. It will review the experience accumulated since May 2007 during the standalone commissioning of the main detectors and the global cosmic runs and the lessons learned from this exposure on the b attle field . It will also discuss the test protocol followed to integrate and validate each sub-detector with the online systems and it will conclude with the first results of the LHC injection tests and startup in September 2008. Several papers of the same conference present in more details some elements of the ALICE DAQ system.

  14. Commissioning and initial experience with the ALICE on-line

    Energy Technology Data Exchange (ETDEWEB)

    Altini, V [INFN, Dipartimento di Fisica dell' Universita and Sezione INFN Bari (Italy); Anticic, T [Ruder Botkovic Institute, Zagreb (Croatia); Carena, F; Carena, W; Chapeland, S; Barroso, V Chibante; Costa, F; Divia, R; Fuchs, U; Makhlyueva, I; Roukoutakis, F; Schossmaier, K; Soos, C; Vyvre, P Vande; Haller, B von [CERN, Physics department, Geneva (Switzerland); Denes, E; Kiss, T, E-mail: pierre.vande.vyvre@cern.c [KFKI Research Institute for Particle and Nuclear Physics, Budapest (Hungary)

    2010-04-01

    ALICE (A Large Ion Collider Experiment) is the heavy-ion detector designed to study the physics of strongly interacting matter and the quark-gluon plasma at the CERN Large Hadron Collider (LHC). A large bandwidth and flexible Data Acquisition System (DAQ) has been designed and deployed to collect sufficient statistics in the short running time available per year for heavy ions and to accommodate very different requirements originated from the 18 sub-detectors. This paper will present the large scale tests conducted to assess the standalone DAQ performances, the interfaces with the other online systems and the extensive commissioning performed in order to be fully prepared for physics data taking. It will review the experience accumulated since May 2007 during the standalone commissioning of the main detectors and the global cosmic runs and the lessons learned from this exposure on the {sup b}attle field{sup .} It will also discuss the test protocol followed to integrate and validate each sub-detector with the online systems and it will conclude with the first results of the LHC injection tests and startup in September 2008. Several papers of the same conference present in more details some elements of the ALICE DAQ system.

  15. Commissioning and initial experience with the ALICE on-line

    Science.gov (United States)

    Altini, V.; Anticic, T.; Carena, F.; Carena, W.; Chapeland, S.; Chibante Barroso, V.; Costa, F.; Dénes, E.; Divià, R.; Fuchs, U.; Kiss, T.; Makhlyueva, I.; Roukoutakis, F.; Schossmaier, K.; Soós, C.; Vande Vyvre, P.; von Haller, B.; ALICE Collaboration

    2010-04-01

    ALICE (A Large Ion Collider Experiment) is the heavy-ion detector designed to study the physics of strongly interacting matter and the quark-gluon plasma at the CERN Large Hadron Collider (LHC). A large bandwidth and flexible Data Acquisition System (DAQ) has been designed and deployed to collect sufficient statistics in the short running time available per year for heavy ions and to accommodate very different requirements originated from the 18 sub-detectors. This paper will present the large scale tests conducted to assess the standalone DAQ performances, the interfaces with the other online systems and the extensive commissioning performed in order to be fully prepared for physics data taking. It will review the experience accumulated since May 2007 during the standalone commissioning of the main detectors and the global cosmic runs and the lessons learned from this exposure on the "battle field". It will also discuss the test protocol followed to integrate and validate each sub-detector with the online systems and it will conclude with the first results of the LHC injection tests and startup in September 2008. Several papers of the same conference present in more details some elements of the ALICE DAQ system.

  16. Initial experience with purely laparoscopic living-donor right hepatectomy.

    Science.gov (United States)

    Hong, S K; Lee, K W; Choi, Y; Kim, H S; Ahn, S W; Yoon, K C; Kim, H; Yi, N J; Suh, K S

    2018-05-01

    There may be concerns about purely laparoscopic donor right hepatectomy (PLDRH) compared with open donor right hepatectomy, especially when performed by surgeons accustomed to open surgery. This study aimed to describe technical tips and pitfalls in PLDRH. Data from donors who underwent PLDRH at Seoul National University Hospital between December 2015 and July 2017 were analysed retrospectively. Endpoints analysed included intraoperative events and postoperative complications. All operations were performed by a single surgeon with considerable experience in open living donor hepatectomy. A total of 26 donors underwent purely laparoscopic right hepatectomy in the study interval. No donor required transfusion during surgery, whereas two underwent reoperation. In two donors, the dissection plane at the right upper deep portion of the midplane was not correct. One donor experienced portal vein injury during caudate lobe transection, and one developed remnant left hepatic duct stenosis. One donor experienced remnant portal vein angulation owing to a different approach angle, and one experienced arterial damage associated with the use of a laparoscopic energy device. One donor had postoperative bleeding due to masking of potential bleeding foci owing to intra-abdominal pressure during laparoscopy. Two donors experienced right liver surface damage caused by a xiphoid trocar. Purely laparoscopic donor hepatectomy differs from open donor hepatectomy in terms of angle and caudal view. Therefore, surgeons experienced in open donor hepatectomy must gain adequate experience in laparoscopic liver surgery and make adjustments when performing PLDRH. © 2018 BJS Society Ltd Published by John Wiley & Sons Ltd.

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

    Directory of Open Access Journals (Sweden)

    Gustavo C. Lemos

    2011-08-01

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

  18. Construction and Initial Validation of the Multiracial Experiences Measure (MEM)

    Science.gov (United States)

    Yoo, Hyung Chol; Jackson, Kelly; Guevarra, Rudy P.; Miller, Matthew J.; Harrington, Blair

    2015-01-01

    This article describes the development and validation of the Multiracial Experiences Measure (MEM): a new measure that assesses uniquely racialized risks and resiliencies experienced by individuals of mixed racial heritage. Across two studies, there was evidence for the validation of the 25-item MEM with 5 subscales including Shifting Expressions, Perceived Racial Ambiguity, Creating Third Space, Multicultural Engagement, and Multiracial Discrimination. The 5-subscale structure of the MEM was supported by a combination of exploratory and confirmatory factor analyses. Evidence of criterion-related validity was partially supported with MEM subscales correlating with measures of racial diversity in one’s social network, color-blind racial attitude, psychological distress, and identity conflict. Evidence of discriminant validity was supported with MEM subscales not correlating with impression management. Implications for future research and suggestions for utilization of the MEM in clinical practice with multiracial adults are discussed. PMID:26460977

  19. Initial results from the Wisconsin Spherically Convergent Ion Focus experiment

    International Nuclear Information System (INIS)

    Thorson, T.A.; Durst, R.D.; Fonck, R.J.; Foucher, B.S.; Wainwright, L.P.

    1995-01-01

    The Spherically Convergent Ion Focus (SCIF) is an alternative plasma confinement scheme in which ions are electrostatically confined, accelerated, and concentrated at fusion-relevant energies. This concept has been recently promoted for various near-term applications including waste disposal, particle production, neutron radiography and tomography, plastic explosive detection, materials research, and medical isotope production. The Wisconsin SCIF experiments are designed to evaluate the practicality of the SCIF concept for given applications. In the experiment, a wire globe serves as a simple means of producing the trapping potential well and the ion source consists of a cold, uniform plasma at the edge. Hydrogen ions formed from the background neutral gas are typically accelerated to energies of 5--20 kV, and measured cathode grid currents approach the space-charge limit for concentric spheres. Core size measurements utilize spectrally-filtered CCD camera images of the visible emission from the core region, and the minimal observed core radius of 0.6 cm (HWHM) is within a factor of 2--3 of the theoretical convergence ratio for the device. Neutral particle interactions and potential asymmetries imposed by the grid lead to non-ideal convergence, as evidenced by measured potential asymmetries and core size dependence on cathode grid spacing. Floating probes with 30 kV isolation have allowed unique measurements of the density, electric potential and temperature in the converged core. The ratio of core to edge density is 10--20, which is in good agreement with scaling from radial flux conservation

  20. Initial Australian experience with daily ultrasound localisation for prostate radiotherapy

    International Nuclear Information System (INIS)

    Kneebone, A.; Fuller, M.W.; Williams, M.J.

    2003-01-01

    Variability in prostate position is a major problem in the delivery of external beam radiotherapy (EBRT). Daily ultrasound localisation prior to radiotherapy has become popular in the United States but to date has not been used clinically in Australia or New Zealand. Daily transabdominal ultrasound images through the prostate were acquired using the BAT ultrasound system. Contour data from the planning system is reconstructed at the same locations/angles as the BAT images. By overlaying the planned contours with the newly acquired images, the isocentre is adjusted to ensure that the prostate will be within the irradiated volume. After commissioning by Medical Physics, an initial pre-clinical trial period was adopted. This involved performing BAT alignments daily but treating to the planned isocentre in 30 patients. Eighty three percent of patients (25/30) had images judged to be of good or excellent quality by the reviewing radiation oncologist. It was noted that for each operator there was a period needed to build confidence/competence in both imaging and interpreting the images for the moves. The median scan time in addition to the normal patient set-up was 3.2 minutes (range=1.5-12.0 mins) with the second 15 patients scanned quicker than the first 15 (2.9 minutes versus 3.8 minutes). A summary of the movements recommended by the BAT system is contained in the table. We feel that daily prostate ultrasound localization offers a significant advance in delivering EBRT for prostate cancer. The incorporation of the system into clinical use, however, was not without difficulty and requires significant time and effort from therapists, physicists and medical staff. Further clinical evaluation of the unit is ongoing

  1. Social Health Maintenance Organizations: assessing their initial experience.

    Science.gov (United States)

    Newcomer, R; Harrington, C; Friedlob, A

    1990-08-01

    The Social/Health Maintenance Organization (S/HMO) is a four-site national demonstration. This program combines Medicare Part A and B coverage, with various extended and chronic care benefits, into an integrated health plan. The provision of these services extends both the traditional roles of HMOs and that of long-term care community-service case management systems. During the initial 30 months of operation the four S/HMOs shared financial risk with the Health Care Financing Administration. This article reports on this developmental period. During this phase the S/HMOs had lower-than-expected enrollment levels due in part to market competition, underfunding of marketing efforts, the limited geographic area served, and an inability to differentiate the S/HMO product from that of other Medicare HMOs. The S/HMOs were allowed to conduct health screening of applicants prior to enrolling them. The number of nursing home-certifiable enrollees was controlled through this mechanism, but waiting lists were never very long. Persons joining S/HMOs and other Medicare HMOs during this period were generally aware of the alternatives available. S/HMO enrollees favored the more extensive benefits; HMO enrollees considerations of cost. The S/HMOs compare both newly formed HMOs and established HMOs. On the basis of administrator cost, it is more efficient to add chronic care benefits to an HMO than to add an HMO component to a community care provider. All plans had expenses greater than their revenues during the start-up period, but they were generally able to keep service expenditures within planned levels.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-01-15

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

  3. Initial experience of the medical clinic of the education Casmu

    International Nuclear Information System (INIS)

    Musé, M.; Laureiro, E.; Musetti, C.

    2010-01-01

    Full text: What happens when a patient (p te) is faced once treatment Q T? We know that for p te involves both how their family; face a charge of myths and half-truths; causing the treatment is so vivid apprehension as the disease itself. In this context the concern of the Department of Oncology Casmu arises; of give patients an area where the p te to receive information contribute to reaching the treatment of Q T in better condition. All patients will start treatment Q T for the first time; are cited for an interview at the Polyclinic of Education. It is coordinated delayed with respect to the talks with the Treating oncologist, in order to allow the patient to develop their doubts and to raise them. In the interview also involved the p te and his family, Oncology Residents Department, and a member of Campus Nursing thereof. the interview is divided into five modules: 1) Administrative Aspects 2) Nursing Care 3) Potential side effects. 4) Social Benefits 5) Resources Information. Between January 2003 and August 2004, 70 interviews were conducted education. the average length thereof was 30 minutes. Is in progress writing a brochure based on the questions most frequently asked by patients and their families; well as an evaluation of the experience

  4. Magnetic resonance imaging of the female pelvis: initial experience

    International Nuclear Information System (INIS)

    Hricak, H.; Alpers, C.; Crooks, L.E.; Sheldon, P.E.

    1983-01-01

    The potential of magnetic resonance imaging (MRI) was evaluated in 21 female subjects: seven volunteers, 12 patients scanned for reasons unrelated to the lower genitourinary tract, and two patients referred with gynecologic disease. The uterus at several stages was examined; the premenarcheal uterus (one patient), the uterus of reproductive age (12 patients), the postmenopausal uterus (two patients), and in an 8 week pregnancy (one patient). The myometrium and cyclic endometrium in the reproductive age separated by a low-intensity line (probably stratum basale), which allows recognition of changes in thickness of the cyclic endometrium during the menstrual cycle. The corpus uteri can be distinguished from the cervix by the transitional zone of the isthmus. The anatomic relation of the uterus to bladder and rectum is easily outlined. The vagina can be distinguished from the cervix, and the anatomic display of the closely apposed bladder, vagina, and rectum is clear on axial and coronal images. The ovary is identified; the signal intensity from the ovary depends on the acquisition parameter used. Uterine leiomyoma, endometriosis, and dermoid cyst were depicted, but further experience is needed to ascertain the specificity of the findings

  5. Initial experience with a nuclear medicine viewing workstation

    Science.gov (United States)

    Witt, Robert M.; Burt, Robert W.

    1992-07-01

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

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

    Science.gov (United States)

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

    2004-10-01

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

  7. Breast vibro-acoustography: initial experience in benign lesions

    International Nuclear Information System (INIS)

    Alizad, Azra; Mehrmohammadi, Mohammad; Ghosh, Karthik; Glazebrook, Katrina N; Carter, Rickey E; Karaberkmez, Leman Gunbery; Whaley, Dana H; Fatemi, Mostafa

    2014-01-01

    Vibro-acoustography (VA) is a newly developed imaging technology that is based on low-frequency vibrations induced in the object by the radiation force of ultrasound. VA is sensitive to the dynamic characteristics of tissue. Here, we evaluate the performance of VA in identifying benign lesions and compare the results to those of mammography. An integrated mammography-VA system designed for in vivo breast imaging was tested on a group of female volunteers, age ≥ 18 years, with suspected breast lesions based on clinical examination. A set of VA scans was acquired after each corresponding mammography. Most lesions were classified as benign based on their histological results. However, in 4 cases, initial diagnosis based on clinical imaging determined that the lesions were cysts. These cysts were aspirated with needle aspiration and disappeared completely under direct ultrasound visualization. Therefore, no biopsies were performed on these cases and lesions were classified as benign based on clinical findings per clinical standards. To define the VA characteristics of benign breast masses, we adopted the features that are normally attributed to such masses in mammography. In a blinded assessment, three radiologists evaluated the VA images independently. The diagnostic accuracy of VA for detection of benign lesions was assessed by comparing the reviewers’ evaluations with clinical data. Out of a total 29 benign lesions in the group, the reviewers were able to locate all lesions on VA images and mammography, 100% with (95% confidence interval (CI): 88% to 100%). Two reviewers were also able to correctly classify 83% (95% CI: 65% to 92%), and the third reviewer 86% (95% CI: 65% to 95%) of lesions, as benign on VA images and 86% (95% CI: 69% to 95%) on mammography. The results suggest that the mammographic characteristics of benign lesion may also be used to identify such lesions in VA. Furthermore, the results show the ability of VA to detect benign breast

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

    International Nuclear Information System (INIS)

    Skaane, Per; Gullien, Randi; Eben, Ellen B.; Haakenaasen, Unni; Naess Jebsen, Ingvild; Krager, Mona; Bjoerndal, Hilde; Ekseth, Ulrika; Jahr, Gunnar

    2012-01-01

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

  9. Negative Interest Rates: Central Banks Initiated an Experiment

    Directory of Open Access Journals (Sweden)

    Aleksey N. Burenin

    2016-01-01

    Full Text Available Negative interest rates appeared as a consequence of economic problems that countries with market economy came across after the crises of2007-2008. The attempts of monetary authorities to stimulate economies with the help of quantitative easing didn't bring the desired result. That's why the central banks once again resorted to a traditional tool of their monetary policy of changing interest rates. But this time they launched an experiment, they used negative interest rates. The European Central Bank, the Swedish Riksbank, the Bank of Japan, and the National Bank of Hungary introduced negative rates in order to stimulate economic growth and fight the threat of deflation, the Danish National Bank and the Swiss National Bank tried to deter appreciation of their currencies. Negative rates of the central banks brought about negative yields of government and nongovernment securities in several countries. The problem acquires an aggravated form due to the fact that negative rates appeared in several European countries simultaneously at the moment when global financial markets were not in crises. Some questions arise concerning the negative rates, for example, how low can central banks bring down the rates in the future, what is their influence on the stock markets, what is the reaction of depositors to the introduction of negative deposit rates by commercial banks, must one consider a negative rate as a rate of interest or payment to store money of the depositor, in which circumstances negative rates can be justified to fight deflation. The last question plays an important role, because recent studies find that positive economic growth is possible during deflation. If central banks don't take this nuance into consideration, they can create economic imbalances by increasing liquidity. Negative rates are not as inoffensive as it may seem at first glance. Not far ago an investor, who tried to averse risk, was buying government securities. Their yields

  10. The initial experience of trans-rectal ultrasound and biopsy in ...

    African Journals Online (AJOL)

    The initial experience of trans-rectal ultrasound and biopsy in diagnosis of carcinoma prostate in Gezira Hospital for Renal Disease and Surgery (GHRDS). Walaa Eldin Ibraheem, Sami Mahjoub Taha, Mustafa Omran Mansour, Mohammed El Imam Mohamed Ahmed ...

  11. The Community Reclaims Control? Learning Experiences from Rural Broadband Initiatives in the Netherlands

    NARCIS (Netherlands)

    Salemink, Koen; Strijker, Dirk; Bosworth, Gary

    2017-01-01

    Based on four illustrative case studies from the Netherlands, this article discusses learning experiences gained from rural broadband initiatives. As an example of the big society' (or participatiesamenleving' in Dutch), initiatives try to step in where the market and the government fail. The main

  12. Plans for longitudinal and transverse neutralized beam compression experiments, and initial results from solenoid transport experiments

    International Nuclear Information System (INIS)

    Seidl, P.A.; Armijo, J.; Baca, D.; Bieniosek, F.M.; Coleman, J.; Davidson, R.C.; Efthimion, P.C.; Friedman, A.; Gilson, E.P.; Grote, D.; Haber, I.; Henestroza, E.; Kaganovich, I.; Leitner, M.; Logan, B.G.; Molvik, A.W.; Rose, D.V.; Roy, P.K.; Sefkow, A.B.; Sharp, W.M.; Vay, J.L.; Waldron, W.L.; Welch, D.R.; Yu, S.S.

    2007-01-01

    This paper presents plans for neutralized drift compression experiments, precursors to future target heating experiments. The target-physics objective is to study warm dense matter (WDM) using short-duration (∼1 ns) ion beams that enter the targets at energies just above that at which dE/dx is maximal. High intensity on target is to be achieved by a combination of longitudinal compression and transverse focusing. This work will build upon recent success in longitudinal compression, where the ion beam was compressed lengthwise by a factor of more than 50 by first applying a linear head-to-tail velocity tilt to the beam, and then allowing the beam to drift through a dense, neutralizing background plasma. Studies on a novel pulse line ion accelerator were also carried out. It is planned to demonstrate simultaneous transverse focusing and longitudinal compression in a series of future experiments, thereby achieving conditions suitable for future WDM target experiments. Future experiments may use solenoids for transverse focusing of un-neutralized ion beams during acceleration. Recent results are reported in the transport of a high-perveance heavy ion beam in a solenoid transport channel. The principal objectives of this solenoid transport experiment are to match and transport a space-charge-dominated ion beam, and to study associated electron-cloud and gas effects that may limit the beam quality in a solenoid transport system. Ideally, the beam will establish a Brillouin-flow condition (rotation at one-half the cyclotron frequency). Other mechanisms that potentially degrade beam quality are being studied, such as focusing-field aberrations, beam halo, and separation of lattice focusing elements

  13. African American women's experiences with the initial discovery, diagnosis, and treatment of breast cancer.

    Science.gov (United States)

    Lackey, N R; Gates, M F; Brown, G

    2001-04-01

    To describe the experiences of African American women living with breast cancer following the primary diagnosis and while undergoing initial treatment. Phenomenologic. 13 African American women (ages 30-66) purposefully selected from two oncology clinics in the mid-South. Phenomenologic interviews (transcribed verbatim) and field notes were analyzed using Colaizzi's method of phenomenologic description and analysis. Experience Trajectory, Femininity, and Spirituality were the three major themes. The Experience Trajectory subthemes were finding the lump, getting the diagnosis, undergoing surgery and adjuvant treatment. The Femininity subthemes were loss of all or part of the breast, loss of hair, and sexual attractiveness to a man. Spirituality was reflected as a reliance on God. Telling the story of their experience trajectory during their breast cancer experience is valuable in assessing African American women's feelings, emotions, and fears of body changes that occur during surgery and treatment. Their spirituality helps them through this experience. Research involving both African American women and their partners would provide greater insight into specific relationship patterns and communication related to sexuality during this experience. Nurses need to listen to the stories of African American women about the initial experience of discovery, diagnosis, and treatment of breast cancer so they can be more informed advocates for these women. African American women need more information from healthcare providers regarding the whole experience trajectory.

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

    Science.gov (United States)

    Alef, S.; Bauer, P.; Bayadilov, D.; Beck, R.; Becker, M.; Bella, A.; Bielefeldt, P.; Böse, S.; Braghieri, A.; Brinkmann, K.; Cole, P.; Di Salvo, R.; Dutz, H.; Elsner, D.; Fantini, A.; Freyermuth, O.; Friedrich, S.; Frommberger, F.; Ganenko, V.; Geffers, D.; Gervino, G.; Ghio, F.; Görtz, S.; Gridnev, A.; Gutz, E.; Hammann, D.; Hannappel, J.; Hillert, W.; Ignatov, A.; Jahn, R.; Joosten, R.; Jude, T. C.; Klein, F.; Knaust, J.; Kohl, K.; Koop, K.; Krusche, B.; Lapik, A.; Levi Sandri, P.; Lopatin, I. V.; Mandaglio, G.; Messi, F.; Messi, R.; Metag, V.; Moricciani, D.; Mushkarenkov, A.; Nanova, M.; Nedorezov, V.; Novinskiy, D.; Pedroni, P.; Reitz, B.; Romaniuk, M.; Rostomyan, T.; Rudnev, N.; Schaerf, C.; Scheluchin, G.; Schmieden, H.; Stugelev, A.; Sumachev, V.; Tarakanov, V.; Vegna, V.; Walther, D.; Watts, D.; Zaunick, H.; Zimmermann, T.

    2016-11-01

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

  15. Blast experiments for the derivation of initial cloud dimensions after a ''Dirty Bomb'' event

    International Nuclear Information System (INIS)

    Thielen, H.; Schroedl, E.

    2004-01-01

    Basis for the assessment of potential consequences of a ''dirty bomb'' event is the calculation of the atmospheric dispersion of airborne particles. The empirical derivation of parameters for the estimation of the initial pollutant cloud dimensions was the principal purpose for blast experiments performed in the training area Munster in summer 2003 with the participation of several highly engaged German organisations and institutions. The experiments were performed under variation of parameters like mass and kind of explosive, subsurface characteristics or meteorological conditions and were documented by digital video recording. The blasting experiments supplied significant results under reproducible conditions. The initial cloud dimension was primarily influenced by the explosive mass. The influence of other parameters was relatively small and within the range of the experimental uncertainties. Based on these experimental results a new correlation was determined for the empirical estimation of the initial cloud dimensions as a function of explosive mass. The observed initial cloud volumes were more than an order of magnitude smaller than those calculated with other widely-used formulas (e.g. HOTSPOT). As a smaller volume of the initial cloud leads to higher near-ground concentration maxima, our results support an appropriate adjustment of currently employed calculation methods. (orig.)

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

    Science.gov (United States)

    Wilkins, Chris

    2017-01-01

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

  17. Initial experiences of simultaneous laparoscopic resection of colorectal cancer and liver metastases

    NARCIS (Netherlands)

    Hoekstra, L. T.; Busch, O. R. C.; Bemelman, W. A.; van Gulik, T. M.; Tanis, P. J.

    2012-01-01

    Introduction. Simultaneous resection of primary colorectal carcinoma (CRC) and synchronous liver metastases (SLMs) is subject of debate with respect to morbidity in comparison to staged resection. The aim of this study was to evaluate our initial experience with this approach. Methods. Five patients

  18. High/Scope Preschool Key Experiences: Initiative and Social Relations. [with] Curriculum Videotape.

    Science.gov (United States)

    Graves, Michelle

    As preschoolers develop the ability to carry out their ideas and play alone and with others, they are developing the foundation for social competence. This booklet and a companion videotape help teachers and parents recognize and support nine High/Scope key experiences in initiative and social relations: (1) making and expressing choices, plans,…

  19. HDR brachytherapy in carcinoma of cervix: initial experience at AWARE hospitals

    International Nuclear Information System (INIS)

    Rajendran, M.; Reddy, K.D.; Reddy, R.M.; Reddy, J.M.; Reddy, B.V.N.; Kiran Kumar; Gopi, S.; Dharaniraj; Janardhanan

    2002-01-01

    High dose rate (HDR) brachytherapy is well established in the management of gynaecological malignancies. A report on the initial results of one and half year experience with a consistent dose/fractionation schedule and procedure of planning with delivery of treatment schedule is presented

  20. Comparison of the initial ETA gas propagation experiments with theoretical models

    Energy Technology Data Exchange (ETDEWEB)

    Chambers, F.W.; Clark, J.C.; Fessenden, T.J.

    1982-04-20

    This report contains a description of the initial ETA propagation experiments in air at a beam current of 4.5 kA. The beam was observed to propagate at the pressures anticipated on the basis of previous theory and experiment. A comparison of measured net current waveforms with predictions of the PHOENIX code showed good agreement over the pressure range 0.1 to 200 torr. However, the beam was observed to expand with Z at a faster rate than theory predicts. Excessive transverse beam modulation at injection complicated the experiments and limited their comparison with theory.

  1. Comparison of the initial ETA gas propagation experiments with theoretical models

    International Nuclear Information System (INIS)

    Chambers, F.W.; Clark, J.C.; Fessenden, T.J.

    1982-01-01

    This report contains a description of the initial ETA propagation experiments in air at a beam current of 4.5 kA. The beam was observed to propagate at the pressures anticipated on the basis of previous theory and experiment. A comparison of measured net current waveforms with predictions of the PHOENIX code showed good agreement over the pressure range 0.1 to 200 torr. However, the beam was observed to expand with Z at a faster rate than theory predicts. Excessive transverse beam modulation at injection complicated the experiments and limited their comparison with theory

  2. Initial experiment of focusing wiggler of MM wave Free Electron Laser on LAX-1

    International Nuclear Information System (INIS)

    Sakamoto, Keishi; Maebara, Sunao; Watanabe, Akihiko; Kishimoto, Yasuaki; Nagashima, Takashi; Maeda, Hikosuke; Shiho, Makoto; Oda, Hisako; Kawasaki, Sunao.

    1991-03-01

    Initial results of Free Electron laser (FEL) Experiment in the mm wave region are presented. The experiment is carried out using a induction linac system (LAX-1: Large current Accelerator Experiment) of E b = 1 MeV, Ib = 1 ∼ 3 kA. The wiggler of FEL is composed of the curved surface magnets arrays (focusing wiggler), which is found to be effective for a transport of low energy and high current beam through the wiggler. The superradiance of the mm wave region (30 GHz ∼ 40 GHz) is observed. The growth rate of this radiation is 0.42 dB/cm. (author)

  3. The experiences of employees participating in organisational corporate social responsibility initiatives

    Directory of Open Access Journals (Sweden)

    Gretha Cook

    2018-04-01

    Full Text Available Orientation: This article is about the experiences of employees who actively participate in organisational corporate social responsibility (CSR initiatives.   Research purpose: The general aim of this study was to explore the experiences of employees who participate in CSR initiatives within an organisation where a well-developed framework exists.   Motivation for the study: Whilst an emergent number of studies have considered the various dimensions of CSR initiatives, the focus appears to be on stakeholders such as the recipients of CSR, organisations, consumers and shareholders but not the perspective of the employees who actively participate in CSR initiatives.   Research design, approach and method: A qualitative research approach was employed with the intent of exploring the experiences of employees participating in organisational CSR initiatives. Data were collected and analysed from a purposive sample of 12 employees, by means of interactive qualitative analysis.   Main findings: The study revealed that the primary driver that motivates employees to participate in CSR is love. Love sparks a sense of compassion. Compassion, coupled with an enabling environment, stimulates generosity. By being generous, a feeling of hope and inspiration is induced in both the givers and receivers of generosity. A secondary outcome of generosity and hope and inspiration is bringing about change to others, and whilst going through this journey and making a difference in the lives of others, participants experience a progressive change within themselves. This change evokes a feeling of fulfilment, and ultimately a feeling of complete joy.   Contributions or value-add: This research complements existing CSR literature by focussing and reporting on the experiences of the employee as an important stakeholder.

  4. Initial experiences of family caregivers of survivors of a traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Mandi Broodryk

    2015-08-01

    Full Text Available Background: There seems to be a paucity of research on the initial subjective experiences of family caregivers of survivors of a traumatic brain injury (TBI. Objective: To explore the challenges that family caregivers face during the initial stages of recovery of a relative who has sustained a TBI. Methods: Thematic analysis was used to explore the findings from semi-structured interviews that were conducted with 12 female family caregivers of relatives who had sustained a TBI. Results: Family caregivers recalled their initial experiences of the shock at hearing the news about their relative’s TBI, negative experiences in hospital and frustrating interactions with healthcare professionals as particularly challenging. Conclusion: The findings of this study emphasise caregivers’ need for support, information and psycho-education, especially from healthcare professionals, from the very beginning stages of recovery from a TBI. Practical and physical needs with regard to admission to and care in the hospital were also highlighted. This research will hopefully contribute to creating awareness amongst healthcare professionals on how they can contribute to improvement of the services provided by the healthcare system based on the experiences of the caregivers who participated in this study.

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

    OpenAIRE

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

    2012-01-01

    This randomized-control trial examined the learning of preservice teachers taking an initial Early Literacy course in an early childhood education program and of the kindergarten or first grade students they tutored in their field experience. Preservice teachers were randomly assigned to one of two tutoring programs: Book Buddies and Tutor Assisted Intensive Learning Strategies (TAILS), which provided identical meaning-focused instruction (shared book reading), but differed ...

  6. SPINAL CORD STIMULATION IN TREATMENT OF THE NEUROPATHIC PAIN SYNDROMES: INITIAL EXPERIENCE

    Directory of Open Access Journals (Sweden)

    D. A. Rzaev

    2010-01-01

    Full Text Available In the article initial experience of spinal cord stimulation for chronic pain syndromes is described. The trial was done for 62 patients, in 52 cases trial was successful and subcutaneous pulse generator were implanated. Maximal follow-up is 26 months. The level of pain evaluates at VAS. Permanent pain-relieve results were achieved in 46 patients (74,2%. These results correspond to literature data.

  7. Analysis of molten fuel-coolant interaction during a reactivity-initiated accident experiment

    International Nuclear Information System (INIS)

    El-Genk, M.S.; Hobbins, R.R.

    1981-01-01

    The results of a reactivity-initiated accident experiment, designated RIA-ST-4, are discussed and analyzed with regard to molten fuel-coolant interaction (MFCI). In this experiment, extensive amounts of molten UO 2 fuel and zircaloy cladding were produced and fragmented upon mixing with the coolant. Coolant pressurization up to 35 MPa and coolant overheating in excess of 940 K occurred after fuel rod failure. The initial coolant conditions were similar to those in boiling water reactors during a hot startup (that is, coolant pressure of 6.45 MPa, coolant temperature of 538 K, and coolant flow rate of 85 cm 3 /s). It is concluded that the high coolant pressure recorded in the RIA-ST-4 experiment was caused by an energetic MFCI and was not due to gas release from the test rod at failure, Zr/water reaction, or to UO 2 fuel vapor pressure. The high coolant temperature indicated the presence of superheated steam, which may have formed during the expansion of the working fluid back to the initial coolant pressure; yet, the thermal-to-mechanical energy conversion ratio is estimated to be only 0.3%

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

    Directory of Open Access Journals (Sweden)

    Federico Scarpa

    2015-01-01

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

  9. Patients' Experiences of Performing Self-care of Stomas in the Initial Postoperative Period.

    Science.gov (United States)

    Lim, Siew Hoon; Chan, Sally Wai Chi; He, Hong-Gu

    2015-01-01

    With the loss of an important bodily function and the distortion in body image, a stoma patient experiences physical, psychological, and social changes. With limited current studies exploring experiences of patients in the management of their stoma, there is a need to explore their experiences, their needs, and factors that influence their self-management. The aim of this study was to investigate patients' experiences of performing self-care of stomas in the initial postoperative period. This study adopted a descriptive qualitative approach from the interpretive paradigm. Semistructured interviews were conducted with 12 patients 1 month postoperatively in a colorectal ward in a hospital in Singapore. Thematic analysis was applied to the interview data. Five themes were identified: process of acceptance and self-management of stoma, physical limitations, psychological reactions, social support, and need for timely and sufficient stoma preparation and education. This study highlights the importance of health professionals' role in helping patients adjust preoperatively and postoperatively and accept the presence of a stoma. Health professionals need to be aware of the physical, psychological, and social impact of stoma on patients in the initial 30-day postoperative period. Research findings informed the type and level of assistance and support to be offered to patients by nurses and the importance of encouraging patients to be involved in stoma care at an early stage, which will ultimately contribute to effective and independent self-management. Patients can be prepared preoperatively to reduce the psychological and social impact of stoma after creation of their stoma.

  10. Initial cathode processing experiences and results for the treatment of spent fuel

    International Nuclear Information System (INIS)

    Westphal, B.R.; Laug, D.V.; Brunsvold, A.R.; Roach, P.D.

    1996-01-01

    As part of the spent fuel treatment demonstration at Argonne National Laboratory, a vacuum distillation process is being employed for the recovery of uranium following an electrorefining process. Distillation of a salt electrolyte, primarily consisting of a eutectic mixture of lithium and potassium chlorides, from uranium is achieved by a batch operation termed ''cathode processing.'' Cathode processing is performed in a retort furnace which enables the production of a stable uranium product that can be isotopically diluted and stored. To date, experiments have been performed with two distillation units; one for prototypical testing and the other for actual spent fuel treatment operations. The results and experiences from these initial experiments with both units will be discussed as well as problems encountered and their resolution

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

    International Nuclear Information System (INIS)

    Sheehey, P.T.

    1994-02-01

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

  12. Experience of Initial Symptoms of Breast Cancer and Triggers for Action in Ethiopia

    International Nuclear Information System (INIS)

    Dye, T.D.; Hobden, C.; Reeler, A.; Dye, T.D.; Bogale, S.; Tilahun, Y.; Deressa, T.

    2012-01-01

    Objective. This study assessed the initial experiences, symptoms, and actions of patients in Ethiopia ultimately determined to have breast cancer. Methods. 69 participants in a comprehensive breast cancer treatment program at the main national cancer hospital in Ethiopia were interviewed using mixed qualitative and quantitative approaches. Participants narratives of their initial cancer experience were coded and analyzed for themes around their symptoms, time to seeking advice, triggers for action, and contextual factors. The assessment was approved by the Addis Ababa University Faculty of Medicine Institutional Review Board. Results. Nearly all women first noticed lumps, though few sought medical advice within the first year (average time to action: 1.5 years). Eventually, changes in their symptoms motivated most participants to seek advice. Most participants did not think the initial lump would be cancer, nor was a lump of any particular concern until symptoms changed. Conclusion. Given the frequency with which lumps are the first symptom noticed, raising awareness among participants that lumps should trigger medical consultation could contribute significantly to more rapid medical advice-seeking among women in Ethiopia. Primary care sites should be trained and equipped to offer evaluation of lumps so that women can be referred appropriately for assessment if needed

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

    Energy Technology Data Exchange (ETDEWEB)

    D. M. McEligot; G. E. McCreery

    2004-09-01

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

  14. Experience in initial training required for the recognition of the qualified RP expert in Spain

    International Nuclear Information System (INIS)

    Rodriguez Suarez, M.; Marco Arboli, M.; Menarguez, J.

    2003-01-01

    An important point of the actions inside the European framework to achieve the harmonisation of the training programmes and recognition was included in the European directive 96/29/Euratom which includes definition and specific tasks of the European Qualified Expert on Radiation Protection (RP). Basic syllabus for training of those experts was developed in the communication 98/C 133/03 concerning BSS applications. Although, in the Spanish education system, the training and recognition requirements of the high level qualified experts on RP was defined since 1977, until 2001, the figure of the Technical Qualified Expert on RP does not appear in the legal framework. In December 2002, a new regulation of the Spanish Regulatory Body, CSN, about qualifications to obtain the recognition of RP Expert in Spain (both high qualified and technical RP experts) was published. Concerning the qualified expert on RP, (RP Officer), responsible of the RP Service, which takes charge of the effective protection and advise radioactive and nuclear facilities in Rp aspects,has to be authorised by the regulatory body. to obtain the RP officer diploma, conceded by the CSN, an initial training of 300 hours and a three-year minimum experience are required (for X-ray installation a 6-month experience is enough). The technical qualified expert on RP is the worker who carried out the tasks in the a RP Service under the supervision of the RP officer. A Technician Qualified Expert on RP does not need an specific accreditation of the Regulatory Body, but an initial RP training and a three-month minimum experience are required and has hold a certificate by the RP officer. Continuous training is also required and as well has to receive a certificate from the RP officer. Since 1977, The Institute for energy Studies has been implementing specific training courses for those professionals who want to obtain the diploma of RP officer (high degree qualified RP expert), conceded by the CSN. Since then

  15. Initial resident refractive surgical experience: outcomes of PRK and LASIK for myopia.

    Science.gov (United States)

    Wagoner, Michael D; Wickard, Joseph C; Wandling, George R; Milder, Lisa C; Rauen, Matthew P; Kitzmann, Anna S; Sutphin, John E; Goins, Kenneth M

    2011-03-01

    To evaluate and compare the outcome of initial resident surgical experience with photorefractive keratectomy (PRK) and LASIK. Retrospective review of all cases performed with the VISX Star S4 platform (Abbott Medical Optics) between July 1, 2003 and June 30, 2007. Inclusion criteria were spherical equivalent of -0.50 to -10.00 diopters (D), refractive astigmatic error of ≤3.00 D, intention to provide full distance correction, and minimum 3-month postoperative follow-up after initial ablation or retreatment (if performed). A total of 153 cases performed by 20 different residents met the inclusion criteria; 38 eyes underwent PRK and 115 eyes had LASIK. After initial treatment, mean Snellen uncorrected distance visual acuity (UDVA) after PRK was 20/17.3 and after LASIK was 20/19.5. Photorefractive keratectomy was associated with a significantly better approximation between preoperative corrected distance visual acuity (CDVA) and postoperative UDVA (ΔlogMAR 0.009 vs 0.091; P=.004) and a greater percentage of eyes that achieved UDVA of 20/20 or better (94.7% vs 78.3%; P=.02) or 20/30 or better (100% vs 87.8%; P=.02). There was a higher prevalence of retreatment in eyes that underwent LASIK (7.0% vs 0%; P=.20). One (0.9%) eye lost 2 lines of CDVA after LASIK. Supervised refractive surgery residents can achieve excellent visual outcomes in patients operated during their initial refractive experience. Photorefractive keratectomy was associated with better visual outcome than LASIK. Copyright 2011, SLACK Incorporated.

  16. Prototype radiographic system for emergency and intensive care units: Initial experience

    International Nuclear Information System (INIS)

    Mirvis, S.

    1986-01-01

    A prototype radiographic system has been developed for use in bedside examinations in multibed trauma or intensive care units and emergency rooms. The system features a single-phase, high-frequency 30-kW ceiling-mounted generator with an x-ray tube extending from a long counterbalanced arm. All movements are servo-assisted for ease of operation. Based on initial experience, the unit allows easier access to the patient around resuscitation and monitoring equipment, occupies less floor space, and yields better quality images than do standard mobile radiographic units

  17. Initial experience gained with the balance-group system of the Swiss power supply legislation

    International Nuclear Information System (INIS)

    Waldner, M.; Rechsteiner, S.

    2010-01-01

    This article takes a look at the initial experience gained with the Swiss balance-group system. This system was introduced within the framework of Swiss power supply legislation (StromVG - Stromversorgungsgesetz). The balance-group system was considered to be an essential precondition for the implementation of an energy trading business in a liberalised power market. The associated rights and responsibilities and the economic risks involved are discussed in detail. The partners and structures involved in such a balance-group are looked at and basic models for the associated contracts are examined. The relationship between balance-groups and the national power grid Swissgrid are discussed

  18. Transient debris freezing and potential wall melting during a severe reactivity initiated accident experiment

    International Nuclear Information System (INIS)

    El-Genk, M.S.; Moore, R.L.

    1981-01-01

    It is important to light water reactor (LWR) safety analysis to understand the transient freezing of molten core debris on cold structures following a hypothetical core meltdown accident. The purpose of this paper is to (a) present the results of a severe reactivity initiated accident (RIA) in-pile experiment with regard to molten debris distribution and freezing following test fuel rod failure, (b) analyze the transient freezing of molten debris (primarily a mixture of UO/sub 2/ fuel and Zircaloy cladding) deposited on the inner surface of the test shroud wall upon rod failure, and (c) assess the potential for wall melting upon being contacted by the molten debris. 26 refs

  19. Pore Formation and Mobility Investigation (PFMI): Concept, Hardware Development and Initial Analysis of Experiments

    Science.gov (United States)

    Grugel, Richard N.

    2004-01-01

    Porosity in the form of "bubbles and pipes" can occur during controlled directional solidification processing of metal alloys. This is a consequence that 1) precludes obtaining any meaningful scientific results and 2) is detrimental to desired material properties. Unfortunately, several Microgravity experiments have been compromised by porosity. The intent of the PFMI investigation is to conduct a systematic effort directed towards understanding porosity formation and mobility during controlled directional solidification (DS) in a microgravity environment. PFMI uses a pure transparent material, succinonitrile (SCN), as well as SCN "alloyed" with water, in conjunction with a translating temperature gradient stage so that direct observation and recording of pore generation and mobility can be made. PFMI is investigating the role of thermocapillary forces and temperature gradients in affecting bubble dynamics as well as other solidification processes in a microgravity Environment. This presentation will cover the concept, hardware development, operations, and the initial results from experiments conducted aboard the International Space Station. .

  20. Simulation of rod drop experiments in the initial cores of Loviisa and Mochovce

    International Nuclear Information System (INIS)

    Kaloinen, E.; Kyrki-Rajamaeki, R.; Wasastjerna, F.

    1999-01-01

    Interpretation of rod drop measurements during startup tests of the Loviisa reactors has earlier been studied with two-dimensional core calculations using a spatial prompt jump approximation. In these calculations the prediction for the reactivity meter reading was lower than the measured values by 25%. Another approach to solve the problem is simulation of the rod drop experiment with dynamic core calculations coupled with out of core calculations to estimate the response of ex-core ionization chambers for the reactivity meter. This report described the calculations performed with the three-dimensional dynamic code HEXTRAN for prediction of the reactivity meter readings in rod drop experiments in initial cores of the WWER-440 reactors. (Authors)

  1. Mapping patients' experiences from initial symptoms to gout diagnosis: a qualitative exploration.

    Science.gov (United States)

    Liddle, Jennifer; Roddy, Edward; Mallen, Christian D; Hider, Samantha L; Prinjha, Suman; Ziebland, Sue; Richardson, Jane C

    2015-09-14

    To explore patients' experiences from initial symptoms to receiving a diagnosis of gout. Data from in-depth semistructured interviews were used to construct themes to describe key features of patients' experiences of gout diagnosis. A maximum variation sample of 43 UK patients with gout (29 men; 14 women; age range 32-87 years) were recruited from general practices, rheumatology clinics, gout support groups and through online advertising. Severe joint pain, combined with no obvious signs of physical trauma or knowledge of injury, caused confusion for patients attempting to interpret their symptoms. Reasons for delayed consultation included self-diagnosis and/or self-medication, reluctance to seek medical attention, and financial/work pressures. Factors potentially contributing to delayed diagnosis after consultation included reported misdiagnosis, attacks in joints other than the first metatarsophalangeal joint, and female gender. The limitations in using serum uric acid (SUA) levels for diagnostic purposes were not always communicated effectively to patients, and led to uncertainty and lack of confidence in the accuracy of the diagnosis. Resistance to the diagnosis occurred in response to patients' beliefs about the causes of gout and characteristics of the people likely to be affected. Diagnosis prompted actions, such as changes in diet, and evidence was found of self-monitoring of SUA levels. This study is the first to report data specifically about patients' pathways to initial consultation and subsequent experiences of gout diagnosis. A more targeted approach to information provision at diagnosis would improve patients' experiences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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

    International Nuclear Information System (INIS)

    Avula, Shivaram; Garlick, Deborah; Abernethy, Laurence J.; Mallucci, Connor L.; Pizer, Barry; Crooks, Daniel

    2012-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-02-15

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

  4. F-18 FDG PET with coincidence detection, dual-head gamma camera, initial experience in oncology

    Energy Technology Data Exchange (ETDEWEB)

    Chu, J.M.G.; Pocock, N.; Quach, T.; Camden, B.M.C. [Liverpool Health Services, Liverpool, NSW (Australia). Department of Nuclear Medicine and Clinical Ultrasound

    1998-06-01

    Full text: The development of Co-incidence Detection (CD) in gamma camera technology has allowed the use of positron radiopharmaceuticals in clinical practice without dedicated PET facilities. We report our initial experience of this technology in Oncological applications. All patients were administered 200 MBq of F- 18 FDG intravenously in a fasting state, with serum glucose below 8.9 mmol/L., and hydration well maintained. Tomography was performed using an ADAC Solus Molecular Co-incidence Detection (MCD) dual-head gamma camera, 60 minutes after administration and immediately after voiding. Tomography of the torso required up to three collections depending on the length of the patient, with each collection requiring 32 steps of 40 second duration, and a 50% overlap. Tomography of the brain required a single collection with 32 steps of 80 seconds. Patients were scanned in the supine position. An iterative reconstruction algorithm was employed without attenuation correction. All patients had histologically confirmed malignancy. Scan findings were correlated with results of all conventional diagnostic imaging procedures that were pertinent to the evaluation and management of each individual patient`s disease. Correlation with tumour type and treatment status was also undertaken. F-18 FDG uptake as demonstrated by CD-PET was increased in tumour bearing sites. The degree of increased uptake varied with tumour type and with treatment status. Our initial experience with CD-PET has been very encouraging, and has led us to undertake prospective short and long term studies to define its role in oncology

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

    Directory of Open Access Journals (Sweden)

    L. T. Hoekstra

    2012-01-01

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

  6. The AGING Initiative experience: a call for sustained support for team science networks.

    Science.gov (United States)

    Garg, Tullika; Anzuoni, Kathryn; Landyn, Valentina; Hajduk, Alexandra; Waring, Stephen; Hanson, Leah R; Whitson, Heather E

    2018-05-18

    Team science, defined as collaborative research efforts that leverage the expertise of diverse disciplines, is recognised as a critical means to address complex healthcare challenges, but the practical implementation of team science can be difficult. Our objective is to describe the barriers, solutions and lessons learned from our team science experience as applied to the complex and growing challenge of multiple chronic conditions (MCC). MCC is the presence of two or more chronic conditions that have a collective adverse effect on health status, function or quality of life, and that require complex healthcare management, decision-making or coordination. Due to the increasing impact on the United States society, MCC research has been identified as a high priority research area by multiple federal agencies. In response to this need, two national research entities, the Healthcare Systems Research Network (HCSRN) and the Claude D. Pepper Older Americans Independence Centers (OAIC), formed the Advancing Geriatrics Infrastructure and Network Growth (AGING) Initiative to build nationwide capacity for MCC team science. This article describes the structure, lessons learned and initial outcomes of the AGING Initiative. We call for funding mechanisms to sustain infrastructures that have demonstrated success in fostering team science and innovation in translating findings to policy change necessary to solve complex problems in healthcare.

  7. Using Controlled Landslide Initiation Experiments to Test Limit-Equilibrium Analyses of Slope Stability

    Science.gov (United States)

    Reid, M. E.; Iverson, R. M.; Brien, D. L.; Iverson, N. R.; Lahusen, R. G.; Logan, M.

    2004-12-01

    Most studies of landslide initiation employ limit equilibrium analyses of slope stability. Owing to a lack of detailed data, however, few studies have tested limit-equilibrium predictions against physical measurements of slope failure. We have conducted a series of field-scale, highly controlled landslide initiation experiments at the USGS debris-flow flume in Oregon; these experiments provide exceptional data to test limit equilibrium methods. In each of seven experiments, we attempted to induce failure in a 0.65m thick, 2m wide, 6m3 prism of loamy sand placed behind a retaining wall in the 31° sloping flume. We systematically investigated triggering of sliding by groundwater injection, by prolonged moderate-intensity sprinkling, and by bursts of high intensity sprinkling. We also used vibratory compaction to control soil porosity and thereby investigate differences in failure behavior of dense and loose soils. About 50 sensors were monitored at 20 Hz during the experiments, including nests of tiltmeters buried at 7 cm spacing to define subsurface failure geometry, and nests of tensiometers and pore-pressure sensors to define evolving pore-pressure fields. In addition, we performed ancillary laboratory tests to measure soil porosity, shear strength, hydraulic conductivity, and compressibility. In loose soils (porosity of 0.52 to 0.55), abrupt failure typically occurred along the flume bed after substantial soil deformation. In denser soils (porosity of 0.41 to 0.44), gradual failure occurred within the soil prism. All failure surfaces had a maximum length to depth ratio of about 7. In even denser soil (porosity of 0.39), we could not induce failure by sprinkling. The internal friction angle of the soils varied from 28° to 40° with decreasing porosity. We analyzed stability at failure, given the observed pore-pressure conditions just prior to large movement, using a 1-D infinite-slope method and a more complete 2-D Janbu method. Each method provides a static

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-04-24

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

  9. Operation of the tokamak fusion test reactor tritium systems during initial tritium experiments

    International Nuclear Information System (INIS)

    Anderson, J.L.; Gentile, C.; Kalish, M.; Kamperschroer, J.; Kozub, T.; LaMarche, P.; Murray, H.; Nagy, A.; Raftopoulos, S.; Rossmassler, R.; Sissingh, R.; Swanson, J.; Tulipano, F.; Viola, M.; Voorhees, D.; Walters, R.T.

    1995-01-01

    The high power D-T experiments on the tokamak fusion test reactor (TFTR) at the Princeton Plasma Physics Laboratory commenced in November 1993. During initial operation of the tritium systems a number of start-up problems surfaced and had to be corrected. These were corrected through a series of system modifications and upgrades and by repair of failed or inadequate components. Even as these operational concerns were being addressed, the tritium systems continued to support D-T operations on the tokamak. During the first six months of D-T operations more than 107kCi of tritium were processed successfully by the tritium systems. D-T experiments conducted at TFTR during this period provided significant new data. Fusion power in excess of 9MW was achieved in May 1994. This paper describes some of the early start-up issues, and reports on the operation of the tritium system and the tritium tracking and accounting system during the early phase of TFTR D-T experiments. (orig.)

  10. Measuring health systems strength and its impact: experiences from the African Health Initiative.

    Science.gov (United States)

    Sherr, Kenneth; Fernandes, Quinhas; Kanté, Almamy M; Bawah, Ayaga; Condo, Jeanine; Mutale, Wilbroad

    2017-12-21

    Health systems are essential platforms for accessible, quality health services, and population health improvements. Global health initiatives have dramatically increased health resources; however, funding to strengthen health systems has not increased commensurately, partially due to concerns about health system complexity and evidence gaps demonstrating health outcome improvements. In 2009, the African Health Initiative of the Doris Duke Charitable Foundation began supporting Population Health Implementation and Training Partnership projects in five sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to catalyze significant advances in strengthening health systems. This manuscript reflects on the experience of establishing an evaluation framework to measure health systems strength, and associate measures with health outcomes, as part of this Initiative. Using the World Health Organization's health systems building block framework, the Partnerships present novel approaches to measure health systems building blocks and summarize data across and within building blocks to facilitate analytic procedures. Three Partnerships developed summary measures spanning the building blocks using principal component analysis (Ghana and Tanzania) or the balanced scorecard (Zambia). Other Partnerships developed summary measures to simplify multiple indicators within individual building blocks, including health information systems (Mozambique), and service delivery (Rwanda). At the end of the project intervention period, one to two key informants from each Partnership's leadership team were asked to list - in rank order - the importance of the six building blocks in relation to their intervention. Though there were differences across Partnerships, service delivery and information systems were reported to be the most common focus of interventions, followed by health workforce and leadership and governance. Medical products, vaccines and technologies, and

  11. Initial clinical experience with a sac-anchoring endoprosthesis for aortic aneurysm repair.

    Science.gov (United States)

    Donayre, Carlos E; Zarins, Christopher K; Krievins, Dainis K; Holden, Andrew; Hill, Andrew; Calderas, Carlos; Velez, Jaime; White, Rodney A

    2011-03-01

    All current aortic endografts depend on proximal and distal fixation to prevent migration. However, migration and rupture can occur, particularly in patients with aortic necks that are short or angulated, or both. We present our initial clinical experience with a new sac-anchoring endoprosthesis designed to anchor and seal the device within the aneurysm sac. The initial worldwide experience using a new endoprosthesis for the treatment of aortic aneurysms (Nellix Endovascular, Palo Alto, Calif) was reviewed. The endoprosthesis consists of dual balloon-expandable endoframes surrounded by polymer-filled endobags designed to obliterate the aneurysm sac and maintain endograft position. Clinical results and follow-up contrast computed tomography (CT) scans at 30 days and 6 and 12 months were reviewed. The endograft was successfully deployed in 21 patients with infrarenal aortic aneurysms measuring 5.7 ± 0.7 cm (range, 4.3-7.4 cm). Two patients with common iliac aneurysms were treated with sac-anchoring extenders that maintained patency of the internal iliac artery. Infusion of 71 ± 37 mL of polymer (range, 19-158 mL) into the aortic endobags resulted in complete aneurysm exclusion in all patients. Mean implant time was 76 ± 35 minutes, with 33 ± 17 minutes of fluoroscopy time and 180 ± 81 mL of contrast; estimated blood loss was 174 ± 116 mL. One patient died during the postoperative period (30-day mortality, 4.8%), and one died at 10 months from non-device-related causes. During a mean follow-up of 8.7 ± 3.1 months and a median of 6.3 months, there were no late aneurysm- or device-related adverse events and no secondary procedures. CT imaging studies at 6 months and 1 year revealed no increase in aneurysm size, no device migration, and no new endoleaks. One patient had a limited proximal type I endoleak at 30 days that resolved at 60 days and remained sealed. One patient has an ongoing distal type I endoleak near the iliac bifurcation, with no change in aneurysm

  12. Preliminary experiments using light-initiated high explosive for driving thin flyer plates

    International Nuclear Information System (INIS)

    Benham, R.A.

    1980-02-01

    Light-initiated high explosive, silver acelytide - silver-nitrate (SASN), has been used to produce simulated x ray blow-off impulse loading on reentry vehicles to study the system structural response. SASN can be used to accelerate thin flyer plates to high terminal velocities which, in turn, can deliver a pressure pulse that can be tailored to the target material. This process is important for impulse tests where both structural and material response is desired. The theories used to calculate the dynamic state of the flyer plate prior to impact are summarized. Data from several experiments are presented which indicate that thin flyer plates can be properly accelerated and that there are predictive techniques available which are adequate to calculate the motion of the flyer plate. Recommendations are made for future study that must be undertaken to make the SASN flyer plate technique usable

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

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-06-15

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

  14. Initial experience of using an active beam delivery technique at PSI

    International Nuclear Information System (INIS)

    Pedroni, E.; Boehringer, T.; Coray, A.; Egger, E.; Grossmann, M.; Lin Shixiong; Lomax, A.; Goitein, G.; Roser, W.; Schaffner, B.

    1999-01-01

    At PSI a new proton therapy facility has been assembled and commissioned. The major features of the facility are the spot scanning technique and the very compact gantry. The operation of the facility was started in 1997 and the feasibility of the spot scanning technique has been demonstrated in practice with patient treatments. In this report we discuss the usual initial difficulties encountered in the commissioning of a new technology, the very positive preliminary experience with the system and the optimistic expectations for the future. The long range goal of this project is to parallel the recent developments regarding inverse planning for photons with a similar advanced technology optimized for a proton beam. (orig.)

  15. Initial operating experience and recent development on the TRIUMF optically pumped polarized H- ion source

    International Nuclear Information System (INIS)

    Schmor, P.W.; Law, W.M.; Levy, C.D.P.; McDonald, M.

    1988-01-01

    A polarized H - ion source using optical pumping techniques has been developed at TRIUMF. This source was used to demonstrate (on an ion source test stand) the feasibility of producing 10- μA of ∼ 60% polarized H - ion beam in a dc mode suitable for injection into the TRIUMF cyclotron. The source has been installed in a 300 kV high voltage terminal connected to the cyclotron via a recently constructed beam transport line. A polarization of 80% is anticipated near the end of 1988 after the installation of a superconducting solenoid to the source. In this paper the authors describe the initial operating experience, recent developments, and the future plans for the TRIUMF optically pumped polarized ion source

  16. [A unit for emergency psychiatry and crisis intervention--concepts, structure and initial experiences].

    Science.gov (United States)

    Feuerlein, W; Bronisch, T; Fürmaier, A

    1983-03-01

    The article reports on a ward with 12 beds which has been set up for emergency cases in psychiatry or for immediate intervention in case of a crisis experienced by a patient. In the theoretical part of this article, it is explained that crisis situations are present in most of the psychiatric emergency patients. The article then goes briefly into the fundamentals of therapeutic strategy in such patients: A therapy which helps to uncover hidden conflicts, the pros and cons of therapy focussed on conflict and on supportive measures; as well as a therapy which supports and promotes the ego. This is followed by a comparison of the ward with corresponding facilities in Germany and abroad and a description of their structure, their patients and their function within a psychiatric care system. The concluding part of the article is devoted to a description of the authors' initial experiences and impressions gained during their work with the ward patients, quoting several examples.

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

    Directory of Open Access Journals (Sweden)

    Ying Adeline Ng Ling

    2017-01-01

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

  18. Bile Duct Anastomosis Supplied With Biodegradable Stent in Liver Transplantation: The Initial Experience.

    Science.gov (United States)

    Janousek, L; Maly, S; Oliverius, M; Kocik, M; Kucera, M; Fronek, J

    2016-12-01

    The most common biliary complications after orthotopic liver transplantation are bile leaks, anastomotic and intrahepatic strictures, stones, and ampullary dysfunction. These complications can occur in up to 10% to 30% of liver transplant recipients. Leaks occur early in the posttransplant period; the stricture formation typically graduates over time. Ten patients underwent transplantation in our preliminary study: 5 were randomized to the group with stent placement and 5 to the control group. We investigated the role of an absorbable biliary stent with the goal of proving patency of duct-to-duct biliary anastomosis. The stents are made of machine-knitted polydioxanone monofilaments. Our initial results show that duct-to-duct biliary reconstruction using an absorbable internal stent had good patency in all 5 patients. There were no signs of biliary leakage accompanying the anastomoses in any of the cases, and there was no stone formation observed after liver transplantation. The biliary stent was completely absorbed, with no adverse effects. Based on our initial experience and data, we concluded that biodegradable stents can be successfully and safely used in clinical practice. Further large prospective randomized studies are needed to estimate the efficacy of the bioabsorbable stents. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Initial experience with the new da Vinci single-port robot-assisted platform.

    Science.gov (United States)

    Ballestero Diego, R; Zubillaga Guerrero, S; Truan Cacho, D; Carrion Ballardo, C; Velilla Diez, G; Calleja Hermosa, P; Gutiérrez Baños, J L

    2017-06-01

    To describe our experience in the first cases of urological surgeries performed with the da Vinci single-port robot-assisted platform. We performed 5 single-port robot-assisted surgeries (R-LESS) between May and October 2014. We performed 3 ureteral reimplant surgeries, one ureteropyeloplasty in an inverted kidney and 1 partial nephrectomy. The perioperative and postoperative results were collected, as well as a report of the complications according to the Clavien classification system. Of the 5 procedures, 4 were performed completely by LESS, while 1 procedure was reconverted to multiport robot-assisted surgery. There were no intraoperative complications. We observed perioperative complications in 4 patients, all of which were grade 1 or 2. The mean surgical time was 262minutes (range, 230-300). In our initial experience with the da Vinci device, R-LESS surgery was feasible and safe. There are still a number of limitations in its use, which require new and improved R-LESS platforms. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Robotic resections in hepatobiliary oncology - initial experience with Xi da Vinci system in India.

    Science.gov (United States)

    Chandarana, M; Patkar, S; Tamhankar, A; Garg, S; Bhandare, M; Goel, M

    2017-01-01

    Minimal invasive surgery has proven its advantages over open surgeries in the perioperative period. Food and Drug Administration approved da Vinci robot in 2000. The latest version, da Vinci Xi system has a mobile tower-based robot with several modifications to improve the functionality, versatility, and operative ease. None of the centers have reported exclusively on hepatobiliary oncology using the da Vinci Xi system. We report our initial experience. To study the feasibility, advantages, and discuss the operative technique of da Vinci Xi system in hepatobiliary oncology. Data were analyzed retrospectively from a prospectively maintained database from June 2015 to October 2016. Twenty-five patients with suspected or proven hepatobiliary malignancies were operated. Total robotic technique using da Vinci Xi system was used. Demographic details and perioperative outcomes were noted. Of the 25 surgeries, 14 patients had a suspected gallbladder malignancy, 11 patients had primary or metastatic liver tumor. Median age was 53 years. The average duration of surgery was 225 min with a median blood loss 150 ml. The median postoperative stay was 4 days. The median nodal yield for radical cholecystectomy was seven. Five patients required conversion. Two of these developed postoperative morbidity. Robotic surgery for hepatobiliary oncology is feasible and can be performed safely in experienced hands. Increasing experience in this field may equal or even prove advantageous over conventional or laparoscopic approach in future. A cautious approach with judicious patient selection is the key to establishing robotic surgery as a standard surgical approach.

  1. Student Experiences: the 2013 Cascadia Initiative Expedition Team's Apply to Sail Program

    Science.gov (United States)

    Mejia, H.; Hooft, E. E.; Fattaruso, L.

    2013-12-01

    During the summer of 2013, the Cascadia Initiative Expedition Team led six oceanographic expeditions to recover and redeploy ocean bottom seismometers (OBSs) across the Cascadia subduction zone and Juan de Fuca plate. The Cascadia Initiative (CI) is an onshore/offshore seismic and geodetic experiment to study questions ranging from megathrust earthquakes to volcanic arc structure to the formation, deformation and hydration of the Juan de Fuca and Gorda plates with the overarching goal of understanding the entire subduction zone system. The Cascadia Initiative Expedition Team is a team of scientists charged with leading the oceanographic expeditions to deploy and recover CI OBSs and developing the associated Education and Outreach effort. Students and early career scientists were encouraged to apply to join the cruises via the Cascadia Initiative Expedition Team's Apply to Sail Program. The goal of this call for open participation was to help expand the user base of OBS data by providing opportunities for students and scientists to directly experience at-sea acquisition of OBS data. Participants were required to have a strong interest in learning field techniques, be willing to work long hours at sea assisting in OBS deployment, recovery and preliminary data processing and have an interest in working with the data collected. In total, there were 51 applicants to the Apply to Sail Program from the US and 4 other countries; 21 graduate students as well as a few undergraduate students, postdocs and young scientists from the US and Canada were chosen to join the crew. The cruises lasted from 6 to 14 days in length. OBS retrievals comprised the three first legs, of which the first two were aboard the Research Vessel Oceanus. During each of the retrievals, multiple acoustic signals were sent while the vessel completed a semi-circle around the OBS to accurately determine its position, a final signal was sent to drop the seismometer's anchor, and finally the ship and crew

  2. In Their Own Words: Young Adults' Menthol Cigarette Initiation, Perceptions, Experiences and Regulation Perspectives.

    Science.gov (United States)

    Wackowski, Olivia A; Evans, Kiameesha R; Harrell, Melissa B; Loukas, Alexandra; Lewis, M Jane; Delnevo, Cristine D; Perry, Cheryl L

    2017-02-17

    Menthol cigarettes are disproportionately used by young people and have been called smoking starter products. However, limited qualitative research exists on young adults' perceptions of and experiences with these products, with much of it based on document reviews of the tobacco industry's research. We conducted six focus groups with young adult (ages 18-24) menthol smokers in New Jersey (half with black smokers) between December 2014 and March 2015. Participants were asked open-ended questions about their menthol smoking initiation, preference reasons, substitution behaviors, and perceptions of menthol cigarette risks and regulation. Participants' menthol cigarette initiation and preference were influenced by their perceived popularity, brand recognition, taste, smoothness, satisfaction and access (including as "loosies," typically available for Newport). Some believed menthol cigarettes were less harmful than non-menthol cigarettes when initiating smoking. Many currently believed menthol cigarettes were more harmful because they contained extra "additives," were stronger (ie, requiring fewer cigarettes to feel satisfied), and/or based on hearsay. Many had tried new brand Camel Crush, which was perceived to be especially minty, fun, and attractive for newer smokers. While some used non-menthol cigarettes when menthols were unavailable, many said they would never or almost never substitute. Many acknowledged a menthol cigarettes ban would likely help them quit smoking, even though they did not support the idea. Menthol cigarette initiation is influenced by an interplay of multiple factors including their sensory properties, marketing, perceived popularity and availability. The FDA should continue to pursue closing this flavored cigarette loophole. In this first qualitative study of menthol cigarette use among young adults, we found further evidence that menthol cigarettes can act as starter products because they are perceived as easier to smoke and taste and smell

  3. Initial clinical experience with frameless radiosurgery for patients with intracranial metastases

    International Nuclear Information System (INIS)

    Kamath, Reena; Ryken, Timothy C.; Meeks, Sanford L.; Pennington, Edward C.; Ritchie, Justine; Buatti, John M.

    2005-01-01

    Purpose: To review the initial clinical experience with frameless stereotactic radiosurgery (SRS) for treating intracranial metastatic disease. Methods and Materials: Sixty-four patients received frameless SRS for intracranial metastatic disease. Minimum follow-up was 6 months with none lost to follow-up. Patients had a median of 2 metastases and a maximum of 4. The median number of isocenters was 2 with median arcs of 10 and median dose of 17.5 Gy. Thirteen patients were treated for progressive/recurrent disease after surgical resection or whole brain radiotherapy (WBRT). Fifty-one patients were treated with frameless SRS as an an adjunct to initial treatment. Of the total treated, 17 were treated with SRS alone, 20 were treated with WBRT plus SRS, 16 were treated with surgical resection plus SRS, and the remaining 11 were treated with surgical resection plus WBRT plus SRS. Results: With a median actuarial follow-up period of 8.2 months, ultimate local control was 88%. The median time to progression was 8.1 months. The median overall survival was 8.7 months. Of the 17 patients treated with SRS alone, 86% had ultimate local control with mean overall survival of 7.1 months. Of the 13 patients who received surgical resection plus SRS without WBRT as primary treatment, there was 85% ultimate local control with an overall survival of 10.3 months. Three patients treated with initial surgery alone had recurrence treated with SRS 2-3 months after resection. All these patients obtained local control and median survival was >10 months. Of the 13 patients who received WBRT followed by SRS as boost treatment, 92% had local control and mean overall survival was 7.3 months. Of 7 patients who received SRS after recurrence after WBRT, 100% had local control with median survival of 8.2 months. For 8 patients who received surgery followed by WBRT and SRS, local control was 50%; however, ultimate intracranial control was achieved in 7 of 8 patients with repeat SRS and surgical

  4. [Evaluation of the influence of humidity and temperature on the drug stability by initial average rate experiment].

    Science.gov (United States)

    He, Ning; Sun, Hechun; Dai, Miaomiao

    2014-05-01

    To evaluate the influence of temperature and humidity on the drug stability by initial average rate experiment, and to obtained the kinetic parameters. The effect of concentration error, drug degradation extent, humidity and temperature numbers, humidity and temperature range, and average humidity and temperature on the accuracy and precision of kinetic parameters in the initial average rate experiment was explored. The stability of vitamin C, as a solid state model, was investigated by an initial average rate experiment. Under the same experimental conditions, the kinetic parameters obtained from this proposed method were comparable to those from classical isothermal experiment at constant humidity. The estimates were more accurate and precise by controlling the extent of drug degradation, changing humidity and temperature range, or by setting the average temperature closer to room temperature. Compared with isothermal experiments at constant humidity, our proposed method saves time, labor, and materials.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-10-15

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

  6. Laparoendoscopic single-site extraperitoneal inguinal hernia repair: initial experience in 10 patients.

    Science.gov (United States)

    Do, Minh; Liatsikos, Evangelos; Beatty, John; Haefner, Tim; Dunn, Ian; Kallidonis, Panagiotis; Stolzenburg, Jens-Uwe

    2011-06-01

    Recent technical advances and a trend toward laparoscopic single incision surgery have led us to explore the feasibility of laparoendoscopic single-site (LESS) hernia repair. We present our technique and initial experience with LESS extraperitoneal inguinal hernia repair in 10 consecutive men with unilateral inguinal hernias. Age range was 43.7 (28-64) years. Mean body mass index was 28 (range 24-30). Six were left inguinal hernias. There were six indirect and four direct hernias. Three patients had undergone previous open appendectomy. Incarcerated or bilateral hernias were excluded from our initial series. All cases were performed by three surgeons who were experienced in conventional totally extraperitoneal laparoscopic hernia repair as well as experienced in LESS. A literature review of current single-port inguinal hernia repair data is also presented. The mean operative time was 53 minutes (range 45-65  min). The average length of skin incision was 2.8  cm (range 2.3-3.2  cm). No drain was necessary in any of the patients, while no recordable bleeding was observed. There were no intraoperative or immediate postoperative complications. Hospitalization period was 2 days for all patients. After a limited follow-up of 1 month, there have been no recurrences and no complaints of testicular pain. The results of the current series compare favorably with those found in a literature review. LESS extraperitoneal inguinal hernia repair is both feasible and safe, although more technically demanding than its conventional laparoscopic counterpart. Although the cosmetic result with the former approach may prove superior, there are standing questions regarding the complications and long-term outcome. Randomized and if possible blinded trials that compare conventional and single-incision laparoscopic hernia repair may help to distinguish the most advantageous technique.

  7. Modelling Reactivity-Initiated-Accident Experiments With Falcon And SCANAIR: A Comparison Exercise

    International Nuclear Information System (INIS)

    Romano, A.; Wallin, H.; Zimmermann, M.A.

    2005-01-01

    A critical assessment is made of the state-of-the-art fuel performance code FALCON in the context of selected Reactivity Initiated Accident (RIA) experiments from the CABRI REP Na series, and contrasts its predictions against those of the extensively benchmarked SCANAIR (Version 3.2) code. The thermal fields in the fuel and cladding, the clad mechanical deformation, and the Fission Gas Release (FGR) are adopted as 'Figures of Merit' by which to judge code performance. Particular attention is paid to the importance of fission-gas-induced clad deformation (which is modelled in SCANAIR, but not in FALCON), relative to that driven by the fuel thermal expansion (which is modelled by both codes). The thermal fields calculated by the codes are in good agreement with each other, especially during the initial stages of the transients --- the adiabatic phase. Larger discrepancies are observed at later times, and are due to the different models applied to calculate the gap conductance. FALCON predicts clad permanent deformations at the end of the transients with a maximum deviation from the experimental measurements of about 20%. Generally, the code always tends to underpredict the measurements. SCANAIR performs similarly, but grossly overpredicts the permanent clad strain for the case involving a very energetic pulse. The fission-gas-driven clad deformation is only relevant for very fast pulse energy injection cases, which are not prototypical of the RIA transients expected in PWRs. The FGR models in FALCON do not capture the mechanism of 'burst-release' in the RIA transients, having been developed for steady-state irradiation conditions. This also explains why they performed poorly when applied to the fast-transient cases analyzed here. In contrast, the FGR results from SCANAIR are in satisfactory agreement with the experimental results. (author)

  8. Transanal minimally-invasive surgery (TAMIS: Technique and results from an initial experience

    Directory of Open Access Journals (Sweden)

    Carlos Ramon Silveira Mendes

    2013-10-01

    Full Text Available Transanal endoscopic microsurgery is a minimally-invasive approach for rectal lesions. Superior exposure and access to the entire rectum result in lesser risk of compromised margins and lower recurrence rates, when compared to conventional transanal excision. The aim of this study was to describe a single institution's initial experience with transanal minimally invasive surgery (TAMIS. This was a prospective review of our database. Elev- en procedures from January 2012 to June 2013 were analyzed. Results: eleven operations were completed. Five men were evaluated. Mean age was 62.9 (40-86. Mean follow-up was 9.3 (2-17 months. Average tumor size was 3.8 (1.8-8 cm. Mean distance from anal verge was 6.3 (3-12 cm. Mean operating time was 53.73 (28-118 min. Postoperative complica- tion rate was 9.1%. There were no readmissions. Mortality was null. Operative pathology disclosed the presence of adenoma in four patients, invasive adenocarcinoma in two, neu- roendocrine carcinoma in three, and no residual lesion in one case. TAMIS is a minimally- invasive procedure with low postoperative morbidity at the initial experience. TAMIS is a curative procedure for benign lesions and for selected early cancers. It is useful after neoadjuvant therapy for strictly selected cancers, pending the results of multi-institutional trials. Resumo: Microcirurgia endoscópica transanal é uma abordagem minimamente invasiva para lesões retais. Apresenta menor risco de margem comprometida e menores taxas de recorrência em comparação com excisão transanal convencional. Objetivou-se descrever a experiência inicial, de uma única instituição, com cirurgia minimamente invasiva transanal (TAMIS. Avaliação prospectiva de nosso banco de dados. Onze procedimentos de janeiro de 2012 a junho de 2013, foram analisados. Resultados: onze operações foram concluídas. Havia cinco homens. A média de idade foi de 62,9 (40-86. O acompanhamento médio foi de ww9,3 (2-17 meses. O

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

    Science.gov (United States)

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

    2016-12-01

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

  10. Neonatal extracorporeal membrane oxygenation: Initial experience of Hospital de São João

    Directory of Open Access Journals (Sweden)

    G. Rocha

    2014-11-01

    Full Text Available The purpose of this series is to report the initial ECMO experience of the Neonatal Intensive Care Unit of Hospital de São João. The first three clinical cases are reported. Case report 1: a 39 weeks gestational age girl with severe lung hypoplasia secondary to a bilateral congenital diaphragmatic hernia. Case report 2: a 39 weeks gestational age girl with a right congenital diaphragmatic hernia and a tracheal stenosis. Case report 3: a 34 weeks gestational age boy, with 61 days of life, with a Bordetella pertussis pneumonia, severe pulmonary hypertension, shock, hyperleukocytosis and seizures. Resumo: O objetivo desta série é apresentar a experiência inicial da Unidade de Cuidados Intensivos Neonatais do Hospital de São João com ECMO no recém-nascido. São apresentados os 3 primeiros casos. Caso 1: recém-nascido de 39 semanas de idade gestacional, com hipoplasia pulmonar severa secundária a hérnia diafragmática congénita bilateral. Caso 2: recém-nascido de 39 semanas de idade gestacional, com hérnia diafragmática congénita direita e estenose traqueal. Caso 3: pré-termo de 34 semanas de idade gestacional, sexo masculino, com 61 dias de vida, com pneumonia por Bordetella pertussis, hipertensão pulmonar severa, choque, hiperleucocitose e convulsões. Keywords: Extracorporeal membrane oxygenation, Newborn, Congenital diaphragmatic hernia, Tracheal stenosis, Bordetella pertussis infection, Palavras-chave: Oxigenação por membrana extracorporal, Recém-nascido, Hérnia diafragmática congénita, Estenose traqueal, Infeção por Bordetella pertussis

  11. Myocardial delayed-enhancement CT: initial experience in children and young adults

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of)

    2017-10-15

    Clinical utility of myocardial delayed enhancement CT has not been reported in children and young adults. To describe initial experience of myocardial delayed enhancement CT regarding image quality, radiation dose and identification of myocardial lesions in children and young adults. Between August 2013 and November 2016, 29 consecutive children and young adults (median age 16 months) with suspected coronary artery or myocardial abnormality underwent arterial- and delayed-phase cardiac CT at our institution. We measured CT densities in normal myocardium, left ventricular cavity, and arterial and delayed hypo-enhancing and delayed hyperenhancing myocardial lesions. We then compared the extent of delayed hyperenhancing lesions with delayed-enhancement MRI or thallium single-photon emission CT. Normal myocardium and left ventricular cavity showed significantly higher CT numbers on arterial-phase CT than on delayed-phase CT (t-test, P<0.0001). Contrast-to-noise ratios of the arterial and delayed hypo-enhancing and delayed hyperenhancing lesions on CT were 26.7, 17.6 and 18.7, respectively. Delayed-phase CT findings were equivalent to those of delayed-enhancement MRI in all cases (7/7) and to those of thallium single-photon emission CT in 70% (7/10). Myocardial delayed-enhancement CT can be added to evaluate myocardial lesions in select children and young adults with suspected coronary artery or myocardial abnormality. (orig.)

  12. Myocardial delayed-enhancement CT: initial experience in children and young adults

    International Nuclear Information System (INIS)

    Goo, Hyun Woo

    2017-01-01

    Clinical utility of myocardial delayed enhancement CT has not been reported in children and young adults. To describe initial experience of myocardial delayed enhancement CT regarding image quality, radiation dose and identification of myocardial lesions in children and young adults. Between August 2013 and November 2016, 29 consecutive children and young adults (median age 16 months) with suspected coronary artery or myocardial abnormality underwent arterial- and delayed-phase cardiac CT at our institution. We measured CT densities in normal myocardium, left ventricular cavity, and arterial and delayed hypo-enhancing and delayed hyperenhancing myocardial lesions. We then compared the extent of delayed hyperenhancing lesions with delayed-enhancement MRI or thallium single-photon emission CT. Normal myocardium and left ventricular cavity showed significantly higher CT numbers on arterial-phase CT than on delayed-phase CT (t-test, P<0.0001). Contrast-to-noise ratios of the arterial and delayed hypo-enhancing and delayed hyperenhancing lesions on CT were 26.7, 17.6 and 18.7, respectively. Delayed-phase CT findings were equivalent to those of delayed-enhancement MRI in all cases (7/7) and to those of thallium single-photon emission CT in 70% (7/10). Myocardial delayed-enhancement CT can be added to evaluate myocardial lesions in select children and young adults with suspected coronary artery or myocardial abnormality. (orig.)

  13. Initial experience in hybrid PET-MRI for evaluation of refractory focal onset epilepsy.

    Science.gov (United States)

    Shin, Hae W; Jewells, Valerie; Sheikh, Arif; Zhang, Jingwen; Zhu, Hongtu; An, Hongyu; Gao, Wei; Shen, Dinggang; Hadar, Eldad; Lin, Weili

    2015-09-01

    We aim to evaluate the utility/improved accuracy of hybrid PET/MR compared to current practice separate 3T MRI and PET-CT imaging for localization of seizure foci. In a pilot study, twenty-nine patients undergoing epilepsy surgery evaluation were imaged using PET/MR. This subject group had 29 previous clinical 3T MRI as well as 12 PET-CT studies. Prior clinical PET and MR images were read sequentially while the hybrid PET/MR was concurrently read. The median interval between hybrid PET/MR and prior imaging studies was 5 months (range 1-77 months). In 24 patients, there was no change in the read between the clinical exams and hybrid PET/MR while new anatomical or functional lesions were identified by hybrid PET/MR in 5 patients without significant clinical change. Four new anatomical MR lesions were seen with concordant PET findings. The remaining patient revealed a new abnormal PET lesion without an MR abnormality. All new PET/MR lesions were clinically significant with concordant EEG and/or SPECT results as potential epileptic foci. Our initial hybrid PET-MRI experience increased diagnostic yields for detection of potential epileptic lesions. This may be due to the unique advantage of improved co-registration and simultaneous review of both structural and functional data. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  14. Transluminal Angioplasty of Peroneal Artery Branches in Diabetics: Initial Technical Experience

    International Nuclear Information System (INIS)

    Graziani, Lanfroi; Silvestro, Antonio; Monge, Luca; Boffano, Gian Mario; Kokaly, Francesco; Casadidio, Ilaria; Giannini, Francesco

    2008-01-01

    The present study aimed to report the technical feasibility of percutaneous transluminal angioplasty (PTA) of obstructed or insufficient collateral branches (anterior and posterior perforating branches) from distal peroneal to foot arteries in diabetic patients with chronic critical limb ischemia (CLI) and chronic noncrossable occlusion of the anterior and posterior tibial arteries. Twenty-four diabetic CLI patients (age, 67 ± 8 years; 87% males) undergoing collateral PTA were included. Baseline clinical angiographic and follow-up data were retrospectively reviewed. Collateral PTA was associated with a concomitant PTA of other sites in 21 (83%) cases. In 15 cases the treated collateral linked the peroneal with the plantaris communis; in 9 cases, the peroneal with the dorsalis pedis. Angiographic results of collateral PTA were good in 13 cases (<30% residual stenosis), whereas the result was considered moderate (30%-49% residual stenosis) in the remaining cases. Neither perforation nor acute occlusion of the treated collaterals or other relevant complications were observed. Mean follow-up was 32 ± 17 months. Major amputation was necessary for two (8.3%) patients. Cumulative limb salvage rates at 2 and 4 years were 96% and 87%, respectively. In conclusion, this initial experience shows that PTA of the collateral branches from distal peroneal to foot arteries is a feasible technique. Future studies are required to define the clinical role of this novel approach

  15. The effect of residual ventricular septal defects on early clinical outcome: initial experience

    International Nuclear Information System (INIS)

    Zaman, H.; Cheema, M.A.; Jalal, A.

    2000-01-01

    Residual ventricular septal defect (VSD)after repair of isolated VSD or Fallot's tetralogy is one of the main causes of morbidity and re-operations. In this paper we have presented the results of out initial experience regarding the management of this problem. The data consists of 71 patients (22 isolated VSD and 29 fallout's tetralogy) operate during January 1991 to July, 1993. The incidence of residual VSD as shown by color doppler study at the time of discharge from hospital and at three month's follow-up was 3 out of 60 patients(73%) and 12 out of to (20%) respectively. Six out of these 12 patients were NYHA class III-IV who underwent cardiac catheterization which revealed patch dehiscence in two patients and residual right ventricular outflow tract obstruction in four patients. The two patients, with patch dehiscence were reported successfully with very good outcome. Simple color doppler mapping tends to over-diagnose residual VSDs since it can pick up small haemodynamically insignificant leaks around stitches and needle holes which seal off in due course. The findings of color doppler should, therefore, be correlated with actual clinical outcome in order to proceed with further investigation and re-operation. (author)

  16. Percutaneous fiducial marker placement prior to stereotactic body radiotherapy for malignant liver tumors: an initial experience

    International Nuclear Information System (INIS)

    Ohta, Kengo; Shimohira, Masashi; Murai, Taro; Nishimura, Junichi; Iwata, Hiromitsu; Ogino, Hiroyuki; Hashizume, Takuya; Shibamoto, Yuta

    2016-01-01

    The aim of this study was to describe our initial experience with a gold flexible linear fiducial marker and to evaluate the safety and technical and clinical efficacy of stereotactic body radiotherapy using this marker for malignant liver tumors. Between July 2012 and February 2015, 18 patients underwent percutaneous fiducial marker placement before stereotactic body radiotherapy for malignant liver tumors. We evaluated the technical and clinical success rates of the procedure and the associated complications. Technical success was defined as successful placement of the fiducial marker at the target site, and clinical success was defined as the completion of stereotactic body radiotherapy without the marker dropping out of position. All 18 fiducial markers were placed successfully, so the technical success rate was 100% (18/18). All 18 patients were able to undergo stereotactic body radiotherapy without marker migration. Thus, the clinical success rate was 100% (18/18). Slight pneumothorax occurred as a minor complication in one case. No major complications such as coil migration or bleeding were observed. The examined percutaneous fiducial marker was safely placed in the liver and appeared to be useful for stereotactic body radiotherapy for malignant liver tumors

  17. Catheter closure of patent foramen ovale in patients with cryptogenic cerebrovascular accidents: initial experiences in Japan.

    Science.gov (United States)

    Kijima, Yasufumi; Akagi, Teiji; Nakagawa, Koji; Taniguchi, Manabu; Ueoka, Akira; Deguchi, Kentaro; Toh, Norihisa; Oe, Hiroki; Kusano, Kengo; Sano, Shunji; Ito, Hiroshi

    2014-01-01

    Although numerous studies have shown an association between a patent foramen ovale (PFO) and cryptogenic cerebrovascular accidents (CVA), there has been no definitive control study that demonstrated the benefit of percutaneous device closure of a PFO compared to medical therapy in patients with CVA. Additionally, few clinical data exist for Japanese patients in this field. We demonstrate the initial experiences in catheter closure of a PFO as secondary prevention of CVA in Japan. Catheter closure of a PFO was attempted in 7 patients who were diagnosed with cryptogenic CVA. Mean age at the procedure was 54 ± 19 years. The presence of spontaneous interatrial right-to-left shunts was demonstrated by transesophageal contrast echocardiography without Valsalva maneuver in all of the patients. Amplatzer Cribriform device (n = 4) or Amplatzer PFO Occluder (n = 3) was used for the procedure and was successfully deployed. Device-related complications were not observed at the time of the procedure or during the follow-up period (mean period of 16 ± 9 months). Catheter closure of a PFO could be safely performed with Amplatzer Cribriform or Amplatzer PFO Occluder. This procedure may contribute to prevention of recurrent cryptogenic CVA in Japanese patients.

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

    Science.gov (United States)

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

    2014-11-01

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

  19. Initial experience of two national centers in transcatheter aortic prosthesis implantation.

    Science.gov (United States)

    Lluberas, Sebastián; Abizaid, Alexandre; Siqueira, Dimytri; Ramos, Auristela; Costa, J Ribamar; Arrais, Magaly; Kambara, Antônio; Bihan, David Le; Sousa, Amanda; Sousa, J Eduardo

    2014-04-01

    Transcatheter aortic valve implantation is an effective alternative to surgical treatment of severe aortic stenosis in patients who are inoperable or at high surgical risk. To report the immediate and follow-up clinical and echocardiographic results of the initial experience of transcatheter aortic valve implantation. From 2009 June to 2013 February, 112 patients underwent transcatheter aortic valve implantation. Mean age was 82.5 ± 6.5 years, and the logistic EuroSCORE was 23.6 ± 13.5. Procedural success was 84%. After the intervention, a reduction in the mean systolic gradient was observed (pre: 54.7 ± 15.3 vs. post: 11.7 ± 4.0 mmHg; p < 0.01). Cerebrovascular accidents occurred in 3.6%, vascular complications in 19% and permanent pacemaker was required by 13% of the patients. Thirty-day mortality and at follow-up of 16 ± 11 months was 14% and 8.9% respectively. The presence of chronic obstructive pulmonary disease was the only predictor of mortality at 30 days and at follow-up. During follow up, aortic valve area and mean systolic gradient did not change significantly. Transcatheter aortic valve implantation is an effective and safe procedure for the treatment of aortic stenosis in high-surgical risk or inoperable patients. The presence of chronic obstructive pulmonary disease was the only independent predictor of mortality identified both in the first month post-intervention and at follow-up.

  20. MR imaging-guided cryoablation of metastatic brain tumours: initial experience in six patients

    International Nuclear Information System (INIS)

    Li, Chengli; Wu, Lebin; Song, Jiqing; Liu, Ming; Lv, Yubo; Sequeiros, Roberto Blanco

    2010-01-01

    The objective was to evaluate the initial experience and safety of magnetic resonance imaging (MRI)-guided transcranial cryoablation in cystic metastatic brain tumours. Seven cystic metastatic brain tumours in six patients were treated with cryoablation. The approval from the local ethics committee and individual patient consent were acquired before the study. Before the procedure the tumours were detected with conventional CT or MRI. The procedure was performed under local anaesthesia and conscious sedation. A 0.23-T open MRI system with optical tracking was used for procedural planning, instrument guidance and procedural monitoring of the ice ball formation. An MR-compatible, argon-based cryoablation system was used. The schedule of follow-up imaging ranged from 12 days to 12 months. Seven treatment sessions were performed. All the cryoprobes were successfully inserted into the target with one pass. All the patients tolerated the procedure well without experiencing any neurological deficits during the treatment phase or during the immediate post-treatment period. One patient died 12 days after cryoablation. MR-guided and monitored metastasis brain tumour cryoablation is technically feasible and may represent an alternative treatment in selected patients. (orig.)

  1. Low-dose CT colonography in children: initial experience, technical feasibility and utility

    International Nuclear Information System (INIS)

    Anupindi, Sudha; Perumpillichira, James; Zalis, Michael E.; Jaramillo, Diego; Israel, Esther J.

    2005-01-01

    CT colonography (CTC) is utilized as a diagnostic tool in the detection of colon polyps and early colorectal cancer in adults. Large studies in the literature, although focused on adult populations, have shown CTC to be a safe, accurate, non-invasive technique. We evaluated the technical feasibility of CTC in children using a low-dose technique. From November 2001 to April 2004 we evaluated eight patients (3-17 years) with non-contrast CTC. Seven of the patients had CTC, followed by standard colonoscopy (SC) the same day; in one patient, CTC followed a failed SC. CTC results were compared to results of SC. The estimated effective dose from each CTC was calculated and compared to that of standard barium enema. CTC results were consistent with those of SC. Sensitivity for polyps 5-10 mm was 100%, and sensitivity for polyps 10 mm and larger was 66.7%. The estimated mean effective dose was 2.17 mSv for CTC, compared to the 5-6 mSv for a standard air-contrast barium enema in a small child. Our initial experience shows CTC in children is well-tolerated, safe, and useful. The procedure can be performed successfully with a low radiation dose, and preliminary results compare well with SC. (orig.)

  2. Lateral Transorbital Endoscopic Access to the Hippocampus, Amygdala, and Entorhinal Cortex: Initial Clinical Experience.

    Science.gov (United States)

    Chen, H Isaac; Bohman, Leif-Erik; Emery, Lyndsey; Martinez-Lage, Maria; Richardson, Andrew G; Davis, Kathryn A; Pollard, John R; Litt, Brian; Gausas, Roberta E; Lucas, Timothy H

    2015-01-01

    Transorbital approaches traditionally have focused on skull base and cavernous sinus lesions medial to the globe. Lateral orbital approaches to the temporal lobe have not been widely explored despite several theoretical advantages compared to open craniotomy. Recently, we demonstrated the feasibility of the lateral transorbital technique in cadaveric specimens with endoscopic visualization. We describe our initial clinical experience with the endoscope-assisted lateral transorbital approach to lesions in the temporal lobe. Two patients with mesial temporal lobe pathology presenting with seizures underwent surgery. The use of a transpalpebral or Stallard-Wright eyebrow incision enabled access to the intraorbital compartment, and a lateral orbital wall 'keyhole' opening permitted visualization of the anterior temporal pole. This approach afforded adequate access to the surgical target and surrounding structures and was well tolerated by the patients. To the best of our knowledge, this report constitutes the first case series describing the endoscope-assisted lateral transorbital approach to the temporal lobe. We discuss the limits of exposure, the nuances of opening and closing, and comparisons to open craniotomy. Further prospective investigation of this approach is warranted for comparison to traditional approaches to the mesial temporal lobe. © 2015 S. Karger AG, Basel.

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

    Science.gov (United States)

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

    2016-09-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-09-15

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

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

    Science.gov (United States)

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

    2012-01-01

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

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

    NARCIS (Netherlands)

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

    2014-01-01

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

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

    NARCIS (Netherlands)

    Deichmann, D.; van den Ende, J..

    2014-01-01

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

  8. Minimizing complications of ultrasound-assisted lipoplasty: an initial experience with no related complications.

    Science.gov (United States)

    Tebbetts, J B

    1998-10-01

    Numerous complications and increased operating times were reported with ultrasonically assisted lipoplasty in the first several months after introduction of the technology in the United States. The purpose of this study was to review early reported complications and management regimens, evaluate possible causes of problems, and apply indications and techniques to attempt to minimize complications during an initial experience with this technique beginning in January of 1997. Seven specific indications and modifications of existing techniques were developed and applied to an initial clinical series of 70 consecutive patients who underwent ultrasound-assisted suction lipoplasty between January 10, 1997, and August 1, 1997. Follow-up ranged from 1 to 7 months. No perioperative or postoperative complication occurred in any patient in this series. In this series of ultrasound-assisted lipoplasty cases, application of the following criteria resulted in a series of 70 patients with 1 to 7-month follow-up without complications: (1) selecting patients with well localized fat deposits who were no more than 20 percent above their ideal body weight; (2) infusing a solution of Ringer's Lactate containing 1 cc of 1:1000 epinephrine per 1000 cc into the area of fat removal, stopping infusion when the tissues first become firm, not infusing to marked tissue turgor or skin induration; (3) restricting the level of energy application to a minimum of 1 cm from the undersurface of the dermis; (4) limiting ultrasonic energy application in each area to approximately 1 minute per estimated 100 cc of total aspirate in a wet to superwet environment; (5) not performing ultrasound-assisted lipoplasty in the same area as another procedure that could potentially compromise tissue vascularity; (6) using a Lysonix 2000 generator and 5-mm golf tee tip probe at a power setting of 8 to apply ultrasonic energy to the area of fat removal, ceasing energy application when tissue resistance to the passage

  9. The experience of initiating injection drug use and its social context: a qualitative systematic review and thematic synthesis.

    Science.gov (United States)

    Guise, Andy; Horyniak, Danielle; Melo, Jason; McNeil, Ryan; Werb, Dan

    2017-12-01

    Understanding the experience of initiating injection drug use and its social contexts is crucial to inform efforts to prevent transitions into this mode of drug consumption and support harm reduction. We reviewed and synthesized existing qualitative scientific literature systematically to identify the socio-structural contexts for, and experiences of, the initiation of injection drug use. We searched six databases (Medline, Embase, PsychINFO, CINAHL, IBSS and SSCI) systematically, along with a manual search, including key journals and subject experts. Peer-reviewed studies were included if they qualitatively explored experiences of or socio-structural contexts for injection drug use initiation. A thematic synthesis approach was used to identify descriptive and analytical themes throughout studies. From 1731 initial results, 41 studies reporting data from 1996 participants were included. We developed eight descriptive themes and two analytical (higher-order) themes. The first analytical theme focused on injecting initiation resulting from a social process enabled and constrained by socio-structural factors: social networks and individual interactions, socialization into drug-using identities and choices enabled and constrained by social context all combine to produce processes of injection initiation. The second analytical theme addressed pathways that explore varying meanings attached to injection initiation and how they link to social context: seeking pleasure, responses to increasing tolerance to drugs, securing belonging and identity and coping with pain and trauma. Qualitative research shows that injection drug use initiation has varying and distinct meanings for individuals involved and is a dynamic process shaped by social and structural factors. Interventions should therefore respond to the socio-structural influences on injecting drug use initiation by seeking to modify the contexts for initiation, rather than solely prioritizing the reduction of individual

  10. In-pile observations of fuel and clad relocation during LMFBR initiation phase accident experiments - the STAR experiments

    International Nuclear Information System (INIS)

    Wright, S.A.; Schumacher, G.; Henkel, P.R.; Royl, P.

    1987-01-01

    A series of seven in-pile experiments (the STAR experiments) were performed in which clad motion and fuel dispersal were observed in small pin bundles with high-speed cinematography. The experimental heating conditions reproduced a range of Loss of Flow (LOF) accident scenarios for the lead subassemblies in LMFBRs. The experiments show strong tendencies for limited clad motion in multiple pin bundles, early fuel disruption and dispersal (prior to fuel melting) in moderate power transients having simultaneous clad melting and fuel disruption. The more recent experiments indicate a possibility of steel vapor driven fuel dispersal after fuel breakup and intimate fuel/steel mixing. (author)

  11. The Global Tracheostomy Collaborative: one institution's experience with a new quality improvement initiative.

    Science.gov (United States)

    Lavin, Jennifer; Shah, Rahul; Greenlick, Hannah; Gaudreau, Philip; Bedwell, Joshua

    2016-01-01

    Given the low frequency of adverse events after tracheostomy, individual institutions struggle to collect outcome data to generate effective quality improvement protocols. The Global Tracheostomy Collaborative (GTC) is a multi-institutional, multi-disciplinary organization that utilizes a prospective database to collect data on patients undergoing tracheostomy. We describe our institution's preliminary experience with this collaborative. It was hypothesized that entry into the database would be non-burdensome and could be easily and accurately initiated by skilled specialists at the time of tracheostomy placement and completed at time of patient discharge. Demographic, diagnostic, and outcome data on children undergoing tracheostomy at our institution from January 2013 to June 2015 were entered into the GTC database, a database collected and managed by REDCap (Research Electronic Data Capture). All data entry was performed by pediatric otolaryngology fellows and all post-operative updates were completed by a skilled tracheostomy nurse. Tracked outcomes included accidental decannulation, failed decannulation, tracheostomy tube obstruction, bleeding/tracheoinnominate fistula, and tracheocutaneous fistula. Data from 79 patients undergoing tracheostomy at our institution were recorded. Database entry was straightforward and entry of patient demographic information, medical comorbidities, surgical indications, and date of tracheostomy placement was completed in less than 5min per patient. The most common indication for surgery was facilitation of ventilation in 65 patients (82.3%). Average time from admission to tracheostomy was 62.6 days (range 0-246). Stomal breakdown was seen in 1 patient. A total of 72 patients were tracked to hospital discharge with 53 patients surviving (88.3%). No mortalities were tracheostomy-related. The Global Tracheostomy Collaborative is a multi-institutional, multi-disciplinary collaborative that collects data on patients undergoing

  12. Gamma Imaging-Guided Minimally Invasive Breast Biopsy: Initial Clinical Experience.

    Science.gov (United States)

    Brem, Rachel F; Mehta, Anita K; Rapelyea, Jocelyn A; Akin, Esma A; Bazoberry, Adriana M; Velasco, Christel D

    2018-03-01

    The purpose of this study was to evaluate our initial experience with gamma imaging-guided vacuum-assisted breast biopsy in women with abnormal findings. A retrospective review of patients undergoing breast-specific gamma imaging (BSGI), also known as molecular breast imaging (MBI), between April 2011 and October 2015 found 117 nonpalpable mammographically and sonographically occult lesions for which gamma imaging-guided biopsies were recommended. Biopsy was performed with a 9-gauge vacuum-assisted device with subsequent placement of a titanium biopsy site marker. Medical records and pathologic findings were evaluated. Of the 117 biopsies recommended, 104 were successful and 13 were canceled. Of the 104 performed biopsies, 32 (30.8%) had abnormal pathologic findings. Of those 32 biopsies, nine (28.1%) found invasive cancers, six (18.8%) found ductal carcinoma in situ (DCIS), and 17 (53.1%) found high-risk lesions. Of the 17 high-risk lesions, there were three (17.6%) lobular carcinomas in situ, five (29.4%) atypical ductal hyperplasias, two (11.8%) atypical lobular hyperplasias, one (5.9%) flat epithelial atypia, and six (35.3%) papillomas. Two cases of atypical ductal hyperplasia were upgraded to DCIS at surgery. The overall cancer detection rate for gamma imaging-guided biopsy was 16.3%. In this study, gamma imaging-guided biopsy had a positive predictive value of total successful biopsies of 16.3% for cancer and 30.8% for cancer and high-risk lesions. Gamma imaging-guided biopsy is a viable approach to sampling BSGI-MBI-detected lesions without sonographic or mammographic correlate. Our results compare favorably to those reported for MRI-guided biopsy.

  13. Initiating an online asthma management program in urban emergency departments: the recruitment experience.

    Science.gov (United States)

    Joseph, Christine L M; Lu, Mei; Stokes-Bruzzelli, Stephanie; Johnson, Dayna A; Duffy, Elizabeth; Demers, Michele; Zhang, Talan; Ownby, Dennis R; Zoratti, Edward; Mahajan, Prashant

    2016-01-01

    The emergency department could represent a means of identifying patients with asthma who could benefit from asthma interventions. To assess the initiation of a Web-based tailored asthma intervention in the emergency department of 2 urban tertiary care hospitals. In addition to awareness strategies for emergency department staff (eg, attending nursing huddles, division meetings, etc), recruitment experiences are described for 2 strategies: (1) recruitment during an emergency department visit for acute asthma and (2) recruitment from patient listings (mail or telephone). Patient enrollment was defined as baseline completion, randomization, and completion of the first of 4 online sessions. Of 499 eligible patients 13 to 19 years old visiting the emergency department for asthma during the study period, 313 (63%) were contacted in the emergency department (n = 65) or by mail or telephone (n = 350). Of these, 121 (38.6%) were randomized. Mean age of the study sample was 15.4 years and 88.4% were African American. Refusal rates for emergency department recruitment and mail or telephone were 18.5% (12 of 65) and 16.6% (58 of 350), respectively. On average, emergency department enrollment took 44 to 67 minutes, including downtime. When surveyed, emergency department providers were more positive about awareness activities and emergency department recruitment than were research staff. Emergency department recruitment was feasible but labor intensive. Refusal rates were similar for the 2 strategies. Targeting patients with acute asthma in the emergency department is one way of connecting with youth at risk of future acute events. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2014-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Carlo Camargo Passerotti

    2012-02-01

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

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

    Science.gov (United States)

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

    2016-02-01

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

  17. Implementation of a patient dose monitoring system in conventional digital X-ray imaging: initial experiences

    Energy Technology Data Exchange (ETDEWEB)

    Heilmaier, Christina; Zuber, Niklaus; Weishaupt, Dominik [Stadtspital Triemli Zurich, Department of Radiology and Nuclear Medicine, Zurich (Switzerland)

    2017-03-15

    The purpose was to report on the initial experience after implementation of a patient dose-monitoring system in conventional X-ray imaging. A dose-monitoring system collected dose data relating to different radiographs (one projection) and studies (two or more projections). Images were acquired on digital X-ray systems equipped with flat-panel detectors. During period 1, examinations were performed in a routine fashion in 12,614 patients. After period 1, technical modifications were performed and radiographers underwent training in radiation protection. During period 2, examinations were performed in 14,514 patients, and the radiographers were advised to read dose data after each radiograph/study. Dose data were compared by means of kerma area product (KAP, gray x centimetre squared) and entrance surface air kerma (ESAK, milligray). During period 1, 13,955 radiographs and 8,466 studies were performed, and in period 2 16,090 radiographs and 10,389 studies. In period 2, KAP values for radiographs were an average of 25 % lower and for studies 7 % lower, and ESAK values for radiographs were 24 % lower and for studies 5 % lower. The reduction in KAP was significant in 8/13 radiographs and in 6/14 studies, and the reduction in ESAK was significant in 6/13 radiographs and 5/14 studies. Implementation of a patient dose-monitoring system in conventional X-ray imaging allows easy data collection, supports dose reduction efforts, and may increase radiographers' dose awareness. (orig.)

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

    International Nuclear Information System (INIS)

    Green, O; Kashani, R; Santanam, L; Wooten, H; Li, H; Rodriguez, V; Hu, Y; Mutic, S; Hand, T; Victoria, J; Steele, C

    2014-01-01

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

  19. MR imaging-guided percutaneous cryotherapy for lung tumors: initial experience.

    Science.gov (United States)

    Liu, Shangang; Ren, Ruimei; Liu, Ming; Lv, Yubo; Li, Bin; Li, Chengli

    2014-09-01

    To evaluate prospectively the initial clinical experience of magnetic resonance (MR) imaging-guided percutaneous cryotherapy of lung tumors. MR imaging-guided percutaneous cryotherapy was performed in 21 patients with biopsy-proven lung tumors (12 men, 9 women; age range, 39-79 y). Follow-up consisted of contrast-enhanced chest computed tomography (CT) scan performed at 3-month intervals to assess tumor control; CT scanning was carried out for 12 months or until death. Cryotherapy procedures were successfully completed in all 21 patients. Pneumothorax occurred in 7 (33.3%) of 21 patients. Chest tube placement was required in one (4.8%) case. Hemoptysis was exhibited by 11 (52.4%) patients, and pleural effusion occurred in 6 (28.6%) patients. Other complications were observed in 14 (66.7%) patients. The mean follow-up period was 10.5 months (range, 9-12 mo) in patients who died. At month 12 of follow-up, 7 (33.3%) patients had a complete response to therapy, and 10 (47.6%) patients showed a partial response. In addition, two patients had stable disease, and two patients developed progressive disease; one patient developed a tumor in the liver, and the other developed a tumor in the brain. The 1-year local control rate was 81%, and 1-year survival rate was 90.5%. MR imaging-guided percutaneous cryotherapy appears feasible, effective, and minimally invasive for lung tumors. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

  20. Early initial clinical experience with intravitreal aflibercept for wet age-related macular degeneration.

    Science.gov (United States)

    Ferrone, Philip J; Anwar, Farihah; Naysan, Jonathan; Chaudhary, Khurram; Fastenberg, David; Graham, Kenneth; Deramo, Vincent

    2014-06-01

    Age-related macular degeneration (AMD) is a degenerative process that leads to severe vision loss. Wet AMD is defined by choroidal neovascularisation, leading to the accumulation of subretinal fluid (SRF), macular oedema (ME), and pigment epithelium detachments (PED). Purpose To evaluate the initial clinical experience of conversion from bevacizumab or ranibizumab to aflibercept in wet AMD patients. Records of 250 consecutive wet AMD patients were retrospectively reviewed. Of 250 patients, 29 were naive (with no previous treatment), and 221 were previously treated with bevacizumab (1/3) or ranibizumab (2/3). On average, converted patients received 14 injections every 6 weeks on a treat-and-extend regimen with Avastin or Lucentis before being converted to aflibercept every 7 weeks on average (no loading dose) for three doses. For the purposes of this study, we concentrated on the patients converted to aflibercept since the number of naive patients was too small to draw any conclusion from. Snellen (as logMar) visual acuities, and optical coherence tomography (OCT) were compared predrug and postdrug conversion. Converted patients did not show a significant difference in visual acuity or average OCT thickness from preconversion values; however, small improvements in ME (p=0.0001), SRF (p=0.0001), and PED (p=0.008) grading were noted on average after conversion to aflibercept. No significant difference in visual outcome or average OCT thickness was observed when switched from bevacizumab or ranibizumab q6 week to aflibercept 7-week dosing, on average. Mild anatomic improvements did occur in converted patients with regard to ME, SRF and PED improvement, on average, after conversion to aflibercept, and aflibercept was injected less frequently. No serious adverse reactions, including ocular infections or inflammation, as well as ocular and systemic effects were noted. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted

  1. Prioritising integrated care initiatives on a national level. Experiences from Austria

    Directory of Open Access Journals (Sweden)

    Karin Eger

    2009-09-01

    Full Text Available Introduction and background: Based on a policy initiative and the foundation of the Competence Centre for Integrated Care by the Austrian Social Security Institutions in 2006, the aim of the project was to identify and prioritise potential diseases and target groups for which integrated care models should be developed and implemented within the Austrian health system. The project was conducted as a cooperation between the Competence Centre for Integrated Care of the Viennese Health Insurance Fund and the Institute of Social Medicine of the Medical University Vienna to ensure the involvement of both, theory and practice. Project report: The focus of the project was to develop an evidence-based process for the identification and prioritisation of diseases and target groups for integrated care measures. As there was no evidence of similar projects elsewhere, the team set out to design the prioritisation process and formulate the selection criteria based on the work in a focus group, literature reviews and a scientific council of national and international experts. The method and criteria were evaluated by an expert workshop. Discussion: The active involvement of all stakeholders from the beginning was crucial for the success. The time constraint proved also beneficial since it allowed the project team to demand focus and cooperation from all experts and stakeholders included. Conclusion: Our experience demonstrates that, with a clear concept and model, an evidence-based prioritisation including all stakeholders can be achieved. Ultimately however, the prioritisation is a political discussion and decision. Our model can only help base these decisions on sound and reasonable assumptions.

  2. Sternal plate fixation for sternal wound reconstruction: initial experience (Retrospective study

    Directory of Open Access Journals (Sweden)

    Musgrave Melinda

    2011-04-01

    Full Text Available Abstract Background Median sternotomy infection and bony nonunion are two commonly described complications which occur in 0.4 - 5.1% of cardiac procedures. Although relatively infrequent, these complications can lead to significant morbidity and mortality. The aim of this retrospective study is to evaluate the initial experience of a transverse plate fixation system following wound complications associated with sternal dehiscence with or without infection following cardiac surgery. Methods A retrospective chart review of 40 consecutive patients who required sternal wound reconstruction post sternotomy was performed. Soft tissue debridement with removal of all compromised tissue was performed. Sternal debridement was carried using ronguers to healthy bleeding bone. All patients underwent sternal fixation using three rib plates combined with a single manubrial plate (Titanium Sternal Fixation System®, Synthes. Incisions were closed in a layered fashion with the pectoral muscles being advanced to the midline. Data were expressed as mean ± SD, Median (range or number (%. Statistical analyses were made by using Excel 2003 for Windows (Microsoft, Redmond, WA, USA. Results There were 40 consecutive patients, 31 males and 9 females. Twenty two patients (55% were diagnosed with sternal dehiscence alone and 18 patients (45% with associated wound discharge. Thirty eight patients went on to heal their wounds. Two patients developed recurrent wound infection and required VAC therapy. Both were immunocompromised. Median post-op ICU stay was one day with the median hospital stay of 18 days after plating. Conclusion Sternal plating appears to be an effective option for the treatment of sternal wound dehiscence associated with sternal instability. Long-term follow-up and further larger studies are needed to address the indications, benefits and complications of sternal plating.

  3. Accelerated partial-breast irradiation using proton beams: Initial clinical experience

    International Nuclear Information System (INIS)

    Kozak, Kevin R.; Smith, Barbara L.; Adams, Judith C.; Kornmehl, Ellen; Katz, Angela; Gadd, Michele; Specht, Michelle; Hughes, Kevin; Gioioso, Valeria; Lu, H.-M.; Braaten, Kristina; Recht, Abram; Powell, Simon N.; DeLaney, Thomas F.; Taghian, Alphonse G.

    2006-01-01

    Purpose: We present our initial clinical experience with proton, three-dimensional, conformal, external beam, partial-breast irradiation (3D-CPBI). Methods and Materials: Twenty patients with Stage I breast cancer were treated with proton 3D-CPBI in a Phase I/II clinical trial. Patients were followed at 3 to 4 weeks, 6 to 8 weeks, 6 months, and every 6 months thereafter for recurrent disease, cosmetic outcome, toxicity, and patient satisfaction. Results: With a median follow-up of 12 months (range, 8-22 months), no recurrent disease has been detected. Global breast cosmesis was judged by physicians to be good or excellent in 89% and 100% of cases at 6 months and 12 months, respectively. Patients rated global breast cosmesis as good or excellent in 100% of cases at both 6 and 12 months. Proton 3D-CPBI produced significant acute skin toxicity with moderate to severe skin color changes in 79% of patients at 3 to 4 weeks and moderate to severe moist desquamation in 22% of patients at 6 to 8 weeks. Telangiectasia was noted in 3 patients. Three patients reported rib tenderness in the treated area, and one rib fracture was documented. At last follow-up, 95% of patients reported total satisfaction with proton 3D-CPBI. Conclusions: Based on our study results, proton 3D-CPBI offers good-to-excellent cosmetic outcomes in 89% to 100% of patients at 6-month and 12-month follow-up and nearly universal patient satisfaction. However, proton 3D-CPBI, as used in this study, does result in significant acute skin toxicity and may potentially be associated with late skin (telangiectasia) and rib toxicity. Because of the dosimetric advantages of proton 3D-CPBI, technique modifications are being explored to improve acute skin tolerance

  4. Initial experience with xenograft bioconduit for the treatment of complex prosthetic valve endocarditis.

    Science.gov (United States)

    Roubelakis, Apostolos; Karangelis, Dimos; Sadeque, Syed; Yanagawa, Bobby; Modi, Amit; Barlow, Clifford W; Livesey, Steven A; Ohri, Sunil K

    2017-07-01

    The treatment of complex prosthetic valve endocarditis (PVE) with aortic root abscess remains a surgical challenge. Several studies support the use of biological tissues to minimize the risk of recurrent infection. We present our initial surgical experience with the use of an aortic xenograft conduit for aortic valve and root replacement. Between October 2013 and August 2015, 15 xenograft bioconduits were implanted for complex PVE with abscess (13.3% female). In 6 patients, concomitant procedures were performed: coronary bypass (n=1), mitral valve replacement (n=5) and tricuspid annuloplasty (n=1). The mean age at operation was 60.3±15.5 years. The mean Logistic European system for cardiac operating risk evaluation (EuroSCORE) was 46.6±23.6. The median follow-up time was 607±328 days (range: 172-1074 days). There were two in-hospital deaths (14.3% mortality), two strokes (14.3%) and seven patients required permanent pacemaker insertion for conduction abnormalities (46.7%). The mean length of hospital stay was 26 days. At pre-discharge echocardiography, the conduit mean gradient was 9.3±3.3mmHg and there was either none (n=6), trace (n=6) or mild aortic insufficiency (n=1). There was no incidence of mid-term death, prosthesis-related complications or recurrent endocarditis. Xenograft bioconduits may be safe and effective for aortic valve and root replacement for complex PVE with aortic root abscess. Although excess early mortality reflects the complexity of the patient population, there was good valve hemodynamics, with no incidence of recurrent endocarditis or prosthesis failure in the mid-term. Our data support the continued use and evaluation of this biological prosthesis in this high-risk patient cohort.

  5. South American Field Experience: An Initiative in International Education. The Implementation Journal for the South American Field Experience.

    Science.gov (United States)

    Martin, William J.

    A description is provided of Williamsport Area Community College's (WACC's) South American Field Experience program, a travel/study program for faculty and staff designed to provide a variety of learning experiences through a three week trip to Peru, Chile, Argentina, and Brazil. Chapter I presents an overview of the development of the project,…

  6. HL-1 tokamak data acquisition system and its initial application in the physical experiment

    International Nuclear Information System (INIS)

    Deng Huichen; Fu Bo; Dong Jiafu

    1989-11-01

    A HL-1 tokamak data acquisition system has been developed and has been used in the physical experiment. The hardware and software configuration of the system, as well as the typical acquired data in the HL-1 experiment are introduced

  7. Clinical and technical considerations for head and neck cancers treated by IMRT: initial experience

    International Nuclear Information System (INIS)

    Chao, K.S. Clifford; Low, Daniel A.; Gerber, Russell L.; Perez, Carlos A.; Purdy, James A.

    1997-01-01

    Purpose/Objective Intensity modulated radiation therapy (IMRT) has the potential to deliver dose distributions that decrease normal tissue toxicity while allowing dose escalation to the tumor to improve local control. Methods have been developed to critically assess patient immobilization, treatment planning, dose prescription, and treatment verification in patients with head and neck cancer treated using a commercial IMRT system (Peacock, NOMOS Corp.). This report presents our initial experience with inverse planning optimization and patient setup and immobilization evaluations. Materials and Methods Patients are non-invasively immobilized using a reinforced thermoplastic mask and a custom head support. The treatment planning computed tomography scan is acquired using a dedicated scanner. Targets and normal structures are defined on the treatment planning system. Dose optimization requires the input for each structure of dose limits, spatial margin, and optimization algorithm weight (range from zero to two). The optimization algorithm allows each spatial location to be occupied by only one structure. Applying a spatial margin often causes target and normal structures to overlap, so a structure-by-structure decision is made to determine if the target or the structure occupies overlapping space (target priority). The effect on the dose distribution of modifying the optimization parameters was evaluated for the parotid gland (see Figure 1 for plan identification). Verification of treatment setup and immobilization was conducted by acquiring two portal images each treatment session, one prior to and one after treatment, and comparing the locations of visible bony landmarks on the portal film against positions on a digitally reconstructed radiograph. Both inter- and intra-treatment motion in the cranio-caudal (CC) and anterior-posterior (AP) directions were studied. Results Figure 2 summarizes the compromise made between target coverage and tissue sparing. The plan

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

    International Nuclear Information System (INIS)

    Noel, Cory V.; Krishnamurthy, Ramkumar; Krishnamurthy, Rajesh; Moffett, Brady

    2017-01-01

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

  9. Guidelines Regarding §16 of the German Transplantation Act - Initial Experiences with Structured Reporting.

    Science.gov (United States)

    Pinto Dos Santos, Daniel; Arnhold, Gordon; Mildenberger, Peter; Düber, Christoph; Kloeckner, Roman

    2017-12-01

    the German Transplantation Act - Initial Experiences with Structured Reporting. Fortschr Röntgenstr 2017; 189: 1145 - 1151. © Georg Thieme Verlag KG Stuttgart · New York.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-03-15

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

  11. Prevalence of Sexual Experience and Initiation of Sexual Intercourse Among Adolescents, Rakai District, Uganda, 1994-2011

    DEFF Research Database (Denmark)

    Santelli, John S; Song, Xiaoyu; Larsen Holden, Inge Kristine

    2015-01-01

    : Sexual experience was more common among adolescent women than men. The prevalence of sexual experience rose for most age-gender groups after 1994 and then declined after 2002. Factors associated with higher prevalence of sexual experience (without adjustment for other factors) included age, not enrolled......PURPOSE: The purpose of the study was to identify risk factors and time trends for sexual experience and sexual debut in rural Uganda. METHODS: Using population-based, longitudinal data from 15- to 19-year olds in Rakai, Uganda, we examined temporal trends in the prevalence of sexual experience...... and potential risk factors for sexual experience (n = 31,517 person-round observations) using logistic regression. We then identified factors associated with initiation of sex between survey rounds, using Poisson regression to estimate incidence rate ratios (IRR; n = 5,126 person-year observations). RESULTS...

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

    Directory of Open Access Journals (Sweden)

    Pavel Měřička

    2014-05-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  14. Use of Simulation in Nursing Education: Initial Experiences on a European Union Lifelong Learning Programme--Leonardo Da Vinci Project

    Science.gov (United States)

    Terzioglu, Fusun; Tuna, Zahide; Duygulu, Sergul; Boztepe, Handan; Kapucu, Sevgisun; Ozdemir, Leyla; Akdemir, Nuran; Kocoglu, Deniz; Alinier, Guillaume; Festini, Filippo

    2013-01-01

    Aim: The aim of this paper is to share the initial experiences on a European Union (EU) Lifelong Learning Programme Leonardo Da Vinci Transfer of Innovation Project related to the use of simulation-based learning with nursing students from Turkey. The project started at the end of the 2010 involving 7 partners from 3 different countries including…

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

    Science.gov (United States)

    Shane, Nancy R.

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

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

    CSIR Research Space (South Africa)

    Cloete, Jacob PL

    2004-08-01

    Full Text Available ) claim process [2]. Dual Tone Multi Frequency (DTMF) and Wizard of Oz [3] based voice recognition system versions of the system were implemented in English and two in- digenous local languages: IsiZulu and Setswana. Each experiment consisted of pre... experiments based on a government application. 2 Experimental approach and results The objectives of the experiments were to improve theory on the use of user ex- periments, develop design guidelines and develop an ability to predict the success...

  17. Initiatives on early detection and intervention to proactively identify health and social problems in older people: experiences from the Netherlands.

    Science.gov (United States)

    Lette, Manon; Baan, Caroline A; van den Berg, Matthijs; de Bruin, Simone R

    2015-10-30

    Over the last years, several initiatives on early detection and intervention have been put in place to proactively identify health and social problems in (frail) older people. An overview of the initiatives currently available in the Netherlands is lacking, and it is unknown whether they meet the preferences and needs of older people. Therefore, the objectives of this study were threefold: 1. To identify initiatives on early detection and intervention for older people in the Netherlands and compare their characteristics; 2. To explore the experiences of professionals with these initiatives; and 3. To explore to what extent existing initiatives meet the preferences and needs of older people. We performed a qualitative descriptive study in which we conducted semi-structured interviews with seventeen experts in preventive elderly care and three group interviews with volunteer elderly advisors. Data were analysed using the framework analysis method. We identified eight categories of initiatives based on the setting (e.g. general practitioner practice, hospital, municipality) in which they were offered. Initiatives differed in their aims and target groups. The utilization of peers to identify problems and risks, as was done by some initiatives, was seen as a strength. Difficulties were experienced with identifying the target group that would benefit from proactive delivery of care and support most, and with addressing prevalent issues among older people (e.g. psychosocial issues, self-reliance issues). Although there is a broad array of initiatives available, there is a discrepancy between supply and demand. Current initiatives insufficiently address needs of (frail) older people. More insight is needed in "what should be done by whom, for which target group and at what moment", in order to improve current practice in preventive elderly care.

  18. Effect of flaming on Hydrocotyle ranunculoides L.f. survival. An initial experiment

    NARCIS (Netherlands)

    Burg, van der W.J.; Michielsen, J.G.P.

    2010-01-01

    The background of this pilot experiment was to find out if treatment in nature with hydrogen peroxide would be feasible as control measure. The experiment was designed to 1. try to raise plants in containers, and 2. to observe the effect of hydrogen spraying on the plants. This would allow to

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    of dietary habits of the employees and some experiments with healthier worksite eating schemes. Blue-collar employees, employees with working hours outside normal working hours and employees with shifting worksites are likely to be offered less organised and less healthy food schemes. Worksites experiments...

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

    CERN Document Server

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

    2005-01-01

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

  1. Cooling of particulate debris beds: analysis of the initial D-series experiments

    International Nuclear Information System (INIS)

    Rivard, J.B.

    1978-01-01

    In an effort to provide basic data on the cooling of fast reactor debris, three in-pile experiments employing oxide fuel particulate in liquid sodium were completed in late 1977. Preliminary results from these experiments were reported shortly after their completion at the Third Post-Accident Heat Removal Information Exchange, at Argonne National Laboratory. In these experiments, a distribution of 100 μm to 1000 μm-sized particles of enriched UO 2 was fission-heated to simulate decay-heated debris. In each experiment, the UO 2 particles were contained in a closed, flat-bottomed vessel 012 mm in diameter which was insulated on the diameter and bottom. Sufficient sodium was included to saturate the bed of particles and to provide a volume of bulk sodium above the bed at a controlled temperature. Parameters of interest in the experiments are given

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

    Science.gov (United States)

    Skinner, Barbara

    2010-01-01

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

  3. Short pulse duration shock initiation experiments plus ignition and growth modeling on Composition B

    International Nuclear Information System (INIS)

    May, Chadd M; Tarver, Craig M

    2014-01-01

    Composition B (63% RDX, 36% TNT, 1% wax) is still a widely used energetic material whose shock initiation characteristics are necessary to understand. It is now possible to shock initiate Composition B and other secondary explosives at diameters well below their characteristic failure diameters for unconfined self-sustaining detonation. This is done using very high velocity, very thin, small diameter flyer plates accelerated by electric or laser power sources. Recently experimental detonation versus failure to detonate threshold flyer velocity curves for Composition B using several Kapton TM flyer thicknesses and diameters were measured. Flyer plates with diameters of 2 mm successfully detonated Composition B, which has a nominal failure diameter of 4.3 mm. The shock pressures required for these initiations are greater than the Chapman-Jouguet (C-J) pressure in self-sustaining Composition B detonation waves. The initiation process is two-dimensional, because both rear and side rarefactions can affect the shocked Composition B reaction rates. The Ignition and Growth reactive flow model for Composition B is extended to yield accurate simulations of this new threshold velocity data for various flyer thicknesses.

  4. Percutaneous transcatheter closure of patent ductus arteriosus: Initial experience of Sohag University

    Directory of Open Access Journals (Sweden)

    Safaa Husein Ali

    2014-06-01

    Conclusion: Our initial results show that transcatheter occlusion of PDA using different types of devices is safe and effective with good midterm outcome alternative to surgery. Complications occurred in those with unfavorable duct anatomy and presence of pulmonary hypertension. Surgical backup was not important for such interventional procedures.

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

    Directory of Open Access Journals (Sweden)

    Marcio José da Silva Campos

    2013-10-01

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

  6. EXPERIENCES INITIATING SOFTWARE PRODUCT LINE ENGINEERING IN SMALL TEAMS WITH PULSE

    DEFF Research Database (Denmark)

    Mærsk-Møller, Hans Martin; Jørgensen, Bo Nørregaard

    2010-01-01

    Small teams of software engineers are represented both in small companies and semi-independent fractions in medium and large companies. Even though some results and experience papers have been published in the context of Small- and Medium-Sized Enterprises (SMEs), there is a lack of experience pa...... an existing methodology, PuLSETM, drew advantages of NetBeans Rich Client Platform, and based the product line on the existing application....

  7. Role of radiology in a national initiative to interdict drug smuggling: the Dutch experience.

    Science.gov (United States)

    Algra, Paul R; Brogdon, Byron G; Marugg, Roque C

    2007-08-01

    The purpose of this pictorial essay is to describe the role of radiology in a national initiative to intercept illegal narcotics concealed within the bodies of human transporters. Radiologic examination is increasingly important in identifying intracorporeal drug smuggling as improved wrapping techniques undermine the usefulness of blood and urine testing and clinical observation. Detection rates of high accuracy, sensitivity, and specificity are achieved by experienced radiologists.

  8. Initial measurements of two- and three-dimensional ordering, waves, and plasma filamentation in the Magnetized Dusty Plasma Experiment

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, Edward, E-mail: etjr@auburn.edu; Konopka, Uwe [Physics Department, Auburn University, Auburn, Alabama 36849 (United States); Merlino, Robert L. [Department of Physics and Astronomy, The University of Iowa, Iowa City, Iowa 52242 (United States); Rosenberg, Marlene [Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, California 92093 (United States)

    2016-05-15

    The Magnetized Dusty Plasma Experiment at Auburn University has been operational for over one year. In that time, a number of experiments have been performed at magnetic fields up to B = 2.5 T to explore the interaction between magnetized plasmas and charged, micron-sized dust particles. This paper reports on the initial results from studies of: (a) the formation of imposed, ordered structures, (b) the properties of dust wave waves in a rotating frame, and (c) the generation of plasma filaments.

  9. [Management of recurrent urethrocutaneous fistula after hypospadias surgery in pediatric patients: initial experience with dermal regeneration sheet Integra].

    Science.gov (United States)

    Casal-Beloy, I; Somoza Argibay, I; García-González, M; García-Novoa, A M; Míguez Fortes, L; Blanco, C; Dargallo Carbonell, T

    2017-10-25

    To present our initial experience using a dermal regeneration sheet as an urethral cover in the repair of recurrent urethrocutaneous fistulae in pediatric patients. Since May 2016 to March a total of 8 fistulaes were repaired using this new technique. We performed the ddissection of the fistulous tract and posterior closure of the urethral defect. A dermal regeneration sheet was used to cover the urethral suture. Finally a rotational flap was performed to avoid overlap sutures. During the follow-up (average 6 months), one patient presented in the immediate postoperative period infection of the surgical wound. This patient presented recurrence of the fistula. 88% of the patients included presented a good evolution with no other complications. In our initial experience the new technique seems easy, safe and effective in the management of the recurrent urethrocutaneous fistulae in pediatric patients. More studies are needed to prove these results.

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

    Science.gov (United States)

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

    2017-09-01

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

  11. 78 FR 73518 - Notice Inviting Suggestions for New Experiments for the Experimental Sites Initiative; Federal...

    Science.gov (United States)

    2013-12-06

    ... postsecondary educational institutions participating in one or more of eight on- going experiments. Information... program accountability. Institutions and others, including businesses, philanthropies, and State agencies... Federal Regulations is available via the Federal Digital System at: www.gpo.gov/fdsys . At this site you...

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

    LENUS (Irish Health Repository)

    Forde, J C

    2009-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Cheng-Kuang Yang

    2009-12-01

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

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

    Science.gov (United States)

    Nelson, Lori A.

    2011-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  16. Initial experiences in the photoacoustic detection of melanoma metastases in resected lymph nodes

    Science.gov (United States)

    Grootendorst, D.; Jose, J.; Van der Jagt, P.; Van der Weg, W.; Nagel, K.; Wouters, M.; Van Boven, H.; Van Leeuwen, T. G.; Steenbergen, W.; Ruers, T.; Manohar, S.

    2011-03-01

    Accurate lymph node analysis is essential to determine the prognosis and treatment of patients suffering from melanoma. The initial results of a tomographic photoacoustic modality to detect melanoma metastases in resected lymph nodes are presented based on phantom models and a human lymph node. The results show melanoma metastases detection is feasible and the setup is capable of distinguishing absorbing structures down to 1 mm. In addition, the use of longer laser wavelengths could result in an image containing a higher contrast ratio. Future research shall be focused on using the melanin characteristics to improve contrast and detection possibilities.

  17. Assessment of crown fire initiation and spread models in Mediterranean conifer forests by using data from field and laboratory experiments

    Energy Technology Data Exchange (ETDEWEB)

    Rodríguez y Silva, F.; Guijarro, M.; Madrigal, J.; Jiménez, E.; Molina, J.R.; Hernando, C.; Vélez, R.; Vega, J.A.

    2017-11-01

    Aims of study: To conduct the first full-scale crown fire experiment carried out in a Mediterranean conifer stand in Spain; to use different data sources to assess crown fire initiation and spread models, and to evaluate the role of convection in crown fire initiation. Area of study: The Sierra Morena mountains (Coordinates ETRS89 30N: X: 284793-285038; Y: 4218650-4218766), southern Spain, and the outdoor facilities of the Lourizán Forest Research Centre, northwestern Spain. Material and methods: The full-scale crown fire experiment was conducted in a young Pinus pinea stand. Field data were compared with data predicted using the most used crown fire spread models. A small-scale experiment was developed with Pinus pinaster trees to evaluate the role of convection in crown fire initiation. Mass loss calorimeter tests were conducted with P. pinea needles to estimate residence time of the flame, which was used to validate the crown fire spread model. Main results: The commonly used crown fire models underestimated the crown fire spread rate observed in the full-scale experiment, but the proposed new integrated approach yielded better fits. Without wind-forced convection, tree crowns did not ignite until flames from an intense surface fire contacted tree foliage. Bench-scale tests based on radiation heat flux therefore offer a limited insight to full-scale phenomena. Research highlights: Existing crown fire behaviour models may underestimate the rate of spread of crown fires in many Mediterranean ecosystems. New bench-scale methods based on flame buoyancy and more crown field experiments allowing detailed measurements of fire behaviour are needed.

  18. Assessment of crown fire initiation and spread models in Mediterranean conifer forests by using data from field and laboratory experiments

    International Nuclear Information System (INIS)

    Rodríguez y Silva, F.; Guijarro, M.; Madrigal, J.; Jiménez, E.; Molina, J.R.; Hernando, C.; Vélez, R.; Vega, J.A.

    2017-01-01

    Aims of study: To conduct the first full-scale crown fire experiment carried out in a Mediterranean conifer stand in Spain; to use different data sources to assess crown fire initiation and spread models, and to evaluate the role of convection in crown fire initiation. Area of study: The Sierra Morena mountains (Coordinates ETRS89 30N: X: 284793-285038; Y: 4218650-4218766), southern Spain, and the outdoor facilities of the Lourizán Forest Research Centre, northwestern Spain. Material and methods: The full-scale crown fire experiment was conducted in a young Pinus pinea stand. Field data were compared with data predicted using the most used crown fire spread models. A small-scale experiment was developed with Pinus pinaster trees to evaluate the role of convection in crown fire initiation. Mass loss calorimeter tests were conducted with P. pinea needles to estimate residence time of the flame, which was used to validate the crown fire spread model. Main results: The commonly used crown fire models underestimated the crown fire spread rate observed in the full-scale experiment, but the proposed new integrated approach yielded better fits. Without wind-forced convection, tree crowns did not ignite until flames from an intense surface fire contacted tree foliage. Bench-scale tests based on radiation heat flux therefore offer a limited insight to full-scale phenomena. Research highlights: Existing crown fire behaviour models may underestimate the rate of spread of crown fires in many Mediterranean ecosystems. New bench-scale methods based on flame buoyancy and more crown field experiments allowing detailed measurements of fire behaviour are needed.

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

    Directory of Open Access Journals (Sweden)

    Hong-Chiang Chang

    2006-01-01

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

  20. Initial Smoking Experiences and Current Smoking Behaviors and Perceptions among Current Smokers

    Directory of Open Access Journals (Sweden)

    Hugh Klein

    2013-01-01

    Full Text Available Purpose. We examine early-onset cigarette smoking and how, if at all, it is related to subsequent smoking practices. Methods. From 2004 to 2007, face-to-face interviews were conducted with 485 adult cigarette smokers residing in the Atlanta metropolitan area. Data analysis involved a multivariate analysis to determine whether age of smoking onset was related to current smoking practices when the effects of gender, age, race, marital/relationship status, income, and educational attainment were taken into account. Results. The mean age for smoking onset was 14.8, and more than one-half of all smokers had their first cigarette between the ages of 12 and 16. Most people reported an interval of less than one month between their first and second time using tobacco. Earlier onset cigarette smoking was related to more cigarette use and worse tobacco-related health outcomes in adulthood. Conclusions. Early prevention and intervention are needed to avoid early-onset smoking behaviors. Intervening after initial experimentation but before patterned smoking practices are established will be challenging, as the interval between initial and subsequent use tends to be short.

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

    Directory of Open Access Journals (Sweden)

    Leonard Anthony Polakiewicz

    2007-01-01

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

  2. Initial experience with a new articulating energy device for laparoscopic liver resection.

    Science.gov (United States)

    Berber, Eren; Akyuz, Muhammet; Aucejo, Federico; Aliyev, Shamil; Aksoy, Erol; Birsen, Onur; Taskin, Eren

    2014-03-01

    Although significant advances have been made in laparoscopic liver resection (LLR), most techniques still rely on multiple energy devices and staplers, which increase operative costs. The aim of this study was to report the initial results of a new multifunctional energy device for hepatic parenchymal transection. Fourteen patients who underwent LLR using this new device were compared to 20 patients who had LLR using current laparoscopic techniques (CL). Data were collected prospectively. The groups were similar demographics and tumor type and size. Although the type of resection was similar between the groups, the parenchymal transection time was less in the Caiman group (32 ± 5 vs. 63 ± 4 min, respectively, p = 0.0001). The operative time was similar (194 ± 21 vs. 233 ± 16 min, respectively, p = 0.158). There was reduction of the number of advanced instrumentation used in the Caiman group, including the staplers. Estimated blood loss, size of surgical margin, and hospital stay were similar. There was no mortality, and morbidity was 7 % in the Caiman and 20 % in the CL group. This initial study shows that the new device is safe and efficient for LLR. Its main advantage is shortening of hepatic parenchymal transection time. This has implications for increasing efficiency and cost saving in LLR.

  3. Experiences from the anatomy track in the ontology alignment evaluation initiative.

    Science.gov (United States)

    Dragisic, Zlatan; Ivanova, Valentina; Li, Huanyu; Lambrix, Patrick

    2017-12-04

    One of the longest running tracks in the Ontology Alignment Evaluation Initiative is the Anatomy track which focuses on aligning two anatomy ontologies. The Anatomy track was started in 2005. In 2005 and 2006 the task in this track was to align the Foundational Model of Anatomy and the OpenGalen Anatomy Model. Since 2007 the ontologies used in the track are the Adult Mouse Anatomy and a part of the NCI Thesaurus. Since 2015 the data in the Anatomy track is also used in the Interactive track of the Ontology Alignment Evaluation Initiative. In this paper we focus on the Anatomy track in the years 2007-2016 and the Anatomy part of the Interactive track in 2015-2016. We describe the data set and the changes it went through during the years as well as the challenges it poses for ontology alignment systems. Further, we give an overview of all systems that participated in the track and the techniques they have used. We discuss the performance results of the systems and summarize the general trends. About 50 systems have participated in the Anatomy track. Many different techniques were used. The most popular matching techniques are string-based strategies and structure-based techniques. Many systems also use auxiliary information. The quality of the alignment has increased for the best performing systems since the beginning of the track and more and more systems check the coherence of the proposed alignment and implement a repair strategy. Further, interacting with an oracle is beneficial.

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

    Science.gov (United States)

    Shah, Udayan K.

    2001-05-01

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

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

    International Nuclear Information System (INIS)

    Álvarez, V; Cárcel, S; Cervera, A; Díaz, J; Ferrario, P; Bandac, I; Bettini, A; Castel, J; Cebrián, S; Dafni, T; Borges, F I G M; Conde, C A N; Dias, T H V T; Fernandes, L M P; Freitas, E D C; Egorov, M; Gehman, V M; Esteve, R; Evtoukhovitch, P; Ferreira, A L

    2013-01-01

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

  6. Initiations, interactions, cognoscenti: social and cultural capital in the music festival experience

    OpenAIRE

    Wilks, Linda

    2009-01-01

    This thesis explores the role of social and cultural capital in the music festival experience. It does so by gathering observations and post-festival accounts from attendees at three separate music festivals located in England. The data were analysed using Fairclough's approach to critical discourse analysis, resulting in the identification of styles and orders of discourse.\\ud \\ud Little research, particularly of a qualitative nature, has investigated the roles of cultural taste and social i...

  7. Initial results of a high-power microwave sintering experiment at ORNL

    International Nuclear Information System (INIS)

    Kimrey, H.D.; White, T.L.; Bigelow, T.S.; Becher, P.F.

    1986-01-01

    Experiments have recently begun at Oak Ridge National Laboratory to develop microwave sintering techniques suitable for large ceramic parts. Microwave sintering offers the advantages of faster heating rates, more uniform heating, and greater energy efficiency than conventional sintering techniques. We are using 28-GHz, 200-kW cw gyrotrons as the heating source. An untuned cavity is used as the applicator to eliminate geometry sensitivity in coupling efficiency

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

    Science.gov (United States)

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

    2017-05-01

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

  9. Use of Iodine-based contrast media in digital full-field mammography - initial experience

    International Nuclear Information System (INIS)

    Diekmann, F.; Diekmann, S.; Taupitz, M.; Bick, U.; Winzer, K.-J.; Huettner, C.; Muller, S.; Jeunehomme, F.; Hamm, B.

    2003-01-01

    Aim: To investigate the use of iodine-based contrast media in digital full-field mammography. Methods: After performing initial phantom studies, seven patients underwent digital mammography (Senographe 2000D, GE Medical Systems, Milwaukee, USA) using a specially filtered beam before as well as 60, 120, and 180 seconds after injection of 80 ml of iodine contrast medium (Ultravist 370, Schering AG, Germany). The precontrast mammograms were then subtracted from the postcontrast mammograms and the resulting images compared with a contrast-enhanced dynamic MRI study, performed on all women. Results: Contrast medium accumulation within the tumors was visualized with a good quality in all cases. The conditions under which successful contrast-enhanced digital mammography can be performed were determined in phantom studies. Conclusions: Contrast-enhanced digital mammography has a potential for improving the visualization of breast tumors in mammography using special beam filtering, adjusted X-ray parameters, proper timing, and suitable subtraction software. (orig.) [de

  10. Experiment data report for Test RIA 1-2 (Reactivity Initiated Accident Test Series)

    International Nuclear Information System (INIS)

    Zimmermann, C.L.; White, C.E.; Evans, R.P.

    1979-06-01

    Recorded test data are presented for the second of six planned tests in the Reactivity Initiated Accident (RIA) Test Series I, Test RIA 1-2. This test, conducted at the Power Burst Facility, had the following objectives: (1) characterize the response of preirradiated fuel rods during an RIA event conducted at boiling water reactor hot-startup conditions; and (2) evaluate the effect of rod internal pressure on preirradiated fuel rod response during an RIA event. The data from Test RIA 1-2 are graphed in engineering units and have been appraised for quality and validity. These uninterpreted data are presented for use in the nuclear fuel behavior research field before detailed analysis and interpretation have been completed

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

    International Nuclear Information System (INIS)

    Álvarez, V; Cárcel, S; Cervera, A; Díaz, J; Ferrario, P; Gil, A; Borges, F I G; Conde, C A N; Dias, T H V T; Fernandes, L M P; Freitas, E D C; Castel, J; Cebrián, S; Dafni, T; Egorov, M; Gehman, V M; Goldschmidt, A; Esteve, R; Evtoukhovitch, P; Ferreira, A L

    2013-01-01

    NEXT-DEMO is a large-scale prototype of the NEXT-100 detector, an electroluminescent time projection chamber that will search for the neutrinoless double beta decay of XE using 100–150 kg of enriched xenon gas. NEXT-DEMO was built to prove the expected performance of NEXT-100, namely, energy resolution better than 1% FWHM at 2.5 MeV and event topological reconstruction. In this paper we describe the prototype and its initial results. A resolution of 1.75% FWHM at 511 keV (which extrapolates to 0.8% FWHM at 2.5 MeV) was obtained at 10 bar pressure using a gamma-ray calibration source. Also, a basic study of the event topology along the longitudinal coordinate is presented, proving that it is possible to identify the distinct dE/dx of electron tracks in high-pressure xenon using an electroluminescence TPC.

  12. North by Northwestern: initial experience with PACS at Northwestern Memorial Hospital

    Science.gov (United States)

    Channin, David S.; Hawkins, Rodney C.; Enzmann, Dieter R.

    2000-05-01

    This paper describes the initial phases and configuration of the Picture Archive and Communication System (PACS) deployed at Northwestern Memorial Hospital. The primary goals of the project were to improve service to patients, improve service to referring physicians, and improve the process of radiology. Secondary goals were to enhance the academic mission, and modernize institutional information systems. The system consists of a large number of heterogeneous imaging modalities sending imaging studies via DICOM to a GE medical Systems PathSpeed PACS. The radiology department workflow is briefly described. The system is currently storing approximately 140,000 studies and over 5 million images, growing by approximately 600 studies and 25,000 images per day. Data reflecting use of the short term and long term storage is provided.

  13. Axial oblique MR imaging of the intrinsic ligaments of the wrist: initial experience

    International Nuclear Information System (INIS)

    Robinson, G.; Chung, T.; Finlay, K.; Friedman, L.

    2006-01-01

    To evaluate two separate MR sequences acquired in the axial oblique plane, parallel to the long axis of the scapholunate (SL) and lunotriquetral (LT) ligaments, to determine whether the addition of these sequences to the standard MR wrist examination improves visualization of the intrinsic ligaments, and the evaluation of their integrity. To our knowledge, this plane has not been described in the literature previously. In total we evaluated 26 patients with chronic wrist pain or instability, referred for MR imaging following assessment by an orthopedic surgeon or physiatrist. All patients underwent initial conventional tri-compartment wrist arthrography, which served as the reference standard. This was immediately followed by MR arthrography, in the standard coronal and true axial planes, as well as in the axial oblique plane. The SL and LT ligaments were initially assessed for the presence or absence of tear, using the standard coronal and true axial sequences, and subsequently re-evaluated with the addition of the axial oblique planes. A total of ten intrinsic ligament tears were identified with conventional arthrography: six SL and four LT tears. Five of the six SL tears were identified on the standard sequences. All six were diagnosed with the addition of the oblique sequences. There were three false-positive SL tears identified using standard MR imaging, and two false-positives with the addition of the oblique sequences. No LT tear was identified on standard sequences, whereas all four were confidently seen with the addition of oblique images. No false-positives of the LT ligament were recorded with either standard or axial oblique sequences. The study suggests that the addition of axial oblique MR sequences helps identify tears to the intrinsic ligaments of the wrist, particularly the LT ligament. In addition, the axial oblique images assist in localization of the tear. (orig.)

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

    Science.gov (United States)

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

    2014-10-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-06-01

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

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

    International Nuclear Information System (INIS)

    Zhang, J; Williams, D; DiSantis, D; Hardy, P; Oates, M

    2014-01-01

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

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

    Science.gov (United States)

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

    2017-02-01

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

  18. Initial operational experience with Gd-2M+ fuel at Dukovany NPP

    International Nuclear Information System (INIS)

    Borovička, M.; Zýbal, J.

    2015-01-01

    Trend of continuous development of nuclear fuel and fuel cycle can be observed from the very beginning of Dukovany NPP operation. The results of this development are documented on the one hand by extending the length of the cycle and on the other by significant reduction in the number of fresh FA’s which are loaded into reactor cores. As a continuation of this trend introduces Dukovany NPP evolutional change of nuclear fuel from the fuel Gd-2M to the Gd-2M + . (authors) Keywords: Gd-2M + , fuel assembly, operational experience

  19. UNIX trademark in high energy physics: What we can learn from the initial experiences at Fermilab

    International Nuclear Information System (INIS)

    Butler, J.N.

    1991-03-01

    The reasons why Fermilab decided to support the UNIX operating system are reviewed and placed in the content of an overall model for high energy physics data analysis. The strengths and deficiencies of the UNIX environment for high energy physics are discussed. Fermilab's early experience in dealing with a an ''open'' multivendor environment, both for computers and for peripherals, is described. The human resources required to fully exploit the opportunities are clearly growing. The possibility of keeping the development and support efforts within reasonable bounds may depend on our ability to collaborate or at least to share information even more effectively than we have in the past. 7 refs., 4 figs., 5 tabs

  20. Digital library initiative in an Indian research library: an experience report

    International Nuclear Information System (INIS)

    Venkadesan, S.; Narayanan, A.

    1999-01-01

    Libraries all over the world are transiting from the traditional print only era to the electronic era. The migration to an electronic library involves the understanding of several issues and requirements at the planning stage itself. This paper describes the various aspects of building a digital library system. Experience of implementing certain strategies in the IGCAR library is discussed in detail. The components of the digital library and the various access levels are discussed with examples. Finally, samples of the IGCAR library web site and the Newsletter web site are shown. (author)

  1. Evaluating the influence of initial magnetization conditions on extracted exchange parameters in NMR relaxation experiments: applications to CPMG and CEST

    Energy Technology Data Exchange (ETDEWEB)

    Yuwen, Tairan; Sekhar, Ashok; Kay, Lewis E., E-mail: kay@pound.med.utoronto.ca [The University of Toronto, Departments of Molecular Genetics, Biochemistry and Chemistry (Canada)

    2016-08-15

    Transient excursions of native protein states to functionally relevant higher energy conformations often occur on the μs–ms timescale. NMR spectroscopy has emerged as an important tool to probe such processes using techniques such as Carr–Purcell–Meiboom–Gill (CPMG) relaxation dispersion and Chemical Exchange Saturation Transfer (CEST). The extraction of kinetic and structural parameters from these measurements is predicated upon mathematical modeling of the resulting relaxation profiles, which in turn relies on knowledge of the initial magnetization conditions at the start of the CPMG/CEST relaxation elements in these experiments. Most fitting programs simply assume initial magnetization conditions that are given by equilibrium populations, which may be incorrect in certain implementations of experiments. In this study we have quantified the systematic errors in extracted parameters that are generated from analyses of CPMG and CEST experiments using incorrect initial boundary conditions. We find that the errors in exchange rates (k{sub ex}) and populations (p{sub E}) are typically small (<10 %) and thus can be safely ignored in most cases. However, errors become larger and cannot be fully neglected (20–40 %) as k{sub ex} falls near the lower limit of each method or when short CPMG/CEST relaxation elements are used in these experiments. The source of the errors can be rationalized and their magnitude given by a simple functional form. Despite the fact that errors tend to be small, it is recommended that the correct boundary conditions be implemented in fitting programs so as to obtain as robust estimates of exchange parameters as possible.

  2. NASA Controller Acceptability Study 1(CAS-1) Experiment Description and Initial Observations

    Science.gov (United States)

    Chamberlain, James P.; Consiglio, Maria C.; Comstock, James R., Jr.; Ghatas, Rania W.; Munoz, Cesar

    2015-01-01

    This paper describes the Controller Acceptability Study 1 (CAS-1) experiment that was conducted by NASA Langley Research Center personnel from January through March 2014 and presents partial CAS-1 results. CAS-1 employed 14 air traffic controller volunteers as research subjects to assess the viability of simulated future unmanned aircraft systems (UAS) operating alongside manned aircraft in moderate-density, moderate-complexity Class E airspace. These simulated UAS were equipped with a prototype pilot-in-the-loop (PITL) Detect and Avoid (DAA) system, specifically the Self-Separation (SS) function of such a system based on Stratway+ software to replace the see-and-avoid capabilities of manned aircraft pilots. A quantitative CAS-1 objective was to determine horizontal miss distance (HMD) values for SS encounters that were most acceptable to air traffic controllers, specifically HMD values that were assessed as neither unsafely small nor disruptively large. HMD values between 0.5 and 3.0 nautical miles (nmi) were assessed for a wide array of encounter geometries between UAS and manned aircraft. The paper includes brief introductory material about DAA systems and their SS functions, followed by descriptions of the CAS-1 simulation environment, prototype PITL SS capability, and experiment design, and concludes with presentation and discussion of partial CAS-1 data and results.

  3. LOFT facility PSS experiments: analysis of wet well vertical loads resulting from transient initiation

    International Nuclear Information System (INIS)

    Berta, V.T.

    1977-05-01

    Fourteen experiments on the Loss-of-Fluid Test (LOFT) facility pressure suppression system (PSS) are analyzed in relation to the vertical load generated on the suppression tank in the first 0.5 sec of the transient. Variations in principle parameters affecting the generation of vertical loads were included in the experiments. The internal and external vent submergences are identified from the analysis as being parameters which are first order in influencing the magnitude of the vertical load. These parameters are geometric in nature and depend only on PSS design. Physical parameters of total energy input and rate of energy input to the dry well, which influence the dry well pressurization, also are identified as being first order in influencing the magnitude of the vertical loads. The vertical load magnitude is a direct function of these geometric and physical parameters. The analysis indicates that a small value in any one of the parameters will cause the vertical load to be small and to have little dependence on the magnitude of the other parameters. In addition, the phenomena of nonuniform nonsynchronized vent inlet pressures, which have origins that are either geometric, physical, or a combination of both, act as a significant vertical load reduction mechanism

  4. Can we reduce the burden of depression? The Australian experience with beyondblue: the national depression initiative.

    Science.gov (United States)

    Hickie, Ian

    2004-01-01

    Throughout the Asia Pacific region, there is an urgent need to reduce the burden of depression by increasing depression awareness, reducing stigma and dismantling those social barriers that prevent full participation by people with depression. This paper describes the development and early achievements of the Australian depression initiative, beyondblue. A review of the key priorities of beyondblue and their impacts during the first three years of operation (2001-03). Key achievements include: the degree of national recognition of beyondblue; size and scope of media impact; growth in website utilisation; increased reporting of the community's recognition of people with depression; genuine reforms in life insurance and income protection; development of a new national consumer and carer organisation; establishment of major population-based preventative and early intervention programs; system-wide reform of primary care-based mental health services; national educational program uptake by general practitioners; and, development of key awareness and intervention programs for use in schools and the workplace. In its first three years of operation, beyondblue has had a major impact on depression awareness in Australia and demonstrable gains have been made in reducing stigma and major social barriers. A pre-existing national mental health policy and implementation plan, a substantial funding base and participation by key political, media and community leaders have been essential elements of its short-term success. Its longer-term impact will now depend on more sustainable community and business partnerships as well as the growth of a more influential consumer and carer voice.

  5. Analysis of the initial experience with first PET scanner and in Chile

    International Nuclear Information System (INIS)

    Massardo, Teresa; Jofre, Maria Josefina; Canessa, Jose; Gonzalez, Patricio; Humeres, Pamela; Sierralta, Paulina; Valdebenito, Robert; Galaz, Rodrigo

    2005-01-01

    The main application of positron emission tomography (PET) with Fluorine 18- deoxyglucose (FDG) is in the management of cancer patients due to the high correlation between cellular glucidic activity and malignancy. Objective: To analyze the initial group of cases performed with the first dedicated PET scanner in Chile. Method: We present the first 500 patients studied with a Siemens HR+ system using FDG produced at the Chilean Atomic Energy Commission facilities. Results: Most of the referrals were from oncology (96%). Four percent were studied due to neurological or psychiatric disorders and only 1% for myocardial viability. Lung lesions, gastrointestinal and breast carcinomas, melanoma and lymphoma corresponded to the most frequent diagnosis. Lung and lymphoma patients had clinical follow-up. There was good concordance with anatomical images and histology in those cases with available data. Fusion of FDG images with computed tomography or magnetic resonance was helpful. In a significant number of patients new tumoral sites were detected Conclusion: We confirm that in clinical practice, metabolic imaging with F18-FDG is helpful for cancer evaluation and management (au)

  6. Analysis of the initial experience with first PET scanner and in Chile

    Energy Technology Data Exchange (ETDEWEB)

    Massardo, Teresa; Jofre, Maria Josefina; Canessa, Jose; Gonzalez, Patricio; Humeres, Pamela; Sierralta, Paulina; Valdebenito, Robert; Galaz, Rodrigo [Centro PET de Imagenes Moleculares, Hospital Militar da Santiago, Santiago (Chile)

    2005-07-01

    The main application of positron emission tomography (PET) with Fluorine 18- deoxyglucose (FDG) is in the management of cancer patients due to the high correlation between cellular glucidic activity and malignancy. Objective: To analyze the initial group of cases performed with the first dedicated PET scanner in Chile. Method: We present the first 500 patients studied with a Siemens HR+ system using FDG produced at the Chilean Atomic Energy Commission facilities. Results: Most of the referrals were from oncology (96%). Four percent were studied due to neurological or psychiatric disorders and only 1% for myocardial viability. Lung lesions, gastrointestinal and breast carcinomas, melanoma and lymphoma corresponded to the most frequent diagnosis. Lung and lymphoma patients had clinical follow-up. There was good concordance with anatomical images and histology in those cases with available data. Fusion of FDG images with computed tomography or magnetic resonance was helpful. In a significant number of patients new tumoral sites were detected Conclusion: We confirm that in clinical practice, metabolic imaging with F18-FDG is helpful for cancer evaluation and management (au)

  7. Intent at day case laparoscopic cholecystectomy in Owerri, Nigeria: Initial experiences

    Directory of Open Access Journals (Sweden)

    Christopher Nonso Ekwunife

    2013-01-01

    Full Text Available Background and Objective: Laparoscopic cholecystectomy has been the default operation for cholelithiasis at Federal Medical Centre, Owerri for the past 2 years and the outcomes have been good. The duration of post operative stay has been decreasing. We therefore initiated a preliminary 2-year prospective study in May 2010 to determine the feasibility of carrying out day case laparoscopic cholecystectomy in our hospital. Materials and Methods: Patients undergoing laparoscopic cholecystectomy were included in the study if they satisfied the following criteria: Age < 65 years, body mass index < 35 kg/m 2 , American Society of Anaesthesiology physical status class I and II, patient residence within 20 km radius of the hospital, patient acceptance of the procedure and absence of previous complicated upper abdominal surgery. Results: Twelve patients (10 females, 2 males were worked up with the intent of achieving same-day discharge of the patients. Five of the patients (41.7% were discharged on the day of operation. The reasons for overnight stay included inadequate pain control, insertion of drain and patient wishes. There was no conversion to open surgery, no major complications and no case of readmission to the hospital. Conclusions: Day case laparoscopic cholecystectomy in our environment could be safely promoted but will depend on improved facilities and patient enlightenment.

  8. Flat panel computed tomography of human ex vivo heart and bone specimens: initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Nikolaou, Konstantin; Becker, Christoph R.; Reiser, Maximilian F. [Ludwig-Maximilians-University, Department of Clinical Radiology, Munich (Germany); Flohr, Thomas; Stierstorfer, Karl [CT Division, Siemens Medical Solutions, Forchheim (Germany)

    2005-02-01

    The aim of this technical investigation was the detailed description of a prototype flat panel detector computed tomography system (FPCT) and its initial evaluation in an ex vivo setting. The prototype FPCT scanner consists of a conventional radiographic flat panel detector, mounted on a multi-slice CT scanner gantry. Explanted human ex vivo heart and foot specimens were examined. Images were reformatted with various reconstruction algorithms and were evaluated for high-resolution anatomic information. For comparison purposes, the ex vivo specimens were also scanned with a conventional 16-detector-row CT scanner (Sensation 16, Siemens Medical Solutions, Forchheim, Germany). With the FPCT prototype used, a 1,024 x 768 resolution matrix can be obtained, resulting in an isotropic voxel size of 0.25 x 0.25 x 0.25 mm at the iso-center. Due to the high spatial resolution, very small structures such as trabecular bone or third-degree, distal branches of coronary arteries could be visualized. This first evaluation showed that flat panel detector systems can be used in a cone-beam computed tomography scanner and that very high spatial resolutions can be achieved. However, there are limitations for in vivo use due to constraints in low contrast resolution and slow scan speed. (orig.)

  9. Initial experience with FDG-PET/CT in the evaluation of breast cancer

    International Nuclear Information System (INIS)

    Tatsumi, Mitsuaki; Cohade, Christian; Mourtzikos, Karen A.; Wahl, Richard L.; Fishman, Elliot K.

    2006-01-01

    We retrospectively reviewed FDG-PET/CT images in patients with breast cancer to determine whether PET/CT improved the level of diagnostic confidence as compared with PET and to compare PET/CT and CT findings at the location of suspected malignancies. The study included 75 patients with known breast cancer. The initial PET/CT study for each patient was retrospectively reviewed to determine whether improved diagnostic confidence (IDC) regarding lesion localization and characterization was observed with PET/CT as compared with PET alone. PET/CT and CT findings were compared regarding lesion characterization and staging in 69 of the 75 patients, and in the case of discordant findings, comparison with histological or informative follow-up results was also performed. Fifty of the 75 patients exhibited increased FDG uptake in a total of 95 regions. In the comparison of PET/CT and PET, PET/CT resulted in IDC in 30 (60%) of these 50 patients and in 52 (55%) of the 95 regions. In the comparison between PET/CT and CT in 69 patients, PET/CT demonstrated a significantly better accuracy than CT (P<0.05). PET/CT showed definitely positive findings in 60 regions with malignancies, among which CT exhibited positive findings in 43 (72%). PET/CT and CT accurately staged 59 (86%) and 53 (77%) of the 69 patients, respectively. (orig.)

  10. Development of a new compact intraoperative magnetic resonance imaging system: concept and initial experience.

    Science.gov (United States)

    Morita, Akio; Sameshima, Tetsuro; Sora, Shigeo; Kimura, Toshikazu; Nishimura, Kengo; Itoh, Hirotaka; Shibahashi, Keita; Shono, Naoyuki; Machida, Toru; Hara, Naoko; Mikami, Nozomi; Harihara, Yasushi; Kawate, Ryoichi; Ochiai, Chikayuki; Wang, Weimin; Oguro, Toshiki

    2014-06-01

    Magnetic resonance imaging (MRI) during surgery has been shown to improve surgical outcomes, but the current intraoperative MRI systems are too large to install in standard operating suites. Although 1 compact system is available, its imaging quality is not ideal. We developed a new compact intraoperative MRI system and evaluated its use for safety and efficacy. This new system has a magnetic gantry: a permanent magnet of 0.23 T and an interpolar distance of 32 cm. The gantry system weighs 2.8 tons and the 5-G line is within the circle of 2.6 m. We created a new field-of-view head coil and a canopy-style radiofrequency shield for this system. A clinical trial was initiated, and the system has been used in 44 patients. This system is significantly smaller than previous intraoperative MRI systems. High-quality T2 images could discriminate tumor from normal brain tissue and identify anatomic landmarks for accurate surgery. The average imaging time was 45.5 minutes, and no clinical complications or MRI system failures occurred. Floating organisms or particles were minimal (1/200 L maximum). This intraoperative, compact, low-magnetic-field MRI system can be installed in standard operating suites to provide relatively high-quality images without sacrificing safety. We believe that such a system facilitates the introduction of the intraoperative MRI.

  11. Dual-contrast agent photon-counting computed tomography of the heart: initial experience.

    Science.gov (United States)

    Symons, Rolf; Cork, Tyler E; Lakshmanan, Manu N; Evers, Robert; Davies-Venn, Cynthia; Rice, Kelly A; Thomas, Marvin L; Liu, Chia-Ying; Kappler, Steffen; Ulzheimer, Stefan; Sandfort, Veit; Bluemke, David A; Pourmorteza, Amir

    2017-08-01

    To determine the feasibility of dual-contrast agent imaging of the heart using photon-counting detector (PCD) computed tomography (CT) to simultaneously assess both first-pass and late enhancement of the myocardium. An occlusion-reperfusion canine model of myocardial infarction was used. Gadolinium-based contrast was injected 10 min prior to PCD CT. Iodinated contrast was infused immediately prior to PCD CT, thus capturing late gadolinium enhancement as well as first-pass iodine enhancement. Gadolinium and iodine maps were calculated using a linear material decomposition technique and compared to single-energy (conventional) images. PCD images were compared to in vivo and ex vivo magnetic resonance imaging (MRI) and histology. For infarct versus remote myocardium, contrast-to-noise ratio (CNR) was maximal on late enhancement gadolinium maps (CNR 9.0 ± 0.8, 6.6 ± 0.7, and 0.4 ± 0.4, p contrast agent cardiac imaging is feasible with photon-counting detector CT. These initial proof-of-concept results may provide incentives to develop new k-edge contrast agents, to investigate possible interactions between multiple simultaneously administered contrast agents, and to ultimately bring them to clinical practice.

  12. OCO-2 (Orbiting Carbon Observatory-2) mission operations planning and initial operations experiences

    Science.gov (United States)

    Basilio, Ralph R.; Pollock, H. Randy; Hunyadi-Lay, Sarah L.

    2014-10-01

    OCO-2 (Orbiting Carbon Observatory-2) is the first NASA (National Aeronautics and Space Administration) mission dedicated to studying atmospheric carbon dioxide, specifically to identify sources (emitters) and sinks (absorbers) on a regional (1000 km x 1000 km) scale. The mission is designed to meet a science imperative by providing critical and urgent measurements needed to improve understanding of the carbon cycle and global climate change processes. The single instrument consisting of three grating spectrometers was built at the Jet Propulsion Laboratory, but is based on the design co-developed with Hamilton Sundstrand Corporation for the original OCO mission. The instrument underwent an extensive ground test program. This was generally made possible through the use of a thermal vacuum chamber with a window/port that allowed optical ground support equipment to stimulate the instrument. The instrument was later delivered to Orbital Sciences Corporation for integration and test with the LEOStar-2 spacecraft. During the overall ground test campaign, proper function and performance in simulated launch, ascent, and space environments were verified. The observatory was launched into space on 02 July 2014. Initial indications are that the instrument is meeting functional and performance specifications, and there is every expectation that the spatially-order, geo-located, calibrated spectra of reflected sunlight and the science retrievals will meet the Level 1 science requirements.

  13. Local Control of Perivascular Malignant Liver Lesions Using Percutaneous Irreversible Electroporation: Initial Experiences

    Energy Technology Data Exchange (ETDEWEB)

    Eller, Achim, E-mail: Achim.Eller@uk-erlangen.de; Schmid, Axel, E-mail: axel.schmid@uk-erlangen.de [University Hospital Erlangen, University of Erlangen-Nuremberg, Department of Radiology (Germany); Schmidt, Joachim, E-mail: joachim.schmidt@kfa.imed.uni-erlangen.de [University Hospital Erlangen, University of Erlangen-Nuremberg, Department of Anesthesiology (Germany); May, Matthias, E-mail: matthias.may@uk-erlangen.de; Brand, Michael, E-mail: michael.brand@uk-erlangen.de; Saake, Marc, E-mail: marc.saake@uk-erlangen.de; Uder, Michael, E-mail: michael.uder@uk-erlangen.de; Lell, Michael, E-mail: michael.lell@uk-erlangen.de [University Hospital Erlangen, University of Erlangen-Nuremberg, Department of Radiology (Germany)

    2015-02-15

    PurposeThis study was designed to assess efficacy and safety in the treatment of perivascular malignant liver lesions using percutaneous, computed tomography (CT)-guided irreversible electroporation (IRE).MethodsFourteen patients (mean age 58 ± 11 years) with 18 malignant liver lesions were consecutively enrolled in this study. IRE was performed in patients not eligible for surgery and lesions abutting large vessels or bile ducts. Follow-up exams were performed using multislice-CT (MS-CT) or MRI.ResultsMedium lesion diameter was 20 ± 5 mm. Ten of 14 (71 %) were successfully treated with no local recurrence to date (mean follow-up 388 ± 160 days). One case left initial tumor control unclear and additional RFA was performed 4 weeks after IRE. Complications occurred in 4 of 14 (29 %) cases. In one case, intervention was terminated and abdominal bleeding required laparotomy. In two cases, a postinterventional hematothorax required intervention. In another case, abdominal bleeding could be managed conservatively. No complications related to the bile ducts occurred.ConclusionsPercutaneous IRE seems to be effective in perivascular lesions but is associated with a higher complication rate compared with thermoablative techniques.

  14. Experiences from the Brazilian Atlantic Forest: ecological findings and conservation initiatives.

    Science.gov (United States)

    Joly, Carlos A; Metzger, Jean Paul; Tabarelli, Marcelo

    2014-11-01

    The Brazilian Atlantic Forest hosts one of the world's most diverse and threatened tropical forest biota. In many ways, its history of degradation describes the fate experienced by tropical forests around the world. After five centuries of human expansion, most Atlantic Forest landscapes are archipelagos of small forest fragments surrounded by open-habitat matrices. This 'natural laboratory' has contributed to a better understanding of the evolutionary history and ecology of tropical forests and to determining the extent to which this irreplaceable biota is susceptible to major human disturbances. We share some of the major findings with respect to the responses of tropical forests to human disturbances across multiple biological levels and spatial scales and discuss some of the conservation initiatives adopted in the past decade. First, we provide a short description of the Atlantic Forest biota and its historical degradation. Secondly, we offer conceptual models describing major shifts experienced by tree assemblages at local scales and discuss landscape ecological processes that can help to maintain this biota at larger scales. We also examine potential plant responses to climate change. Finally, we propose a research agenda to improve the conservation value of human-modified landscapes and safeguard the biological heritage of tropical forests. © 2014 The Authors. New Phytologist © 2014 New Phytologist Trust.

  15. Experimental warming delays autumn senescence in a boreal spruce bog: Initial results from the SPRUCE experiment

    Science.gov (United States)

    Richardson, Andrew; Furze, Morgan; Aubrecht, Donald; Milliman, Thomas; Nettles, Robert; Krassovski, Misha; Hanson, Paul

    2016-04-01

    Phenology is considered one of the most robust indicators of the biological impacts of global change. In temperate and boreal regions, long-term data show that rising temperatures are advancing spring onset (e.g. budburst and flowering) and delaying autumn senescence (e.g. leaf coloration and leaf fall) in a wide range of ecosystems. While warm and cold temperatures, day length and insolation, precipitation and water availability, and other factors, have all been shown to influence plant phenology, the future response of phenology to rising temperatures and elevated CO2 still remains highly uncertain because of the challenges associated with conducting realistic manipulative experiments to simulate future environmental conditions. At the SPRUCE (Spruce and Peatland Responses Under Climatic and Environmental Change) experiment in the north-central United States, experimental temperature (0 to +9° C above ambient) and CO2 (ambient and elevated) treatments are being applied to mature, and intact, Picea mariana-Sphagnum spp. bog communities in their native habitat through the use of ten large (approximately 12 m wide, 10 m high) open-topped enclosures. We are tracking vegetation green-up and senescence in these chambers, at both the individual and whole-community level, using repeat digital photography. Within each chamber, digital camera images are recorded every 30 minutes and uploaded to the PhenoCam (http://phenocam.sr.unh.edu) project web page, where they are displayed in near-real-time. Image processing is conducted nightly to extract quantitative measures of canopy color, which we characterize using Gcc, the green chromatic coordinate. Data from a camera mounted outside the chambers (since November 2014) indicate strong seasonal variation in Gcc for both evergreen shrubs and trees. Shrub Gcc rises steeply in May and June, and declines steeply in September and October. By comparison, tree Gcc rises gradually from March through June, and declines gradually from

  16. Teleradiology service for mission hospitals: initial experiences in Ethiopia and Kenya

    Directory of Open Access Journals (Sweden)

    Matthew Larrison

    2016-01-01

    Full Text Available Throughout their history, mission hospitals have provided high quality and lifesaving medical care to regions of the world where medical care is sparse. These hospitals are generally built and equipped through a combination of governmental and non-governmental sources. As advances in diagnostic medical imaging have progressed and become mainstream in the developed world, mission hospitals have adopted advanced imaging modalities. These modalities provide early diagnosis and treatment options for their patients. In addition to the installation and operation of advanced imaging equipment, the need for professional expert interpretation of these studies remains a challenge for mission hospitals. Historically these hospitals have used either voluntary services on site or paid for interpretations from local radiologists; however, with the introduction of high speed internet, teleradiology has become a possibility. This article describes the teleradiology experience of two mission hospitals in rural Africa.

  17. UNIX trademark in high energy physics: What we can learn from the initial experiences at Fermilab

    Energy Technology Data Exchange (ETDEWEB)

    Butler, J.N.

    1991-03-01

    The reasons why Fermilab decided to support the UNIX operating system are reviewed and placed in the content of an overall model for high energy physics data analysis. The strengths and deficiencies of the UNIX environment for high energy physics are discussed. Fermilab's early experience in dealing with a an open'' multivendor environment, both for computers and for peripherals, is described. The human resources required to fully exploit the opportunities are clearly growing. The possibility of keeping the development and support efforts within reasonable bounds may depend on our ability to collaborate or at least to share information even more effectively than we have in the past. 7 refs., 4 figs., 5 tabs.

  18. Laparoscopic pectopexy: initial experience of single center with a new technique for apical prolapse surgery

    Directory of Open Access Journals (Sweden)

    Ahmet Kale

    Full Text Available ABSTRACT Objective: To share our first experience with laparoscopic pectopexy, a new technique for apical prolapse surgery, and to evaluate the feasibility of this technique. Materials and Methods: Seven patients with apical prolapse underwent surgery with laparoscopic pectopexy. The lateral parts of the iliopectineal ligament were used for a bilateral mesh fixation of the descended structures. The medical records of the patients were reviewed, and the short-term clinical outcomes were analyzed. Results: The laparoscopic pectopexy procedures were successfully performed, without intraoperative and postoperative complications. De novo apical prolapse, de novo urgency, de novo constipation, stress urinary incontinence, anterior and lateral defect cystoceles, and rectoceles did not occur in any of the patients during a 6-month follow-up period. Conclusion: Although laparoscopic sacrocolpopexy has shown excellent anatomical and functional long-term results, laparoscopic pectopexy offers a feasible, safe, and comfortable alternative for apical prolapse surgery. Pectopexy may increase a surgeon's technical perspective for apical prolapse surgery.

  19. Crossing the gender boundaries: The gender experiences of male nursing students in initial nursing clinical practice in Taiwan.

    Science.gov (United States)

    Liu, Hsing-Yuan; Li, Yun Ling

    2017-11-01

    The initial nursing clinical practice is the necessary practicum required for nursing students. Because of the changing learning style, many of them are under great pressure for environmental change and therefore their daily routine is severe affected. Interacting directly with patients in a female-dominated occupation, along with the general gender stereotypes, the impact is especially significant to male nursing students than to female nursing students. The purpose of this preliminary qualitative study is to explore the gendered experiences of male nursing students during their first initial nursing clinical practice. Both focus group interviews and individual interviews are conducted with twenty-two sophomore nursing students from a university of technology in northern Taiwan, with ten male students and twelve female students. Two main themes emerge from the gendered experiences shared by the nursing students: Gender consciousness awakening and thus maintaining masculinity, and male advantage in the learning environments. The results identify the specific gendered experiences of nursing students, providing implications for future nursing education and counseling service. Further, this study may serve to promote an active yet gender-sensitive nursing education for training nursing professionals. Published by Elsevier Ltd.

  20. Versatile fill coils: initial experience as framing coils for oblong aneurysms. A technical case report.

    Science.gov (United States)

    Osanai, Toshiya; Bain, Mark; Hui, Ferdinand K

    2014-01-01

    Coil embolization of oblong aneurysms is difficult because the majority of commercially available coils are manufactured with a helical or spherical tertiary structure. While adopting framing strategies for oblong aneurysms (aspect ratio ≥ 2: 1), traditional coils may be undersized in the long axis but oversized in the short axis, resulting in increased aneurysmal wall stress, risk of re-rupture, and difficulty creating a basket that respects the aneurysmal neck. We review three cases in which versatile filling coils (VFCs) were used as the initial coils for embolization of oblong aneurysms and report coil distribution characteristics and clinical outcomes. Packing density after VFC implantation was assessed using the software AngioSuite-Neuro edition and AngioCalc. a 58-year-old woman experienced a subarachnoid hemorrhage from a ruptured anterior communicating artery aneurysm (7.5 mm × 3.5 mm). A 3-6 mm × 15 cm VFC was selected as the first coil because the flexibility of its wave-loop structure facilitates framing of an irregularly shaped aneurysm. The loop portions of the structures tend to be pressed to the extremes of the aneurysmal sac by the wave component. The VFC was introduced smoothly into the aneurysmal sac without catheter kickback. We were then able to insert detachable filling coils without any adjunctive technique and achieved complete occlusion. Complete occlusion without severe complications was achieved in all three cases in our study. Average packing density after the first coil was 15.63%. VFC coils may have a specific role in framing oblong aneurysms given their complex loop-wave design, allowing spacing of the coils at the dome and neck while keeping sac stress to a minimum.

  1. Initial Surgical Experience with Aortic Valve Repair: Clinical and Echocardiographic Results

    Directory of Open Access Journals (Sweden)

    Francisco Diniz Affonso da Costa

    Full Text Available Abstract Introduction: Due to late complications associated with the use of conventional prosthetic heart valves, several centers have advocated aortic valve repair and/or valve sparing aortic root replacement for patients with aortic valve insufficiency, in order to enhance late survival and minimize adverse postoperative events. Methods: From March/2012 thru March 2015, 37 patients consecutively underwent conservative operations of the aortic valve and/or aortic root. Mean age was 48±16 years and 81% were males. The aortic valve was bicuspid in 54% and tricuspid in the remaining. All were operated with the aid of intraoperative transesophageal echocardiography. Surgical techniques consisted of replacing the aortic root with a Dacron graft whenever it was dilated or aneurysmatic, using either the remodeling or the reimplantation technique, besides correcting leaflet prolapse when present. Patients were sequentially evaluated with clinical and echocardiographic studies and mean follow-up time was 16±5 months. Results: Thirty-day mortality was 2.7%. In addition there were two late deaths, with late survival being 85% (CI 95% - 68%-95% at two years. Two patients were reoperated due to primary structural valve failure. Freedom from reoperation or from primary structural valve failure was 90% (CI 95% - 66%-97% and 91% (CI 95% - 69%-97% at 2 years, respectively. During clinical follow-up up to 3 years, there were no cases of thromboembolism, hemorrhage or endocarditis. Conclusions: Although this represents an initial series, these data demonstrates that aortic valve repair and/or valve sparing aortic root surgery can be performed with satisfactory immediate and short-term results.

  2. Subchondroplasty for treating bone marrow lesions in the knee - initial experience

    Directory of Open Access Journals (Sweden)

    Marcelo Batista Bonadio

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the use of subchondroplasty in the treatment of bone marrow lesions in an initial series of five cases. METHODS: The study included patients aged between 40 and 75 years old, with pain in the knee for at least six months, associated with high-signal MRI lesion on T2 sequences, on the tibia or femur. Patients were assessed using the visual analog pain scale and the KOOS score, one week before surgery and one, three, six, 12, and 24 weeks after the procedure. Subchondroplasty was performed with a technique developed for filling the area of the bone marrow lesion with a calcium phosphate bone substitute. RESULTS: The filling was performed on the medial femoral condyle in four patients and medial tibial plateau in one case. The assessment by the KOOS score presented a preoperative average of 38.44 points and 62.7, 58.08, 57.92, 63.34, and 71.26 points with one, three, six, 12, and 24 weeks after surgery, respectively. In the evaluation by the VAS, the average was 7.8 points preoperatively and 2.8, 3, 2.8, 1.8, and 0.6 points over the same periods. All patients were able to ambulate without additional support, on the first day after the procedure. One patient had a minimal graft dislocation to the soft tissue, with local pain, which resolved completely after a week. CONCLUSION: The subchondroplasty technique provided significant improvements in the parameters of pain and functional capacity in the short-term assessment.

  3. Initial experience of Fag-PET/CT guided Imr of head-and-neck carcinoma

    International Nuclear Information System (INIS)

    Wang Dian; Schultz, Christopher J.; Jursinic, Paul A.; Bialkowski, Mirek; Zhu, X. Ronald; Brown, W. Douglas; Rand, Scott D.; Michel, Michelle A.; Campbell, Bruce H.; Wong, Stuart; Li, X. Allen; Wilson, J. Frank

    2006-01-01

    Purpose: The purpose of this study is to evaluate the impact of 18 F-fluorodeoxyglucose positron emission tomography (Fag-PET) fused with planning computed tomography (CT) on tumor localization, which guided intensity-modulated radiotherapy (Imr) of patients with head-and-neck carcinoma. Methods and Materials: From October 2002 through April 2005, we performed Fag-PET/CT guided Imr for 28 patients with head-and-neck carcinoma. Patients were immobilized with face masks that were attached with five fiducial markers. Fag-PET and planning CT scans were performed on the same flattop table in one session and were then fused. Target volumes and critical organs were contoured, and Imr plans were generated based on the fused images. Results: All 28 patients had abnormal increased uptake in Fag-PET/CT scans. PET/CT resulted in CT-based staging changes in 16 of 28 (57%) patients. PET/CT fusions were successfully performed and were found to be accurate with the use of the two commercial planning systems. Volume analysis revealed that the PET/CT-based gross target volumes (GTVs) were significantly different from those contoured from the CT scans alone in 14 of 16 patients. In addition, 16 of 28 patients who were followed for more than 6 months did not have any evidence of locoregional recurrence in the median time of 17 months. Conclusion: Fused images were found to be useful to delineate GTV required in IMRT planning. PET/CT should be considered for both initial staging and treatment planning in patients with head-and-neck carcinoma

  4. Private initiatives and policy options: recent health system experience in India.

    Science.gov (United States)

    Purohit, B C

    2001-03-01

    In the recent past the impact of structural adjustment in the Indian health care sector has been felt in the reduction in central grants to States for public health and disease control programmes. This falling share of central grants has had a more pronounced impact on the poorer states, which have found it more difficult to raise local resources to compensate for this loss of revenue. With the continued pace of reforms, the likelihood of increasing State expenditure on the health care sector is limited in the future. As a result, a number of notable trends are appearing in the Indian health care sector. These include an increasing investment by non-resident Indians (NRIs) in the hospital industry, leading to a spurt in corporatization in the States of their original domicile and an increasing participation by multinational companies in diagnostics aiming to capture the potential of the Indian health insurance market. The policy responses to these private initiatives are reflected in measures comprising strategies to attract private sector participation and management inputs into primary health care centres (PHCs), privatization or semi-privatization of public health facilities such as non-clinical services in public hospitals, innovating ways to finance public health facilities through non-budgetary measures, and tax incentives by the State governments to encourage private sector investment in the health sector. Bearing in mind the vital importance of such market forces and policy responses in shaping the future health care scenario in India, this paper examines in detail both of these aspects and their implications for the Indian health care sector. The analysis indicates that despite the promising newly emerging atmosphere, there are limits to market forces; appropriate refinement in the role of government should be attempted to avoid undesirable consequences of rising costs, increasing inequity and consumer exploitation. This may require opening the health

  5. An initial experience using concurrent paclitaxel and radiation in the treatment of head and neck malignancies

    International Nuclear Information System (INIS)

    Tishler, Roy B.; Busse, Paul M.; Norris, Charles M.; Rossi, Rene; Poulin, Mark; Thornhill, Lee; Costello, Rosemary; Peters, Edward S.; Colevas, A. Dimitrios; Posner, Marshall R.

    1999-01-01

    Background: Combined modality therapy plays a central role in the management of head and neck malignancies. This study examined the feasibility and preliminary results of treating a group of patients using concurrent bolus paclitaxel (Taxol TM ) and radiation therapy. Methods: Fourteen patients with a median age of 56 years (range 42-81) were treated. Paclitaxel was given every 3 weeks at a dose of 100 mg/m 2 concurrently with external beam radiation. The patients treated included those who had failed to achieve a complete response (CR) to induction chemotherapy with cisplatin, 5-fluorouracil, and leucovorin (PFL), or who had locally advanced disease not previously treated. Results: Median follow-up from the initiation of treatment is 40 months (range 23-48). The majority of patients (13/14) achieved clinical CRs at the primary site. The development of responses was characterized by a long time course. Three patients who were nonresponders (NRs) to induction PFL chemotherapy were treated. One was a clinical CR at the primary site, one did not achieve a CR, and the other had residual disease in the neck. Four patients have failed, one with local-regional disease, one with a marginal failure, one with distant metastases, and one was not rendered disease-free by the treatment. As expected, significant local toxicity was observed. Most patients were managed with the aid of a percutaneous endoscopic gastrostomy (PEG). Two patients experienced significant moist desquamation and required treatment breaks of greater than 1 week. Conclusion: Paclitaxel can be given on a 3-week schedule at 100 mg/m 2 concurrently with radiation. The preliminary results indicate good local responses and acceptable toxicity. This treatment approach merits further study in the treatment of head and neck malignancies, and should be considered as an option in other sites

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-01-09

    Accurate models of X-ray absorption and re-emission in partly stripped ions are necessary to calculate the structure of stars, the performance of hohlraums for inertial confinement fusion and many other systems in high-energy-density plasma physics. Despite theoretical progress, a persistent discrepancy exists with recent experiments at the Sandia Z facility studying iron in conditions characteristic of the solar radiative–convective transition region. The increased iron opacity measured at Z could help resolve a longstanding issue with the standard solar model, but requires a radical departure for opacity theory. To replicate the Z measurements, an opacity experiment has been designed for the National Facility (NIF). The design uses established techniques scaled to NIF. A laser-heated hohlraum will produce X-ray-heated uniform iron plasmas in local thermodynamic equilibrium (LTE) at temperatures${\\geqslant}150$ eV and electron densities${\\geqslant}7\\times 10^{21}~\\text{cm}^{-3}$. The iron will be probed using continuum X-rays emitted in a${\\sim}200$ ps,${\\sim}200~\\unicode[STIX]{x03BC}\\text{m}$diameter source from a 2 mm diameter polystyrene (CH) capsule implosion. In this design

  7. Early Experience with Technology-Based Eye Care Services (TECS): A Novel Ophthalmologic Telemedicine Initiative.

    Science.gov (United States)

    Maa, April Y; Wojciechowski, Barbara; Hunt, Kelly J; Dismuke, Clara; Shyu, Jason; Janjua, Rabeea; Lu, Xiaoqin; Medert, Charles M; Lynch, Mary G

    2017-04-01

    The aging population is at risk of common eye diseases, and routine eye examinations are recommended to prevent visual impairment. Unfortunately, patients are less likely to seek care as they age, which may be the result of significant travel and time burdens associated with going to an eye clinic in person. A new method of eye-care delivery that mitigates distance barriers and improves access was developed to improve screening for potentially blinding conditions. We present the quality data from the early experience (first 13 months) of Technology-Based Eye Care Services (TECS), a novel ophthalmologic telemedicine program. With TECS, a trained ophthalmology technician is stationed in a primary care clinic away from the main hospital. The ophthalmology technician follows a detailed protocol that collects information about the patient's eyes. The information then is interpreted remotely. Patients with possible abnormal findings are scheduled for a face-to-face examination in the eye clinic. Any patient with no known ocular disease who desires a routine eye screening examination is eligible. Technology-Based Eye Care Services was established in 5 primary care clinics in Georgia surrounding the Atlanta Veterans Affairs hospital. Four program operation metrics (patient satisfaction, eyeglass remakes, disease detection, and visit length) and 2 access-to-care metrics (appointment wait time and no-show rate) were tracked. Care was rendered to 2690 patients over the first 13 months of TECS. The program has been met with high patient satisfaction (4.95 of 5). Eyeglass remake rate was 0.59%. Abnormal findings were noted in 36.8% of patients and there was >90% agreement between the TECS reading and the face-to-face findings of the physician. TECS saved both patient (25% less) and physician time (50% less), and access to care substantially improved with 99% of patients seen within 14 days of contacting the eye clinic, with a TECS no-show rate of 5.2%. The early experience with

  8. Initial experience with a group presentation of study results to research participants

    Directory of Open Access Journals (Sweden)

    Bent Stephen

    2008-03-01

    Full Text Available Abstract Background Despite ethical imperatives, informing research participants about the results of the studies in which they take part is not often performed. This is due, in part, to the costs and burdens of communicating with each participant after publication of the results. Methods Following the closeout and publication of a randomized clinical trial of saw palmetto for treatment of symptoms of benign prostatic hyperplasia, patients were invited back to the research center to participate in a group presentation of the study results. Results Approximately 10% of participants attended one of two presentation sessions. Reaction to the experience of the group presentation was very positive among the attendees. Conclusion A group presentation to research participants is an efficient method of communicating study results to those who desire to be informed and was highly valued by those who attended. Prospectively planning for such presentations and greater scheduling flexibility may result in higher attendance rates. Trial Registration Number Clinicaltrials.gov #NCT00037154

  9. Enterprise stent for the treatment of symptomatic intracranial atherosclerotic stenosis: an initial experience of 44 patients.

    Science.gov (United States)

    Feng, Zhengzhe; Duan, Guoli; Zhang, Ping; Chen, Lei; Xu, Yi; Hong, Bo; Zhao, Wenyuan; Liu, Jianmin; Huang, Qinghai

    2015-10-08

    Wingspan stenting for the treatment of complex intracranial atherosclerotic stenosis (ICAS), i.e., that involving tortuous vascular pathways, long (>15 mm) lesions or arterial bifurcations, has a relatively high risk of complications. This retrospective study assessed the safety and efficacy of undersized balloon angioplasty followed by deployment of the more flexible Enterprise stent for the treatment of complex symptomatic ICAS. Forty-four patients on combined antiplatelet therapy and intensive risk factor management and a symptomatic 70-99% stenosis of a major intracranial artery in complex settings that was treated with balloon angioplasty and Enterprise stent deployment between July 2009 and August 2013 were enrolled. Primary outcome was occurrence of ischemic or hemorrhagic stroke or death within 30 days after intervention. Secondary outcomes included procedural success (defined as achievement of 50% in-stent restenosis after mean 22 months follow-up. In this retrospective, single-center experience, undersized balloon angioplasty followed by Enterprise stent deployment appears technically feasible with a relatively low rate of complications for the treatment of complex symptomatic ICAS. Prospective, multicenter, randomized controlled trials against optimal medical management are warranted.

  10. The initial experience of antithrombin III in the management of neonates with necrotizing enterocolitis.

    Science.gov (United States)

    St Peter, Shawn D; Little, Danny C; Calkins, Casey M; Holcomb, George W; Snyder, Charles L; Ostlie, Daniel J

    2007-04-01

    Necrotizing enterocolitis (NEC), the devastating enteric process of premature neonates, is marked by severe intravascular abnormalities and disseminated intravascular coagulation. Treatment to date remains historical and continues to be merely supportive without attempts to ameliorate progress within the inflammatory or coagulation cascades. Antithrombin III (ATIII) supplementation has been shown to favorably alter the process of disseminated intravascular coagulation and sepsis in adults. However, no reported use of this treatment exists in neonates. Therefore, we analyze the efficacy of our recent experience with ATIII replacement therapy in neonates with NEC. Age and diseased-matched controls with NEC were identified before the introduction of ATIII in our institution and compared against neonates with NEC undergoing ATIII replacement for diminished ATIII levels. Data collected included demographics, course of treatment parameters, and outcomes. Course of treatment parameters included hemoglobin, platelet count, prothrombin time, and partial thromboplastin time over the first 10 consecutive days of treatment. Outcome variables included packed red blood cell, platelet, fresh frozen plasma, and cryoprecipitate transfusions, as well as transfusion cost, length of stay, and survival. Over a 5-year period, 19 neonates with NEC received ATIII and were compared to 17 historical controls. Treatment hematologic profiles were not worsened in the ATIII-treated patients. The control patients received less overall transfusions and had a shorter length of stay. Antithrombin III appears to be safe in neonates with NEC, and its impact on reversing intravascular pathology in these patients warrants more thorough investigation.

  11. Initial experience with the Freedom Solo® stentless aortic valve in a low volume centre.

    Science.gov (United States)

    Kolseth, Solveig Moss; Nordhaug, Dag; Stenseth, Roar; Wahba, Alexander

    2010-10-01

    Freedom Solo is a stentless biological aortic valve which is implanted supra-annularly with a single suture line. An increased risk of postoperative thrombocytopenia in the early postoperative period has been reported in recent studies. In our study we evaluated postoperative haemodynamic performance and thrombocyte-levels. Thirty seven patients who underwent valve implantation of the Sorin Freedom Solo stentless valve were included. The haemodynamic performance of the valve was evaluated by transthoracic echocardiography postoperatively at the fourth day (mean) and after a median of 4.2 months. The mean gradient (mmHg) of Freedom Solo was 7.5 at four days and 8.6 at 4.2 months. Postoperatively no patient had more than grade 1 leakage. Seven percent of the patients had a reduction of thrombocytes to less than 20% of the preoperative level. Seventy six percent had a minimum postoperative thrombocyte level less than 100*10(9)/L. The 30 days mortality in our patient material was zero. Implantation of the Freedom Solo valve was uncomplicated in our experience. Favourable transvalvular gradients and no significant leaks were found. In accordance with the literature, we found a high percentage of patients having a postoperative level of thrombocytes less than 100*10(9)/L after implantation of Freedom Solo.

  12. The (Co-Construction of Knowledge within Initial Teacher Training: Experiences from Croatia

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    Lidija Vujičić

    2015-06-01

    Full Text Available “Learning by doing” within and together with a “community that learns” ought to become the fundamental method of learning – not only for children, but also for their teachers and other participants in the educational process. To what extent are students of early and preschool education involved in such work methods, and what have their experiences been like? An example of a research-based, reflective approach to practice grounded in action research and the co-construction of knowledge with students shall be presented as an example of quality practice at the Faculty of Teacher Education in Rijeka. Such a form of practice creates knowledge through the action itself and through contemplation of one’s actions and the actions of others, all with the purpose of strengthening the practical competencies of future teachers. Our conclusion is that mutual learning, as propounded by the social constructivist approach to education, within the context of the mutual discussions between students and teachers that we organized directly contributed to the development of (self-reflection competencies among future teachers, while also immersing all participants in an environment conducive to deliberation and the (redefinition of oneself and one’s own pedagogical work.

  13. Treatment of Complete and Partial Obstruction of the Nasolacrimal System with Polyurethane Stents: Initial Experience

    International Nuclear Information System (INIS)

    Pulido-Duque, Juan M.; Reyes, Ricardo; Carreira, Jose M.; Vega, Francisco; Gorriz, Elias; Pardo, M. Dolores; Perez, Francisco; Maynar, Manuel

    1998-01-01

    Purpose: To present our experience in the treatment of nasolacrimal occlusion by means of polyurethane stents. Methods: Forty polyurethane stents were placed under fluoroscopic guidance in 35 consecutive patients with epiphora due to total or partial obstruction of the nasolacrimal system. The set designed by Song was used in all patients. The procedure was performed by introducing a guidewire through the superior punctum into the canaliculus and advancing it across the obstruction into the inferior meatus of the nasal cavity. After pulling out the guidewire, the stent was advanced in retrograde fashion and released into the sac and the nasolacrimal duct.Results: The technical success rate was 100%. The average time for the procedure was 25 min (range 10-60 min). Immediate complications were: mild pain (n= 5), severe pain (n= 1), minimal epistaxis (n= 7), and moderate epistaxis (n= 1). No major complications occurred. The last clinical control revealed complete resolution of epiphora in 35 eyes and partial resolution in four; one patient did not improve. Conclusion: This technique for treatment of obstruction of the nasolacrimal system is simple and safe, and may obviate the use of more invasive procedures

  14. Minimal access surgery in children: An initial experience of 28 months

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    Gupta Abhaya

    2009-01-01

    Full Text Available Background : This study reports our 28 months experience with minimal access surgery (MAS in children. Materials and Methods : This was a review of all children who underwent MAS between December 2004 and March 2007 at the Departments of Paediatric Surgery, Seth Gordhandas Sunderdas Medical College (GSMC and King Edward the VII Memorial (KEM Hospital, India. Results and observations were tabulated and analysed, comparing with observations by various other authors regarding variety of indications such as, operative time, hospital stay, conversion rate, complications, safety, and feasibilty of MAS in neonates, in the appropriate operative groups. Results : A total of 199 procedures were performed in 193 children aged between 10 days and 12 years (average age: 5.7 years. One case of each, adrenal mass, retroperitoneoscopic nephrectomy, laparoscopic congenital diaphragmatic hernia (CDH repair, and abdominoperineal pull-through for anorectal malformation, were converted to open surgeries due to technical difficulty. The overall conversion rate was 3%. Morbidity and mortality were very minimal and the procedures were well tolerated in majority of cases. Conclusion : We concluded that MAS procedures appear to be safe for a wide range of indications in neonates and children. Further development and expansion of its indications in neonatal and paediatric surgery requires further multi-institutional studies and larger cohort of patients, to compare with standards of open surgery.

  15. Laparoscopic pancreaticoduodenectomy via a reverse-''V'' approach with four ports: initial experience and perioperative outcomes.

    Science.gov (United States)

    Liu, Zhao; Yu, Mu-Chuan; Zhao, Rui; Liu, Yan-Feng; Zeng, Jian-Ping; Wang, Xian-Qiang; Tan, Jing-Wang

    2015-02-07

    To evaluate the feasibility, safety, and efficacy of laparoscopic pancreaticoduodenectomy (LPD) using a reverse-"V" approach with four ports. This is a retrospective study of selected patients who underwent LPD at our center between April 2011 and April 2012. The following data were collected and reviewed: patient characteristics, tumor histology, surgical outcome, resection margins, morbidity, and mortality. All patients were thoroughly evaluated preoperatively by complete hematologic investigations, triple-phase helical computed tomography, upper gastrointestinal endoscopy, and biopsy of ampullary lesions (when present). Magnetic resonance cholangiopancreatography was performed for doubtful cases of lower common bile duct lesions. There was no perioperative mortality. LPD was performed with tumor-free margins in all patients, including patients with pancreatic ductal adenocarcinoma (n = 6), ampullary carcinoma (n = 6), intra-ductal papillary mucinous neoplasm (n = 2), pancreatic cystadenocarcinoma (n = 2), pancreatic head adenocarcinoma (n = 3), and bile duct cancer (n = 2). The mean patient age was 65 years (range, 42-75 years). The median blood loss was 240 mL, and the mean operative time was 368 min. LPD using a reverse-"V" approach can be performed safely and yields good results in elective patients. Our preliminary experience showed that LDP can be performed via a reverse-"V" approach. This approach can be used to treat localized malignant lesions irrespective of histopathology.

  16. Coronary computed tomography angiography with 320-row detector and using the AIDR-3D: initial experience

    International Nuclear Information System (INIS)

    Sasdelli Neto, Roberto; Nomura, Cesar Higa; Macedo, Ana Carolina Sandoval; Bianco, Danilo Perussi; Kay, Fernando Uliana; Szarf, Gilberto; Teles, Gustavo Borges da Silva; Shoji, Hamilton; Santana Netto, Pedro Vieira; Passos, Rodrigo Bastos Duarte; Chate, Rodrigo Caruso; Ishikawa, Walther Yoshiharu; Lima, Joao Paulo Bacellar Costa; Rocha, Marcelo Assis; Marcos, Vinicius Neves; Funari, Marcelo Buarque de Gusmao; Failla, Bruna Bonaventura

    2013-01-01

    Coronary computed tomography angiography (coronary CTA) is a powerful non-invasive imaging method to evaluate coronary artery disease. Nowadays, coronary CTA estimated effective radiation dose can be dramatically reduced using state-of-the-art scanners, such as 320-row detector CT (320-CT), without changing coronary CTA diagnostic accuracy. To optimize and further reduce the radiation dose, new iterative reconstruction algorithms were released recently by several CT manufacturers, and now they are used routinely in coronary CTA. This paper presents our first experience using coronary CTA with 320-CT and the Adaptive Iterative Dose Reduction 3D (AIDR-3D). In addition, we describe the current indications for coronary CTA in our practice as well as the acquisition standard protocols and protocols related to CT application for radiation dose reduction. In conclusion, coronary CTA radiation dose can be dramatically reduced following the 'as low as reasonable achievable' principle by combination of exam indication and well-documented technics for radiation dose reduction, such as beta blockers, low-kV, and also the newest iterative dose reduction software as AIDR-3D. (author)

  17. Magnetic resonance spectroscopy imaging in the diagnosis of prostate cancer: initial experience

    International Nuclear Information System (INIS)

    Melo, Homero Jose de Farias e; Abdala, Nitamar; Goldman, Suzan Menasce; Szejnfeld, Jacob

    2009-01-01

    Objective: to report an experiment involving the introduction of a protocol utilizing commercially available three-dimensional 1H magnetic resonance spectroscopy imaging (3D 1H MRSI) method in patients diagnosed with prostatic tumors under suspicion of neoplasm. Materials and methods: forty-one patients in the age range between 51 and 80 years (mean, 67 years) were prospectively evaluated. The patients were divided into two groups: patients with one or more biopsies negative for cancer and high specific-prostatic antigen levels (group A), and patients with cancer confirmed by biopsy (group B). The determination of the target area (group A) or the known cancer extent (group B) was based on magnetic resonance imaging and MRSI studies. Results: the specificity of MRSI in the diagnosis of prostate cancer was lower than the specificity reported in the literature (about 47%). On the other hand, for tumor staging, it corresponded to the specificity reported in the literature. Conclusion: the introduction and standardization of 3D 1H MRSI has allowed the obtention of a presumable diagnosis of prostate cancer, by a combined analysis of magnetic resonance imaging and metabolic data from 3D 1H MRSI. (author)

  18. Documentation of polio eradication initiative best practices: Experience from WHO African Region.

    Science.gov (United States)

    Okeibunor, Joseph; Nshimirimana, Deo; Nsubuga, Peter; Mutabaruka, Evariste; Tapsoba, Leonard; Ghali, Emmanuel; Kabir, Shaikh Humayun; Gassasira, Alex; Mihigo, Richard; Mkanda, Pascal

    2016-10-10

    The African Region is set to achieving polio eradication. During the years of operations, the Polio Eradication Initiative [PEI] in the Region mobilized and trained tremendous amount of manpower with specializations in surveillance, social mobilization, supplementary immunization activities [SIAs], data management and laboratory staff. Systems were put in place to accelerate the eradication of polio in the Region. Standardized, real-time surveillance and response capacity were established. Many innovations were developed and applied to reaching people in difficult and security challenged terrains. All of these resulted in accumulation of lessons and best practices, which can be used in other priority public health intervention if documented. The World Health Organization Regional Office for Africa [WHO/AFRO] developed a process for the documentation of these best practices, which was pretested in Uganda. The process entailed assessment of three critical elements [effectiveness, efficiency and relevance] five aspects [ethical soundness, sustainability, involvement of partners, community involvement, and political commitment] of best practices. A scored card which graded the elements and aspects on a scale of 0-10 was developed and a true best practice should score >50 points. Independent public health experts documented polio best practices in eight countries in the Region, using this process. The documentation adopted the cross-sectional design in the generation of data, which combined three analytical designs, namely surveys, qualitative inquiry and case studies. For the selection of countries, country responses to earlier questionnaire on best practices were screened for potential best practices. Another criterion used was the level of PEI investment in the countries. A total of 82 best practices grouped into ten thematic areas were documented. There was a correlation between the health system performances with DPT3 as proxy, level of PEI investment in countries

  19. Establishing a health demographic surveillance site in Bhaktapur district, Nepal: initial experiences and findings

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    Aryal Umesh

    2012-09-01

    Full Text Available Abstract Background A health demographic surveillance system (HDSS provides longitudinal data regarding health and demography in countries with coverage error and poor quality data on vital registration systems due to lack of public awareness, inadequate legal basis and limited use of data in health planning. The health system in Nepal, a low-income country, does not focus primarily on health registration, and does not conduct regular health data collection. This study aimed to initiate and establish the first HDSS in Nepal. Results We conducted a baseline survey in Jhaukhel and Duwakot, two villages in Bhaktapur district. The study surveyed 2,712 households comprising a total population of 13,669. The sex ratio in the study area was 101 males per 100 females and the average household size was 5. The crude birth and death rates were 9.7 and 3.9/1,000 population/year, respectively. About 11% of births occurred at home, and we found no mortality in infants and children less than 5 years of age. Various health problems were found commonly and some of them include respiratory problems (41.9%; headache, vertigo and dizziness (16.7%; bone and joint pain (14.4%; gastrointestinal problems (13.9%; heart disease, including hypertension (8.8%; accidents and injuries (2.9%; and diabetes mellitus (2.6%. The prevalence of non-communicable disease (NCD was 4.3% (95% CI: 3.83; 4.86 among individuals older than 30 years. Age-adjusted odds ratios showed that risk factors, such as sex, ethnic group, occupation and education, associated with NCD. Conclusion Our baseline survey demonstrated that it is possible to collect accurate and reliable data in a village setting in Nepal, and this study successfully established an HDSS site. We determined that both maternal and child health are better in the surveillance site compared to the entire country. Risk factors associated with NCDs dominated morbidity and mortality patterns.

  20. The initial experience of transjugular retrieval of Geunther Tulip inferior vena cava filters

    International Nuclear Information System (INIS)

    Xiao Liang; Shen Jing; Tong Jiajie; Li Haiwei; Xu Ke

    2011-01-01

    Objective: To explore the indications and technical procedures of transjugular retrieval of Geunther Tulip inferior vena cava filters. Methods: Seventy-four patients (40 males and 34 females with a mean age of 45.8 years) with acute lower extremity deep venous thrombosis encountered in our hospital from September 2007 to Mar 2009 were involved in this study. The onset of the disease was from one day to 14 days. Clinical symptoms included swelling, pain, cyanosis or pallescence of the affected limb with higher or normal skin temperature. Thirty-one patients who complicated with pulmonary embolism suffered from dyspnoea, chest pain, hemoptysis, etc. Implantation of Geunther Tulip retrievable inferior vena cava filters through femoral or right internal jugular vein was carried out, which was followed by intravenous transcatheter thrombolysis. Vascular ultrasound and angiography showed no fresh or free thrombus in 12-80 days after initial treatment, then the Geunther Tulip filter was taken out from right internal jugular vein, and inferior vena cavography was performed again. All patients accepted anticoagulation and antibiotic treatment for 3-5 days after operation. A follow-up lasting for 4-12 months was made. Results: Successful implantation of Geunther Tulip retrievable inferior vena cava filter with only one session was obtained in all 74 patients. During implantation procedure one filter became tilted 25 degrees. Successful removal of Geunther Tulip retrievable inferior vena cava filter was achieved in 40 patients in 41.3 days (12-80 days) after the filter was delivered, and the procedure cost only 5.8 minutes (1-115 minutes) with a successful rate of 97.6% (40/41). Failure of retrieval of IVC filter due to compact adhesion of the filter to IVC wall happened in one patient. Inferior vena cavography again confirmed that there was no any sign of vascular perforation or rupture. Retrieval of IVC filter was not performed in other 33 patients and no clinical

  1. "The refer less resolve more" initiative: A five-year experience from CMC Vellore, India

    Directory of Open Access Journals (Sweden)

    Jachin Velavan

    2012-01-01

    Full Text Available India′s one billion plus strong population presents huge health care needs. Presently, approximately 250,000 general practitioners and 30,000 Government doctors are a part of the Indian healthcare workforce, but 80% of them are based in urban India. Problems which plague healthcare delivery and attributed to physician practice may be enumerated as - physicians (1 lack competencies, (2 lack updating, (3 prescribe irrationally (pressures from pharmaceutical companies and patients, (4 practice unethically, (5 refer excessively to specialists and other clinical professionals, and (6 investigate for diseases without justification. A multi-competent Family Physician who could provide a single-window, ethical, and holistic healthcare to patients and families is the need of the hour. Therefore, training, equipping, and empowering these 250,000 doctors to become such physicians will reduce health costs considerably. Distance medical education using all the andragogic methods can be used to train large number of individuals without displacing them from their work-places. Distance learning provides a useful interface for rapidly developing a specialized pool of doctors practicing and advocating family medicine as most-needed discipline. This motivated CMC Vellore, a premier institution for medical education in India, to start a the "refer less resolve more initiative" by offering "two year family medicine diploma course" by distance mode. This is an innovatively-written program consisting of problem-based self-learning modules, video-lectures, video-conferencing, and face-to-face contact programs. Ten secondary level hospitals, across the country, under the supervision of national and international family medicine faculty form the pillars of this program. This distance learning program offered by CMC Vellore has become the platform for change as there is special focus is on ethics, rational prescribing, consultation skills, application of family medicine

  2. "The Refer Less Resolve More" Initiative: A Five-year Experience from CMC Vellore, India.

    Science.gov (United States)

    Velavan, Jachin

    2012-01-01

    India's one billion plus strong population presents huge health care needs. Presently, approximately 250,000 general practitioners and 30,000 Government doctors are a part of the Indian healthcare workforce, but 80% of them are based in urban India. Problems which plague healthcare delivery and attributed to physician practice may be enumerated as - physicians (1) lack competencies, (2) lack updating, (3) prescribe irrationally (pressures from pharmaceutical companies and patients), (4) practice unethically, (5) refer excessively to specialists and other clinical professionals, and (6) investigate for diseases without justification. A multi-competent Family Physician who could provide a single-window, ethical, and holistic healthcare to patients and families is the need of the hour. Therefore, training, equipping, and empowering these 250,000 doctors to become such physicians will reduce health costs considerably. Distance medical education using all the andragogic methods can be used to train large number of individuals without displacing them from their work-places. Distance learning provides a useful interface for rapidly developing a specialized pool of doctors practicing and advocating family medicine as most-needed discipline. This motivated CMC Vellore, a premier institution for medical education in India, to start a the "refer less resolve more initiative" by offering "two year family medicine diploma course" by distance mode. This is an innovatively-written program consisting of problem-based self-learning modules, video-lectures, video-conferencing, and face-to-face contact programs. Ten secondary level hospitals, across the country, under the supervision of national and international family medicine faculty form the pillars of this program. This distance learning program offered by CMC Vellore has become the platform for change as there is special focus is on ethics, rational prescribing, consultation skills, application of family medicine principles

  3. Safety of autologous bone marrow aspiration concentrate transplantation: initial experiences in 101 patients

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    Christian Hendrich

    2009-12-01

    Full Text Available The clinical application of cellular based therapies with ex vivo cultivation for the treatment of diseases of the musculoskeletal system has until now been limited. In particular, the advanced laboratory and technical effort necessary, regulatory issues as well as high costs are major obstacles. On the other hand, newly developed cell therapy systems permit intra-operative enrichment and application of mesenchymal and progenitor stem cells from bone marrow aspirate concentrate (BMAC in one single operative session. The objective of the present clinical surveillance study was to evaluate new bone formation after the application of BMAC as well as to record any possible therapy-specific complications For this purpose, the clinical-radiological progress of a total of 101 patients with various bone healing disturbances was documented (surveillance study. The study included 37 necrosis of the head of the femur, 32 avascular necroses/bone marrow edema of other localization, 12 non-unions, 20 other defects. The application of BMAC was performed in the presence of osteonecrosis via a local injection as part of a core decompression (n=72 or by the local adsorption of intra-operative cellular bone substitution material (scaffold incubated with BMAC during osteosynthesis (n=17 or in further surgery (n=12. After an average of 14 months (2-24 months, the patients were re-examined clinically and radiologically and interviewed. Further surgery was necessary in 2 patients within the follow-up period. These were due to a progression of a collapsed head of the femur with initial necrosis in ARCO Stage III, as well as inadequate new bone formation with secondary loss of correction after periprosthetic femoral fracture. The latter healed after repeated osteosynthesis plus BMAC application without any consequences. Other than these 2 patients, no further complications were observed. In particular, no infections, no excessive new bone formation, no induction of

  4. Extracorporeal Shock-wave Lithotripsy Success Rate and Complications: Initial Experience at Sultan Qaboos University Hospital

    Directory of Open Access Journals (Sweden)

    Mohammed S. Al-Marhoon

    2013-07-01

    Full Text Available Objective: To assess the efficacy and safety of extracorporeal shock wave lithotripsy with Modularis Vario Siemens in the management of patients with renal and ureteral stones.Methods: Between 2007 and 2009, 225 outpatients were treated with Siemens Modularis Vario lithotripter at Sultan Qaboos University Hospital. Stone size, location, total number of shockwaves, stone-free rate, complications and adjunctive interventions were investigated. Chi-Square and Logistic Regression analyses were used, with p<0.05 set as the level of significance.Results: Of the 225 initial consecutive patients who underwent extracorporeal shock wave lithotripsy, 192 (85% had renal stones and 33 (15% had ureteric stones. The mean±SD stone size was 11.3 ± 4.5 mm, while the mean age of the patients was 39.9 ± 12.8 years with 68.5% males. The mean renal stone size was 11.6 ± 4.7 mm; a mean of 1.3 sessions was required. The mean ureteric stone size was 9.9 ± 3 mm; and a mean of 1.3 sessions was required. Treatment success (defined as complete clearance of ureteric stones, stone-free or clinically insignificant residual fragments of <4 mm for renal stones was 74% for renal stones and 88% for ureteric stones. Additional extracorporeal shock wave lithotripsy and ureteroscopy were the most adjunctive procedures used for stone clearance. Complications occurred in 74 patients (38.5% with renal stones and 13 patients (39.4% with uretetric stones. The most common complication was loin pain (experienced by 16.7% with renal stones and 21% with ureteric stones. Severe renal colic mandating admission occurred in 2% of patients with renal stones and 6% of patients with ureteric stones. In patients with renal stone, steinstrasse occurred in 3.6% and infection post extracorporeal shock wave lithotripsy in 0.5%. Using Multivariate Logistic Regression analysis, factors found to have significant effect on complete stone clearance were serum creatinine (p=0.004 and the number of

  5. Initial Experience with IV Ketamine Infusion for Treatment of Post Sternotomy Pain in a Patient with a Total Artificial Heart.

    Science.gov (United States)

    Maher, Dermot P; Loyferman, Rusty; Yumul, Roya; Louy, Charles

    2015-01-01

    The implantation of total artificial hearts (TAH) via midline sternotomy for the treatment of severe biventricular cardiac dysfunction is associated with complex postoperative pain management. Ketamaine increases blood pressure by raising sympathetic outflow and cardiac output; however, ketamine is a direct vasodilator on isolated arterial tissues. In the setting of a TAH with a mechanically fixed cardiac output, a ketamine infusion for postoperative pain control has the potential to decrease blood pressure due to direct arterial vasodilation. We present the initial experience with a ketamine infusion in a patient with a TAH with minimal observed decreases in blood pressure and significantly improved postoperative pain.

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

    Science.gov (United States)

    Terra, Ricardo Mingarini; Araujo, Pedro Henrique Xavier Nabuco de; Lauricella, Leticia Leone; Campos, José Ribas Milanez de; Costa, Herbert Felix; Pego-Fernandes, Paulo Manuel

    2016-01-01

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

  7. Alignment of an interprofessional student learning experience with a hospital quality improvement initiative.

    Science.gov (United States)

    Fowler, Terri O; Wise, Holly H; Mauldin, Mary P; Ragucci, Kelly R; Scheurer, Danielle B; Su, Zemin; Mauldin, Patrick D; Bailey, Jennifer R; Borckardt, Jeffrey J

    2018-04-11

    reliability as teamwork-observers was a valuable learning experience and also yielded an opportunity to gather unique, and otherwise difficult to attain, data from a hospital unit for use by quality managers and administrators.

  8. Robotic-assisted modified retroauricular cervical approach: initial experience in Latin America.

    Science.gov (United States)

    Chulam, Thiago Celestino; Lira, Renan Bezerra; Kowalski, Luiz Paulo

    2016-01-01

    to evaluate the thickness of the gastric wall at the time of intra gastric balloon (IGB) placement, at the time of its withdrawal and one month after withdrawal. fifteen morbidly obese patients underwent the introduction of IGB under general anesthesia. In all patients, there was infusion of 500ml of distilled water in the balloon for the test. Measurements of the thickness of the gastric wall were made in the antrum, body and proximal body, using a radial echoendoscope with a frequency of 12MHz and maximum zoom, and its own balloon inflated with 5ml of distilled water. the presence of IGB led to increased wall thickness of the gastric body by expanding the muscle layer. These changes were apparently transient, since 30 days after the balloon withdrawal there was a tendency to return of the wall thickness values ​​observed before the balloon insertion. the use of intragastric balloon for the treatment of obesity determines transient increase in the wall thickness of the gastric body caused by expanded muscle layer. A preocupação com a melhoria dos resultados estéticos e funcionais sem comprometimento dos resultados oncológicos na cirurgia de cabeça e pescoço tem aumentado significativamente. Os procedimentos minimamente invasivos e principalmente aqueles que utilizam a tecnologia robótica permitiram o desenvolvimento de novas abordagens, incluindo o acesso retroauricular, que agora é usado rotineiramente, especialmente na Coréia do Sul. A presente nota irá ilustrar a técnica e a experiência inicial na América Latina, demonstrando que esta abordagem é viável, segura e eficaz oncologicamente, podendo ser utilizada em casos selecionados com um benefício estético evidente.

  9. Initial employment experiences of 1997 graduates of radiation oncology training programs

    International Nuclear Information System (INIS)

    Bushee, Gerald R.; Sunshine, Jonathan H.; Simon, Carol; Schepps, Barbara

    2001-01-01

    Purpose: To inform the profession of current trends in the job market, the American College of Radiology (ACR) sought to detail the job-hunting experiences and outcomes of 1997 graduates of radiation oncology training programs. Methods and Materials: In early 1998, questionnaires were mailed to all graduates; 67% responded. Results were compared with similar surveys of 1996 graduates. Results: Similar to past years, immediately after graduation, 13% of residency graduates and 1 of 10 fellowship graduates encountered serious employment difficulties - that is, spent some time working locums, working outside radiation oncology, or unemployed. By 6-12 months after graduation, approximately 2% of all residency graduates were working outside the profession and approximately 3% were not working at all. Eighty-five percent of residency graduates and 7 of 8 fellowship graduates reported that their employment reasonably matched their training and individual goals. On average, graduates' actual salaries approximately corresponded to expected salaries. Eleven percent of all graduates were in nonownership-track jobs, a significant decline since 1996. For residents and fellows combined, 46% had a job with at least one characteristic some observers associate with a weak job market, but fewer than half of those with one of these characteristics actually disliked it. These percentages are similar to 1996. Women graduates were more likely than men to have spouse-related restrictions on job location but less likely to end up in a self-reportedly undesirable location. Conclusion: Unemployment remained low. Some other indicators of the employment market showed improvement, while others did not

  10. Analysis of results from a loss-of-offsite-power-initiated ATWS experiment in the LOFT Facility

    International Nuclear Information System (INIS)

    Varacalle, D.J.; Giri, A.M.; Koizumi, Y.; Koske, J.E.

    1983-01-01

    An anticipated transient without scram (ATWS), initiated by loss-of-offsite power, was experimentally simulated in the Loss-of-Fluid Test (LOFT) pressurized water reactor (PWR). Primary system pressure was controlled using a scaled safety relief valve (SRV) representative of those in a commercial PWR, while reactor power was reduced by moderator reactivity feedback in a natural circulation mode. The experiment showed that reactor power decreases more rapidly when the primary pumps are tripped in a loss-of-offsite-power ATWS than in a loss-of-feedwater induced ATWS when the primary pumps are left on. During the experiment, the SRV had sufficient relief capacity to control primary system pressure. Natural circulation was effective in removing core heat at high temperature, pressure, and core power. The system transient response predicted using the RELAPS/MOD1 computer code showed good agreement with the experimental data

  11. Pore Formation and Mobility Investigation (PFMI): Concept, Hardware Development, and Initial Analysis of Experiments Conducted Aboard the International Space Station

    Science.gov (United States)

    Grugel, Richard N.

    2003-01-01

    Porosity in the form of "bubbles and pipes" can occur during controlled directional solidification processing of metal alloys. This is a consequence that 1) precludes obtaining any meaningful scientific results and 2) is detrimental to desired material properties. Unfortunately, several Microgravity experiments have been compromised by porosity. The intent of the PFMl investigation is to conduct a systematic effort directed towards understanding porosity formation and mobility during controlled directional solidification (DS) in a microgravity environment. PFMl uses a pure transparent material, succinonitrile (SCN), as well as SCN "alloyed" with water, in conjunction with a translating temperature gradient stage so that direct observation and recording of pore generation and mobility can be made. PFMl is investigating the role of thermocapillary forces and temperature gradients in affecting bubble dynamics as well as other solidification processes in a microgravity environment. This presentation will cover the concept, hardware development, operations, and the initial results from experiments conducted aboard the International Space Station.

  12. Impact of Advanced Practice Registered Nurses on Quality Measures: The Missouri Quality Initiative Experience.

    Science.gov (United States)

    Rantz, Marilyn J; Popejoy, Lori; Vogelsmeier, Amy; Galambos, Colleen; Alexander, Greg; Flesner, Marcia; Murray, Cathy; Crecelius, Charles; Ge, Bin; Petroski, Gregory

    2018-06-01

    The purpose of this article is to review the impact of advanced practice registered nurses (APRNs) on the quality measure (QM) scores of the 16 participating nursing homes of the Missouri Quality Initiative (MOQI) intervention. The MOQI was one of 7 program sites in the US, with specific interventions unique to each site tested for the Centers for Medicaid and Medicare Services Innovations Center. While the goals of the MOQI for long-stay nursing home residents did not specifically include improvement of the QM scores, it was anticipated that improvement most likely would occur. Primary goals of the MOQI were to reduce the frequency of avoidable hospital admissions and readmissions; improve resident health outcomes; improve the process of transitioning between inpatient hospitals and nursing facilities; and reduce overall healthcare spending without restricting access to care or choice of providers. A 2-group comparison analysis was conducted using statewide QMs; a matched comparison group was selected from facilities in the same counties as the intervention homes, similar baseline QM scores, similar size and ownership. MOQI nursing homes each had an APRN embedded full-time to improve care and help the facility achieve MOQI goals. Part of their clinical work with residents and staff was to focus on quality improvement strategies with potential to influence healthcare outcomes. Trajectories of QM scores for the MOQI intervention nursing homes and matched comparison group homes were tested with nonparametric tests to examine for change in the desired direction between the 2 groups from baseline to 36 months. A composite QM score for each facility was constructed, and baseline to 36-month average change scores were examined using nonparametric tests. Then, adjusting for baseline, a repeated measures analysis using analysis of covariance as conducted. Composite QM scores of the APRN intervention group were significantly better (P = .025) than the comparison group

  13. Motion-Corrected Real-Time Cine Magnetic Resonance Imaging of the Heart: Initial Clinical Experience.

    Science.gov (United States)

    Rahsepar, Amir Ali; Saybasili, Haris; Ghasemiesfe, Ahmadreza; Dolan, Ryan S; Shehata, Monda L; Botelho, Marcos P; Markl, Michael; Spottiswoode, Bruce; Collins, Jeremy D; Carr, James C

    2018-01-01

    Free-breathing real-time (RT) imaging can be used in patients with difficulty in breath-holding; however, RT cine imaging typically experiences poor image quality compared with segmented cine imaging because of low resolution. Here, we validate a novel unsupervised motion-corrected (MOCO) reconstruction technique for free-breathing RT cardiac images, called MOCO-RT. Motion-corrected RT uses elastic image registration to generate a single heartbeat of high-quality data from a free-breathing RT acquisition. Segmented balanced steady-state free precession (bSSFP) cine images and free-breathing RT images (Cartesian, TGRAPPA factor 4) were acquired with the same spatial/temporal resolution in 40 patients using clinical 1.5 T magnetic resonance scanners. The respiratory cycle was estimated using the reconstructed RT images, and nonrigid unsupervised motion correction was applied to eliminate breathing motion. Conventional segmented RT and MOCO-RT single-heartbeat cine images were analyzed to evaluate left ventricular (LV) function and volume measurements. Two radiologists scored images for overall image quality, artifact, noise, and wall motion abnormalities. Intraclass correlation coefficient was used to assess the reliability of MOCO-RT measurement. Intraclass correlation coefficient showed excellent reliability (intraclass correlation coefficient ≥ 0.95) of MOCO-RT with segmented cine in measuring LV function, mass, and volume. Comparison of the qualitative ratings indicated comparable image quality for MOCO-RT (4.80 ± 0.35) with segmented cine (4.45 ± 0.88, P = 0.215) and significantly higher than conventional RT techniques (3.51 ± 0.41, P cine (1.51 ± 0.90, P = 0.088 and 1.23 ± 0.45, P = 0.182) were not different. Wall motion abnormality ratings were comparable among different techniques (P = 0.96). The MOCO-RT technique can be used to process conventional free-breathing RT cine images and provides comparable quantitative assessment of LV function and volume

  14. 3D angiography in the evaluation of intracranial aneurysms before and after treatment. Initial experience

    International Nuclear Information System (INIS)

    Lauriola, Walter; Nardella, Michele; Strizzi, Vincenzo; Florio, Francesco; Cali, Alessandro; D'Angelo, Vincenzo

    2005-01-01

    Purpose: The aim of the study is to evaluate the advantages of 3D angiography as compared to 2D angiography in assessing intracranial aneurysms before and after treatment and, in particular, in selecting and planning the correct treatment. Materials and methods: Thirty intracranial aneurysms were retrospectively reviewed before and after treatment. The study population consisted of 12 men and 18 women (age range: 35-77 years; mean age: 58 years). Eighteen aneurysms were treated surgically, 10 endovascularly and 2 with combined treatment. The 2D and 3D finding before and after the treatment were compared , and the pre-treatment angiographic images were compared with surgical findings. The following parameters were assessed and compared: aneurysmal sac and neck size, vascular involvement and evaluation of post-treatment residual mass. Results: On the 2D DSA images, visualisation of the sac and neck was optimal in 45% and 15% of cases, adequate in 10% and 35% of cases and inadequate in 5% and 50% of cases, respectively. On the 3D DSA images, visualisation of the sac and neck was optimal in 100% of cases. Three-dimensional DSA was able to detect 8 aneurysms with vessel involvement in all cases (100%). Of these, four (50%) went undetected on 2D DSA; in two cases, two-dimensional DSA erroneously detected the presence of vascular involvement (false positive). Three-dimensional angiography proved superior to 2D angiography in the evaluation of the residual aneurysms treated with clipping. Finally, 3D DSA was able to reduce the number of the radiographic projections, the quantity of contrast medium, the time and associated risks necessary for a precise evaluation of the aneurysm. Conclusions: In our first experience, 3D DSA proved useful in reducing the risks and diagnostic time as well as in selecting and planning the treatment. Moreover, it improved the operating conditions of both surgical and endovascular treatment. Technological advances in this field will enable the

  15. Quantitative shear wave ultrasound elastography: initial experience in solid breast masses.

    Science.gov (United States)

    Evans, Andrew; Whelehan, Patsy; Thomson, Kim; McLean, Denis; Brauer, Katrin; Purdie, Colin; Jordan, Lee; Baker, Lee; Thompson, Alastair

    2010-01-01

    Shear wave elastography is a new method of obtaining quantitative tissue elasticity data during breast ultrasound examinations. The aims of this study were (1) to determine the reproducibility of shear wave elastography (2) to correlate the elasticity values of a series of solid breast masses with histological findings and (3) to compare shear wave elastography with greyscale ultrasound for benign/malignant classification. Using the Aixplorer® ultrasound system (SuperSonic Imagine, Aix en Provence, France), 53 solid breast lesions were identified in 52 consecutive patients. Two orthogonal elastography images were obtained of each lesion. Observers noted the mean elasticity values in regions of interest (ROI) placed over the stiffest areas on the two elastography images and a mean value was calculated for each lesion. A sub-set of 15 patients had two elastography images obtained by an additional operator. Reproducibility of observations was assessed between (1) two observers analysing the same pair of images and (2) findings from two pairs of images of the same lesion taken by two different operators. All lesions were subjected to percutaneous biopsy. Elastography measurements were correlated with histology results. After preliminary experience with 10 patients a mean elasticity cut off value of 50 kilopascals (kPa) was selected for benign/malignant differentiation. Greyscale images were classified according to the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS). BI-RADS categories 1-3 were taken as benign while BI-RADS categories 4 and 5 were classified as malignant. Twenty-three benign lesions and 30 cancers were diagnosed on histology. Measurement of mean elasticity yielded an intraclass correlation coefficient of 0.99 for two observers assessing the same pairs of elastography images. Analysis of images taken by two independent operators gave an intraclass correlation coefficient of 0.80. Shear wave elastography versus

  16. Initial experiments with the Nevis Cyclotron, the Brookhaven Cosmotron, the Brookhaven AGS and their effects on high energy physics

    International Nuclear Information System (INIS)

    Lindenbaum, S.J.

    1988-01-01

    The first experiment at the Nevis Cyclotron by Bernardini, Booth and Lindenbaum demonstrated that nuclear stars are produced by a nucleon-nucleon cascade within the nucleon. This solved a long standing problem in Cosmic rays and made it clear that where they overlap cosmic ray investigation would not be competitive with accelerator investigations. The initial experiments at the Brookhaven Cosmotron by Lindenbaum and Yuan demonstrated that low energy pion nucleon scattering and pion production were unexpectedly mostly due to excitation of the isotopic spin = angular momentum = 3/2 isobaric state of the nucleon. This contradicted the Fermi statistical theory and led to the Isobar model proposed by the author and a collaborator. The initial experiments at the AGS by the author and collaborators demonstrated that the Pomeronchuck Theorem would not come true till at least several hundred GeV. These scattering experiments led to the development of the ''On-line Computer Technique'' by the author and collaborators which is now the almost universal technique in high energy physics. The first accomplishment which flowed from this technique led to contradiction of the Regge pole theory as a dynamical asymptotic theory, by the author and collaborators. The first critical experimental proof of the forward dispersion relation in strong interactions was accomplished by the author and collaborators. They were then used as a crystal ball to predict that ''Asymptopia''---the theoretically promised land where all asymptotic theorems come true---would not be reached till at least 25,000 BeV and probably not before 1,000,000 BeV. 26 refs., 11 figs., 2 tabs

  17. Ultrasound-guided Breast Biopsy in the Resource-limited Setting: An Initial Experience in Rural Uganda

    Directory of Open Access Journals (Sweden)

    Christopher R. Stark

    2017-06-01

    Full Text Available Purpose: To describe the methodology and initial experience behind creation of an ultrasoundguided percutaneous breast core biopsy program in rural Uganda. Methods and Materials: Imaging the World Africa (ITWA is the registered non-governmental organization division of Imaging the World (ITW, a not-for-profit organization whose primary aim is the integration of affordable high-quality ultrasound into rural health centers. In 2013, ITWA began the pilot phase of an IRB-approved breast care protocol at a rural health center in Uganda. As part of the protocol’s diagnostic arm, an ultrasound-guided percutaneous breast core biopsy training curriculum was implemented in tandem with creation of regionally supplied biopsy kits. Results: A surgeon at a rural regional referral hospital was successfully trained and certified to perform ultrasound-guided percutaneous breast core biopsies. Affordable and safe biopsy kits were created using locally available medical supplies with the cost of each kit totaling $10.62 USD. Conclusion: Successful implementation of an ultrasound-guided percutaneous breast core biopsy program in the resource-limited setting is possible and can be made sustainable through incorporation of local health care personnel and regionally supplied biopsy materials. Our hope is that ITWA’s initial experience in rural Uganda can serve as a model for similar programs in the future.

  18. Large-Scale Laboratory Experiments of Initiation of Motion and Burial of Objects under Currents and Waves

    Science.gov (United States)

    Landry, B. J.; Wu, H.; Wenzel, S. P.; Gates, S. J.; Fytanidis, D. K.; Garcia, M. H.

    2017-12-01

    Unexploded ordnances (UXOs) can be found at the bottom of coastal areas as the residue of military wartime activities, training or accidents. These underwater objects are hazards for humans and the coastal environment increasing the need for addressing the knowledge gaps regarding the initiation of motion, fate and transport of UXOs under currents and wave conditions. Extensive experimental analysis was conducted for the initiation of motion of UXOs under various rigid bed roughness conditions (smooth PVC, pitted steel, marbles, gravels and bed of spherical particles) for both unidirectional and oscillatory flows. Particle image velocimetry measurements were conducted under both flow conditions to resolve the flow structure estimate the critical flow conditions for initiation of motion of UXOs. Analysis of the experimental observations shows that the geometrical characteristics of the UXOs, their properties (i.e. volume, mass) and their orientation with respect to the mean flow play an important role on the reorientation and mobility of the examined objects. A novel unified initiation of motion diagram is proposed using an effective/unified hydrodynamic roughness and a new length scale which includes the effect of the projected area and the bed-UXO contact area. Both unidirectional and oscillatory critical flow conditions collapsed into a single dimensionless diagram highlighting the importance and practical applicability of the proposed work. In addition to the rigid bed experiments, the burial dynamics of proud UXOs on a mobile sand bed were also examined. The complex flow-bedform-UXOs interactions were evaluated which highlighted the effect of munition density on burial rate and final burial depth. Burial dynamics and mechanisms for motion were examined for various UXOs types, and results show that, for the case of the low density UXOs under energetic conditions, lateral transport coexists with burial. Prior to burial, UXO re-orientation was also observed

  19. Parents' experiences with neonatal home care following initial care in the neonatal intensive care unit: a phenomenological hermeneutical interview study.

    Science.gov (United States)

    Dellenmark-Blom, Michaela; Wigert, Helena

    2014-03-01

    A descriptive study of parents' experiences with neonatal home care following initial care in the neonatal intensive care unit. As survival rates improve among premature and critically ill infants with an increased risk of morbidity, parents' responsibilities for neonatal care grow in scope and degree under the banner of family-centred care. Concurrent with medical advances, new questions arise about the role of parents and the experience of being provided neonatal care at home. An interview study with a phenomenological hermeneutic approach. Parents from a Swedish neonatal (n = 22) home care setting were extensively interviewed within one year of discharge. Data were collected during 2011-2012. The main theme of the findings is that parents experience neonatal home care as an inner emotional journey, from having a child to being a parent. This finding derives from three themes: the parents' experience of leaving the hospital milieu in favour of establishing independent parenthood, maturing as a parent and processing experiences during the period of neonatal intensive care. This study suggests that neonatal home care is experienced as a care structure adjusted to incorporate parents' needs following discharge from a neonatal intensive care unit. Neonatal home care appears to bridge the gap between hospital and home, supporting the family's adaptation to life in the home setting. Parents become empowered to be primary caregivers, having nurse consultants serving the needs of the whole family. Neonatal home care may therefore be understood as the implementation of family-centred care during the transition from NICU to home. © 2013 John Wiley & Sons Ltd.

  20. Independence and Interdependence: An Analysis of Pre-Service Candidates' Use of Focused Assignments on an Electronic Discussion Forum during the Initial Field Experience

    Science.gov (United States)

    Fisch, Audrey A.; Bennett, Deborah J.

    2011-01-01

    This article describes a case study using an electronic learning platform for creating an interactive learning community through asynchronous discussion to enhance the initial field experience of secondary math and English teacher candidates enrolled in Field Experience. We identified three problems with the field experience course--lack of…

  1. SUPERCOLLIDER: Preparing initial experiments

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

    The Superconducting Supercollider (SSC) Laboratory in Ellis County, Texas, has taken an important step toward its scientific programme. While three letters of intent for large detectors had been invited, only two could be considered due to funding limitations. Two letters were received from existing collaborations (SDC and L*) and one from a merger of (EMPACT and TEXAS)

  2. Using the modern Silverhawk™ atherectomy catheter to characterize biliary structures that appear malignant: review of initial experience

    Science.gov (United States)

    Schwartz, Jason J; Thiesset, Heather F; Clayton, Frederic; Adler, Douglas G; Hutson, William R; Carlisle, James G

    2011-01-01

    Background Diagnosis of a biliary stricture often hinges on cytological interpretation. In the absence of accompanying stroma, these results can often be equivocal. In theory, advanced shave biopsy techniques would allow for the preservation of tissue architecture and a more accurate definition of biliary pathology. Objectives We sought to determine the initial diagnostic utility of the modern Silverhawk™ atherectomy (SA) catheter in the evaluation of biliary strictures that appear to be malignant. Methods A total of 141 patients with biliary pathology were identified during a retrospective review of medical records for the years 2006–2011. The SA catheter was employed 12 times in seven patients for whom a tissue diagnosis was otherwise lacking. Results Neoplasia was definitively excluded in seven specimens from four patients. These four individuals were followed for 1–5 years to exclude the development of cholangiocarcinoma (CC). Samples were positive for CC in three patients, one of whom became eligible for neoadjuvant therapy and orthotopic liver transplantation. Conclusions The SA catheter appears to be a useful adjunct in diagnosing patients with biliary pathology. The existence of this technique, predicated on tissue architecture, may impact therapy, allow more timely diagnosis, and exclude cases of equivocal cytology. Although the initial results of SA use are promising, more experience is required to effectively determine its clinical accuracy. PMID:21999597

  3. Robot-Assisted Laparoendoscopic Single-Site Partial Nephrectomy With the Novel Da Vinci Single-Site Platform: Initial Experience

    Science.gov (United States)

    Komninos, Christos; Tuliao, Patrick; Kim, Dae Keun; Choi, Young Deuk; Chung, Byung Ha

    2014-01-01

    Purpose To report our initial clinical cases of robotic laparoendoscopic single-site (R-LESS) partial nephrectomy (PN) performed with the use of the novel Da Vinci R-LESS platform. Materials and Methods Three patients underwent R-LESS PN from November 2013 through February 2014. Perioperative and postoperative outcomes were collected and intraoperative difficulties were noted. Results Operative time and estimated blood loss volume ranged between 100 and 110 minutes and between 50 and 500 mL, respectively. None of the patients was transfused. All cases were completed with the off-clamp technique, whereas one case required conversion to the conventional (multiport) approach because of difficulty in creating the appropriate scope for safe tumor resection. No major postoperative complications occurred, and all tumors were resected in safe margins. Length of hospital stay ranged between 3 and 7 days. The lack of EndoWrist movements, the external collisions, and the bed assistant's limited working space were noticed to be the main drawbacks of this surgical method. Conclusions Our initial experience with R-LESS PN with the novel Da Vinci platform shows that even though the procedure is feasible, it should be applied in only appropriately selected patients. However, further improvement is needed to overcome the existing limitations. PMID:24955221

  4. The initial magnetic susceptibility of polydisperse ferrofluids: A comparison between experiment and theory over a wide range of concentration

    International Nuclear Information System (INIS)

    Solovyova, Anna Y.; Goldina, Olga A.; Ivanov, Alexey O.; Elfimova, Ekaterina A.; Lebedev, Aleksandr V.

    2016-01-01

    Temperature dependencies of the static initial magnetic susceptibility for ferrofluids at various concentrations are studied using experiment and statistical-mechanical theories. Magnetic susceptibility measurements are carried out for twelve samples of magnetite-based fluids stabilized with oleic acid over a wide range of temperatures (210 K ≲T ≲ 390 K); all samples have the same granulometric composition but different volume ferroparticle concentrations (0.2 ≲ φ ≲ 0.5). Experimental results are analyzed using three theories: the second-order modified mean-field theory (MMF2) [A. O. Ivanov and O. B. Kuznetsova, Phys. Rev. E 64, 41405 (2001)]; its correction for polydisperse ferrofluids arising from Mayer-type cluster expansion and taking into account the first terms of the polydisperse second virial coefficient [A. O. Ivanov and E. A. Elfimova, J. Magn. Magn. Mater 374, 327 (2015)]; and a new theory based on MMF2 combined with the first terms of the polydisperse second and third virial contributions to susceptibility. It turns out that the applicability of each theory depends on the experimental sample density. If twelve ferrofluid samples are split into three groups of strong, moderate, and low concentrated fluids, the temperature dependences of the initial magnetic susceptibility in each group are very precisely described by one of the three theories mentioned above. The determination of a universal formula predicting a ferrofluid susceptibility over a broad range of concentrations and temperatures remains as a challenge.

  5. Initial Results from On-Orbit Testing of the Fram Memory Test Experiment on the Fastsat Micro-Satellite

    Science.gov (United States)

    MacLeond, Todd C.; Sims, W. Herb; Varnavas,Kosta A.; Ho, Fat D.

    2011-01-01

    The Memory Test Experiment is a space test of a ferroelectric memory device on a low Earth orbit satellite that launched in November 2010. The memory device being tested is a commercial Ramtron Inc. 512K memory device. The circuit was designed into the satellite avionics and is not used to control the satellite. The test consists of writing and reading data with the ferroelectric based memory device. Any errors are detected and are stored on board the satellite. The data is sent to the ground through telemetry once a day. Analysis of the data can determine the kind of error that was found and will lead to a better understanding of the effects of space radiation on memory systems. The test is one of the first flight demonstrations of ferroelectric memory in a near polar orbit which allows testing in a varied radiation environment. The initial data from the test is presented. This paper details the goals and purpose of this experiment as well as the development process. The process for analyzing the data to gain the maximum understanding of the performance of the ferroelectric memory device is detailed.

  6. Evaluating the experiences and support needs of people living with chronic cancer: development and initial validation of the Chronic Cancer Experiences Questionnaire (CCEQ).

    Science.gov (United States)

    Harley, Clare; Pini, Simon; Kenyon, Lucille; Daffu-O'Reilly, Amrit; Velikova, Galina

    2016-08-10

    Many advanced cancers are managed as chronic diseases, yet there are currently no international guidelines for the support of patients living with chronic cancer. It is important to understand whether care and service arrangements meet the needs of this rapidly growing patient group. This study aimed to develop and validate a questionnaire to capture patients' experiences of living with chronic cancer and their views of clinical and support services. The research was carried out between 1 July 2010 and 21 February 2013. A conceptual framework and initial item bank were derived from prior interviews with 56 patients with chronic cancer. Items were reviewed by 4 oncologists and 1 clinical nurse specialist and during 2 focus groups with 9 patients. Pilot questionnaires were completed by 416 patients across 5 cancer units. Item selection and scale reliability was explored using descriptive data, exploratory factor analysis, internal consistency analyses, multitrait scaling analyses and known-groups comparisons. The final Chronic Cancer Experiences Questionnaire (CCEQ) includes 75 items. 62 items contribute to 14 subscales with internal consistency between α 0·68-0·88 and minimal scaling errors. Known-groups comparisons confirmed subscale utility in distinguishing between patient groups. Subscales were labelled: managing appointments, coordination of care, general practitioner involvement, clinical trials, information and questions, making treatment decisions, symptom non-reporting, key worker, limitations, sustaining normality, financial advice, worries and anxieties, sharing feelings with others, and accessing support. 13 items assessing symptom experiences were retained as single items. The CCEQ has the potential to be used as a clinical instrument to assess patient experiences of chronic cancer or to screen for patient needs. It may also be used as an outcome measure for evaluating programmes and models of care and may identify areas for service development that

  7. Impact of a hospital improvement initiative in Bangladesh on patient experiences and satisfaction with services: two cross-sectional studies

    Directory of Open Access Journals (Sweden)

    Omer Khalid

    2011-12-01

    Full Text Available Abstract Background The Bangladesh government implemented a pilot Hospital Improvement Initiative (HII in five hospitals in Sylhet division between 1998 and 2003. This included management and behaviour change training for staff, waste disposal and procurement, and referral arrangements. Two linked cross-sectional surveys in 2000 and 2003 assessed the impact of the HII, assessing both patients' experience and satisfaction and public views and use of the hospitals. Methods In each survey we asked 300 consecutive outpatients and a stratified random sample of 300 inpatients in the five hospitals about waiting and consultation time, use of an agent for admission, and satisfaction with privacy, cleanliness, and staff behaviour. The field teams observed cleanliness and privacy arrangements, and visited a sample of households in communities near the hospitals to ask about their opinions and use of the hospital services. Analysis examined changes over time in patients' experience and views. Multivariate analysis took account of other variables potentially associated with the outcomes. Survey managers discussed the survey findings with gender stratified focus groups in each sample community. Results Compared with 2000, an outpatient in three of the hospitals in 2003 was more likely to be seen within 10 minutes and for at least five minutes by the doctor, but outpatients were less likely to report receiving all the prescribed medicines from the hospital. In 2003, inpatients were more likely to have secured admission without using an agent. Although patients’ satisfaction with several aspects of care improved, most changes were not statistically significant. Households in 2003 were significantly more likely to rate the hospitals as good than in 2000. Use of the hospitals did not change, except that more households used the medical college hospital for inpatient care in 2003. Focus groups confirmed criticisms of services and suggested improvements

  8. Feasibility of single-incision laparoscopic surgery for appendicitis in abnormal anatomical locations: A single surgeon′s initial experience

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    Sanoop K Zachariah

    2013-01-01

    Full Text Available Background: Single-incision laparoscopic surgery is considered as a more technically demanding procedure than the standard laparoscopic surgery. Based on an initial and early experience, single-incision laparoscopic appendectomy (LA was found to be technically advantageous for dealing with appendicitis in unusual anatomical locations. This study aims to highlight the technical advantages of single-incision laparoscopic surgery in dealing with the abnormally located appendixes and furthermore report a case of acute appendicitis occurring in a sub-gastric position, which is probably the first such case to be reported in English literature. Materials and Methods: A retrospective analysis of the first 10 cases of single-incision LA which were performed by a single surgeon is presented here. Results: There were seven females and three males. The mean age of the patients was 30.6 (range 18-52 years, mean BMI was 22.7 (range 17-28 kg/m 2 and the mean operative time was 85.5 (range 45-150 min. The mean postoperative stay was 3.6 (range 1-7 days. The commonest position of the appendix was retro-caecal (50% followed by pelvic (30%. In three cases the appendix was found to be in abnormal locations namely sub-hepatic, sub-gastric and deep pelvic or para-vesical or para-rectal. All these cases could be managed with this technique without any conversions Conclusion: Single-incision laparoscopic surgery appears to be a feasible and safe technique for dealing with appendicitis in rare anatomical locations. Appendectomy may be a suitable procedure for the initial training in single-incision laparoscopic surgery.

  9. Model and experiences of initiating collaboration with traditional healers in validation of ethnomedicines for HIV/AIDS in Namibia

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    Chinsembu Kazhila C

    2009-10-01

    Full Text Available Abstract Many people with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS in Namibia have access to antiretroviral drugs but some still use traditional medicines to treat opportunistic infections and offset side-effects from antiretroviral medication. Namibia has a rich biodiversity of indigenous plants that could contain novel anti-HIV agents. However, such medicinal plants have not been identified and properly documented. Various ethnomedicines used to treat HIV/AIDS opportunistic infections have not been scientifically validated for safety and efficacy. These limitations are mostly attributable to the lack of collaboration between biomedical scientists and traditional healers. This paper presents a five-step contextual model for initiating collaboration with Namibian traditional healers in order that candidate plants that may contain novel anti-HIV agents are identified, and traditional medicines used to treat HIV/AIDS opportunistic infections are subjected to scientific validation. The model includes key structures and processes used to initiate collaboration with traditional healers in Namibia; namely, the National Biosciences Forum, a steering committee with the University of Namibia (UNAM as the focal point, a study tour to Zambia and South Africa where other collaborative frameworks were examined, commemorations of the African Traditional Medicine Day (ATMD, and consultations with stakeholders in north-eastern Namibia. Experiences from these structures and processes are discussed. All traditional healers in north-eastern Namibia were willing to collaborate with UNAM in order that their traditional medicines could be subjected to scientific validation. The current study provides a framework for future collaboration with traditional healers and the selection of candidate anti-HIV medicinal plants and ethnomedicines for scientific testing in Namibia.

  10. Micro Vascular Plug (MVP)-assisted vessel occlusion in neurovascular pathologies: technical results and initial clinical experience.

    Science.gov (United States)

    Beaty, Narlin B; Jindal, Gaurav; Gandhi, Dheeraj

    2015-10-01

    Deconstructive approaches may be necessary to treat a variety of neurovascular pathologies. Recently, a new device has become available for endovascular arterial occlusion that may have unique applications in neurovascular disease. The Micro Vascular Plug (MVP, Reverse Medical, Irvine, California, USA) has been designed for vessel occlusion through targeted embolization. To report the results from our initial experience with eight consecutive patients in whom the MVP was used to achieve endovascular occlusion of an artery in the head and neck. Eight consecutive patients treated over a nine-month period were included. The patients' radiographic and electronic medical records were retrospectively reviewed. Specifically demographic information, clinical indication, site of arterial occlusion, size of MVP, time to vessel occlusion, clinical complications, use of other secondary embolic agents, and clinical outcome were recorded. Follow-up information when available is presented. The MVP was used in eight patients for the treatment of neurovascular disease. Indications for treatment included post-traumatic head/neck bleeding (n=3), carotid-cavernous fistula (1), vertebral-vertebral fistula (1), giant fusiform vertebral aneurysm (1), stump-emboli after carotid dissection (1), and iatrogenic vertebral artery penetrating injury (1). One device was used in five patients, two in two patients, and one patient with extensive vertebral-vertebral venous fistula required three plugs to effectively trap the fistula from proximal and distal aspects. Vessel occlusion was obtained in MVP in neurovascular disease. Use of this device may be associated with shorter procedural times and cost savings in comparison with the use of microcoils for vessel occlusion. Our experience shows that MVP can have unique applications in neurovascular pathologies and it complements other occlusive devices. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted

  11. Therapeutic rigid bronchoscopy at a tertiary care center in North India: Initial experience and systematic review of Indian literature

    Directory of Open Access Journals (Sweden)

    Karan Madan

    2014-01-01

    Full Text Available Background and Aim: Rigid bronchoscopy is often an indispensable procedure in the therapeutic management of a wide variety of tracheobronchial disorders. However, it is performed at only a few centers in adult patients in India. Herein, we report our initial 1-year experience with this procedure. Materials and Methods: A prospective observational study on the indications, outcomes, and safety of various rigid bronchoscopy procedures performed between November 2009 and October 2010. Improvement in dyspnea, cough, and the overall quality of life was recorded on a visual analog scale from 0 to 100 mm. A systematic review of PubMed was performed to identify studies reporting the use of rigid bronchoscopy from India. Results: Thirty-eight rigid bronchoscopies (50 procedures were performed in 19 patients during the study period. The commonest indication was benign tracheal stenosis followed by central airway tumor, and the procedures performed were rigid bronchoplasty, tumor debulking, and stent placement. The median procedure duration was 45 (range, 30-65 min. There was significant improvement in quality of life associated with therapeutic rigid bronchoscopy. Minor procedural complications were encountered in 18 bronchoscopies, and there was no procedural mortality. The systematic review identified 15 studies, all on the role of rigid bronchoscopy in foreign body removal. Conclusions: Rigid bronchoscopy is a safe and effective modality for treatment of a variety of tracheobronchial disorders. There is a dire need of rigid bronchoscopy training at teaching hospitals in India.

  12. The correlation of in vivo and ex vivo tissue dielectric properties to validate electromagnetic breast imaging: initial clinical experience

    International Nuclear Information System (INIS)

    Halter, Ryan J; Zhou, Tian; Meaney, Paul M; Hartov, Alex; Barth, Richard J Jr; Rosenkranz, Kari M; Wells, Wendy A; Kogel, Christine A; Borsic, Andrea; Rizzo, Elizabeth J; Paulsen, Keith D

    2009-01-01

    Electromagnetic (EM) breast imaging provides low-cost, safe and potentially a more specific modality for cancer detection than conventional imaging systems. A primary difficulty in validating these EM imaging modalities is that the true dielectric property values of the particular breast being imaged are not readily available on an individual subject basis. Here, we describe our initial experience in seeking to correlate tomographic EM imaging studies with discrete point spectroscopy measurements of the dielectric properties of breast tissue. The protocol we have developed involves measurement of in vivo tissue properties during partial and full mastectomy procedures in the operating room (OR) followed by ex vivo tissue property recordings in the same locations in the excised tissue specimens in the pathology laboratory immediately after resection. We have successfully applied all of the elements of this validation protocol in a series of six women with cancer diagnoses. Conductivity and permittivity gauged from ex vivo samples over the frequency range 100 Hz–8.5 GHz are found to be similar to those reported in the literature. A decrease in both conductivity and permittivity is observed when these properties are gauged from ex vivo samples instead of in vivo. We present these results in addition to a case study demonstrating how discrete point spectroscopy measurements of the tissue can be correlated and used to validate EM imaging studies

  13. EPID-based in vivo dosimetry for stereotactic body radiotherapy of non-small cell lung tumors: Initial clinical experience.

    Science.gov (United States)

    Consorti, R; Fidanzio, A; Brainovich, V; Mangiacotti, F; De Spirito, M; Mirri, M A; Petrucci, A

    2017-10-01

    EPID-based in vivo dosimetry (IVD) has been implemented for stereotactic body radiotherapy treatments of non-small cell lung cancer to check both isocenter dose and the treatment reproducibility comparing EPID portal images. 15 patients with lung tumors of small dimensions and treated with volumetric modulated arc therapy were enrolled for this initial experience. IVD tests supplied ratios R between in vivo reconstructed and planned isocenter doses. Moreover a γ-like analysis between daily EPID portal images and a reference one, in terms of percentage of points with γ-value smaller than 1, P γlevels of 5% for R ratio, P γlevel, and an average P γ90%. Paradigmatic discrepancies were observed in three patients: a set-up error and a patient morphological change were identified thanks to CBCT image analysis whereas the third discrepancy was not fully justified. This procedure can provide improved patient safety as well as a first step to integrate IVD and CBCT dose recalculation. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  14. Initial Experience with Balloon-Occluded Trans-catheter Arterial Chemoembolization (B-TACE) for Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Maruyama, Mitsunari, E-mail: mitunari@med-shimane.u.ac.jp; Yoshizako, Takeshi, E-mail: yosizako@med.shimane-u.ac.jp; Nakamura, Tomonori, E-mail: t-naka@med.shimane-u.ac.jp; Nakamura, Megumi, E-mail: megumi@med.shimane-u.ac.jp; Yoshida, Rika, E-mail: yoshidar@med.shimane-u.ac.jp; Kitagaki, Hajime, E-mail: kitagaki@med.shimane-u.ac.jp [Shimane University Faculty of Medicine, Department of Radiology (Japan)

    2016-03-15

    PurposeThis study was performed to evaluate the accumulation of lipiodol emulsion (LE) and adverse events during our initial experience of balloon-occluded trans-catheter arterial chemoembolization (B-TACE) for hepatocellular carcinoma (HCC) compared with conventional TACE (C-TACE).MethodsB-TACE group (50 cases) was compared with C-TACE group (50 cases). The ratio of the LE concentration in the tumor to that in the surrounding embolized liver parenchyma (LE ratio) was calculated after each treatment. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Effects (CTCAE) version 4.0.ResultsThe LE ratio at the level of subsegmental showed a statistically significant difference between the groups (t test: P < 0.05). Only elevation of alanine aminotransferase was more frequent in the B-TACE group, showing a statistically significant difference (Mann–Whitney test: P < 0.05). While B-TACE caused severe adverse events (liver abscess and infarction) in patients with bile duct dilatation, there was no statistically significant difference in incidence between the groups. Multivariate logistic regression analysis suggested that the significant risk factor for liver abscess/infarction was bile duct dilatation (P < 0.05).ConclusionThe LE ratio at the level of subsegmental showed a statistically significant difference between the groups (t test: P < 0.05). B-TACE caused severe adverse events (liver abscess and infarction) in patients with bile duct dilatation.

  15. Initial experience with intravenous pentobarbital sedation for children undergoing MRI at a tertiary care pediatric hospital: the learning curve

    International Nuclear Information System (INIS)

    Greenberg, S.B.; Adams, R.C.; Aspinall, C.L.

    2000-01-01

    Objective. Our purpose is to describe the initial experience with intravenous pentobarbital sedation in children undergoing MRI at a tertiary pediatric hospital to identify errors associated with inexperience. Subjects and methods. The study included the first 100 children sedated with intravenous pentobarbital prior to magnetic resonance examination at a tertiary pediatric hospital. The protocol included a maximum dose of 6 mg/kg administered in three divided doses with the total dose not to exceed 200 mg. Flow sheets documenting vital signs, administered drug doses, and adverse reactions were maintained contemporaneous to sedation. Results. Sedation was successful in 92 children. Of the eight children who failed sedation, three were at least 12 years old and three weighed more than 50 kg. χ 2 tests identified significantly greater failure rates in children older than 11 years or weight greater than 50 kg. Two children had prolonged sedation after the maximum suggested dose was exceeded. Conclusions. The success rate was good, but could have been improved by restricting the use of pentobarbital to children less than 12 years of age and weighing less than 50 kg. Radiologists inexperienced with intravenous sedation should strictly observe the maximum suggested dose of pentobarbital to prevent prolonged sedation. (orig.)

  16. Initial Operative Experience and Short-term Hearing Preservation Results With a Mid-scala Cochlear Implant Electrode Array.

    Science.gov (United States)

    Svrakic, Maja; Roland, J Thomas; McMenomey, Sean O; Svirsky, Mario A

    2016-12-01

    To describe our initial operative experience and hearing preservation results with the Advanced Bionics (AB) Mid Scala Electrode (MSE). Retrospective review. Tertiary referral center. Sixty-three MSE implants in pediatric and adult patients were compared with age- and sex-matched 1j electrode implants from the same manufacturer. All patients were severe to profoundly deaf. Cochlear implantation with either the AB 1j electrode or the AB MSE. The MSE and 1j electrodes were compared in their angular depth of insertion and pre to postoperative change in hearing thresholds. Hearing preservation was analyzed as a function of angular depth of insertion. Secondary outcome measures included operative time, incidence of abnormal intraoperative impedance and telemetry values, and incidence of postsurgical complications. Depth of insertion was similar for both electrodes, but was more consistent for the MSE array and more variable for the 1j array. Patients with MSE electrodes had better hearing preservation. Thresholds shifts at four audiometric frequencies ranging from 250 to 2000 Hz were 10, 7, 2, and 6 dB smaller for the MSE electrode than for the 1j (p < 0.05). Hearing preservation at low frequencies was worse with deeper insertion, regardless of array. Secondary outcome measures were similar for both electrodes. The MSE electrode resulted in more consistent insertion depth and somewhat better hearing preservation than the 1j electrode. Differences in other surgical outcome measures were small or unlikely to have a meaningful effect.

  17. Development and initial porcine and cadaver experience with three-dimensional printing of endoscopic and laparoscopic equipment.

    Science.gov (United States)

    del Junco, Michael; Okhunov, Zhamshid; Yoon, Renai; Khanipour, Ramtin; Juncal, Samuel; Abedi, Garen; Lusch, Achim; Landman, Jaime

    2015-01-01

    Recent advances in three-dimensional (3D) printing technology have made it possible to print surgical devices. We report our initial experience with the printing and deployment of endoscopic and laparoscopic equipment. We created computer-aided designs for ureteral stents and laparoscopic trocars using SolidWorks. We developed three generations of stents, which were printed with an Objet500 Connex printer, and a fourth generation was printed with an EOSINT P395 printer. The trocars were printed with an Objet30 Pro printer. We deployed the printed stents and trocars in a female cadaver and in vivo porcine model. We compared the printed trocars to two standard trocars for defect area and length using a digital caliper. Paired T-tests and ANOVA were used to test for statistical difference. The first two generations of stents (7F and 9F) were functional failures as their diminutive inner lumen failed to allow the passage of a 0.035 guidewire. The third generation 12F stent allowed passage of a 0.035 guidewire. The 12F diameter limited its deployment, but it was introduced in a cadaver through a ureteral access sheath. The fourth-generation 9F stents were printed and deployed in a porcine model using the standard Seldinger technique. The printed trocars were functional for the maintenance of the pneumoperitoneum and instrument passage. The printed trocars had larger superficial defect areas (pcadaver models. Three-dimensional printing is rapidly advancing and may be clinically viable in the future.

  18. Initial dosimetric experience using simple three-dimensional conformal external-beam accelerated partial-breast irradiation

    International Nuclear Information System (INIS)

    Taghian, Alphonse G.; Kozak, Kevin R.; Doppke, Karen P.; Katz, Angela; Smith, Barbara L.; Gadd, Michele; Specht, Michelle; Hughes, Kevin; Braaten, Kristina; Kachnic, Lisa A.; Recht, Abram; Powell, Simon N.

    2006-01-01

    Purpose: Several accelerated partial-breast irradiation (APBI) techniques are being investigated in patients with early-stage breast cancer. We present our initial experience using three-dimensional conformal radiation therapy (3D-CRT). Methods and Materials: Sixty-one patients with tumors of 2 cm or less and negative axillary nodes were treated with 3D-CRT accelerated partial-breast irradiation (APBI) between August 2003 and March 2005. The prescribed radiation dose was 32 Gy in 4-Gy fractions given twice daily. Efforts were made to minimize the number of beams required to achieve adequate planning target volume (PTV) coverage. Results: A combination of photons and electrons was used in 85% of patients. A three-field technique that consisted of opposed, conformal tangential photons and enface electrons was employed in 43 patients (70%). Nine patients (15%) were treated with a four-field arrangement, which consisted of three photon fields and enface electrons. Mean PTV volumes that received 100%, 95%, and 90% of the prescribed dose were 93% ± 7%, 97% ± 4%, and 98% ± 2%, respectively. Dose inhomogeneity exceeded 10% in only 7 patients (11%). Mean doses to the ipsilateral lung and heart were 1.8 Gy and 0.8 Gy, respectively. Conclusions: Simple 3D-CRT techniques of APBI can achieve appropriate PTV coverage while offering significant normal-tissue sparing. Therefore, this noninvasive approach may increase the availability of APBI to patients with early-stage breast cancer

  19. Study of plasma start-up initiated by second harmonic electron cyclotron resonance heating on WEGA experiment

    International Nuclear Information System (INIS)

    Preynas, M.; Laqua, H. P.; Otte, M.; Stange, T.; Aßmus, D.; Wauters, T.

    2014-01-01

    Although both 1st harmonic ordinary mode (O1) and 2nd harmonic extra-ordinary mode (X2) have been successfully used to initiate pre-ionization and breakdown in many devices, a complete theoretical model is still missing to explain the success of this method. Moreover, some experimental observations are not completely understood, such as what occurs during the delay time between the turn-on of ECRH power and first signals of density or light measurements. Since during this free period the ECRH power has to be absorbed by in-vessel components, it is of prime importance to know what governs this delay time. Recently, dedicated start-up experiments have been performed on WEGA, using a 28 GHz ECRH system in X2-mode. This machine has the interesting capability to be run also as a tokamak allowing comparative experiments between stellarator (ι/2π > 0) and tokamak (ι/2π = 0) configurations. Different scans in heating power, neutral gas pressure, and rotational transform (ι) show clearly that the start-up is a two step process. A first step following the turn-on of the ECRH power during which no measurable electron density (or just above the noise level in some cases), ECE and radiated power is detected. Its duration depends strongly on the level of injected power. The second step corresponds to the gas ionization and plasma expansion phase, with a velocity of density build-up and filling-up of the vessel volume depending mainly on pressure, gas and rotational transform. Moreover, an interesting scenario of ECRH pre-ionization without loop voltage in tokamak configuration by applying a small optimal vertical field is relevant for start-up assistance on future experiments like ITER. The results from this experimental parametric study are useful for the modeling of the start-up assisted by the second harmonic electron cyclotron resonance heating. The aim of this work is to establish predictive scenarios for both ITER and W7-X operation

  20. Study of plasma start-up initiated by second harmonic electron cyclotron resonance heating on WEGA experiment

    Energy Technology Data Exchange (ETDEWEB)

    Preynas, M.; Laqua, H. P.; Otte, M.; Stange, T.; Aßmus, D. [Max Planck Institut für Plasmaphysik, EURATOM Association, D-17491 Greifswald (Germany); Wauters, T. [Association Euratom-Belgian State, LPP-ERM/KMS, 1000 Brussels (Belgium)

    2014-02-12

    Although both 1st harmonic ordinary mode (O1) and 2nd harmonic extra-ordinary mode (X2) have been successfully used to initiate pre-ionization and breakdown in many devices, a complete theoretical model is still missing to explain the success of this method. Moreover, some experimental observations are not completely understood, such as what occurs during the delay time between the turn-on of ECRH power and first signals of density or light measurements. Since during this free period the ECRH power has to be absorbed by in-vessel components, it is of prime importance to know what governs this delay time. Recently, dedicated start-up experiments have been performed on WEGA, using a 28 GHz ECRH system in X2-mode. This machine has the interesting capability to be run also as a tokamak allowing comparative experiments between stellarator (ι/2π > 0) and tokamak (ι/2π = 0) configurations. Different scans in heating power, neutral gas pressure, and rotational transform (ι) show clearly that the start-up is a two step process. A first step following the turn-on of the ECRH power during which no measurable electron density (or just above the noise level in some cases), ECE and radiated power is detected. Its duration depends strongly on the level of injected power. The second step corresponds to the gas ionization and plasma expansion phase, with a velocity of density build-up and filling-up of the vessel volume depending mainly on pressure, gas and rotational transform. Moreover, an interesting scenario of ECRH pre-ionization without loop voltage in tokamak configuration by applying a small optimal vertical field is relevant for start-up assistance on future experiments like ITER. The results from this experimental parametric study are useful for the modeling of the start-up assisted by the second harmonic electron cyclotron resonance heating. The aim of this work is to establish predictive scenarios for both ITER and W7-X operation.

  1. First to Flush: The Effects of Ambient Noise on Songbird Flight Initiation Distances and Implications for Human Experiences with Nature

    Directory of Open Access Journals (Sweden)

    Alissa R. Petrelli

    2017-06-01

    Full Text Available Throughout the world, birds represent the primary type of wildlife that people experience on a daily basis. However, a growing body of evidence suggests that alterations to the acoustic environment can negatively affect birds as well as humans in a variety of ways, and altered acoustics from noise pollution has the potential to influence human interactions with wild birds. Birds respond to approaching humans in a manner analogous to approaching predators, but the context of the interaction can also greatly influence the distance at which a bird initiates flight or escape behavior (i.e., flight initiation distance or FID. Here, we hypothesized that reliance on different sensory modalities to balance foraging and threat detection can influence how birds respond to approaching threats in the presence of background noise. We surveyed 12 songbird species in California and Wyoming and categorized each species into one of three foraging guilds: ground foragers, canopy gleaners, and hawking flycatchers and predicted FIDs to decrease, remain the same and increase with noise exposure, respectively. Contrary to expectations, the canopy gleaning and flycatching guilds exhibited mixed responses, with some species exhibiting unchanged FIDs with noise while others exhibited increased FIDs with noise. However, FIDs of all ground foraging species and one canopy gleaner decreased with noise levels. Additionally, we found no evidence of phylogenetic structure among species' mean FID responses and only weak phylogenetic structure for the relationship between FIDs and noise levels. Although our results provide mixed support for foraging strategy as a predictor of bird response to noise, our finding that most of the species we surveyed have shorter FIDs with increases in noise levels suggest that human observers may be able to approach ground foraging species more closely under noisy conditions. From an ecological perspective, however, it remains unclear whether

  2. Experiência inicial com operações cardíacas minimamente invasivas Initial experience with minimally invasive cardiac operations

    Directory of Open Access Journals (Sweden)

    Francisco Costa

    2012-09-01

    initial experience with minimally invasive operations, with emphasis on technical aspects and the learning curve. METHODS: Between July 2009 and March 2012, 95 patients were operated using minimally invasive operations. Mean age was 55 ± 15 years and 53% were females. The operations performed were atrial septal defect closure (25, aortic valve replacement (32, mitral valve repair (23, mitral valve replacement (12, excision of atrial myxoma (2 and resection of subaortic membrane (1. The incision was a mini right thoracotomy in 87 cases and ministernotomy in 8. RESULTS: Early mortality was 4.2%. Mean size of the incision was 6.3 ±1.2 cm. Extension of the original thoracotomy was necessary in only one case. Two patients suffered a stroke, and the mean total blood loss was 470 ± 277 ml. There were no cases of incision infection and 67% the patients had no major morbidity. CONCLUSIONS: Our initial results with minimally invasive operations demonstrated that it was safe and with good clinical results. Patient satisfaction is quite high. After the learning phase has been transversed, minimally invasive operations may be an excellent alternative for many patients with congenital and acquired diseases.

  3. Modifying mixing and instability growth through the adjustment of initial conditions in a high-energy-density counter-propagating shear experiment on OMEGA

    International Nuclear Information System (INIS)

    Merritt, E. C.; Doss, F. W.; Loomis, E. N.; Flippo, K. A.; Kline, J. L.

    2015-01-01

    Counter-propagating shear experiments conducted at the OMEGA Laser Facility have been evaluating the effect of target initial conditions, specifically the characteristics of a tracer foil located at the shear boundary, on Kelvin-Helmholtz instability evolution and experiment transition toward nonlinearity and turbulence in the high-energy-density (HED) regime. Experiments are focused on both identifying and uncoupling the dependence of the model initial turbulent length scale in variable-density turbulence models of k-ϵ type on competing physical instability seed lengths as well as developing a path toward fully developed turbulent HED experiments. We present results from a series of experiments controllably and independently varying two initial types of scale lengths in the experiment: the thickness and surface roughness (surface perturbation scale spectrum) of a tracer layer at the shear interface. We show that decreasing the layer thickness and increasing the surface roughness both have the ability to increase the relative mixing in the system, and thus theoretically decrease the time required to begin transitioning to turbulence in the system. We also show that we can connect a change in observed mix width growth due to increased foil surface roughness to an analytically predicted change in model initial turbulent scale lengths

  4. Initial experiences and innovations in supervising community health workers for maternal, newborn, and child health in Morogoro region, Tanzania.

    Science.gov (United States)

    Roberton, Timothy; Applegate, Jennifer; Lefevre, Amnesty E; Mosha, Idda; Cooper, Chelsea M; Silverman, Marissa; Feldhaus, Isabelle; Chebet, Joy J; Mpembeni, Rose; Semu, Helen; Killewo, Japhet; Winch, Peter; Baqui, Abdullah H; George, Asha S

    2015-04-09

    Supervision is meant to improve the performance and motivation of community health workers (CHWs). However, most evidence on supervision relates to facility health workers. The Integrated Maternal, Newborn, and Child Health (MNCH) Program in Morogoro region, Tanzania, implemented a CHW pilot with a cascade supervision model where facility health workers were trained in supportive supervision for volunteer CHWs, supported by regional and district staff, and with village leaders to further support CHWs. We examine the initial experiences of CHWs, their supervisors, and village leaders to understand the strengths and challenges of such a supervision model for CHWs. Quantitative and qualitative data were collected concurrently from CHWs, supervisors, and village leaders. A survey was administered to 228 (96%) of the CHWs in the Integrated MNCH Program and semi-structured interviews were conducted with 15 CHWs, 8 supervisors, and 15 village leaders purposefully sampled to represent different actor perspectives from health centre catchment villages in Morogoro region. Descriptive statistics analysed the frequency and content of CHW supervision, while thematic content analysis explored CHW, supervisor, and village leader experiences with CHW supervision. CHWs meet with their facility-based supervisors an average of 1.2 times per month. CHWs value supervision and appreciate the sense of legitimacy that arises when supervisors visit them in their village. Village leaders and district staff are engaged and committed to supporting CHWs. Despite these successes, facility-based supervisors visit CHWs in their village an average of only once every 2.8 months, CHWs and supervisors still see supervision primarily as an opportunity to check reports, and meetings with district staff are infrequent and not well scheduled. Supervision of CHWs could be strengthened by streamlining supervision protocols to focus less on report checking and more on problem solving and skills development

  5. Initial experience of robotic versus laparoscopic colectomy for transverse colon cancer: a matched case-control study.

    Science.gov (United States)

    de'Angelis, Nicola; Alghamdi, Salah; Renda, Andrea; Azoulay, Daniel; Brunetti, Francesco

    2015-10-09

    Robotic surgery for transverse colon cancer has rarely been described. This study reports our initial experience in robotic resection for transverse colon cancer, by comparing robotic transverse colectomy (RC) to laparoscopic transverse colectomy (LC) in terms of safety, feasibility, short-term outcomes, and the surgeon's psychological stress and physical pain. The study population included the first 22 consecutive patients who underwent RC between March 2013 and December 2014 for histologically confirmed transverse colon adenocarcinoma. These patients were compared with 22 matched patients undergoing LC between December 2010 and February 2013. Patients were matched based on age, gender, body mass index (BMI), American Society of Anesthesiology (ASA) score, American Joint Committee on Cancer (AJCC) tumor stage, and tumor location (ratio 1:1). Mortality, morbidity, operative, and short-term oncologic outcomes were compared between groups. The operating surgeon's stress and pain were assessed before and after surgery on a 0-100-mm visual analog scale. The demographic and preoperative characteristics were comparable between RC and LC patients. No group difference was observed for intraoperative complications, blood loss, postoperative pain, time to flatus, time to regular diet, and hospital stay. RC was associated with longer operative time than LC (260 min vs. 225 min; p = 0.014), but the overall operative and robotic time in the RC group decreased over time reflecting the increasing experience in performing this procedure. No conversion to laparotomy was observed in the RC group, while two LC patients were converted due to uncontrolled bleeding and technically difficult middle colic pedicle dissection. Postoperative complications (Dindo-Clavien grade I or II) occurred in 11.3 % of patients with no group difference. Mortality was nil. All resections were R0, with >12 lymph nodes harvested in 90.9 % of RC and 95.5 % of LC patients. The surgeon's stress was

  6. Endoscopic endonasal transsphenoidal surgery using the iArmS operation support robot: initial experience in 43 patients.

    Science.gov (United States)

    Ogiwara, Toshihiro; Goto, Tetsuya; Nagm, Alhusain; Hongo, Kazuhiro

    2017-05-01

    Objective The intelligent arm-support system, iArmS, which follows the surgeon's arm and automatically fixes it at an adequate position, was developed as an operation support robot. iArmS was designed to support the surgeon's forearm to prevent hand trembling and to alleviate fatigue during surgery with a microscope. In this study, the authors report on application of this robotic device to endoscopic endonasal transsphenoidal surgery (ETSS) and evaluate their initial experiences. Methods The study population consisted of 43 patients: 29 with pituitary adenoma, 3 with meningioma, 3 with Rathke's cleft cyst, 2 with craniopharyngioma, 2 with chordoma, and 4 with other conditions. All patients underwent surgery via the endonasal transsphenoidal approach using a rigid endoscope. During the nasal and sphenoid phases, iArmS was used to support the surgeon's nondominant arm, which held the endoscope. The details of the iArmS and clinical results were collected. Results iArmS followed the surgeon's arm movement automatically. It reduced the surgeon's fatigue and stabilized the surgeon's hand during ETSS. Shaking of the video image decreased due to the steadying of the surgeon's scope-holding hand with iArmS. There were no complications related to use of the device. Conclusions The intelligent armrest, iArmS, seems to be safe and effective during ETSS. iArmS is helpful for improving the precision and safety not only for microscopic neurosurgery, but also for ETSS. Ongoing advances in robotics ensure the continued evolution of neurosurgery.

  7. Initial experience of functional imaging of upper urinary tract neoplasm by diffusion-weighted magnetic resonance imaging

    International Nuclear Information System (INIS)

    Yoshida, Soichiro; Masuda, Hitoshi; Saito, Kazutaka; Kawakami, Satoru; Kihara, Kazunori; Ishii, Chikako

    2008-01-01

    Diffusion-weighted (DW) magnetic resonance imaging (MRI) provides functional information widely used in the diagnosis of acute cerebral stroke. We reported our initial experience of this imaging technique of upper urinary tract (UUT) urothelial carcinoma (UC). Diffusion-weighted magnetic resonance imaging was carried out in 10 consecutive patients with suspected UUT UC. With conventional imaging, seven were diagnosed as having renal pelvic tumors and two were highly suspected of having UUT UC. These nine patients were diagnosed histopathologically as having renal pelvic UC by subsequent operation. The last patient was confirmed as experiencing benign stenosis. DW MRI was obtained with a 1.5-T MR imager without a breath-holding sequence. The apparent diffusion coefficient (ADC) values of renal parenchyma, dilated collecting system, and tumor were calculated. The differences were analyzed using Wilcoxon t-test. On DW MRI, all nine tumors showed hyperintensity with negligible urinary intensity. Two cases of highly suspected UUT UC with unclear conventional MRI had high signal intensity and contrast. The case of benign stenosis had negative DW MRI. The median (range) ADC value of the tumor (0.803 [0.412-0.958] x 10 -3 mm 2 /s) was significantly lower than those of the dilated collecting system (2.19 [1.42-2.40] x 10 -3 ) and renal parenchyma (1.28 [0.922-1.45] x 10 -3 , respectively (P<0.01 and P<0.01). This is the first report on the application of DW MRI for a series of UUT UC. With this technique, a clear demonstration of UUT UC could be obtained. Moreover, this imaging technique is potentially useful to identify small lesions if they have a low diffusion coefficient. (author)

  8. Initial Operative Experience and Short Term Hearing Preservation Results with a Mid-Scala Cochlear Implant Electrode Array

    Science.gov (United States)

    Svrakic, Maja; Roland, J. Thomas; McMenomey, Sean O.; Svirsky, Mario A.

    2016-01-01

    OBJECTIVE To describe our initial operative experience and hearing preservation results with the Advanced Bionics (AB) Mid Scala Electrode (MSE) STUDY DESIGN Retrospective review. SETTING Tertiary referral center. PATIENTS Sixty-three MSE implants in pediatric and adult patients were compared to age- and gender-matched 1j electrode implants from the same manufacturer. All patients were severe to profoundly deaf. INTERVENTION Cochlear implantation with either the AB 1j electrode or the AB MSE. MAIN OUTCOME MEASURES The MSE and 1j electrode were compared in their angular depth of insertion (aDOI) and pre- to post-operative change in hearing thresholds. Hearing preservation was analyzed as a function of aDOI. Secondary outcome measures included operative time, incidence of abnormal intraoperative impedance and telemetry values, and incidence of postsurgical complications. RESULTS Depth of insertion was similar for both electrodes, but was more consistent for the MSE array and more variable for the 1j array. Patients with MSE electrodes had better hearing preservation. Thresholds shifts at four audiometric frequencies ranging from 250 to 2,000 Hz were 10 dB, 7 dB, 2 dB and 6 dB smaller for the MSE electrode than for the 1j (p<0.05). Hearing preservation at low frequencies was worse with deeper insertion, regardless of array. Secondary outcome measures were similar for both electrodes. CONCLUSIONS The MSE electrode resulted in more consistent insertion depth and somewhat better hearing preservation than the 1j electrode. Differences in other surgical outcome measures were small or unlikely to have a meaningful effect. PMID:27755356

  9. Adoption of an integrated radiology reading room within a urologic oncology clinic: initial experience in facilitating clinician consultations.

    Science.gov (United States)

    Rosenkrantz, Andrew B; Lepor, Herbert; Taneja, Samir S; Recht, Michael P

    2014-05-01

    The authors describe their initial experience in implementing an integrated radiology reading room within a urologic oncology clinic, including the frequency and nature of clinician consultations and the perceived impact on patient management by clinicians. A radiology reading room was established within an office-based urologic oncology clinic in proximity to the surgeon's work area. A radiologist was present in this reading room for a 3-hour shift each day. The frequency and nature of consultations during these shifts were recorded. Also, the clinic's staff completed a survey assessing perceptions of the impact of the integrated reading room on patient management. One hundred two consultations occurred during 57 included dates (average, 1.8 consultations per shift): 52% for review of external cases brought in by patients on discs, 43% for review of internal cases, and 5% for direct review by the radiologist of imaging with patients. The maximum number of consultations during a single shift was 8. All of the clinic's urologists indicated that >90% of consultations benefited patient care. The clinicians indicated tendencies to view consultations as affecting management in the majority of cases, to be more likely to seek consultation for outside imaging when the radiologist was on site, and to be less likely to repeat outside imaging when the radiologist was on site. The integrated reading room within the clinic has potential to improve the quality of care, for instance by facilitating increased review of outside imaging studies and thereby potentially reducing duplicate ordering and by enabling occasional direct image review with patients by radiologists. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  10. SPIDER ® sleeve gastrectomy--a new concept in single-trocar bariatric surgery: initial experience and technical details.

    Science.gov (United States)

    Noel, P; Nedelcu, M; Gagner, M

    2014-04-01

    Single port instrument delivery extended reach (SPIDER(®)) surgical system is a revolutionary surgical platform that allows triangulation of the surgical instruments while eliminating the crossing of instruments, the problematic characteristic of single access laparoscopic surgery. The purpose of this study was to analyze our initial experience with SPIDER(®) sleeve gastrectomy and to present the technical details of this new minimally invasive approach, performed in ten patients at the La Casamance Private Hospital between November 2012 and April 2013. All patients were reviewed at scheduled post-operative consultations at 1, 3 and 6 months. In addition to clinical examination, the post-operative consultation at one month also included a satisfaction survey using the Moorehead-Ardelt questionnaire. An initial series of ten sleeve gastrectomies were performed in female patients with a mean age of 41.5 years (range: 2-52). The mean BMI was 40.11 (range: 37.25-44.3). The intervention was performed through a single trocar in all patients with no "conversion" to classic laparoscopy or open surgery. The mean operative time was 61 ± 15.22 minutes (SD=standard deviation) (range: 43-96 min). The mean BMI at one month was 35.5 (SD:± 3.58, SEM: ± 1.13) (SEM=standard error of mean) with an average percentage of excess weight loss (%EWL) of 32.9% (SD:± 8.56%, SEM:± 2.71%). The mean BMI at three months was 32.4 (SD: ± 2.78, SEM: ± 0.88) with an average %EWL of 52.7% (SD: ± 8.64%, SEM: ± 2.73%). The mean BMI at six months was 29.9 (SD:± 2.60, SEM: ± 0.98) with a mean %EWL of 68.8% (SD: ± 8.38%, SEM:± 3.17%). Complete remission of co-morbid conditions was observed in four patients, improvement in three others, and no change in a single patient. The mean duration of hospitalization was 3.1 days. The mean follow-up period was 161 days (SD:± 57.4 days, range: 90-243 days). There was no mortality and no intra-operative and post-operative complications were noted. The

  11. Quality assurance of 3-D conformal radiation therapy for a cooperative group trial - RTOG 3D QA center initial experience

    International Nuclear Information System (INIS)

    Michalski, Jeff M.; Purdy, James A.; Harms, William B.; Bosch, Walter R.; Oehmke, Frederick; Cox, James D.

    1996-01-01

    's correction and resubmission in 7 of 67 (10.4%) reviewed cases. Normal tissues required correction in 6 of 67 (8.9%) of cases. Initial field shaping differed from the submitted treatment plan by more than 5 mm in significant regions of the field in only 2% of the cases. Isocenter shifts of more than 5 mm on at least one of the treated fields was identified in 7% of initial port films examined. Dosimetry review has demonstrated that 14 of 86 cases (16.3%) had minor variations in target volume coverage (<100% of the target volume coverage by the prescription isodose) and 3.4% had major variation in dose coverage (<95% coverage of target volume by prescription isodose). Nineteen of 93 cases (20%) had more than 7% heterogeneity of dose within the planning target volume. CONCLUSION: 3DCRT can be studied and implemented in a cooperative group setting. Although data exchange problems in this study have been frequent, most of these problems occurred early in the trial and have been resolved in most circumstances. A significant amount of variation has been identified in the definition of target volumes and organs at risk. Similarly, field shaping and port film evaluation showed occasional errors. It is our impression that quality assurance is a critical component of 3DCRT in the cooperative group setting. As experience in the planning of patients with 3DCRT increases, it is expected that the frequency of planning variations will diminish

  12. If I Experience Formative Assessment Whilst Studying at University, Will I Put It into Practice Later as a Teacher? Formative and Shared Assessment in Initial Teacher Education (ITE)

    Science.gov (United States)

    Hamodi, Carolina; López-Pastor, Víctor Manuel; López-Pastor, Ana Teresa

    2017-01-01

    The aim of this article is to analyse whether having experience of formative assessment during their initial teacher education courses (ITE) influences graduates' subsequent practice as teachers. That is, if the assessment methods that university students are subject to during their learning process are then actually employed by them during their…

  13. Complete fabrication of target experimental chamber and implement initial target diagnostics to be used for the first target experiments in NDCX-1

    International Nuclear Information System (INIS)

    Bieniosek, F.M.; Bieniosek, F.M.; Dickinson, M.R.; Henestroza, E.; Katayanagi, T.; Jung, J.Y.; Lee, C.W.; Leitner, M.; Ni, P.; Roy, P.; Seidl, P.; Waldron, W.; Welch, D.

    2008-01-01

    The Heavy Ion Fusion Science Virtual National Laboratory (HIFS-VNL) has completed the fabrication of a new experimental target chamber facility for future Warm Dense Matter (WDM) experiments, and implemented initial target diagnostics to be used for the first target experiments in NDCX-1. The target chamber has been installed on the NDCX-I beamline. This achievement provides to the HIFS-VNL unique and state-of-the-art experimental capabilities in preparation for the planned target heating experiments using intense heavy ion beams

  14. Initiation of simian virus 40 DNA replication in vitro: Pulse-chase experiments identify the first labeled species as topologically unwound

    International Nuclear Information System (INIS)

    Bullock, P.A.; Seo, Yeon Soo; Hurwitz, J.

    1989-01-01

    A distinct unwound form of DNA containing the simian virus 40 (SV40) origin is produced in replication reactions carried out in mixtures containing crude fractions prepared from HeLa cells. This species, termed form U R , comigrates on chloroquine-containing agarose gels with the upper part of the previously described heterogeneous highly unwound circular DNA, form U. As with form U, formation of form U R is dependent upon the SV40 tumor (T) antigen. Pulse-chase experiments demonstrate that the first species to incorporate labeled deoxyribonucleotides comigrates with form U R . Restriction analyses of the products of the pulse-chase experiments show that initiation occurs at the SV40 origin and then proceeds outward in a bidirectional manner. These experiments establish form U R as the earliest detectable substrate for SV40 DNA replication and suggest that SV40 DNA replication initiates on an unwound species

  15. Is tree loss associated with cardiovascular-disease risk in the Women's Health Initiative? A natural experiment

    Science.gov (United States)

    Geoffrey H. Donovan; Yvonne L. Michael; Demetrios Gatziolis; Jeffrey P. Prestemon; Eric A. Whitsel

    2015-01-01

    Data from the Women's Health Initiative were used to quantify the relationship between the loss of trees to an invasive forest pest—the emerald ash borer—and cardiovascular disease. We estimated semi- parametric Cox proportional hazards model of time to cardiovascular disease, adjusting for confounders. We defined the incidence of cardiovascular disease as acute...

  16. The Sensed Presence Questionnaire (SenPQ: initial psychometric validation of a measure of the “Sensed Presence” experience

    Directory of Open Access Journals (Sweden)

    Joseph M. Barnby

    2017-03-01

    Full Text Available Background The experience of ‘sensed presence’—a feeling or sense that another entity, individual or being is present despite no clear sensory or perceptual evidence—is known to occur in the general population, appears more frequently in religious or spiritual contexts, and seems to be prominent in certain psychiatric or neurological conditions and may reflect specific functions of social cognition or body-image representation systems in the brain. Previous research has relied on ad-hoc measures of the experience and no specific psychometric scale to measure the experience exists to date. Methods Based on phenomenological description in the literature, we created the 16-item Sensed Presence Questionnaire (SenPQ. We recruited participants from (i a general population sample, and; (ii a sample including specific selection for religious affiliation, to complete the SenPQ and additional measures of well-being, schizotypy, social anxiety, social imagery, and spiritual experience. We completed an analysis to test internal reliability, the ability of the SenPQ to distinguish between religious and non-religious participants, and whether the SenPQ was specifically related to positive schizotypical experiences and social imagery. A factor analysis was also conducted to examine underlying latent variables. Results The SenPQ was found to be reliable and valid, with religious participants significantly endorsing more items than non-religious participants, and the scale showing a selective relationship with construct relevant measures. Principal components analysis indicates two potential underlying factors interpreted as reflecting ‘benign’ and ‘malign’ sensed presence experiences. Discussion The SenPQ appears to be a reliable and valid measure of sensed presence experience although further validation in neurological and psychiatric conditions is warranted.

  17. Development of the BWR Dry Core Initial and Boundary Conditions for the SNL XR2 Experiments; TOPICAL

    International Nuclear Information System (INIS)

    Ott, L.J.

    1994-01-01

    The objectives of the Boiling Water Reactor Experimental Analysis and Model Development for Severe Accidents (BEAMD) Program at the Oak Ridge National Laboratory (ORNL) are: (1) the development of a sound quantitative understanding of boiling water reactor (BWR) core melt progression; this includes control blade and channel box effects, metallic melt relocation and possible blockage formation under severe accident conditions, and (2) provision of BWR melt progression modeling capabilities in SCDAP/RELAP5 (consistent with the BWR experimental data base). This requires the assessment of current modeling of BWR core melt progression against the expanding BWR data base. Emphasis is placed upon data from the BWR tests in the German CORA test facility and from the ex-reactor experiments[Sandia National Laboratories (SNL)] on metallic melt relocation and blockage formation in BWRs, as well as upon in-reactor data from the Annular Core Research Reactor (ACRR) DF-4 BWR test (conducted in 1986 at SNL). The BEAMD Program is a derivative of the BWR Severe Accident Technology Programs at ORNL. The ORNL BWR programs have studied postulated severe accidents in BWRs and have developed a set of models specific to boiling water reactor response under severe accident conditions. These models, in an experiment-specific format, have been successfully applied to both pretest and posttest analyses of the DF-4 experiment, and the BWR severe fuel damage (SFD) experiments performed in the CORA facility at the Kernforschungszentrum Karlsruhe (KfK) in Germany, resulting in excellent agreement between model prediction and experiment. The ORNL BWR models have provided for more precise predictions of the conditions in the BWR experiments than were previously available. This has provided a basis for more accurate interpretation of the phenomena for which the experiments are performed. The experiment-specific models, as used in the ORNL DF-4 and CORA BWR experimental analyses, also provide a basis

  18. Degrees of Change: Understanding Academics Experiences with a Shift to Flexible Technology- Enhanced Learning in Initial Teacher Education

    Science.gov (United States)

    Kehrwald, Benjamin A.; McCallum, Faye

    2015-01-01

    The implementation of technology enhanced learning in higher education is often associated with changes to academic work. This article reports on a study of staff experiences with curriculum development and teaching in multiple modes of blended and online learning in a Bachelor of Education degree. The findings indicate that the changes…

  19. Experiences of Transgender-Related Discrimination and Implications for Health: Results From the Virginia Transgender Health Initiative Study

    Science.gov (United States)

    Reisner, Sari L.; Honnold, Julie A.; Xavier, Jessica

    2013-01-01

    Objectives. We examined relationships between social determinants of health and experiences of transgender-related discrimination reported by transgender people in Virginia. Methods. In 2005 through 2006, 387 self-identified transgender people completed a statewide health needs assessment; 350 who completed eligibility questions were included in this examination of factors associated with experiences of discrimination in health care, employment, or housing. We fit multivariate logistic regression models using generalized estimating equations to adjust for survey modality (online vs paper). Results. Of participants, 41% (n = 143) reported experiences of transgender-related discrimination. Factors associated with transgender-related discrimination were geographic context, gender (female-to male spectrum vs male-to-female spectrum), low socioeconomic status, being a racial/ethnic minority, not having health insurance, gender transition indicators (younger age at first transgender awareness), health care needed but unable to be obtained (hormone therapy and mental health services), history of violence (sexual and physical), substance use health behaviors (tobacco and alcohol), and interpersonal factors (family support and community connectedness). Conclusions. Findings suggest that transgender Virginians experience widespread discrimination in health care, employment, and housing. Multilevel interventions are needed for transgender populations, including legal protections and training for health care providers. PMID:23153142

  20. Student Perspectives on First Year Experience Initiatives Designed for Pre-Service Teachers in Their First Weeks of University Study

    Science.gov (United States)

    Larkin, Kevin; Rowan, Leonie; Garrick, Barbara; Beavis, Catherine

    2016-01-01

    Universities throughout Australia are increasingly investing significant amounts of time and money in efforts to improve the quality of first year students' experiences and, by extension, increase retention, performance and student satisfaction. This paper reports upon a pilot research project conducted at a Queensland university that investigates…

  1. Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study.

    Science.gov (United States)

    Bradford, Judith; Reisner, Sari L; Honnold, Julie A; Xavier, Jessica

    2013-10-01

    We examined relationships between social determinants of health and experiences of transgender-related discrimination reported by transgender people in Virginia. In 2005 through 2006, 387 self-identified transgender people completed a statewide health needs assessment; 350 who completed eligibility questions were included in this examination of factors associated with experiences of discrimination in health care, employment, or housing. We fit multivariate logistic regression models using generalized estimating equations to adjust for survey modality (online vs paper). Of participants, 41% (n = 143) reported experiences of transgender-related discrimination. Factors associated with transgender-related discrimination were geographic context, gender (female-to male spectrum vs male-to-female spectrum), low socioeconomic status, being a racial/ethnic minority, not having health insurance, gender transition indicators (younger age at first transgender awareness), health care needed but unable to be obtained (hormone therapy and mental health services), history of violence (sexual and physical), substance use health behaviors (tobacco and alcohol), and interpersonal factors (family support and community connectedness). Findings suggest that transgender Virginians experience widespread discrimination in health care, employment, and housing. Multilevel interventions are needed for transgender populations, including legal protections and training for health care providers.

  2. Use of the adjustable trans-obturator male sling system for the treatment of male incontinence. An initial experience

    Directory of Open Access Journals (Sweden)

    M.S. El Badry

    2016-06-01

    Conclusions: Our early experience demonstrated that the ATOMS system may be a safe and effective procedure for the treatment of male urinary incontinence. It has the advantage of being feasible any time after an operation when necessary. However, long-term follow-up on a large number of cases is required to ensure its long-term efficacy and safety.

  3. Using narratives to understand the motivational factors and experience of being a self-initiated academic expatriate in South Africa

    Directory of Open Access Journals (Sweden)

    Tinashe T. Harry

    2017-08-01

    Full Text Available Orientation: A growing movement of foreign nationals is settling in South Africa. Given this, there is a need to understand not only those factors influencing foreign nationals to settle in South Africa but also their lived experiences as a basis for individual career development. Research purpose: To investigate the expatriation motivational factors and experiences of selfinitiated academic expatriates in South Africa. Motivation for the study: Calls have been made within the careers literature for more empirical focus on understanding career development using some of the neglected sample groups. Research approach, design and method: The interpretive paradigm was adopted to understand the main purpose of the study. Guided by study objectives, unstructured interviews were conducted using a sample of foreign academics working in South Africa (n = 25. Main findings: Individual stories and narratives highlighted that academics relocated for the following reasons: (1 individual preference, (2 economic meltdown and (3 political conditions. Furthermore, the lived experiences of the expatriates reflected discrimination within the workplace and the community of residences in South Africa. Practical and managerial implications: Research findings indicate that the human resources (HR function can come up with interventions that positively influence the lived experience and career development of foreign academics working in South Africa. Contribution: The expatriate experience framed in this study provides a picture of the career development processes of neglected sample groups in the extant literature. Such an understanding is key in advancing literature and proposing interventions. All this is important given the global trend on labour and skills movement added to the role South Africa plays in the international arena.

  4. Identification of novel psychoactive drug use in Sweden based on laboratory analysis--initial experiences from the STRIDA project.

    Science.gov (United States)

    Helander, Anders; Beck, Olof; Hägerkvist, Robert; Hultén, Peter

    2013-08-01

    The study aimed to collect information concerning the increasing use of new psychoactive substances, commonly sold through online shops as 'Internet drugs' or 'legal highs', or in terms of masked products such as 'bath salts' and 'plant food'. The Karolinska Institutet and Karolinska University Laboratory and the Swedish Poisons Information Centre have initiated a project called 'STRIDA' aiming to monitor the occurrence and trends of new psychoactive substances in Sweden, and collect information about their clinical symptoms, toxicity and associated health risks. A liquid chromatographic-tandem mass spectrometric (LC-MS/MS) multi-component method has been developed, currently allowing for the determination of > 80 novel psychoactive compounds or metabolites thereof. This study focused mainly on the particular drug substances identified and the population demographics of the initial STRIDA cases. In urine and/or blood samples obtained from 103 consecutive cases of admitted or suspected recreational drug intoxications in mostly young subjects (78% were ≤ 25 years, and 81% were males) presenting at emergency departments all over the country, psychoactive substances were detected in 82%. The substances comprised synthetic cannabinoids ('Spice'; JWH analogues), substituted cathinones ('bath salts'; e.g. butylone, MDPV and methylone) and tryptamines (4-HO-MET), plant-based substances (mitragynine and psilocin), as well as conventional drugs-of-abuse. In 44% of the cases, more than one new psychoactive substance, or a mixture of new and/or conventional drugs were detected. The initial results of the STRIDA project have documented use of a broad variety of new psychoactive substances among mainly young people all over Sweden.

  5. Fusion imaging of computed tomographic pulmonary angiography and SPECT ventilation/perfusion scintigraphy: initial experience and potential benefit

    International Nuclear Information System (INIS)

    Harris, Benjamin; Bailey, Dale; Roach, Paul; Bailey, Elizabeth; King, Gregory

    2007-01-01

    The objective of this study was to examine the feasibility of fusing ventilation and perfusion data from single-photon emission computed tomography (SPECT) ventilation perfusion (V/Q) scintigraphy together with computed tomographic pulmonary angiography (CTPA) data. We sought to determine the accuracy of this fusion process. In addition, we correlated the findings of this technique with the final clinical diagnosis. Thirty consecutive patients (17 female, 13 male) who had undergone both CTPA and SPECT V/Q scintigraphy during their admission for investigation of potential pulmonary embolism were identified retrospectively. Image datasets from these two modalities were co-registered and fused using commercial software. Accuracy of the fusion process was determined subjectively by correlation between modalities of the anatomical boundaries and co-existent pleuro-parenchymal abnormalities. In all 30 cases, SPECT V/Q images were accurately fused with CTPA images. An automated registration algorithm was sufficient alone in 23 cases (77%). Additional linear z-axis scaling was applied in seven cases. There was accurate topographical co-localisation of vascular, parenchymal and pleural disease on the fused images. Nine patients who had positive CTPA performed as an initial investigation had co-localised perfusion defects on the subsequent fused CTPA/SPECT images. Three of the 11 V/Q scans initially reported as intermediate could be reinterpreted as low probability owing to co-localisation of defects with parenchymal or pleural pathology. Accurate fusion of SPECT V/Q scintigraphy to CTPA images is possible. This technique may be clinically useful in patients who have non-diagnostic initial investigations or in whom corroborative imaging is sought. (orig.)

  6. Pain experience during initial alignment with a self-ligating and a conventional fixed orthodontic appliance system. A randomized controlled clinical trial.

    Science.gov (United States)

    Fleming, P S; Dibiase, A T; Sarri, G; Lee, R T

    2009-01-01

    To test the hypotheses that (1) there is no difference in the pain experience during the week following initial placement of two orthodontic appliances (SmartClip and Victory; 3M Unitek, Monrovia, Calif); and (2) there is no difference in the pain experience during removal and insertion of orthodontic archwires with these brackets. Sixty-six consecutive patients were treated with a self-ligating bracket system (SmartClip) or a conventional appliance (Victory) on the basis of computer-generated random allocation. After appliance placement and engagement of a 0.016'' nickel-titanium archwire, pain experience was recorded after 4, 24, and 72 hours and after 7 days with the use of a visual analog system (VAS) questionnaire. At a subsequent visit, participants documented pain experiences during removal and insertion of 0.019 x 0.025'' archwires on an additional 100 mm VAS questionnaire. Independent t-tests and analyses of covariance were used to analyze normally distributed data; the Mann-Whitney U-test was used for skewed distributions. Forty-eight (72.2%) and fifty-one (77.3%) subjects completed the first and second parts of the study, respectively. Bracket type had no influence on pain experience at 4 hours (P = .958), 24 hours (P = .289), 72 hours (P = .569), and 7 days (P = .756) following appliance placement. However, bracket type significantly influenced pain experience during archwire removal (P = .001) and insertion (P = .013). Hypothesis 1 cannot be rejected. The bracket type had no effect on subjective pain experience during the first week after initial placement of two preadjusted orthodontic appliances. Hypothesis 2 was rejected. Significantly greater discomfort was experienced during archwire insertion and removal with the SmartClip appliance.

  7. Experience from a multi-country initiative to improve the monitoring of selected reproductive health indicators in Africa.

    Science.gov (United States)

    Barreix, Maria; Tunçalp, Özge; Mutombo, Namuunda; Adegboyega, Ayotunde A; Say, Lale

    2017-05-01

    Universal access to sexual and reproductive health remains part of the unfinished business of global development in Africa. To achieve it, health interventions should be monitored using programmatic indicators. WHO's Strengthening Measurement of Reproductive Health Indicators in Africa initiative, implemented in Ghana, Nigeria, Kenya, Uganda, and Zimbabwe, aimed to improve national information systems for routine monitoring of reproductive health indicators. Participating countries developed action plans employing a two-pronged strategy: (1) revising, standardizing, and harmonizing existing reproductive health indicators captured through routine information-systems; and (2) building data-collection capacity through training and supervision at select pilot sites. Country teams evaluated existing and new indicators, and outlined barriers to strengthening routine measurement. Activities included updating abortion-care guidelines (spontaneous and induced abortions), providing training on laws surrounding induced abortions, and improving feedback mechanisms. The country teams updated monitoring and evaluation frameworks, and attempted to build recording/reporting capacity in selected pilot areas. Barriers to implementing the initiative that were encountered included restrictive induced-abortion laws, staff turn-over, and administrative delays, including low capacity among healthcare staff and competing priorities for staff time. The areas identified for further improvement were up-scaling programs to a national level, creating scorecards to record data, increasing collaborations with the private sector, conducting related costing exercises, and performing ex-post evaluations. © 2017 World Health Organization; licensed by Wiley on behalf of International Federation of Gynecology and Obstetrics.

  8. Two-Person Technique of Peroral Endoscopic Myotomy for Achalasia with an Advanced Endoscopist and a Thoracic Surgeon: Initial Experience

    Directory of Open Access Journals (Sweden)

    Madhusudhan R. Sanaka

    2016-01-01

    Full Text Available Background and Aims. We initiated peroral endoscopic myotomy (POEM utilizing a two-person technique with combination of an advanced endoscopist and a thoracic surgeon with complementary skills. Our aim was to determine the feasibility and outcomes in initial 20 patients. Methods. In this observational study, main outcomes measured were therapeutic success in relieving symptoms (Eckardt score < 3, decrease in lower esophageal sphincter (LES pressures, improvement in emptying on timed barium esophagogram (TBE, and complications. Results. POEM was successful in all 20 patients with a mean operative time of 140.1+32.9 minutes. Eckardt symptom scores decreased significantly at two-month follow-up (6.4+2.9 versus 0.25+0.45, p<0.001. Both basal and residual LES pressures decreased significantly (28.2+14.1 mmHg versus 12.8+6.3 and 22.4+11.3 versus 6.3+3.4 mmHg, p=0.025 and <0.001, resp.. Barium column height at 5 minutes on TBE reduced from 6.8+4.9 cm to 2.3+2.9 cm (p=0.05. Two patients (10% had mucosal perforations and one had delayed bleeding (5%. Conclusions. Two-person technique of POEM with combination of an advanced endoscopist and a thoracic surgeon is highly successful with low risk of complications.

  9. Initial report on stress-corrosion-cracking experiments using Zircaloy-4 spent fuel cladding C-rings

    International Nuclear Information System (INIS)

    Smith, H.D.

    1988-09-01

    The Nevada Nuclear Waste Storage Investigations (NNWSI) Project is sponsoring C-ring stress corrosion cracking scoping experiments as a first step in evaluating the potential for stress corrosion cracking of spent fuel cladding in a potential tuff repository environment. The objective is to scope the approximate behavior so that more precise pressurized tube testing can be performed over an appropriate range of stress, without expanding the long-term effort needlessly. The experiment consists of stressing, by compression with a dead weight load, C-rings fabricated from spent fuel cladding exposed to an environment of Well J-13 water held at 90/degree/C. The results indicate that stress corrosion cracking occurs at the high stress levels employed in the experiments. The cladding C-rings, tested at 90% of the stress at which elastic behavior is obtained in these specimens, broke in 25 to 64 d when tested in water. This was about one third of the time required for control tests to break in air. This is apparently the first observation of stress corrosion under the test conditions of relatively low temperature, benign environment but very high stress. The 150 ksi test stress could be applied as a result of the particular specimen geometry. By comparison, the uniaxial tensile yield stress is about 100 to 120 ksi and the ultimate stress is about 150 ksi. When a general model that fits the high stress results is extrapolated to lower stress levels, it indicates that the C-rings in experiments now running at /approximately/80% of the yield strength should take 200 to 225 d to break. 21 refs., 24 figs., 5 tabs

  10. Initial liquid metal magnetohydrodynamic thin film flow experiments in the MeGA-loop facility at UCLA

    International Nuclear Information System (INIS)

    Morley, N.B.; Gaizer, A.A.; Tillack, M.S.; Abdou, M.A.

    1995-01-01

    Free surface thin film flows of liquid metal were investigated experimentally in the presence of a coplanar magnetic field. This investigation was performed in a new magnetohydrodynamic (MHD) flow facility, the MeGA-loop, utilizing a low melting temperature lead-bismuth alloy as the working metal. Owing to the relatively low magnetic field produced by the present field coil system, the ordinary hydrodynamic and low MHD interaction regimes only were investigated. At the high flow speeds necessary for self cooling, the importance of a well designed and constructed channel becomes obvious. Partial MHD drag, increasing the film height, is observed as Haβ 2 becomes greater than unity. MHD laminarization of the turbulent film flows is observed when Haβ/Re>0.002, but fully laminar flow was not reached. Suggestions for facility upgrades to achieve greater MHD interaction are presented in the context of these initial results. (orig.)

  11. FROM PHENOMENA AND LAWS OF NATURE TO INITIAL DATA SYMMETRY PRINCIPLES (EXPERIENCE OF RELATIONSHIP OF NATURAL SCIENCE AND THEOLOGY

    Directory of Open Access Journals (Sweden)

    Victor Nikolaevich Pervushin

    2015-01-01

    Full Text Available The aim of the investigation is to show a role of principles of symmetry of the initial data in formation of the consistent physical theory in a context of the newest advances in cosmology and physics of elementary particles.Methods. Methodological problems of modernity are considered on the basis of the retrospective analysis of physical theories, history of theology, comparison and generalisation of knowledge, the facts and positions from scientific, philosophical and religious spheres.Results and scientific novelty. The problems of consistency and completeness of scientific knowledge and convergence of the maintenance of religious texts and the observant scientific data in the physics and cosmology are discussed by the example of modern cosmologic models of the description of the Universe. It is proved that such convergence is claimed and actual not only concerning classification of physical processes in the Universe, including its origin from vacuum, but also in area of ontology and at forming of logics of scientific researches.Former and newest scientific achievements in the physics and cosmology are reinterpreted in a context of Hilbert geometrodynamics, added with a choice of relative standards of lengths and principles measurement of conformal symmetry.Practical significance. The author sees the further prospect of development of the scientific theory in a priority of conformal symmetry of a totality of any initial research data. So, in accordance with conformal symmetry, elementary objects of space-time are twistors that mathematically equivalent to cubits or to quantum generalisations of bits – information units. The general theory of knowledge eventually conducts to the fundamental theory of the information which, probably, will accept the name of quantum informodynamics, by analogy with quantum chromodynamics.

  12. Use of CAHPS® patient experience survey data as part of a patient-centered medical home quality improvement initiative

    Directory of Open Access Journals (Sweden)

    Quigley DD

    2015-07-01

    Full Text Available Denise D Quigley,1 Peter J Mendel,1 Zachary S Predmore,2 Alex Y Chen,3 Ron D Hays41RAND Corporation, Santa Monica, CA, 2RAND Corporation, Boston, MA, 3AltaMed Health Services Corporation, 4Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles, CA, USAObjective: To describe how practice leaders used Consumer Assessment of Healthcare Providers and Systems (CAHPS® Clinician and Group (CG-CAHPS data in transitioning toward a patient-centered medical home (PCMH.Study design: Interviews conducted at 14 primary care practices within a large urban Federally Qualified Health Center in California.Participants: Thirty-eight interviews were conducted with lead physicians (n=13, site clinic administrators (n=13, nurse supervisors (n=10, and executive leadership (n=2.Results: Seven themes were identified on how practice leaders used CG-CAHPS data for PCMH transformation. CAHPS® was used: 1 for quality improvement (QI and focusing changes for PCMH transformation; 2 to maintain focus on patient experience; 3 alongside other data; 4 for monitoring site-level trends and changes; 5 to identify, analyze, and monitor areas for improvement; 6 for provider-level performance monitoring and individual coaching within a transparent environment of accountability; and 7 for PCMH transformation, but changes to instrument length, reading level, and the wording of specific items were suggested.Conclusion: Practice leaders used CG-CAHPS data to implement QI, develop a shared vision, and coach providers and staff on performance. They described how CAHPS® helped to improve the patient experience in the PCMH model, including access to routine and urgent care, wait times, provider spending enough time and listening carefully, and courteousness of staff. Regular reporting, reviewing, and discussing of patient-experience data alongside other clinical quality and productivity measures at multilevels of the organization was critical in maximizing the

  13. Using immersive healthcare simulation for physiology education: initial experience in high school, college, and graduate school curricula.

    Science.gov (United States)

    Oriol, Nancy E; Hayden, Emily M; Joyal-Mowschenson, Julie; Muret-Wagstaff, Sharon; Faux, Russell; Gordon, James A

    2011-09-01

    In the natural world, learning emerges from the joy of play, experimentation, and inquiry as part of everyday life. However, this kind of informal learning is often difficult to integrate within structured educational curricula. This report describes an educational program that embeds naturalistic learning into formal high school, college, and graduate school science class work. Our experience is based on work with hundreds of high school, college, and graduate students enrolled in traditional science classes in which mannequin simulators were used to teach physiological principles. Specific case scenarios were integrated into the curriculum as problem-solving exercises chosen to accentuate the basic science objectives of the course. This report also highlights the historic and theoretical basis for the use of mannequin simulators as an important physiology education tool and outlines how the authors' experience in healthcare education has been effectively translated to nonclinical student populations. Particular areas of focus include critical-thinking and problem-solving behaviors and student reflections on the impact of the teaching approach.

  14. Initial experience with a new biodegradable airway stent in children: Is this the stent we were waiting for?

    Science.gov (United States)

    Antón-Pacheco, Juan L; Luna, Carmen; García, Enrique; López, María; Morante, Rocío; Tordable, Cristina; Palacios, Alba; de Miguel, Mónica; Benavent, Isabel; Gómez, Andrés

    2016-06-01

    To report our experience with a new type of biodegradable airway stent in the setting of severe tracheobronchial obstruction in children. We conducted a retrospective and prospective (since June 2014) study of pediatric patients with severe airway obstruction treated with biodegradable stents in our institution between 2012 and 2015. The following data were collected: demographics, indication for stenting, bronchoscopic findings, insertion technique complications, clinical outcome, stent related complications, re-stenting, and time of follow-up. Thirteen custom-made polydioxanone stents were placed in four infants (mean age, 4 months) with severe tracheobronchial obstruction: tracheomalacia (two patients), bronchomalacia (1), and diffuse tracheal stenosis (1). All the stents were bronchoscopically inserted uneventfully. Immediate and maintained clinical improvement was observed in every case. No major stent related complications have occurred and only mild or moderate granulation tissue was observed during surveillance bronchoscopy. Two patients required repeated stenting as expected. All the patients are alive and in a good respiratory condition with a follow-up ranging from 5 to 40 months. Biodegradable airway stents seem to be safe, effective, and cause fewer complications than other types of stents. They can be an alternative to the classic metallic or plastic stents for severe tracheal stenosis or malacia in small children. More experience is needed in order to establish the definite clinical criteria for their use in pediatric patients. Pediatr Pulmonol. 2016;51:607-612. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  15. Initial experiences in embedding core competency education in entry-level surgery residents through a nonclinical rotation.

    Science.gov (United States)

    Kahol, Kanav; Huston, Carrie; Hamann, Jessica; Ferrara, John J

    2011-03-01

    Health care continues to expand in scope and in complexity. In this changing environment, residents are challenged with understanding its intricacies and the impact it will have on their professional activities and careers. Embedding each of the competency elements in residents in a meaningful way remains a challenge for many surgery residency program directors. We established a nonclinical rotation to provide surgery postgraduate year-1 (PGY-1) residents with a structured, multifaceted, largely self-directed curriculum into which each of the 6 core competencies are woven. Posttesting strategies were established for most curricular experiences to ensure to the greatest possible extent that each resident will have achieved an acceptable level of understanding of each of the competency areas before being given credit for the rotation. By uniformly exceeding satisfactory scores on respective objective analyses, residents demonstrated an increased (at least short-term) understanding of each of the assessed competency areas. Our project sought to address a prior lack of opportunity for our residents to develop a sound foundation for our residents in systems-based practice. Our new rotation addresses systems-based practice in several different learning environments, including emergency medical service ride-along, sentinel event participation, and hospice visits. Several research projects have enhanced the overall learning program. Our experience shows that a rotation dedicated to competency training can provide an innovative and engaging means of teaching residents the value of each element.

  16. Experimental Whole-Ecosystem Warming Alters Vegetation Phenology in a Boreal Spruce Bog: Initial Results from the SPRUCE Experiment

    Science.gov (United States)

    Richardson, A. D.

    2016-12-01

    Phenology is one of the most robust indicators of the biological impacts of global change. However, the response of phenology to future environmental conditions still remains highly uncertain because of the challenges associated with conducting realistic manipulative experiments. At the SPRUCE (Spruce and Peatland Responses Under Climatic and Environmental Change) experiment in the north-central United States, experimental temperature (0 to +9°C above ambient) and CO2 (ambient and elevated) treatments are being applied to mature, and intact, Picea mariana-Sphagnum spp. bog communities in their native habitat through the use of ten large (approximately 12 m wide, 10 m high) open-topped enclosures. We are tracking vegetation green-up and senescence in these chambers using repeat digital photography. Within each chamber, images are recorded every 30 minutes and uploaded to PhenoCam (http://phenocam.sr.unh.edu), where processed to yield quantitative measures of canopy color. These data are complemented by on-the-ground phenological data collected by human observers. Air warming treatments at SPRUCE began in August 2015. We observed a delay in senescence during autumn 2015 (2-5 days per degree of warming) and an advance in onset during spring 2016 (1-4 days per degree of warming). These patterns are robust across species and methods of phenological observation (i.e. camera-based vs. human observer). And, our results show very little evidence for photoperiod acting as a constraint on the response to warming. Early spring onset and consequent loss of frost hardiness in the warmest chambers proved disadvantageous when a brief period of extreme cold (to -12°C in the control chambers, to -3°C in the +9°C chambers) followed a month of generally mild weather. Foliage mortality for both Larix and Picea was immediate and severe, although both species subsequently re-flushed. These results give support for the hypothesis that warming may enhance the likelihood of spring frost

  17. Positron emission tomography/magnetic resonance imaging (PET/MRI: An update and initial experience at HC-FMUSP

    Directory of Open Access Journals (Sweden)

    Marcelo A. Queiroz

    Full Text Available Summary The new technology of PET/MRI is a prototype of hybrid imaging, allowing for the combination of molecular data from PET scanning and morphofunctional information derived from MRI scanning. Recent advances regarding the technical aspects of this device, especially after the development of MRI-compatible silicon photomultipliers of PET, permitted an increase in the diagnostic performance of PET/MRI translated into dose reduction and higher imaging quality. Among several clinical applications, PET/MRI gains ground initially in oncology, where MRI per se plays an essential role in the assessment of primary tumors (which is limited in the case of PET/CT, including prostate, rectal and gynecological tumors. On the other hand, the evaluation of the lungs remains an enigma although new MRI sequences are being designed to overcome this. More clinical indications of PET/MRI are seen in the fields of neurology, cardiology and inflammatory processes, and the use of PET/MRI also opens perspectives for pediatric populations as it involves very low radiation exposure. Our review aimed to highlight the current indications of PET/MRI and discuss the challenges and perspectives of PET/MRI at HC-FMUSP.

  18. Application of the GRAAL model to leaching experiments with SON68 nuclear glass in initially pure water

    International Nuclear Information System (INIS)

    Frugier, P.; Chave, T.; Gin, S.; Lartigue, J.-E.

    2009-01-01

    Based on a review of the current state of knowledge concerning the aqueous alteration of SON68 nuclear glass we have proposed a mechanistic model, GRAAL (Glass Reactivity with Allowance for the Alteration Layer) [P. Frugier, S. Gin, Y. Minet, T. Chave, B. Bonin, N. Godon, J.E. Lartigue, P. Jollivet, A. Ayral, L. De Windt, G. Santarini, J. Nucl. Mater. 380 (2008) 8]. This article describes how the GRAAL model hypotheses are solved using a calculation code coupling chemistry and transport. The geochemical solution of this model combines three major phenomena: chemical equilibria in solution, water and ion transport by convection or diffusion, and element diffusion through the passivating reactive interphase. The model results are compared with experimental data for SON68 glass leached in initially pure water both in a closed system and in renewed media. The comparison shows the model very satisfactorily accounts for variations in the pH and the element concentrations in solution as a function of time, the glass surface area in contact with solution, and the solution renewal rate. This success is due to the fact that the diffusion of elements through the alteration gel is taken into account in the model. This mechanism cannot be disregarded under most experimental conditions - if only to predict the solution pH - and must therefore be an integral part of the geochemical model.

  19. Red Sea Outflow Experiment (REDSOX): Descent and initial spreading of Red Sea Water in the northwestern Indian Ocean

    Science.gov (United States)

    Bower, A.; Johns, W.; Peters, H.; Fratantoni, D.

    2003-04-01

    Two comprehensive surveys were carried out during 2001 to investigate the dense overflow and initial spreading of Red Sea Water (RSW) in the Gulf of Aden. The cruises were timed to coincide with the climatological maximum (February) and minimum (August) periods of outflow transport. The surveys included high-resolution CTD/lowered ADCP/shipboard ADCP observations in the descending plume and in the western gulf, and trajectories from 50 acoustically-tracked RAFOS floats released at the center of the equilibrated RSW (650 m). The measurements reveal a complicated descending plume structure in the western gulf with three main pathways for the high salinity RSW. Different mixing intensities along these pathways lead to variable penetration depths of the Red Sea plume between 450-900 m in the Gulf of Aden. The observations also revealed the hydrographic and velocity structure of large, energetic, deep-reaching mesoscale eddies in the gulf that fundamentally impact the spreading rates and pathways of RSW. Both cyclones and anticyclones were observed, with horizontal scales up to 250 km and azimuthal speeds as high as 0.5 m/s. The eddies appear to reach nearly to the sea floor and entrain RSW from the western gulf at mid-depth. Post-cruise analysis of SeaWiffs imagery suggests that some of these eddies form in the Indian Ocean and propagate into the gulf.

  20. Simultaneous Kidney-Pancreas Transplantation With an Original "Transverse Pancreas" Technique: Initial 9 Years' Experience With 56 Cases.

    Science.gov (United States)

    Paulino, J; Martins, A; Vigia, E; Marcelino, P; Nobre, A M; Bicho, L; Filipe, E; Barroso, E

    2017-10-01

    An innovative technique for pancreas transplantation is described. The main aspect consists of the horizontal positioning of the pancreas, which allows a better venous outflow, thus preventing thrombosis and graft loss. The program of pancreas transplantation in this national reference center for pancreatic and liver surgery was started in 2007; the initial results were considered poor, resulting in the loss of half of the grafts due to venous thrombosis. After analyzing the possible causes, this technique was proposed and successfully implemented, reducing the postoperative complications, particularly the problem of venous thrombosis. A detailed description of the new surgical technique is provided. The main clinical and demographic characteristics of the 56 patients who underwent the surgery are analyzed. The incidence of venous thrombosis was 5.3% (3 patients) and graft loss was 3.5% (2 patients). Due to the good results, this technique became the standard surgery for transplantation of the pancreas in our center. The technique proved to be safe and successful. Due to the unique pancreas graft implantation, we called it "transverse pancreas surgery." Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Neoadjuvant chemotherapy evaluation by MRI volumetry in rectal cancer followed by chemoradiation and total mesorectal excision: Initial experience.

    Science.gov (United States)

    Nougaret, Stephanie; Fujii, Shinya; Addley, Helen C; Bibeau, Frederic; Pandey, Himanshu; Mikhael, Hisham; Reinhold, Caroline; Azria, David; Rouanet, Philippe; Gallix, Benoit

    2013-09-01

    To evaluate rectal cancer volumetry in predicting initial neoadjuvant chemotherapy response. Sixteen consecutive patients who underwent neoadjuvant chemotherapy (CX) before chemoradiotherapy (CRT) and surgery were enrolled in this retrospective study. Tumor volume was evaluated at the first magnetic resonance imaging (MRI), after CX and after CRT. Tumor volume regression (TVR) and downstaging were compared with histological results according to Tumor Regression Grade (TRG) to assess CX and CRT response, respectively. The mean tumor volume was 132 cm(3) ± 166 before and 56 cm(3) ± 71 after CX. TVR after CX was significantly different between patients with poor histologic response (TRG1/2) and those with good histologic response (TRG3/4) (P = 0.001). An optimal cutoff of TVR >68% (area under the curve [AUC]: 0.9, 95% confidence interval [CI]: 0.65-0.98, P = 0.0001) to predict good histology response after CX was assessed by receiver operating characteristic curve. According to previous data and this study, we defined 70% as the best cutoff values according to sensitivity (86%), specificity (100%) of TVR for predicting good histology response. In contradistinction, MRI downstaging was associated with TRG only after CRT (P = 0.04). Our pilot study showed that MRI volumetry can predict early histological response after CX and before CRT. MRI volumetry could help the clinician to distinguish early responders in order to aid appropriate individually tailored therapies. Copyright © 2013 Wiley Periodicals, Inc., a Wiley company.

  2. Initial experience with a prototype dual-crystal (LSO/NaI) dual-head coincidence camera in oncology

    International Nuclear Information System (INIS)

    Joshi, Urvi; Boellaard, Ronald; Comans, Emile F.I.; Raijmakers, Pieter G.H.M.; Pijpers, Rik J.; Teule, Gerrit J.J.; Lingen, Arthur van; Hoekstra, Otto S.; Miller, Steven D.

    2004-01-01

    The aim of this study was to evaluate the in vivo performance of a prototype dual-crystal [lutetium oxyorthosilicate (LSO)/sodium iodide (NaI)] dual-head coincidence camera (DHC) for PET and SPET (LSO-PS), in comparison to BGO-PET with fluorine-18 fluorodeoxyglucose (FDG) in oncology. This follows earlier reports that LSO-PS has noise-equivalent counting (NEC) rates comparable to partial ring BGO-PET, i.e. clearly higher than standard NaI DHCs. Twenty-four randomly selected oncological patients referred for whole-body FDG-PET underwent BGO-PET followed by LSO-PS. Four nuclear medicine physicians were randomised to read a single scan modality, in terms of lesion intensity, location and likelihood of malignancy. BGO-PET was considered the gold standard. Forty-eight lesions were classified as positive with BGO-PET, of which LSO-PS identified 73% (95% CI 60-86%). There was good observer agreement for both modalities in terms of intensity, location and interpretation. Lesions were missed by LSO-PS in 13 patients in the chest (n=6), neck (n=3) and abdomen (n=4). The diameter of these lesions was estimated to be 0.5-1 cm. Initial results justify further evaluation of LSO-PS in specific clinical situations, especially if a role as an instrument of triage for PET is foreseen. (orig.)

  3. Intraoperative Scintigraphy Using a Large Field-of-View Portable Gamma Camera for Primary Hyperparathyroidism: Initial Experience

    Directory of Open Access Journals (Sweden)

    Nathan C. Hall

    2015-01-01

    Full Text Available Background. We investigated a novel technique, intraoperative 99 mTc-Sestamibi (MIBI imaging (neck and excised specimen (ES, using a large field-of-view portable gamma camera (LFOVGC, for expediting confirmation of MIBI-avid parathyroid adenoma removal. Methods. Twenty patients with MIBI-avid parathyroid adenomas were preoperatively administered MIBI and intraoperatively imaged prior to incision (neck and immediately following resection (neck and/or ES. Preoperative and intraoperative serum parathyroid hormone monitoring (IOPTH and pathology (path were also performed. Results. MIBI neck activity was absent and specimen activity was present in 13/20 with imaging after initial ES removal. In the remaining 7/20 cases, residual neck activity and/or absent ES activity prompted excision of additional tissue, ultimately leading to complete hyperfunctioning tissue excision. Postexcision LFOVGC ES imaging confirmed parathyroid adenoma resection 100% when postresection imaging qualitatively had activity (ES and/or no activity (neck. The mean ± SEM time saving using intraoperative LFOVGC data to confirm resection versus first IOPTH or path result would have been 22.0 ± 2 minutes (specimen imaging and 26.0 ± 3 minutes (neck imaging. Conclusion. Utilization of a novel real-time intraoperative LFOVGC imaging approach can provide confirmation of MIBI-avid parathyroid adenoma removal appreciably faster than IOPTH and/or path and may provide a valuable adjunct to parathyroid surgery.

  4. Initial Experience in Colombia in Patients with PET/CT-FDG Studies of the Central Nervous System

    International Nuclear Information System (INIS)

    Ucros, Gonzalo; Bernal, Patricia; Bermudez Sonia

    2009-01-01

    To describe the experience of patients who underwent a brain PET-CT during sixteen consecutive months. Method: 41 studies were made using flourodeoxiglucose (FDG) and registered with computed tomography. Results: These studies correspond to 5% of all PET studies performed at our institution. The age of patients ranged from 11 to 74 years. The main indications were: search for an epileptic focus (34%), cognitive disorder (32%), tumor evaluation (22%) and others (12%). Conclusion: The main applications of the brain PETCT FDG in our patients were: evaluation of untreatable epileptic patients thinking of undergoing surgery, evaluation of patients with cognitive disorders like Alzheimer's and other related dementias and finally, evaluation of patients with residual or primary brain tumors. It is among these patients in which this diagnostic modality has better diagnostic utility with abnormal findings, useful for their management.

  5. The international experience of using tax initiatives as the mechanism to stimulate employers to invest in employees’ education

    Directory of Open Access Journals (Sweden)

    I.V. Voinalovych

    2015-12-01

    Full Text Available The role of the taxation instrument as the mechanism to encourage employers to participate in education and vocational training to facilitate the accumulation of human capital and Ukraine’s economy innovation development are defined. The international experiences in the use of tax incentives for encouraging employers’ investment in the education of employees and training staff are researched. The variety of tax incentives (tax allowance, tax exemption, tax credit, tax relief, tax deferral and the features of their applying in European countries are considered. The author defines the benefits and disadvantages of implementation of tax incentives that should be taken into account in determining the perspectives for their use in vocational education and training in Ukraine. It is determined that increasing the efficiency of taxation is provided by the combination of various tax incentives and economic instruments, aimed at enhancing both employers’ and individuals’ participation in lifelong learning.

  6. Initial clinical experience with a novel biodegradable ring in patients with functional tricuspid insufficiency: Kalangos Biodegradable Tricuspid Ring.

    Science.gov (United States)

    Burma, O; Ustunsoy, H; Davutoglu, V; Celkan, M A; Kazaz, H; Pektok, E

    2007-08-01

    Tricuspid annuloplasty procedures have been widely performed in clinics for many years. The Kalangos Biodegradable Tricuspid Ring (Kalangos Biodegradable Tricuspid Ring, Bioring SA, Lonay, Switzerland) is a novel prosthesis for the treatment of tricuspid insufficiency. The aim of this study was to evaluate the clinical and echocardiographic results of this novel prosthesis for functional tricuspid insufficiency. Between October 2005 and May 2006, 15 patients with the diagnosis of moderate or severe functional tricuspid insufficiency were treated by implantation of a Kalangos Biodegradable Tricuspid Ring. All patients were evaluated clinically and by echocardiography preoperatively, and control tests were performed at the end of the 1st and 6th month following surgery. Moderate and severe insufficiency was documented in 11 and 4 patients, respectively, in the preoperative tests. 1 and 6 months after surgery, 4 patients had trace and 1 patient had mild tricuspid insufficiency, while 10 patients had none. At the 1st and 6th month follow-up, systolic pulmonary arterial pressure, right atrial dimension and right ventricular diastolic diameter were found to be significantly lower than the preoperative values ( P tricuspid valve area had decreased significantly at the end of the 1st month; however, no significant difference was found between the 1st and 6th month tests ( P > 0.05). Three-quarters of the annuloplasty ring had degraded at 6 months. No complications related to the prosthesis or the procedure occurred within this period. Kalangos Biodegradable Ring is a promising prosthesis in patients with functional tricuspid insufficiency, with encouraging initial results.

  7. Concurrent Chemotherapy and Pulsed High-Intensity Focused Ultrasound Therapy for the Treatment of Unresectable Pancreatic Cancer: Initial Experiences

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Young; Choi, Byung Ihn; Ryu, Ji Kon; Kim, Yong Tae; Kim, Se Hyung; Han, Joon Koo [Seoul National University Hospital, Seoul (Korea, Republic of); Hwang, Joo Ha [University of Washington Medical Center, Seattle (United States)

    2011-04-15

    This study was performed to evaluate the potential clinical value of concurrent chemotherapy and pulsed high intensity focused ultrasound (HIFU) therapy (CCHT), as well as the safety of pulsed HIFU, for the treatment of unresectable pancreatic cancer. Twelve patients were treated with HIFU from October 2008 to May 2010, and three of them underwent CCHT as the main treatment (the CCHT group). The overall survival (OS), the time to tumor progression (TTP), the complications and the current performance status in the CCHT and non-CCHT groups were analyzed. Nine patients in the non-CCHT group were evaluated to determine why CCHT could not be performed more than twice. The OS of the three patients in the CCHT group was 26.0, 21.6 and 10.8 months, respectively, from the time of diagnosis. Two of them were alive at the time of preparing this manuscript with an excellent performance status, and one of them underwent a surgical resection one year after the initiation of CCHT. The TTP of the three patients in the CCHT group was 13.4, 11.5 and 9.9 months, respectively. The median OS and TTP of the non-CCHT group were 10.3 months and 4.4 months, respectively. The main reasons why the nine patients of the non-CCHT group failed to undergo CCHT more than twice were as follows: pancreatitis (n = 1), intolerance of the pain during treatment (n = 4), palliative use of HIFU for pain relief (n = 1) and a poor physical condition due to disease progression (n = 3). No major complications were encountered except one case of pancreatitis. This study shows that CCHT is a potentially effective and safe modality for the treatment of unresectable pancreatic cancer

  8. Small animal simultaneous PET/MRI: initial experiences in a 9.4 T microMRI

    Energy Technology Data Exchange (ETDEWEB)

    Maramraju, Sri Harsha; Ravindranath, Bosky; Vaska, Paul; Schlyer, David J [Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY (United States); Smith, S David; Schulz, Daniela [Medical Department, Brookhaven National Laboratory, Upton, NY (United States); Junnarkar, Sachin S; Rescia, Sergio [Instrumentation Division, Brookhaven National Laboratory, Upton, NY (United States); Stoll, Sean; Purschke, Martin L; Woody, Craig L [Physics Department, Brookhaven National Laboratory, Upton, NY (United States); Southekal, Sudeepti [Brigham and Women' s Hospital, Boston, MA (United States); Pratte, Jean-Francois, E-mail: schlyer@bnl.gov [Universite de Sherbrooke, Sherbrooke, Quebec (Canada)

    2011-04-21

    We developed a non-magnetic positron-emission tomography (PET) device based on the rat conscious animal PET that operates in a small-animal magnetic resonance imaging (MRI) scanner, thereby enabling us to carry out simultaneous PET/MRI studies. The PET detector comprises 12 detector blocks, each being a 4 x 8 array of lutetium oxyorthosilicate crystals (2.22 x 2.22 x 5 mm{sup 3}) coupled to a matching non-magnetic avalanche photodiode array. The detector blocks, housed in a plastic case, form a 38 mm inner diameter ring with an 18 mm axial extent. Custom-built MRI coils fit inside the positron-emission tomography (PET) device, operating in transceiver mode. The PET insert is integrated with a Bruker 9.4 T 210 mm clear-bore diameter MRI scanner. We acquired simultaneous PET/MR images of phantoms, of in vivo rat brain, and of cardiac-gated mouse heart using [{sup 11}C]raclopride and 2-deoxy-2-[{sup 18}F]fluoro-d-glucose PET radiotracers. There was minor interference between the PET electronics and the MRI during simultaneous operation, and small effects on the signal-to-noise ratio in the MR images in the presence of the PET, but no noticeable visual artifacts. Gradient echo and high-duty-cycle spin echo radio frequency (RF) pulses resulted in a 7% and a 28% loss in PET counts, respectively, due to high PET counts during the RF pulses that had to be gated out. The calibration of the activity concentration of PET data during MR pulsing is reproducible within less than 6%. Our initial results demonstrate the feasibility of performing simultaneous PET and MRI studies in adult rats and mice using the same PET insert in a small-bore 9.4 T MRI.

  9. Dosimetry-guided high-activity 131I therapy in patients with advanced differentiated thyroid carcinoma: initial experience

    International Nuclear Information System (INIS)

    Verburg, Frederik A.; Haenscheid, Heribert; Biko, Johannes; Hategan, Maria C.; Lassmann, Michael; Kreissl, Michael C.; Reiners, Christoph; Luster, Markus

    2010-01-01

    In patients with advanced differentiated thyroid carcinoma (DTC), therapy with the highest safe 131 I activity is desirable to maximize the tumour radiation dose yet avoid severe myelotoxicity. Recently, the European Association of Nuclear Medicine (EANM) published a standard operational procedure (SOP) for pre-therapeutic dosimetry in DTC patients incorporating a safety threshold of a 2 Gy absorbed dose to the blood as a surrogate for the red marrow. We sought to evaluate the safety and effectiveness in everyday tertiary referral centre practice of treating advanced DTC with high 131 I activities chosen primarily based on the results of dosimetry following this SOP. We retrospectively assessed toxicity as well as biochemical and scintigraphic response in our first ten patients receiving such therapy for advanced DTC. The 10 patients received a total of 13 dosimetrically guided treatments with a median administered activity of 14.0 GBq (range: 7.0-21.4 GBq) 131 I. After 6 of 13 treatments in 6 of 10 patients, short-term side effects of 131 I therapy, namely nausea, vomiting or sialadenitis, were observed. Leukocyte and platelet counts dropped significantly in the weeks after 131 I treatment, but returned to pre-treatment levels by 3 months post-therapy. Serum thyroglobulin levels decreased after 12 of 13 treatments (median reduction: 58%) in 9 of 10 patients. In our initial patient cohort, high-activity 131 I therapy for advanced DTC based on pre-therapeutic blood dosimetry following the EANM SOP was safe and well tolerated. Such treatment almost always produced a partial biochemical tumour response. (orig.)

  10. CT-guided biopsy of thoracic lesions with a novel wire-based needle guide device - initial experiences

    Energy Technology Data Exchange (ETDEWEB)

    Kroepil, Patric; Bilk, Philip; Quentin, Michael; Miese, Falk R; Lanzman, Rotem S; Scherer, Axel (Dept. of Radiology, Medical Faculty, Univ. Duesseldorf, Duesseldorf (Germany)), email: Patric.Kroepil@med.uni-duesseldorf.de

    2011-10-15

    Background Biopsies guided by computed tomography (CT) play an important role in clinical practice. A short duration, minimal radiation dose and complication rate are of particular interest. Purpose To evaluate the potential of a novel self-manufactured wire-based needle guide device for CT-guided thoracic biopsies with respect to radiation dose, intervention time and complication rate. Material and Methods Forty patients that underwent CT-guided biopsies of thoracic lesions were included in this study and assigned to two groups. Patients in group A (n = 20, mean age 69 +- 8.4 years) underwent biopsies with a novel wire-based needle guide device, while patients in group B (n = 20, mean age 68.4 +- 10.1 years) were biopsied without a needle guide device. The novel self-manufactured needle guide device consists of an iron/zinc wire modelled to a ring with a flexible arm and an eye at the end of the arm to stabilize the biopsy needle in the optimal position during intervention. Predefined parameters (radiation dose, number of acquired CT-slices, duration of intervention, complications) were compared between both groups. Results Mean radiation dose (CTDIvol 192 mGy versus 541 mGy; P = 0.001) and the number of acquired slices during intervention (n = 49 +- 33 vs. n = 126 +- 78; P = 0.001) were significantly lower in group A compared with group B. Intervention time in group A (13.1 min) was significantly lower than in group B (18.5 min, P < 0.01). A pneumothorax as peri-interventional complication was observed less frequent after device assisted biopsies (n = 4 vs. n = 8, n.s.). Conclusion The novel wire-based needle guide device is a promising tool to facilitate CT-guided thoracic biopsies reducing radiation dose, intervention time, and related complications. Further studies are mandatory to confirm these initial results

  11. CT-guided biopsy of thoracic lesions with a novel wire-based needle guide device - initial experiences

    International Nuclear Information System (INIS)

    Kroepil, Patric; Bilk, Philip; Quentin, Michael; Miese, Falk R; Lanzman, Rotem S; Scherer, Axel

    2011-01-01

    Background Biopsies guided by computed tomography (CT) play an important role in clinical practice. A short duration, minimal radiation dose and complication rate are of particular interest. Purpose To evaluate the potential of a novel self-manufactured wire-based needle guide device for CT-guided thoracic biopsies with respect to radiation dose, intervention time and complication rate. Material and Methods Forty patients that underwent CT-guided biopsies of thoracic lesions were included in this study and assigned to two groups. Patients in group A (n = 20, mean age 69 ± 8.4 years) underwent biopsies with a novel wire-based needle guide device, while patients in group B (n = 20, mean age 68.4 ± 10.1 years) were biopsied without a needle guide device. The novel self-manufactured needle guide device consists of an iron/zinc wire modelled to a ring with a flexible arm and an eye at the end of the arm to stabilize the biopsy needle in the optimal position during intervention. Predefined parameters (radiation dose, number of acquired CT-slices, duration of intervention, complications) were compared between both groups. Results Mean radiation dose (CTDIvol 192 mGy versus 541 mGy; P = 0.001) and the number of acquired slices during intervention (n = 49 ± 33 vs. n = 126 ± 78; P = 0.001) were significantly lower in group A compared with group B. Intervention time in group A (13.1 min) was significantly lower than in group B (18.5 min, P < 0.01). A pneumothorax as peri-interventional complication was observed less frequent after device assisted biopsies (n = 4 vs. n = 8, n.s.). Conclusion The novel wire-based needle guide device is a promising tool to facilitate CT-guided thoracic biopsies reducing radiation dose, intervention time, and related complications. Further studies are mandatory to confirm these initial results

  12. Novel temperature-controlled RFA probe for treatment of blocked metal biliary stents in patients with pancreaticobiliary cancers: initial experience.

    Science.gov (United States)

    Nayar, Manu K; Oppong, Kofi W; Bekkali, Noor L H; Leeds, John S

    2018-05-01

     Radiofrequency ablation (RFA) is used to treat blocked biliary stents in patients with pancreaticobiliary (PB) tumors with varying results. We report our experience with a novel temperature-controlled probe for treatment of blocked metal stents.  Patients with histologically proven PB cancers and a blocked biliary stents were treated using ELRATM electrode (Taewoong Medical) under fluoroscopic guidance. Demographics, clinical outcome, stricture diameter improvements, complications and mortality at 30 days were prospectively recorded.  Nine procedures were performed on seven patients (4 male, 3 female); mean age 65.33 (range 56 - 82 years). Mean stricture diameter prior to RFA was 1.13 mm (SD ± 0.54) and 4.42 mm (SD ± 1.54) following RFA ( P  drainage. There were no procedure-related complications. Mean follow-up was 193.55 days (range 31 - 540) and three of nine patients (33 %) died due to terminal cancer. These are the first reported data on use of a temperature-controlled RFA catheter in humans to treat blocked metal biliary stents. The device is safe but further randomized trials are required to establish the efficacy and survival benefits of this probe.

  13. Initial experience of the medical clinic of the education Casmu; Experiencia inicial de la policlinica de educacion del Casmu

    Energy Technology Data Exchange (ETDEWEB)

    Musé, M.; Laureiro, E.; Musetti, C. [Departamento de Oncologia CASMU, Montevideo (Uruguay)

    2010-12-15

    Full text: What happens when a patient (p te) is faced once treatment Q T? We know that for p te involves both how their family; face a charge of myths and half-truths; causing the treatment is so vivid apprehension as the disease itself. In this context the concern of the Department of Oncology Casmu arises; of give patients an area where the p te to receive information contribute to reaching the treatment of Q T in better condition. All patients will start treatment Q T for the first time; are cited for an interview at the Polyclinic of Education. It is coordinated delayed with respect to the talks with the Treating oncologist, in order to allow the patient to develop their doubts and to raise them. In the interview also involved the p te and his family, Oncology Residents Department, and a member of Campus Nursing thereof. the interview is divided into five modules: 1) Administrative Aspects 2) Nursing Care 3) Potential side effects. 4) Social Benefits 5) Resources Information. Between January 2003 and August 2004, 70 interviews were conducted education. the average length thereof was 30 minutes. Is in progress writing a brochure based on the questions most frequently asked by patients and their families; well as an evaluation of the experience.

  14. Anaesthetic management for awake craniotomy in brain glioma resection: initial experience in Military Hospital Mohamed V of Rabat.

    Science.gov (United States)

    Meziane, Mohammed; Elkoundi, Abdelghafour; Ahtil, Redouane; Guazaz, Miloudi; Mustapha, Bensghir; Haimeur, Charki

    2017-01-01

    The awake brain surgery is an innovative approach in the treatment of tumors in the functional areas of the brain. There are various anesthetic techniques for awake craniotomy (AC), including asleep-awake-asleep technique, monitored anesthesia care, and the recent introduced awake-awake-awake method. We describe our first experience with anesthetic management for awake craniotomy, which was a combination of these techniques with scalp nerve block, and propofol/rémifentanil target controlled infusion. A 28-year-oldmale underwent an awake craniotomy for brain glioma resection. The scalp nerve block was performed and a low sedative state was maintained until removal of bone flap. During brain glioma resection, the patient awake state was maintained without any complications. Once, the tumorectomy was completed, the level of anesthesia was deepened and a laryngeal mask airway was inserted. A well psychological preparation, a reasonable choice of anesthetic techniques and agents, and continuous team communication were some of the key challenges for successful outcome in our patient.

  15. Treatment of symptomatic high-grade intracranial stenoses with the balloon-expandable Pharos stent: initial experience

    International Nuclear Information System (INIS)

    Kurre, W.; Berkefeld, J.; Mesnil de Rochemont, R. du; Sitzer, M.; Neumann-Haefelin, T.

    2008-01-01

    We report our first clinical experience with a CE-marked flexible monorail balloon-expandable stent for treatment of high-grade intracranial stenoses. Between April 2006 and November 2007 21 patients with symptomatic intracranial stenoses (>70%) were treated with the PHAROS stent. In seven patients, the procedure was performed during acute stroke intervention. Procedural success, clinical complication rates and mid-term follow-up data were prospectively recorded. During a median follow-up period of 7.3 months one additional patient died of an unknown cause 3 months after the intervention. A patient with a significant residual stenosis presented with a new stroke after further progression of the residual stenosis. None of the successfully treated patients experienced ipsilateral stroke. Recanalization of intracranial stenoses with the balloon-expandable Pharos stent is technically feasible. The periprocedural complication rate and mid-term follow-up results were in the range of previously reported case series. This pilot study was limited by the small sample size and severe morbidity of the included patients. Final evaluation of the efficacy of Pharos stent treatment demands further investigation. (orig.)

  16. ["Anti-stigma campaign from below" at schools--experience of the initiative "Irre menschlich Hamburg e.V."].

    Science.gov (United States)

    Bock, Thomas; Naber, Dieter

    2003-10-01

    In the process of stigmatisation psychiatry is not neutral but it is up-to-date as well as historically involved. That is why it is responsible to influence not only the social perception of psychiatry but also the public picture of mentally disturbed people in a positive way. Doing so it is dependent on the help of psychosis-experienced persons and relatives. Only working together a plausible enlightenment, that points beyond the status quo, can be achieved. Anti-stigma work must critically reflect the interactions in psychiatry itself. After an analysis of the different concepts of stigmatisation and anti-stigma work there follows the evaluation of an information campaign at schools in Hamburg, which emerged from the Hamburg psychosis seminar. The personal meeting of students and psychosis experienced persons is of immediate importance. In addition to that media about the subject "being different, madness, mental disturbation" are being placed at the teachers disposal according to their wishes. In the meantime experience is there of more then 50 teaching units in primary advanced and secondary education as well as of a special open day attended by over 500 students. The response of students and teachers is definitely positive. For the psychosis experienced persons involved there is a special benefit in the sense of empowerment. The more health politically based motives of the anti-stigma work have meanwhile been completed by educational justifications. This way of open meeting is also being discussed as a completion to the symptom based early diagnosis.

  17. Initiation Processes of the Tropical Intraseasonal Variability Simulated in an Aqua-Planet Experiment: What is the Intrinsic Mechanism for MJO Onset?

    Science.gov (United States)

    Takasuka, Daisuke; Satoh, Masaki; Miyakawa, Tomoki; Miura, Hiroaki

    2018-04-01

    To understand the intrinsic onset mechanism of the Madden-Julian Oscillation (MJO), we simulated a set of initiation processes of MJO-like disturbances in 10 year aqua-planet experiments using a global atmospheric model with a 56 km horizontal mesh and an explicit cloud scheme. Under a condition with a zonally nonuniform sea surface temperature (SST) in the tropics, we reproduced MJO-like disturbances over the western warm pool region. The lagged-composite analysis of detected MJO-like disturbances clarifies the time sequence of three-dimensional dynamic and moisture fields prior to the onset. We found that midtropospheric moistening, a condition that is favorable for deep convection, is particularly obvious in the initiation region 5-9 days before onset. The moistening is caused by two-dimensional horizontal advection due to cross-equatorial shallow circulations associated with mixed Rossby-gravity waves, as well as anomalous poleward flows of a negative Rossby response to suppressed convection. When the midtroposphere is sufficiently moistened, lower tropospheric signals of circumnavigating Kelvin waves trigger active convection. The surface latent heat flux (LHF) feedback contributes to the initial stages of convective organization, while the cloud-radiation feedback contributes to later stages. Sensitivity experiments suggest that circumnavigating Kelvin waves regulate the period of MJO-like disturbances because of efficient convective triggering and that the LHF feedback contributes to rapid convective organization. However, the experiments also reveal that both conditions are not necessary for the existence of MJO-like disturbances. Implications for the relevance of these mechanisms for MJO onset are also discussed.

  18. Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience

    Directory of Open Access Journals (Sweden)

    Betina Bremer Hinckel

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. METHOD: The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo. The following were evaluated before and after the operation: range of motion (ROM, apprehension test, lateral translation test, patellar inclination test, inverted J sign, subluxation upon extension, pain from compression of the patella and pain from contraction of the quadriceps. After the operation, the patients were asked whether any new episode of dislocation had occurred, what their degree of satisfaction with the surgery was (on a scale from 0 to 10 and whether they would be prepared to go through this operation again. RESULTS: Seven knees were operated, in seven patients, with a mean follow-up of 5.46 months (±2.07. Four patients who presented apprehension before the operation did not show this after the operation. The lateral translation test became normal for all the patients, while the patellar inclination test remained positive for two patients. The patients with an inverted J sign continued to be positive for this sign. Five patients were positive for subluxation upon extension before the operation, but all patients were negative for this after the operation. None of the patients presented any new episode of dislocation of the patella. All of them stated that they were satisfied: five gave a satisfaction score of 9 and two, a score of 10. All of them said that they would undergo the operation again. Only one patient presented a postoperative complication: dehiscence of the wound. CONCLUSION: Reconstruction of the

  19. The INTERBALL-Tail ELECTRON experiment: initial results on the low-latitude boundary layer of the dawn magnetosphere

    Directory of Open Access Journals (Sweden)

    J.-A. Sauvaud

    Full Text Available The Toulouse electron spectrometer flown on the Russian project INTERBALL-Tail performs electron measurements from 10 to 26 000 eV over a 4 solid angle in a satellite rotation period. The INTERBALL-Tail probe was launched on 3 August 1995 together with a subsatellite into a 65° inclination orbit with an apogee of about 30 RE. The INTERBALL mission also includes a polar spacecraft launched in August 1996 for correlated studies of the outer magnetosphere and of the auroral regions. We present new observations concerning the low-latitude boundary layers (LLBL of the magnetosphere obtained near the dawn magnetic meridian. LLBL are encountered at the interface between two plasma regimes, the magnetosheath and the dayside extension of the plasma sheet. Unexpectedly, the radial extent of the region where LLBL electrons can be sporadically detected as plasma clouds can reach up to 5 RE inside the magnetopause. The LLBL core electrons have an average energy of the order of 100 eV and are systematically field-aligned and counterstreaming. As a trend, the temperature of the LLBL electrons increases with decreasing distance to Earth. Along the satellite orbit, the apparent time of occurrence of LLBL electrons can vary from about 5 to 20 min from one pass to another. An initial first comparison between electron- and magnetic-field measurements indicates that the LLBL clouds coincide with a strong increase in the magnetic field (by up to a factor of 2. The resulting strong magnetic field gradient can explain why the plasma-sheet electron flux in the keV range is strongly depressed in LLBL occurrence regions (up to a factor of sim10. We also show that LLBL electron encounters are related to field-aligned current structures and that wide LLBL correspond to northward interplanetary magnetic field. Evidence for LLBL/plasma-sheet electron leakage into the magnetosheath during southward IMF is also presented.

  20. Initial Experience of a Primary Urgent Care Clinic Curriculum and Subspecialty Lectureship Series Implementation in a Los Angeles County Hospital.

    Science.gov (United States)

    Agrawal, Harsh; Martinez, Anna; Volkmann, Elizabeth R; Melamed, Oleg; Wali, Soma

    2017-05-01

    excellent, 52% (13) said it was very good, 8% (2) said it was good, and 4% (1) did not respond. We also looked at the number of referrals made pre- and postcurriculum implementation and found that the overall referral percentage was down, from 34% to 31%. We designed an urgent care curriculum and lecture series for the primary urgent care clinics to promote learning and education in a structured, succinct, and systematic manner. This will help triage and manage subspecialty conditions in the scope of primary care settings and thus initiate appropriate and timely referrals to subspecialists.

  1. Rethinking priorities: experience of an educational initiative to change attitudes, behaviours and clinical practice in end-of-life care.

    Science.gov (United States)

    Edwards, Annette; Barros D'Sa, Viv; Hicks, Fiona

    2017-05-08

    To implement the National End of Life Care strategy and enable more people to express and achieve their preferences about care at the end of life, senior clinicians outside palliative medicine need to make it a routine part of their practice. However, it is acknowledged that recognising that people are entering the last phase of their illness is not always straightforward, and having conversations about aims of treatment and planning for future care may not be easy. In order to begin to address these challenges, funding was sought from the Yorkshire and the Humber Strategic Health Authority (SHA), and subsequently Health Education England, Yorkshire and the Humber (HEEYH), to pilot a development programme in 2 acute trusts. 2 palliative medicine consultants shared the trainer role at each site, supporting hospital consultants from a range of specialties, with a GP to give a community perspective. The programme involved individual clinicians identifying their own learning needs and specific issues for end-of-life care in their patients. The group met together monthly in action learning sets to discuss issues in a safe yet challenging environment. Following evaluation using a combination of training needs analyses, feedback questionnaires, audits and service evaluations, it was modified slightly and repiloted in 2 further trusts as 'Rethinking Priorities'. This paper describes the programme and its outcomes, especially in relation to participants' learning, service development and leadership. It also highlights the challenges, including different learning styles, the concept of action learning, obtaining funding and dedicated time, and how to evaluate the effectiveness of a programme. Overall, it suggests that an educational initiative based on clinicians identifying their own learning needs, and using an action learning approach to explore issues with other colleagues, with the addition of some targeted sessions, can result in positive change in knowledge, behaviour

  2. Pathways to multidrug-resistant tuberculosis diagnosis and treatment initiation: a qualitative comparison of patients' experiences in the era of rapid molecular diagnostic tests.

    Science.gov (United States)

    Naidoo, Pren; van Niekerk, Margaret; du Toit, Elizabeth; Beyers, Nulda; Leon, Natalie

    2015-10-28

    Although new molecular diagnostic tests such as GenoType MTBDRplus and Xpert® MTB/RIF have reduced multidrug-resistant tuberculosis (MDR-TB) treatment initiation times, patients' experiences of diagnosis and treatment initiation are not known. This study aimed to explore and compare MDR-TB patients' experiences of their diagnostic and treatment initiation pathway in GenoType MTBDRplus and Xpert® MTB/RIF-based diagnostic algorithms. The study was undertaken in Cape Town, South Africa where primary health-care services provided free TB diagnosis and treatment. A smear, culture and GenoType MTBDRplus diagnostic algorithm was used in 2010, with Xpert® MTB/RIF phased in from 2011-2013. Participants diagnosed in each algorithm at four facilities were purposively sampled, stratifying by age, gender and MDR-TB risk profiles. We conducted in-depth qualitative interviews using a semi-structured interview guide. Through constant comparative analysis we induced common and divergent themes related to symptom recognition, health-care access, testing for MDR-TB and treatment initiation within and between groups. Data were triangulated with clinical information and health visit data from a structured questionnaire. We identified both enablers and barriers to early MDR-TB diagnosis and treatment. Half the patients had previously been treated for TB; most recognised recurring symptoms and reported early health-seeking. Those who attributed symptoms to other causes delayed health-seeking. Perceptions of poor public sector services were prevalent and may have contributed both to deferred health-seeking and to patient's use of the private sector, contributing to delays. However, once on treatment, most patients expressed satisfaction with public sector care. Two patients in the Xpert® MTB/RIF-based algorithm exemplified its potential to reduce delays, commencing MDR-TB treatment within a week of their first health contact. However, most patients in both algorithms experienced

  3. Detailed review and analysis of complex radiotherapy clinical trial planning data: Evaluation and initial experience with the SWAN software system

    International Nuclear Information System (INIS)

    Ebert, Martin A.; Haworth, Annette; Kearvell, Rachel; Hooton, Ben; Coleman, Rhonda; Spry, Nigel; Bydder, Sean; Joseph, David

    2008-01-01

    Aim: Contemporary radiotherapy clinical trials typically require complex three-dimensional (3D) treatment planning. This produces large amounts of data relating technique and dose delivery for correlation with patient outcomes. Assessment of the quality of this information is required to ensure protocol compliance, to quantify the variation in treatments given to patients and to enhance the power of studies to determine correlates of patient outcomes. Materials and methods: A software system ('SWAN') was developed to facilitate the objective analysis, quality-assurance and review of digital treatment planning data from multi-centre radiotherapy trials. The utility of this system was assessed on the basis of its functionality and our experience of its use in the context of multi-centre clinical trials and trials-support activities. Results: The SWAN system has been shown to have the functionality required for use in several multi-centre trials, including automated review and archive processes. Approximately 800 treatment plans from over 30 participating institutions have so far been assessed with the system for several treatment planning scenarios. To illustrate this we include a description of the use of the system for a large-recruitment prostate radiotherapy trial being undertaken in Australasia, including examples of how the review process has changed clinical practice. Conclusion: The successful implementation of SWAN has been demonstrated in a number of clinical trials. The software provides an opportunity for comprehensive review of treatment parameters that could impact on clinical outcomes and trial results. Such quality-assurance (QA) has previously been difficult or impossible to achieve, particularly for a clinical trial involving large numbers of patients. Such reviews have highlighted inconsistencies in clinical practice that have since been addressed through feedback from the review process. The process of data collection and review should be

  4. Initial clinical experience with the Medtronic Micro Vascular Plug™ in transcatheter occlusion of PDAs in extremely premature infants.

    Science.gov (United States)

    Sathanandam, Shyam; Justino, Henri; Waller, B Rush; Radtke, Wolfgang; Qureshi, Athar M

    2017-05-01

    To describe the early multicenter, clinical experience with the Medtronic Micro Vascular Plug™ (MVP) for the occlusion of patent ductus arteriosus (PDA) in premature infants. The MVP is a large diameter plug that can be delivered through a microcatheter for occlusion of abnormal blood vessels. A Retrospective review of PDA embolization procedures performed in two centers using the MVP was performed. Fifteen premature infants underwent attempted PDA occlusion using the MVP. The gestational age and birth weight were 25.6 ± 2.5 weeks and 735 ± 251 g, respectively. The median weight and age at the time of the procedure were 1,210 g (700-3,500 g) and 4.5 weeks (2-12 weeks), respectively. Median procedure and fluoroscopy times were 45 and 6.5 min, respectively. The median radiation and contrast doses were 19.7 mGy and 2.4 mL/kg, respectively. Antegrade occlusion was successfully achieved in 13 patients 2 kg had arterial access and attempted retrograde occlusion; one of which was unsuccessful due to the PDA being short and wide. Complete closure was observed in 13 of 14 successful procedures (93%), with one patient having a small residual shunt that was not seen on follow-up. There were no complications related to the procedure or noted during follow-up (Median 11 months). The MVP is a new, large-diameter vascular embolization device that may be useful for the occlusion of PDA in extremely small, premature infants. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  5. Initial experience using a robotic-driven laparoscopic needle holder with ergonomic handle: assessment of surgeons' task performance and ergonomics.

    Science.gov (United States)

    Sánchez-Margallo, Juan A; Sánchez-Margallo, Francisco M

    2017-12-01

    The objective of this study is to assess the surgeons' performance and ergonomics during the use of a robotic-driven needle holder in laparoscopic suturing tasks. Six right-handed laparoscopic surgeons with different levels of experience took part in this study. Participants performed a set of three different intracorporeal suturing tasks organized in ten trials during a period of five weeks. Surgeons used both conventional (Conv) and robotic (Rob) laparoscopic needle holders. Precision using the surgical needle, quality of the intracorporeal suturing performance, execution time and leakage pressure for the urethrovesical anastomosis, as well as the ergonomics of the surgeon's hand posture, were analyzed during the first, fifth and last trials. No statistically significant differences in precision and quality of suturing performance were obtained between both groups of instruments. Surgeons required more time using the robotic instrument than using the conventional needle holder to perform the urethrovesical anastomosis, but execution time was significantly reduced after training ([Formula: see text] 0.05). There were no differences in leakage pressure for the anastomoses carried out by both instruments. After training, novice surgeons significantly improved the ergonomics of the wrist ([Formula: see text] 0.05) and index finger (Conv: 36.381[Formula: see text], Rob: 30.389[Formula: see text]; p = 0.024) when using the robotic instrument compared to the conventional needle holder. Results have shown that, although both instruments offer similar technical performance, the robotic-driven instrument results in better ergonomics for the surgeon's hand posture compared to the use of a conventional laparoscopic needle holder in intracorporeal suturing.

  6. Telerobotic-assisted laparoscopic operation performed at a remote site: initial experience Cirurgia laparoscópica robotizada a distância: experiência inicial

    Directory of Open Access Journals (Sweden)

    Cássio Andreoni

    2004-06-01

    Full Text Available Robotic surgery is an option to laparoscopy that may offer some benefits including the possibility of performing surgery when the surgeon is geographically away from the patient and faster tireless repetitive movements with greater precision. At present, robot-assisted surgery has been done routinely in several institutions around the world, however, to the best of our knowledge, it is the first time such procedure is performed in our academic environment and herein is reported the first telerobotic-assisted laparoscopic cystectomy performed in a domestic pig at our institution using the Zeus®robotic system (Computer Motion, EUA. The procedure was performed using two different operating rooms geographically apart from each other. The assistant was in an operating room that was set with the operating table and the pig as well as with the Zeus® robotic arms. In the other operating room, the surgeon was seated in the control console with a three-dimensional imaging five meters away from the operating table connected with electric cables. The assistant surgeon established the pneumoperitoneum and five trocars were placed in a fan configuration. The surgeon started performing the surgery using three out of the five ports taking control of the laparoscope (voice control and manual control of laparoscopic instruments connected to the robotic arms using the joysticks. The other two ports were used by the assistant for traction and clips placement that was also necessary for exchanging the many laparoscopic instruments connected to the robot. The laparoscopic total cystectomy was successfully performed in 25 minutes with no complications. The truly benefits as well as the cost-effectiveness of the robotic surgery in our environment is yet to be determined after experience acquisition with telerobotic before start performing such procedures routinely in humans. The present report shows the technical feasibility of telerobotic surgery in a developing

  7. Safety, safety case and society - Lessons from the experience of the Forum on Stakeholder Confidence and other NEA initiatives

    International Nuclear Information System (INIS)

    Pescatore, Claudio

    2014-01-01

    A vast amount of literature on radioactive waste management (RWM) and its governance is available on the web page of the Radioactive Waste Management Committee of the OECD Nuclear Energy Agency (NEA), in particular on the pages of the Forum on Stakeholder Confidence (FSC), the Reversibility and Retrievability (R and R) Project and the Project on Records, Knowledge and Memory (RK and M) Preservation across Generations. The FSC literature alone likely represents the largest collection of literature on RWM governance presently available on any single site. The safety case developed for any deep geological repository project deals with technical safety. A license is to be granted based on the repository being, after closure, safe 'by itself', i.e. without the need to watch it, independent of the existence of the implementer, regulator and others. The main legal requirement of the safety case is that it needs to show convincingly that the technical regulatory criteria are met. The latter are both qualitative and quantitative. Qualitative criteria are technical, but not in a strong sense, e.g. one requirement may simply be the use of 'sound technical and managerial principles'. The safety case also needs to argue robustness upon human intrusion. The human intrusion analyses, however, are only used to make a qualitative judgement on the robustness of the system. The international guidance suggests that their results need not be tested, by the authorities, for compliance against a numerical yardstick. The technical regulator will have an important role in decision making, but others aside from the technical regulator will also play a decision-making role in the development of a repository project and with regard to its safety. For instance, the technical regulator is largely removed from the initial choice of site. Safety nowadays is brought about by a system of actors comprising the implementer, technical regulators, specialist groups in various advisory roles and the

  8. First-Year Students’ Initial Motivational Beliefs at University: Predicted by Motivational Beliefs Derived from Within and Out-of-School Experience and Malleable Regardless of the Extent of Students’ Out-of-School Experience

    Science.gov (United States)

    Gorges, Julia

    2017-01-01

    The present study tested how academic self-concept of ability (ASC) and intrinsic task value (ITV) transpose onto novel university programs that depart from traditional subject areas within the framework of expectancy-value theory. The study focused on two potential sources of information used to anticipate one’s ASC and ITV regarding new learning content (here: business administration). First, students’ experiences from secondary school, especially their ASCs and ITVs established in a school subject they consider similar to business administration—mathematics—should predict their business administration-specific ASC and ITV. Second, students may have gained relevant experience in out-of-school settings such as internships with business companies or commercial vocational training prior to entering higher education. ASC and ITV developed from out-of-school experiences was hypothesized to predict students’ business administration-specific ASC and ITV as well. However, the likely mismatch between anticipated and actual experience with new contents should lead to revisions of ASC and ITV after entering university reflected in a presumably lower stability compared to secondary school settings. In addition, the extent of students’ out-of-school experience might act as a moderator. Data were collected from 341 first-year students in higher education in Germany before they began their study program and again 3–4 months later. Confirmatory factor analyses support the discriminant validity of the measures used in the study. Results from structural equation modeling show that students’ ASC/ITV derived from relevant out-of-school experience make an important contribution to their initial business administration-specific ASC and ITV beyond their mathematics-specific ASC/ITV. Furthermore, both business administration-specific ASC and ITV showed significantly lower stability coefficients over the initial study phase than research from secondary school indicating

  9. First-Year Students' Initial Motivational Beliefs at University: Predicted by Motivational Beliefs Derived from Within and Out-of-School Experience and Malleable Regardless of the Extent of Students' Out-of-School Experience.

    Science.gov (United States)

    Gorges, Julia

    2017-01-01

    The present study tested how academic self-concept of ability (ASC) and intrinsic task value (ITV) transpose onto novel university programs that depart from traditional subject areas within the framework of expectancy-value theory. The study focused on two potential sources of information used to anticipate one's ASC and ITV regarding new learning content (here: business administration). First, students' experiences from secondary school, especially their ASCs and ITVs established in a school subject they consider similar to business administration-mathematics-should predict their business administration-specific ASC and ITV. Second, students may have gained relevant experience in out-of-school settings such as internships with business companies or commercial vocational training prior to entering higher education. ASC and ITV developed from out-of-school experiences was hypothesized to predict students' business administration-specific ASC and ITV as well. However, the likely mismatch between anticipated and actual experience with new contents should lead to revisions of ASC and ITV after entering university reflected in a presumably lower stability compared to secondary school settings. In addition, the extent of students' out-of-school experience might act as a moderator. Data were collected from 341 first-year students in higher education in Germany before they began their study program and again 3-4 months later. Confirmatory factor analyses support the discriminant validity of the measures used in the study. Results from structural equation modeling show that students' ASC/ITV derived from relevant out-of-school experience make an important contribution to their initial business administration-specific ASC and ITV beyond their mathematics-specific ASC/ITV. Furthermore, both business administration-specific ASC and ITV showed significantly lower stability coefficients over the initial study phase than research from secondary school indicating revisions to them

  10. First-Year Students’ Initial Motivational Beliefs at University: Predicted by Motivational Beliefs Derived from Within and Out-of-School Experience and Malleable Regardless of the Extent of Students’ Out-of-School Experience

    Directory of Open Access Journals (Sweden)

    Julia Gorges

    2017-07-01

    Full Text Available The present study tested how academic self-concept of ability (ASC and intrinsic task value (ITV transpose onto novel university programs that depart from traditional subject areas within the framework of expectancy-value theory. The study focused on two potential sources of information used to anticipate one’s ASC and ITV regarding new learning content (here: business administration. First, students’ experiences from secondary school, especially their ASCs and ITVs established in a school subject they consider similar to business administration—mathematics—should predict their business administration-specific ASC and ITV. Second, students may have gained relevant experience in out-of-school settings such as internships with business companies or commercial vocational training prior to entering higher education. ASC and ITV developed from out-of-school experiences was hypothesized to predict students’ business administration-specific ASC and ITV as well. However, the likely mismatch between anticipated and actual experience with new contents should lead to revisions of ASC and ITV after entering university reflected in a presumably lower stability compared to secondary school settings. In addition, the extent of students’ out-of-school experience might act as a moderator. Data were collected from 341 first-year students in higher education in Germany before they began their study program and again 3–4 months later. Confirmatory factor analyses support the discriminant validity of the measures used in the study. Results from structural equation modeling show that students’ ASC/ITV derived from relevant out-of-school experience make an important contribution to their initial business administration-specific ASC and ITV beyond their mathematics-specific ASC/ITV. Furthermore, both business administration-specific ASC and ITV showed significantly lower stability coefficients over the initial study phase than research from secondary

  11. Tratamento cirúrgico da fibrilação atrial: procedimento do "labirinto": experiência inicial Surgical treatment of atrial fibrillation with "maze" procedure: initial experience

    Directory of Open Access Journals (Sweden)

    Adib D Jatene

    1992-06-01

    complicações infecciosas. Os pacientes restantes obtiveram alta hospitalar sem drogas antiarrítmicas. Em um período de um a dez meses (M = 5,4, os pacientes estão assintomáticos e o Holter mostra presença de ritmo atrial irregular permanente (com FC média de 70 a 80 bpm com condução AV preservada; o ecodoppler mostra presença de contração atrial eficiente. Não houve recorrências de FA e nenhum dos pacientes. Em conclusão, podemos admitir que, a curto prazo, a técnica do "labirinto" na FA em reumáticos restaurou a contração atrial organizada e controlou a FC. Assim, pode contribuir para redução de fenômenos trombo-embólicos. Maior número de pacientes deve ser observado durante tempo prolongado para avaliação da eficácia do procedimento.The "maze" procedure for surgical treatment of chronic atrial fibrillation (AF described by Cox was performed in 9 patients from July 91 to May 92; 7 were female and the ages range from 37 to 63y (51,4y. Eight patients had surgical rheumatic valve disfunction (mitral stenosis in 6; mitral double disfunction in 2 being 1 with associated tricuspid regurgitation and 1 had recurrent paroxicistic AF with no valve disfunction. Surgical treatment was performed following the technique described by Cox and the surgery was completed with 6 mitral comissurotomies and 2 mitral valve replacements. Three patients had left atrial thrombosis. There were no immediate deaths and 1 patient died in the 45th day with infeccious complications. The first patient required reoperation for bleeding review. Second and 3rd patients presented transitory atrial tachycardia in 3rd and 5th day, controlled with intravenous amiodarone. No other complications were observed. In a mean follow up period of 5,4m (1 to 10 m, all patients were in regular atrial rhythm without antiarrhythmic drugs. Effective atrial contraction was demonstrated by ECHO in all patients and no one returned to AF. In conclusion, this initial follow up showed good results in

  12. Initial application of a ACI-rat model of hepatocellular carcinoma in the experiments of interventional therapy

    International Nuclear Information System (INIS)

    Qian Jun; Feng Gansheng

    2003-01-01

    Objective: To evaluate the therapeutic efficiency of various methods of interventional therapy in the ACI-rat model of hepatocellular carcinoma, and to assess the value of this model in the experiments of interventional therapy. Methods: The subcapsular implantation of a solid Morris Hepatoma 3924A (1 mm 3 ) in the livers was carried out in 58 male ACI-rats. 13 days after the implantation, the tumor volume (V 1 ) was measured by using magnetic resonance tomography (MRT). After laparotomy and retrograde placement of catheter into the gastroduodenal artery (14 d), the following protocols of interventional therapy were performed: (A) Mitomycin C (n = 4); (B) Degradable starch microspheres (DSM) (n = 4); (C) Lipiodol (n = 5); (D) Ligation (n = 4); (E) Mitomycin C + DSM (n = 4); (F) Mitomycin C + ligation (n = 5); (G) Mitomycin C + Lipiodol (n = 5); (H) DSM + ligation (n = 4); (I) Lipiodol + ligation (n = 4); (J) Mitomycin C + Poly-lactide-coglycollide-microspheres (Plcg) (n = 4); (K) Mitomycin C + Lipiodol + ligation (n = 4); (L) Mitomycin C + DSM + ligation (n = 4); (M) 0.9% NaCl (control group, n = 7). 13 days after these therapies the change of the tumor volume (V 2 ) was determined by MRT again. Results: The rate of implantation was 100%. V 2 /V 1 was 4.50 in group A, 12.73 in group B, 15.84 in group C, 10.17 in group D, 90.20 in group E, 7.16 in group F, 4.08 in group G, 3.45 in group H, 9.99 in group I, 2.86 in group J, 3.76 in group K, 7.71 in group L, and 27.12 in group M, respectively. Compared to the control group, groups A, G, H, J and K showed significant reduced tumor growth (χ 2 = 5.238, 8.571, 5.238, 5.238, 5.238, P = 0.045, 0.008, 0.045, 0.045, 0.045) in the period of observation, whereas the other groups showed no statistical significant differences by the tumor growth [χ 2 = 1.016(B), 3.086(C), 1.016(D), 2.213(E), 3.086(F), 1.061(I), 1.061(L), P = 0.348 (B), 0.121 (C), 0.348 (D), 0.199 (E), 0.121 (F), 0.348 (I), 0.348(L)]. Conclusion: This model of

  13. Development and initial validation of the Parental PELICAN Questionnaire (PaPEQu)--an instrument to assess parental experiences and needs during their child's end-of-life care.

    Science.gov (United States)

    Zimmermann, Karin; Cignacco, Eva; Eskola, Katri; Engberg, Sandra; Ramelet, Anne-Sylvie; Von der Weid, Nicolas; Bergstraesser, Eva

    2015-12-01

    To develop and test the Parental PELICAN Questionnaire, an instrument to retrospectively assess parental experiences and needs during their child's end-of-life care. To offer appropriate care for dying children, healthcare professionals need to understand the illness experience from the family perspective. A questionnaire specific to the end-of-life experiences and needs of parents losing a child is needed to evaluate the perceived quality of paediatric end-of-life care. This is an instrument development study applying mixed methods based on recommendations for questionnaire design and validation. The Parental PELICAN Questionnaire was developed in four phases between August 2012-March 2014: phase 1: item generation; phase 2: validity testing; phase 3: translation; phase 4: pilot testing. Psychometric properties were assessed after applying the Parental PELICAN Questionnaire in a sample of 224 bereaved parents in April 2014. Validity testing covered the evidence based on tests of content, internal structure and relations to other variables. The Parental PELICAN Questionnaire consists of approximately 90 items in four slightly different versions accounting for particularities of the four diagnostic groups. The questionnaire's items were structured according to six quality domains described in the literature. Evidence of initial validity and reliability could be demonstrated with the involvement of healthcare professionals and bereaved parents. The Parental PELICAN Questionnaire holds promise as a measure to assess parental experiences and needs and is applicable to a broad range of paediatric specialties and settings. Future validation is needed to evaluate its suitability in different cultures. © 2015 John Wiley & Sons Ltd.

  14. Initial experience with a robotically operated video optical telescopic-microscope in cranial neurosurgery: feasibility, safety, and clinical applications.

    Science.gov (United States)

    Gonen, Lior; Chakravarthi, Srikant S; Monroy-Sosa, Alejandro; Celix, Juanita M; Kojis, Nathaniel; Singh, Maharaj; Jennings, Jonathan; Fukui, Melanie B; Rovin, Richard A; Kassam, Amin B

    2017-05-01

    . Overall, the authors encountered 3 (1.5%) major neurological morbidities and 6 (3%) 30-day mortalities. Four of the 6 deaths were in the ICH group, resulting in a 1% mortality rate for the remainder of the cohort when excluding these patients. None of the intraoperative complications were considered to be attributable to the visualization provided by the ROVOT-m. When comparing the early and late cohorts, the authors noticed an increase in the proportion of higher-complexity surgeries (Categories IV-VI), from 23% in the early cohort, to 37% in the late cohort (p = 0.030). In addition, a significant reduction in operating room setup time was demonstrated (p < 0.01). CONCLUSIONS The feasibility and safety of the ROVOT-m was demonstrated in a wide range of cranial microsurgical applications. The authors report a gradual increase in case complexity over time, representing an incremental acquisition of experience with this technology. A learning curve of both setup and execution phases should be anticipated by new adopters of the robot system. Further prospective studies are required to address the efficacy of ROVOT-m. This system may play a role in neurosurgery as an integrated platform that is applicable to a variety of cranial procedures.

  15. Initial clinical experience with an interactive, video-based patient-positioning system for head and neck treatment

    International Nuclear Information System (INIS)

    Johnson, L.; Hadley, Scott W.; Milliken, Barrett D.; Pelizzari, Charles A.; Haraf, Daniel J.; Nguyen, Ai; Chen, George T.Y.

    1996-01-01

    Objective: To evaluate an interactive, video-based system for positioning head and neck patients. Materials and Methods: System hardware includes two B and W CCD cameras (mounted to provide left-lateral and AP-inferior views), zoom lenses, and a PC equipped with a frame grabber. Custom software is used to acquire and archive video images, as well as to display real-time subtraction images revealing patient misalignment in multiple views. Live subtraction images are obtained by subtracting a reference image (i.e., an image of the patient in the correct position) from real-time video. As seen in the figure, darker regions of the subtraction image indicate where the patient is currently, while lighter regions indicate where the patient should be. Adjustments in the patient's position are updated and displayed in less than 0.07s, allowing the therapist to interactively detect and correct setup discrepancies. Patients selected for study are treated BID and immobilized with conventional litecast straps attached to a baseframe which is registered to the treatment couch. Morning setups are performed by aligning litecast marks and patient anatomy to treatment room lasers. Afternoon setups begin with the same procedure, and then live subtraction images are used to fine-tune the setup. At morning and afternoon setups, video images and verification films are taken after positioning is complete. These are visually registered offline to determine the distribution of setup errors per patient, with and without video assistance. Results: Without video assistance, the standard deviation of setup errors typically ranged from 5 to 7mm and was patient-dependent. With video assistance, standard deviations are reduced to 1 to 4mm, with the result depending on patient coopertiveness and the length of time spent fine-tuning the setups. At current levels of experience, 3 to 4mm accuracy is easily achieved in about 30s, while 1 to 3mm accuracy is achieved in about 1 to 2 minutes. Studies

  16. The views and experiences of nurses and midwives in the provision and management of provider-initiated HIV testing and counseling: a systematic review of qualitative evidence.

    Science.gov (United States)

    Evans, Catrin; Nalubega, Sylivia; McLuskey, John; Darlington, Nicola; Croston, Michelle; Bath-Hextall, Fiona

    2016-01-15

    Global progress towards HIV prevention and care is contingent upon increasing the number of those aware of their status through HIV testing. Provider-initiated HIV testing and counseling is recommended globally as a strategy to enhance uptake of HIV testing and is primarily conducted by nurses and midwives. Research shows that provider-initiated HIV testing and counseling implementation is sub-optimal. The reasons for this are unclear. The review aimed to explore nurses' and midwives' views and experiences of the provision and management of provider-initiated HIV testing and counseling. All cadres of nurses and midwives were considered, including those who undertake routine HIV testing as part of a diverse role and those who are specifically trained as HIV counselors. Types of phenomenon of interest: The review sought to understand the views and experiences of the provision and management of provider-initiated HIV testing and counseling (including perceptions, opinions, beliefs, practices and strategies related to HIV testing and its implementation in practice). The review included only provider-initiated HIV testing and counseling. It excluded all other models of HIV testing. The review included all countries and all healthcare settings. Types of studies: This review considered all forms of qualitative study design and methodology. Qualitative elements of a mixed method study were included if they were presented separately within the publication. A three-step search strategy was utilized. Eight databases were searched for papers published from 1996 to October 2014, followed by hand searching of reference lists. Only studies published in the English language were considered. Methodological quality was assessed using the Qualitative Assessment and Review Instrument developed by the Joanna Briggs Institute. Qualitative findings were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Qualitative research findings were pooled

  17. Leverage of an Existing Cervical Cancer Prevention Service Platform to Initiate Breast Cancer Control Services in Zambia: Experiences and Early Outcomes

    Directory of Open Access Journals (Sweden)

    Leeya F. Pinder

    2017-09-01

    Full Text Available Purpose: In 2005, the Cervical Cancer Prevention Program in Zambia (CCPPZ was implemented and has since provided cervical cancer screen-and-treat services to more than 500,000 women. By leveraging the successes and experiences of the CCPPZ, we intended to build capacity for the early detection and surgical treatment of breast cancer. Methods: Our initiative sought to build capacity for breast cancer care through the (1 formation of a breast cancer advocacy alliance to raise awareness, (2 creation of resource-appropriate breast cancer care training curricula for mid- and high-level providers, and (3 implementation of early detection and treatment capacity within two major health care facilities. Results: Six months after the completion of the initiative, the following outcomes were documented: Breast health education and clinical breast examination (CBE services were successfully integrated into the service platforms of four CCPPZ clinics. Two new breast diagnostic centers were opened, which provided access to breast ultrasound, ultrasound-guided core needle biopsy, and needle aspiration. Breast health education and CBE were provided to 1,955 clients, 167 of whom were evaluated at the two diagnostic centers; 55 of those evaluated underwent core-needle biopsy, of which 17 were diagnosed with invasive cancer. Newly trained surgeons performed six sentinel lymph node mappings, eight sentinel lymph node dissections, and 10 breast conservation surgeries (lumpectomies. Conclusion: This initiative successfully established clinical services in Zambia that are critical for the early detection and surgical management of breast cancer.

  18. PWR water chemistry controls: a perspective on industry initiatives and trends relative to operating experience and the EPRI PWR water chemistry guidelines

    International Nuclear Information System (INIS)

    Fruzzetti, K.; Choi, S.; Haas, C.; Pender, M.; Perkins, D.

    2010-01-01

    An effective PWR water chemistry control program must address the following goals: Minimize materials degradation (e.g., PWSCC, corrosion of fuel, corrosion damage of steam generator (SG) tubes); Maintain fuel integrity and good performance; Minimize corrosion product transport (e.g., transport and deposition on the fuel, transport into the SGs where it can foul tube surfaces and create crevice environments for the concentration of corrosive impurities); Minimize dose rates. Water chemistry control must be optimized to provide overall improvement considering the sometimes variant constraints of the goals listed above. New technologies are developed for continued mitigation of materials degradation, continued fuel integrity and good performance, continued reduction of corrosion product transport, and continued minimization of plant dose rates. The EPRI chemistry program, in coordination with other EPRI programs, strives to improve these areas through application of chemistry initiatives, focusing on these goals. This paper highlights the major initiatives and issues with respect to PWR primary and secondary system chemistry and outlines the recent, on-going, and proposed work to effectively address them. These initiatives are presented in light of recent operating experience, as derived from EPRI's PWR chemistry monitoring and assessment program, and EPRI's water chemistry guidelines. (author)

  19. Methicillin-resistant Staphylococcus aureus screening as a patient safety initiative: using patients' experiences to improve the quality of screening practices.

    Science.gov (United States)

    Currie, Kay; Knussen, Christina; Price, Lesley; Reilly, Jacqui

    2014-01-01

    while methicillin-resistant Staphylococcus aureus screening is generally acceptable to patients as a regular patient safety initiative, to enhance the quality of the patient experience, clinicians should consider the timing, content and effectiveness of information provision. © 2013 John Wiley & Sons Ltd.

  20. Understanding the experience of initiating community-based physical activity and social support by people with serious mental illness: a systematic review using a meta-ethnographic approach

    Directory of Open Access Journals (Sweden)

    Helen Quirk

    2017-10-01

    Full Text Available Abstract Background People with long-term serious mental illness live with severe and debilitating symptoms that can negatively influence their health and quality of life, leading to outcomes such as premature mortality, morbidity and obesity. An interplay of social, behavioural, biological and psychological factors is likely to contribute to their poor physical health. Participating in regular physical activity could bring symptomatic improvements, weight loss benefits, enhanced wellbeing and when undertaken in a community-based group setting can yield additional, important social support benefits. Yet poor uptake of physical activity by people with serious mental illness is a problem. This review will systematically search, appraise and synthesise the existing evidence that has explored the experience of community-based physical activity initiation and key features of social support within these contexts by adults with schizophrenia, bipolar affective disorder, major depressive disorder or psychosis using the meta-ethnography approach. This new understanding may be key in designing more acceptable and effective community-based group PA programmes that meet patients’ need and expectations. Methods This will be a systematic review of qualitative studies using the meta-ethnography approach. The following databases will be searched: ASSIA, CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, Health Technology Assessment Database, MEDLINE, PsycINFO, Sociological Abstracts, SPORTDiscus and Web of Science. Grey literature will also be sought. Eligible studies will use qualitative methodology; involve adults (≥18 years with schizophrenia, bipolar affective disorder, major depressive disorder or psychosis; will report community-based group physical activity; and capture the experience of physical activity initiation and key features of social support from the perspective of the participant. Study selection and assessment of quality will

  1. Understanding the experience of initiating community-based physical activity and social support by people with serious mental illness: a systematic review using a meta-ethnographic approach.

    Science.gov (United States)

    Quirk, Helen; Crank, Helen; Harrop, Deborah; Hock, Emma; Copeland, Robert

    2017-10-25

    People with long-term serious mental illness live with severe and debilitating symptoms that can negatively influence their health and quality of life, leading to outcomes such as premature mortality, morbidity and obesity. An interplay of social, behavioural, biological and psychological factors is likely to contribute to their poor physical health. Participating in regular physical activity could bring symptomatic improvements, weight loss benefits, enhanced wellbeing and when undertaken in a community-based group setting can yield additional, important social support benefits. Yet poor uptake of physical activity by people with serious mental illness is a problem. This review will systematically search, appraise and synthesise the existing evidence that has explored the experience of community-based physical activity initiation and key features of social support within these contexts by adults with schizophrenia, bipolar affective disorder, major depressive disorder or psychosis using the meta-ethnography approach. This new understanding may be key in designing more acceptable and effective community-based group PA programmes that meet patients' need and expectations. This will be a systematic review of qualitative studies using the meta-ethnography approach. The following databases will be searched: ASSIA, CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, Health Technology Assessment Database, MEDLINE, PsycINFO, Sociological Abstracts, SPORTDiscus and Web of Science. Grey literature will also be sought. Eligible studies will use qualitative methodology; involve adults (≥18 years) with schizophrenia, bipolar affective disorder, major depressive disorder or psychosis; will report community-based group physical activity; and capture the experience of physical activity initiation and key features of social support from the perspective of the participant. Study selection and assessment of quality will be performed by two reviewers. Data will be

  2. Initial experience with a novel pre-sign-out quality assurance tool for review of random surgical pathology diagnoses in a subspecialty-based university practice.

    Science.gov (United States)

    Owens, Scott R; Wiehagen, Luke T; Kelly, Susan M; Piccoli, Anthony L; Lassige, Karen; Yousem, Samuel A; Dhir, Rajiv; Parwani, Anil V

    2010-09-01

    We recently implemented a novel pre-sign-out quality assurance tool in our subspecialty-based surgical pathology practice at the University of Pittsburgh Medical Center. It randomly selects an adjustable percentage of cases for review by a second pathologist at the time the originating pathologist's electronic signature is entered and requires that the review be completed within 24 hours, before release of the final report. The tool replaced a retrospective audit system and it has been in successful use since January 2009. We report our initial experience for the first 14 months of its service. During this time, the disagreement numbers and levels were similar to those identified using the retrospective system, case turnaround time was not significantly affected, and the number of case amendments generated decreased. The tool is a useful quality assurance instrument and its prospective nature allows for the potential prevention of some serious errors.

  3. The POST trial: initial post-market experience of the Penumbra system: revascularization of large vessel occlusion in acute ischemic stroke in the United States and Europe.

    Science.gov (United States)

    Tarr, Robert; Hsu, Dan; Kulcsar, Zsolt; Bonvin, Christophe; Rufenacht, Daniel; Alfke, Karsten; Stingele, Robert; Jansen, Olav; Frei, Donald; Bellon, Richard; Madison, Michael; Struffert, Tobias; Dorfler, Arnd; Grunwald, Iris Q; Reith, Wolfgang; Haass, Anton

    2010-12-01

    The purpose of this study was to assess the initial post-market experience of the device and how it is compared with the Penumbra Pivotal trial used to support the 510k application. A retrospective case review of 157 consecutive patients treated with the Penumbra system at seven international centers was performed. Primary endpoints were revascularization of the target vessel (TIMI score of 2 or 3), good functional outcome as defined by a modified Rankin scale (mRS) score of ≤2 and incidence of procedural serious adverse events. Results were compared with those of the Penumbra pivotal trial. A total of 157 vessels were treated. Mean baseline values at enrollment were: age 65 years, NIHSS score 16. After use of the Penumbra system, 87% of the treated vessels were revascularized to TIMI 2 (54%) or 3 (33%) as compared with 82% reported in the Pivotal trial. Nine procedural serious adverse events were reported in 157 patients (5.7%). All-cause mortality was 20% (32/157), and 41% had a mRS of ≤2 at 90-day follow-up as compared with only 25% in the Pivotal trial. Patients who were successfully revascularized by the Penumbra system had significantly better outcomes than those who were not. Initial post-market experience of the Penumbra system revealed that the revascularization rate and safety profile of the device are comparable to those reported in the Pivotal trial. However, the proportion of patients who had good functional outcome was higher than expected.

  4. Radioembolization using yttrium-90 microspheres as bridging and downstaging treatment for unresectable hepatocellular carcinoma before liver transplantation: initial single-center experience.

    Science.gov (United States)

    Abdelfattah, M R; Al-Sebayel, M; Broering, D; Alsuhaibani, H

    2015-03-01

    HCC is the sixth most common malignancy worldwide and is the third most common cause of cancer related mortality. Moreover, the incidence of HCC is increasing. Surgical treatments for HCC including resection and/or transplantation provide the best curative outcomes in early stages. Unfortunately, many patients present at an advanced stage. Currently, locoregional therapies have an emerging role in the management of HCC for bridging to liver transplantation and for downstaging the disease to within transplant criteria. Radioembolization is among commonly used locoregional therapies. To describe our initial experience with the use of Therasphere® as bridging or downstaging modality before liver transplantation, including our institutional indications, technique and outcome. We retrospectively examined our database for liver transplantation after the use of Therasphere®. Nine patients were identified and reported. They were 5 females and 4 males. Their current age range is 40-72 years with a mean of 53.8 ± 9.5 years. Three patients had Therasphere® as downstaging treatment to our institutional transplantation criteria. Our institution is using UCSF criteria as a cut off limit for liver transplantation as primary treatment modality. The other 6 patients had Therasphere® as bridging for liver transplantation especially when other modalities are not possible. None of these lesions were treated by any other locoregional treatment before or after Therasphere®. Follow-up after liver transplantation ranged between 3.7 and 60.1 months (mean of 15.8 ± 17.7 months). All patients are still living, no retransplantation was done and none of them showed evidence of disease recurrence (100% graft, patient and disease free survival). Our initial experience showed that Therasphere® is a promising therapeutic tool for both downstaging and bridging of HCC before liver transplant. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Transcatheter closure of patent ductus arteriosus in children weighing 10 kg or less: Initial experience at Sohag University Hospital.

    Science.gov (United States)

    Ali, Safaa; El Sisi, Amel

    2016-04-01

    To assess the challenges, feasibility, and efficacy of device closure of patent ductus arteriosus (PDA) in small children weighing ⩽10 kg for different types of devices used in an initial experience at Sohag University hospital. Between March 2011 and September 2014, 91 patients with PDA underwent transcatheter closure in our institute, among whom 54 weighed ⩽10 kg. All of these patients underwent transcatheter closure of PDA using either a Cook Detachable Coil, PFM Nit-Occlud, or Amplatzer duct occluder. A retrospective review of the treatment results and adverse events was performed. Successful device placement was achieved in 53/54 small children (98.1%). The median minimum PDA diameter was 2.4 mm [interquartile range (IQR, 1.8-3.5 mm), median weight 8 kg (IQR, 7-10 kg), and median age 10 months (IQR, 8-17 months)]. Mild aortic obstruction occurred in one case (1.9%), as the device became displaced towards the aorta after release. The device embolized in one case (1.9%) and no retrieval attempt was made. Five cases (9.3%) had minor vascular complications. With the current availability of devices for PDA closure, transcatheter closure of PDA is considered safe and efficacious in small children weighing ⩽10 kg with good mid-term outcome. The procedure had a low rate of high-severity adverse events even with the initial experience of the catheterization laboratory.

  6. Initializing numerical weather prediction models with satellite-derived surface soil moisture: Data assimilation experiments with ECMWF's Integrated Forecast System and the TMI soil moisture data set

    Science.gov (United States)

    Drusch, M.

    2007-02-01

    Satellite-derived surface soil moisture data sets are readily available and have been used successfully in hydrological applications. In many operational numerical weather prediction systems the initial soil moisture conditions are analyzed from the modeled background and 2 m temperature and relative humidity. This approach has proven its efficiency to improve surface latent and sensible heat fluxes and consequently the forecast on large geographical domains. However, since soil moisture is not always related to screen level variables, model errors and uncertainties in the forcing data can accumulate in root zone soil moisture. Remotely sensed surface soil moisture is directly linked to the model's uppermost soil layer and therefore is a stronger constraint for the soil moisture analysis. For this study, three data assimilation experiments with the Integrated Forecast System (IFS) of the European Centre for Medium-Range Weather Forecasts (ECMWF) have been performed for the 2-month period of June and July 2002: a control run based on the operational soil moisture analysis, an open loop run with freely evolving soil moisture, and an experimental run incorporating TMI (TRMM Microwave Imager) derived soil moisture over the southern United States. In this experimental run the satellite-derived soil moisture product is introduced through a nudging scheme using 6-hourly increments. Apart from the soil moisture analysis, the system setup reflects the operational forecast configuration including the atmospheric 4D-Var analysis. Soil moisture analyzed in the nudging experiment is the most accurate estimate when compared against in situ observations from the Oklahoma Mesonet. The corresponding forecast for 2 m temperature and relative humidity is almost as accurate as in the control experiment. Furthermore, it is shown that the soil moisture analysis influences local weather parameters including the planetary boundary layer height and cloud coverage.

  7. With the Advent of Tomosynthesis in the Workup of Mammographic Abnormality, is Spot Compression Mammography Now Obsolete? An Initial Clinical Experience.

    Science.gov (United States)

    Ni Mhuircheartaigh, Neasa; Coffey, Louise; Fleming, Hannah; O' Doherty, Ann; McNally, Sorcha

    2017-09-01

    To determine if the routine use of spot compression mammography is now obsolete in the assessment of screen detected masses, asymmetries and architectural distortion since the availability of digital breast tomosynthesis. We introduced breast tomosynthesis in the workup of screen detected abnormalities in our screening center in January 2015. During an initial learning period with tomosynthesis standard spot compression views were also performed. Three consultant breast radiologists retrospectively reviewed all screening mammograms recalled for assessment over the first 6-month period. We assessed retrospectively whether there was any additional diagnostic information obtained from spot compression views not already apparent on tomography. All cases were also reviewed for any additional lesions detected by tomosynthesis, not detected on routine 2-view screening mammography. 548 women screened with standard 2-view digital screening mammography were recalled for assessment in the selected period and a total of 565 lesions were assessed. 341 lesions were assessed by both tomosynthesis and routine spot compression mammography. The spot compression view was considered more helpful than tomosynthesis in only one patient. This was because the breast was inadequately positioned for tomosynthesis and the area in question was not adequately imaged. Apart from this technical error there was no asymmetry, distortion or mass where spot compression provided more diagnostic information than tomosynthesis alone. We detected three additional cancers on tomosynthesis, not detected by routine screening mammography. From our initial experience with tomosynthesis we conclude that spot compression mammography is now obsolete in the assessment of screen detected masses, asymmetries and distortions where tomosynthesis is available. © 2017 Wiley Periodicals, Inc.

  8. PWR Secondary Water Chemistry Control Status: A Summary of Industry Initiatives, Experience and Trends Relative to the EPRI PWR Secondary Water Chemistry Guidelines

    International Nuclear Information System (INIS)

    Fruzzetti, Keith; Choi, Samuel

    2012-09-01

    The latest revision of the EPRI Pressurized Water Reactor (PWR) Secondary Water Chemistry Guidelines was issued in February 2009. The Guidelines continue to focus on minimizing stress corrosion cracking (SCC) of steam generator tubes, as well as minimizing degradation of other major components / subsystems of the secondary system. The Guidelines provide a technically-based framework for a plant-specific and effective PWR secondary water chemistry program. With the issuance of Revision 7 of the Guidelines in 2009, many plants have implemented changes that allow greater flexibility on startup. For example, the previous Guidelines (Revision 6) contained a possible low power hold at 5% power and a possible mid power hold at approximately 30% power based on chemistry constraints. Revision 7 has established a range over which a plant-specific value can be chosen for the possible low power hold (between 5% and 15%) and mid power hold (between 30% and 50%). This has provided plants the ability to establish significant plant evolutions prior to reaching the possible power hold; such as establishing seal steam to the condenser, placing feed pumps in service, or initiating forward flow of heater drains. The application of this flexibility in the industry will be explored. This paper also highlights the major initiatives and industry trends with respect to PWR secondary chemistry; and outlines the recent work to effectively address them. These will be presented in light of recent operating experience, as derived from EPRI's PWR Chemistry Monitoring and Assessment (CMA) program (which contains more than 400 cycles of operating chemistry data). (authors)

  9. PAN EURASIAN EXPERIMENT (PEEX - A RESEARCH INITIATIVE MEETING THE GRAND CHALLENGES OF THE CHANGING ENVIRONMENT OF THE NORTHERN PAN-EURASIAN ARCTIC-BOREAL AREAS

    Directory of Open Access Journals (Sweden)

    Hanna K. Lappalainen

    2014-01-01

    Full Text Available The Pan-Eurasian Experiment (PEEX is a new multidisciplinary, global change research initiative focusing on understanding biosphere-ocean-cryosphere-climate interactions and feedbacks in Arctic and boreal regions in the Northern Eurasian geographical domain. PEEX operates in an integrative way and it aims at solving the major scientific and society relevant questions in many scales using tools from natural and social sciences and economics. The research agenda identifies the most urgent large scale research questions and topics of the land-atmosphere-aquatic-anthropogenic systems and interactions and feedbacks between the systems for the next decades. Furthermore PEEX actively develops and designs a coordinated and coherent ground station network from Europe via Siberia to China and the coastal line of the Arctic Ocean together with a PEEX-modeling platform. PEEX launches a program for educating the next generation of multidisciplinary researcher and technical experts. This expedites the utilization of the new scientific knowledge for producing a more reliable climate change scenarios in regional and global scales, and enables mitigation and adaptation planning of the Northern societies. PEEX gathers together leading European, Russian and Chinese research groups. With a bottom-up approach, over 40 institutes and universities have contributed the PEEX Science Plan from 18 countries. In 2014 the PEEX community prepared Science Plan and initiated conceptual design of the PEEX land-atmosphere observation network and modeling platform. Here we present the PEEX approach as a whole with the specific attention to research agenda and preliminary design of the PEEX research infrastructure.

  10. Initial Design of the 60 Megawatt Rotating Magnetic Field (RMF) Oscillator System for the University of Washington ''TCS'' Field Reversed Configuration Experiment

    International Nuclear Information System (INIS)

    Reass, W.A.; Miera, D.A.; Wurden, G.A.

    1997-01-01

    presented in addition to anticipated (computer generated) performance characteristics. Initial design and construction began in FY97, and will continue through FY98, with delivery to the experiment in FY99, for commencement of physics experiments on sustaining the FRC

  11. Wire Probe Antenna (WPT) and Electric Field Detector (EFD) of Plasma Wave Experiment (PWE) aboard the Arase satellite: specifications and initial evaluation results

    Science.gov (United States)

    Kasaba, Yasumasa; Ishisaka, Keigo; Kasahara, Yoshiya; Imachi, Tomohiko; Yagitani, Satoshi; Kojima, Hirotsugu; Matsuda, Shoya; Shoji, Masafumi; Kurita, Satoshi; Hori, Tomoaki; Shinbori, Atsuki; Teramoto, Mariko; Miyoshi, Yoshizumi; Nakagawa, Tomoko; Takahashi, Naoko; Nishimura, Yukitoshi; Matsuoka, Ayako; Kumamoto, Atsushi; Tsuchiya, Fuminori; Nomura, Reiko

    2017-12-01

    This paper summarizes the specifications and initial evaluation results of Wire Probe Antenna (WPT) and Electric Field Detector (EFD), the key components for the electric field measurement of the Plasma Wave Experiment (PWE) aboard the Arase (ERG) satellite. WPT consists of two pairs of dipole antennas with 31-m tip-to-tip length. Each antenna element has a spherical probe (60 mm diameter) at each end of the wire (15 m length). They are extended orthogonally in the spin plane of the spacecraft, which is roughly perpendicular to the Sun and enables to measure the electric field in the frequency range of DC to 10 MHz. This system is almost identical to the WPT of Plasma Wave Investigation aboard the BepiColombo Mercury Magnetospheric Orbiter, except for the material of the spherical probe (ERG: Al alloy, MMO: Ti alloy). EFD is a part of the EWO (EFD/WFC/OFA) receiver and measures the 2-ch electric field at a sampling rate of 512 Hz (dynamic range: ± 200 mV/m) and the 4-ch spacecraft potential at a sampling rate of 128 Hz (dynamic range: ± 100 V and ± 3 V/m), with the bias control capability of WPT. The electric field waveform provides (1) fundamental information about the plasma dynamics and accelerations and (2) the characteristics of MHD and ion waves in various magnetospheric statuses with the magnetic field measured by MGF and PWE-MSC. The spacecraft potential provides information on thermal electron plasma variations and structure combined with the electron density obtained from the upper hybrid resonance frequency provided by PWE-HFA. EFD has two data modes. The continuous (medium-mode) data are provided as (1) 2-ch waveforms at 64 Hz (in apoapsis mode, L > 4) or 256 Hz (in periapsis mode, L < 4), (2) 1-ch spectrum within 1-232 Hz with 1-s resolution, and (3) 4-ch spacecraft potential at 8 Hz. The burst (high-mode) data are intermittently obtained as (4) 2-ch waveforms at 512 Hz and (5) 4-ch spacecraft potential at 128 Hz and downloaded with the WFC

  12. Better Measurement for Performance Improvement in Low- and Middle-Income Countries: The Primary Health Care Performance Initiative (PHCPI) Experience of Conceptual Framework Development and Indicator Selection.

    Science.gov (United States)

    Veillard, Jeremy; Cowling, Krycia; Bitton, Asaf; Ratcliffe, Hannah; Kimball, Meredith; Barkley, Shannon; Mercereau, Laure; Wong, Ethan; Taylor, Chelsea; Hirschhorn, Lisa R; Wang, Hong

    2017-12-01

    Policy Points: Strengthening accountability through better measurement and reporting is vital to ensure progress in improving quality primary health care (PHC) systems and achieving universal health coverage (UHC). The Primary Health Care Performance Initiative (PHCPI) provides national decision makers and global stakeholders with opportunities to benchmark and accelerate performance improvement through better performance measurement. Results from the initial PHC performance assessments in low- and middle-income countries (LMICs) are helping guide PHC reforms and investments and improve the PHCPI's instruments and indicators. Findings from future assessment activities will further amplify cross-country comparisons and peer learning to improve PHC. New indicators and sources of data are needed to better understand PHC system performance in LMICs. The Primary Health Care Performance Initiative (PHCPI), a collaboration between the Bill and Melinda Gates Foundation, The World Bank, and the World Health Organization, in partnership with Ariadne Labs and Results for Development, was launched in 2015 with the aim of catalyzing improvements in primary health care (PHC) systems in 135 low- and middle-income countries (LMICs), in order to accelerate progress toward universal health coverage. Through more comprehensive and actionable measurement of quality PHC, the PHCPI stimulates peer learning among LMICs and informs decision makers to guide PHC investments and reforms. Instruments for performance assessment and improvement are in development; to date, a conceptual framework and 2 sets of performance indicators have been released. The PHCPI team developed the conceptual framework through literature reviews and consultations with an advisory committee of international experts. We generated 2 sets of performance indicators selected from a literature review of relevant indicators, cross-referenced against indicators available from international sources, and evaluated through

  13. Laparoendoscopic single-site repair of bladder rupture using a home-made single-port device: initial experience of treatment for a traumatic intraperitoneal bladder rupture.

    Science.gov (United States)

    Lee, Joo Yong; Kang, Dong Hyuk; Lee, Seung Wook

    2012-06-01

    We report our initial experience with a laparoendoscopic single-site (LESS) repair of a bladder rupture using a home-made single-port device. A 37-year-old man presented to the emergency department with complaints of voiding difficulty and gross hematuria after blunt trauma. Cystography and computed tomography revealed an intraperitoneal bladder rupture. The patient underwent LESS repair of a bladder rupture using the Alexis wound retractor, which was inserted through the umbilical incision. A home-made single-port device was made by fixing 6½ surgical gloves to the outer rim of the retractor and securing the glove finger to the end of 3 trocars with a tie. Using the flexible laparoscopic instruments and rigid instruments, LESS surgery was performed using a procedure similar to conventional laparoscopic surgery. The patient did not have any voiding problem after removal of the urethral Foley catheter on the 10th postoperative day. To our knowledge, this is the first published report of LESS repair of a traumatic bladder rupture using a home-made single-port device in the literature.

  14. Aortic aneurysm sac pressure measurements after endovascular repair using an implantable remote sensor: initial experience and short-term follow-up

    International Nuclear Information System (INIS)

    Hoppe, Hanno; Kaufman, John A.; Segall, Jocelyn A.; Liem, Timothy K.; Landry, Gregory J.

    2008-01-01

    The purpose of this single-center study was to report our initial experience with an implantable remote pressure sensor for aneurysm sac pressure measurement in patients post-endovascular aneurysm repair (EVAR) including short-term follow-up. A pressure sensor (EndoSure, Atlanta, GA) was implanted in 12 patients treated with different commercially available aortic endografts for EVAR. Pressure was read pre- and post-EVAR in the operating room. One-month follow-up (30 days ± 6 days) was performed including sac pressure readings and IV contrast CT scans. Variables were compared using the paired Student's t test. An intraprocedure type-I endoleak and a type-III endoleak were successfully treated resulting in decreasing sac pressures. In all patients, post-EVAR systolic sac pressure decreased by an average of 33% (P ≤ 0.005) compared to pre-EVAR measurements. One-month follow-up demonstrated a 47% decrease in systolic sac pressure (P ≤ 0.05). On follow-up CT scans, the average maximum aneurysm diameter pre-EVAR was 6.3 ± 1.6 cm and post-EVAR 6.0 ± 1.7 cm (P≤0.05). The diameter of the aneurysm sac was larger only in one patient with a type-III endoleak. Remote sac pressure measurement may provide important information in addition to imaging and may help to reduce the number of follow-up CT scans. (orig.)

  15. A Diagnostic Algorithm for Eosinophilic Granulomatosis with Polyangiitis Initially Diagnosed as Lumbar Disc Hernia or Lumbar Spinal Stenosis: Personal Experience and Review of the Literature.

    Science.gov (United States)

    Nagata, Kosei; Yamamoto, Shinichi; Miyoshi, Kota; Sato, Masaki; Arino, Yusuke; Mikami, Yoji

    2016-08-01

    Eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome) is a rare systemic vasculitis and is difficult to diagnose. EGPA has a number of symptoms including peripheral dysesthesia caused by mononeuropathy multiplex, which is similar to radiculopathy due to lumbar disc hernia or lumbar spinal stenosis. Therefore, EGPA patients with mononeuropathy multiplex often visit orthopedic clinics, but orthopedic doctors and spine neurosurgeons have limited experience in diagnosing EGPA because of its rarity. We report a consecutive series of patients who were initially diagnosed as having lumbar disc hernia or lumbar spinal stenosis by at least 2 medical institutions from March 2006 to April 2013 but whose final diagnosis was EGPA. All patients had past histories of asthma or eosinophilic pneumonia, and four out of five had peripheral edema. Laboratory data showed abnormally increased eosinophil counts, and nerve conduction studies of all patients revealed axonal damage patterns. All patients recovered from paralysis to a functional level after high-dose steroid treatment. We shortened the duration of diagnosis from 49 days to one day by adopting a diagnostic algorithm after experiencing the first case.

  16. Initial experience with locoregional radioimmunotherapy using {sup 131}I-labelled monoclonal antibodies against tenascin (BC-4) for treatment of glioma (WHO III and IV)

    Energy Technology Data Exchange (ETDEWEB)

    Poepperl, G.; Gildehaus, F.J.; Hahn, K.; Tatsch, K. [Klinik und Poliklinik fuer Nuklearmedizin, Klinikum Grosshadern, Muenchen (Germany); Goetz, C.; Reulen, H.J. [Klinik und Poliklinik fuer Neurochirurgie, Klinikum Grosshadern, Muenchen (Germany); Yousry, T.A. [Inst. fuer Neuroradiologie der LMU Muenchen, Klinikum Grosshadern, Muenchen (Germany)

    2002-06-01

    Aim: None of the established treatments (surgery, radiotherapy, chemotherapy) for malignant glioma has improved its very poor prognosis. Adjuvant locoregional radioimmunotherapy (RIT) represents a new therapeutic approach. We present our initial experience with this therapeutic tool with respect to adverse effects, biokinetics and clinical follow-up. Methods: Following surgery and radiotherapy, 12 patients with glioma (4, WHO stage III; 8, WHO stage IV) underwent 1-5 RIT-cycles (average dose 1100 MBq {sup 131}labelled monoclonal BC-4 antibodies) at six week intervals. Follow-up included serial FDG-PET and MRI investigations. Evaluation of biokinetics included whole body scans, together with analysis of blood, urine and fluid from the tumor cavity. Results: Following RIT, four patients experienced temporary seizures, which, in one case, were associated with temporary aphasia. Eight patients developed HAMA (human anti-mouse anti-bodies) during follow-up. Mean biologic half-life of the radiopharmaceutical in the resection cavity was 3.9 d (range: 1.0-10.2 d) and remained stable intraindividually during further RIT-cycles. The antibody/radionuclide conjugate remain stable in the tumor cavity for at least 5 d. Median survival presently stands at 18.5 months compared to 9.7 months in a historical patient group (n=89) undergoing conventional therapeutic strategies. Five patients show no signs of recurrence. In three patients with post-surgical evidence of residual tumor, one patient showed partial remission, one stable disease, and one progressive disease during RIT. Four patients without evidence of residual tumor mass at the beginning of RIT developed recurrence during therapy. Conclusions: Initial experience demonstrates that locoregional RIT is a well tolerated treatment modality that may represent a promising new approach in the management of patients with malignant glioma. Advantages of local application include passage of the blood-brain barrier, high concentration

  17. MR imaging of patients with localisation-related seizures: initial experience at 3.0T and relevance to the NICE guidelines

    International Nuclear Information System (INIS)

    Griffiths, P.D.; Coley, S.C.; Connolly, D.J.A.; Hodgson, T.; Romanowski, C.A.J.; Widjaja, E.; Darwent, G.; Wilkinson, I.D.

    2005-01-01

    The purpose of this study is to describe our initial experience of imaging adults with localisation-related epilepsy using MR imaging at 3.0T. We discuss the findings in the context of the recently released NICE guidelines that provide detailed advice on imaging people with epilepsy in the UK. 120 consecutive people over the age of 16 years with localisation-related epilepsy were referred for clinical MR examinations from a regional neuroscience centre in England. None of the people had had MR examinations prior to the present study. High resolution MR imaging was performed taking advantage of the high field strength and high performance gradients of the system. Two experienced neuroradiologists reported on the examinations independently and the presence and type of pathology was recorded. There was complete agreement between the two reporters in all 120 cases. The overall frequency of abnormalities shown by MR was 31/120 (26%) and the commonest abnormality shown was mesial temporal sclerosis found in 10/120 (8%). Tumours were shown in 4/120, all of which appeared low grade as judged by imaging criteria. Epilepsy is the commonest neurological condition and demands a significant resource in order to provide good care for sufferers. Recent guidelines published in the UK have suggested that the majority of people with epilepsy should receive brain MR as part of their routine assessment. Our work shows that using the most sophisticated MR imaging in a highly selected population there is a modest pick-up rate of brain abnormalities. If a widespread epilepsy-imaging programme is started the detection rate is likely to be much lower. Although MR is acknowledged to be a reliable way of detecting pathology in people with epilepsy there is a dearth of information studying the health economics of imaging epilepsy in relation to patient management and outcomes

  18. Experiência inicial no fechamento percutâneo da comunicação interatrial com a prótese de Amplatzer Initial experience in percutaneous occlusion of atrial septal defects with the Amplatzer device

    Directory of Open Access Journals (Sweden)

    Valmir F. Fontes

    1998-03-01

    Full Text Available OBJETIVO: Analisar a experiência inicial no fechamento percutâneo da comunicação interatrial ostium secundum (CIA OS com a prótese de Amplatzer. MÉTODOS: Sete pacientes foram submetidos ao procedimento através da via venosa anterógrada, orientados pela ecocardiografia transesofágica (ETE e sob anestesia geral. Uma criança era portadora de 2 CIA e de canal arterial (CA. As CIA medidas pelo ETE variaram de 8,7 a 20mm. Um ecocardiograma transtorácico foi realizado na manhã seguinte do procedimento. RESULTADOS: Oito próteses foram implantadas nos 7 pacientes com sucesso. Em um paciente, o CA foi ocluído na mesma sessão com mola de Gianturco, tendo surgido taquicardia supraventricular durante a oclusão de uma das CIA, controlada com adenosina. Todos receberam alta hospitalar na manhã seguinte, com oclusão total dos defeitos. CONCLUSÃO: O procedimento mostrou-se seguro, eficaz e versátil, podendo ser considerado como uma alternativa terapêutica inicial em pacientes selecionados com CIA OS.PURPOSE: To evaluate our initial experience with percutaneous closure of secundum type atrial septal defects (ASD with the Amplatzer septal occluder. METHODS: Seven patients underwent occlusion by anterograde approach, under general anesthesia and transesophageal echocardiography (TEE guidance. One child had 2 ASD and a patent ductus arteriosus (PDA. The ASD size ranged from 8,7 to 20mm as measured by TEE. A transthoracic echocardiogram was performed in the morning after the procedure. RESULTS: Eight devices were successfully implanted in 7 patients and the PDA was occluded with a Gianturco coil at the same session. In this patient, there was an episode of supraventricular tachycardia during the occlusion of one ASD which was reverted with adenosin. All patients were discharged the day after, with complete occlusion of all defects. CONCLUSION: The procedure is safe, effective and versatile. It can be applied as an initial alternative to the

  19. Preliminary Results of a U.S. Deep South Warm Season Deep Convective Initiation Modeling Experiment using NASA SPoRT Initialization Datasets for Operational National Weather Service Local Model Runs

    Science.gov (United States)

    Medlin, Jeffrey M.; Wood, Lance; Zavodsky, Brad; Case, Jon; Molthan, Andrew

    2012-01-01

    The initiation of deep convection during the warm season is a forecast challenge in the relative high instability and low wind shear environment of the U.S. Deep South. Despite improved knowledge of the character of well known mesoscale features such as local sea-, bay- and land-breezes, observations show the evolution of these features fall well short in fully describing the location of first initiates. A joint collaborative modeling effort among the NWS offices in Mobile, AL, and Houston, TX, and NASA s Short-term Prediction Research and Transition (SPoRT) Center was undertaken during the 2012 warm season to examine the impact of certain NASA produced products on the Weather Research and Forecasting Environmental Modeling System. The NASA products were: a 4-km Land Information System data, a 1-km sea surface temperature analysis, and a 4-km greenness vegetation fraction analysis. Similar domains were established over the southeast Texas and Alabama coastlines, each with a 9 km outer grid spacing and a 3 km inner nest spacing. The model was run at each NWS office once per day out to 24 hours from 0600 UTC, using the NCEP Global Forecast System for initial and boundary conditions. Control runs without the NASA products were made at the NASA SPoRT Center. The NCAR Model Evaluation Tools verification package was used to evaluate both the forecast timing and location of the first initiates, with a focus on the impacts of the NASA products on the model forecasts. Select case studies will be presented to highlight the influence of the products.

  20. Linac-based extracranial radiosurgery with Elekta volumetric modulated arc therapy and an anatomy-based treatment planning system: Feasibility and initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Cilla, Savino, E-mail: savinocilla@gmail.com [Medical Physics Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso (Italy); Deodato, Francesco; Macchia, Gabriella; Digesù, Cinzia [Radiotherapy Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso (Italy); Ianiro, Anna; Viola, Pietro; Craus, Maurizio [Medical Physics Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso (Italy); Valentini, Vincenzo [Radiotherapy Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso (Italy); Radiation Oncology Unit, Policlinico Universitario “A. Gemelli”, Università Cattolica del Sacro Cuore, Roma (Italy); Piermattei, Angelo [Medical Physics Unit, Policlinico Universitario “A. Gemelli”, Università Cattolica del Sacro Cuore, Roma (Italy); Morganti, Alessio G. [Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, S. Orsola-Malpighi Hospital, University of Bologna, Bologna (Italy)

    2016-07-01

    We reported our initial experience in using Elekta volumetric modulated arc therapy (VMAT) and an anatomy-based treatment planning system (TPS) for single high-dose radiosurgery (SRS-VMAT) of liver metastases. This study included a cohort of 12 patients treated with a 26-Gy single fraction. Single-arc VMAT plans were generated with Ergo++ TPS. The prescription isodose surface (IDS) was selected to fulfill the 2 following criteria: 95% of planning target volume (PTV) reached 100% of the prescription dose and 99% of PTV reached a minimum of 90% of prescription dose. A 1-mm multileaf collimator (MLC) block margin was added around the PTV. For a comparison of dose distributions with literature data, several conformity indexes (conformity index [CI], conformation number [CN], and gradient index [GI]) were calculated. Treatment efficiency and pretreatment dosimetric verification were assessed. Early clinical data were also reported. Our results reported that target and organ-at-risk objectives were met for all patients. Mean and maximum doses to PTVs were on average 112.9% and 121.5% of prescribed dose, respectively. A very high degree of dose conformity was obtained, with CI, CN, and GI average values equal to 1.29, 0.80, and 3.63, respectively. The beam-on-time was on average 9.3 minutes, i.e., 0.36 min/Gy. The mean number of monitor units was 3162, i.e., 121.6 MU/Gy. Pretreatment verification (3%-3 mm) showed an optimal agreement with calculated values; mean γ value was 0.27 and 98.2% of measured points resulted with γ < 1. With a median follow-up of 16 months complete response was observed in 12/14 (86%) lesions; partial response was observed in 2/14 (14%) lesions. No radiation-induced liver disease (RILD) was observed in any patients as well no duodenal ulceration or esophagitis or gastric hemorrhage. In conclusion, this analysis demonstrated the feasibility and the appropriateness of high-dose single-fraction SRS-VMAT in liver metastases performed with Elekta

  1. Initial clinical experience with a quadrupole butterfly coil for spinal injection interventions in an open MRI system at 1.0 tesla.

    Science.gov (United States)

    Jonczyk, Martin; Hamm, Bernd; Heinrich, Andreas; Thomas, Andreas; Rathke, Hendrik; Schnackenburg, Bernhard; Güttler, Felix; Teichgräber, Ulf K M; de Bucourt, Maximilian

    2014-02-01

    To report our initial clinical experience with a new magnetic resonance imaging (MRI) quadrupole coil that allows interventions in prone position. Fifteen patients (seven women, eight men; average age, 42.8 years) were treated in the same 1.0-Tesla Panorama High Field Open (HFO) MRI system (Panorama HFO) using a quadrupole butterfly coil (Bfly) and compared with 15 patients matched for sex, age, and MR intervention using the MultiPurposeL coil (MPL), performed in conventional lateral decubitus position (all, Philips Medical Systems, Best, The Netherlands). All interventions were performed with a near-real-time proton density turbo spin echo (PD TSE) sequence (time to repeat/time to echo/flip angle/acquisition time, 600 ms/10 ms/90°/3 s/image). Qualitative and quantitative image analyses were performed, including signal intensity, signal-to-noise and contrast-to-noise ratio (SNR, CNR), contrast, and full width at half maximum (FWHM) measurements. Contrast differed significantly between the needle and muscles (Bfly 0.27/MPL 0.17), as well as the needle and periradicular fat (0.13/0.24) during the intervention (both, p=0.029), as well as the CNR between muscles and the needle (10.61/5.23; p=0.010), although the FWHM values did not (2.4/2.2; p=0.754). The signal intensity of the needle in interventional imaging (1152.9/793.2; p=0.006) and the postinterventional SNR values of subcutaneous fat (15.3/28.6; p=0.007), muscles (6.6/11.8; p=0.011), and the CNR between these tissues (8.7/17.5; p=0.004) yielded significant differences. The new coil is a valid alternative for MR-guided interventions in an open MRI system at 1.0 tesla, especially if patients cannot (or prefer not to) be in a lateral decubitus position or if prone positioning yields better access to the target zone.

  2. The Automated Breast Volume Scanner (ABVS: initial experiences in lesion detection compared with conventional handheld B-mode ultrasound: a pilot study of 50 cases

    Directory of Open Access Journals (Sweden)

    Wojcinski S

    2011-10-01

    Full Text Available Sebastian Wojcinski1, Andre Farrokh1, Ursula Hille2, Jakub Wiskirchen3, Samuel Gyapong1, Amr A Soliman1,4, Friedrich Degenhardt1, Peter Hillemanns21Department of OB/GYN, Franziskus Hospital, Bielefeld, Germany; 2Department of OB/GYN, Hannover Medical School, Hannover, Germany; 3Department of Radiology, Franziskus Hospital, Bielefeld, Germany; 4Department of OB/GYN, Faculty of Medicine, University of Alexandria, Alexandria, EgyptAbstract: The idea of an automated whole breast ultrasound was developed three decades ago. We present our initial experiences with the latest technical advance in this technique, the automated breast volume scanner (ABVS ACUSON S2000TM. Volume data sets were collected from 50 patients and a database containing 23 women with no detectable lesions in conventional ultrasound (BI-RADS®-US 1, 13 women with clearly benign lesions (BI-RADS®-US 2, and 14 women with known breast cancer (BI-RADS®-US 5 was created. An independent examiner evaluated the ABVS data on a separate workstation without any prior knowledge of the patients’ histories. The diagnostic accuracy for the experimental ABVS was 66.0% (95% confidence interval [CI]: 52.9–79.1. The independent examiner detected all breast cancers in the volume data resulting in a calculated sensitivity of 100% in the described setting (95% CI: 73.2%–100%. After the ABVS examination, there were a high number of requests for second-look ultrasounds in 47% (95% CI: 30.9–63.5 of the healthy women (with either a clearly benign lesion or no breast lesions at all in conventional handheld ultrasound. Therefore, the specificity remained at 52.8% (95% CI: 35.7–69.2. When comparing the concordance of the ABVS with the gold standard (conventional handheld ultrasound, Cohen’s Kappa value as an estimation of the inter-rater reliability was κ = 0.37, indicating fair agreement. In conclusion, the ABVS must still be regarded as an experimental technique for breast ultrasound, which

  3. WE-FG-202-08: Assessment of Treatment Response Via Longitudinal Diffusion MRI On A MRI-Guided System: Initial Experience of Quantitative Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Qi, X; Yang, Y; Yang, L; Low, D; Sheng, K [UCLA, Los Angeles, CA (United States)

    2016-06-15

    Purpose: To report our initial experience of systematic monitoring treatment response using longitudinal diffusion MR images on a Co-60 MRI-guided radiotherapy system. Methods: Four patients, including 2 head-and-necks, 1 sarcoma and 1 GBM treated on a 0.35 Tesla MRI-guided treatment system, were analyzed. For each patient, 3D TrueFISP MRIs were acquired during CT simulation and before each treatment for treatment planning and patient setup purposes respectively. Additionally, 2D diffusion-weighted MR images (DWI) were acquired weekly throughout the treatment course. The gross target volume (GTV) and brainstem (as a reference structure) were delineated on weekly 3D TrueFISP MRIs to monitor anatomy changes, the contours were then transferred onto the corresponding DWI images after fusing with the weekly TrueFISP images. The patient-specific temporal and spatial variations during the entire treatment course, such as anatomic changes, target apparent diffusion coefficient (ADC) distribution were evaluated in a longitudinal pattern. Results: Routine MRI revealed progressive soft-tissue GTV volume changes (up to 53%) for the H&N cases during the treatment course of 5–7 weeks. Within the GTV, the mean ADC values varied from −44% (ADC decrease) to +26% (ADC increase) in a week. The gradual increase of ADC value was inversely associated with target volume variation for one H&N case. The maximal changes of mean ADC values within the brainstem were 5.3% for the H&N cases. For the large size sarcoma and GBM tumors, spatial heterogeneity and temporal variations were observed through longitudinal ADC analysis. Conclusion: In addition to the superior soft-tissue visualization, the 0.35T MR system on ViewRay showed the potential to quantitatively measure the ADC values for both tumor and normal tissues. For normal tissue that is minimally affected by radiation, its ADC values are reproducible. Tumor ADC values show temporal and spatial fluctuation that can be exploited for

  4. Manufacturing Initiative

    Data.gov (United States)

    National Aeronautics and Space Administration — The Advanced Manufacturing Technologies (AMT) Project supports multiple activities within the Administration's National Manufacturing Initiative. A key component of...

  5. "I Did Think It Was a Bit Strange Taking Outdoor Education Online": Exploration of Initial Teacher Education Students' Online Learning Experiences in a Tertiary Outdoor Education Unit

    Science.gov (United States)

    Dyment, Janet; Downing, Jillian; Hill, Allen; Smith, Heidi

    2018-01-01

    With a view to attracting more students and offering flexible learning opportunities, online teaching and learning is becoming increasingly wide-spread across the higher education sector. This research reports on the experiences of eight initial teacher education students who studied an outdoor education unit in the online space. Using a…

  6. Conception and initial experiences with the information system for materials in need of control - ISUS; Konzeption und erste Erfahrungen mit dem Informations-System-Ueberwachungsbeduerftige Stoffe - ISUS

    Energy Technology Data Exchange (ETDEWEB)

    Narz, T.

    1997-12-31

    This article presents an information systems for the control of hazardous materials in enterprises. Experiences in the sectors occupational safety, hazardous materials, waste management are described. (SR)

  7. Unilateral initiatives

    International Nuclear Information System (INIS)

    Anon.

    1988-01-01

    This paper reports on arms control which is generally thought of in terms of formal negotiations with an opponent, with the resulting agreements embodied in a treaty. This is not surprising, since arms control discussions between opponents are both important and politically visible. There are, however, strong reasons for countries to consider and frequently take unilateral initiatives. To do so is entirely consistent with the established major precepts of arms control which state that arms control is designed to reduce the risk of war, the costs of preparing for war, and the death and destruction if war should come. Unilateral initiatives on what weapons are purchased, which ones are eliminated and how forces are deployed can all relate to these objectives. There are two main categories of motives for unilateral initiatives in arms control. In one category, internal national objectives are the dominant, often sole, driving force; the initiative is undertaken for our own good

  8. Ports Initiative

    Science.gov (United States)

    EPA's Ports Initiative works in collaboration with the port industry, communities, and government to improve environmental performance and increase economic prosperity. This effort helps people near ports breath cleaner air and live better lives.

  9. Decreased health care utilization and health care costs in the inpatient and emergency department setting following initiation of ketogenic diet in pediatric patients: The experience in Ontario, Canada.

    Science.gov (United States)

    Whiting, Sharon; Donner, Elizabeth; RamachandranNair, Rajesh; Grabowski, Jennifer; Jetté, Nathalie; Duque, Daniel Rodriguez

    2017-03-01

    To assess the change in inpatient and emergency department utilization and health care costs in children on the ketogenic diet for treatment of epilepsy. Data on children with epilepsy initiated on the ketogenic diet (KD) Jan 1, 2000 and Dec 31, 2010 at Ontario pediatric hospitals were linked to province wide inpatient, emergency department (ED) data at the Institute for Clinical Evaluative Sciences. ED and inpatient visits and costs for this cohort were compared for a maximum of 2 years (730days) prior to diet initiation and for a maximum of 2 years (730days) following diet initiation. KD patient were compared to matched group of children with epilepsy who did not receive the ketogenic diet (no KD). Children on the KD experienced a mean decrease in ED visits of 2.5 visits per person per year [95% CI (1.5-3.4)], and a mean decrease of 0.8 inpatient visits per person per year [95% CI (0.3-1.3)], following diet initiation. They had a mean decrease in ED costs of $630 [95% CI (249-1012)] per person per year and a median decrease in inpatient costs of $1059 [IQR: 7890; pdiet experienced a mean reduction of 2.1 ED visits per child per year [95% CI (1.0-3.2)] and a mean decrease of 0.6 [95% CI (0.1-1.1)] inpatient visits per child per year. Patients on the KD experienced a reduction of $442 [95% CI (34.4-850)] per child per year more in ED costs than the matched group. The ketogenic diet group had greater median decrease in inpatient costs per child per year than the matched group [pketogenic diet, experienced decreased ED and inpatient visits as well as costs following diet initiation in Ontario, Canada. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Experiência inicial com a técnica de Buttonhole em um centro de hemodiálise Brasileiro Initial experience with the Buttonhole technique in a Brazilian hemodialysis center

    Directory of Open Access Journals (Sweden)

    Geni dos Santos Teles Silva

    2010-09-01

    Full Text Available INTRODUÇÃO: A técnica de punção de fístulas arteriovenosas para hemodiálise mais comumente utilizada é a de alternância de sítios de punção. Uma técnica opcional (buttonhole vem-se popularizando, pois os sítios de punção são constantes, oferecendo vantagens para pacientes com características especiais. OBJETIVO: Avaliar experiência inicial do serviço com a técnica de buttonhole e determinar sua utilidade. PACIENTES E MÉTODOS: 21 pacientes com fístulas curtas, tortuosas, de difícil punção ou dolorosas foram puncionados pela primeira vez utilizando-se agulhas apropriadas para a técnica buttonhole. RESULTADOS: Não foram observados sangramentos intra- ou pós-hemodiálise, assim como não houve hematomas. Observou-se dor de intensidade leve e mesmo ausência de dor em alguns pacientes (15%. Houve perda de duas fístulas arteriovenosas (9,5% e 47,6% dos pacientes apresentaram coágulos em algum momento, situações essas relacionadas com a troca de puncionador. Um paciente apresentou abscesso paravertebral, admitindo-se a disseminação via fístula arteriovenosa. DISCUSSÃO E CONCLUSÃO: As vantagens de menor dor, menor erro de punção e hematoma são contrabalançadas por aumento do risco de infecção e perda do acesso quando ocorre quebra da técnica ou mais de um puncionador está envolvido. É técnica útil para pacientes selecionados.INTRODUCTION: The most commonly used technique of arteriovenous fistula cannulation for hemodialysis is the rope-ladder technique with alternation of the cannulation site. An alternative technique, the buttonhole (BH technique, has become popular because its constant cannulation sites are advantageous for patients with special characteristics. OBJECTIVE: To assess the initial experience of our service with the BH technique and determine its usefulness. PATIENTS AND METHODS: Twenty-one patients with short, tortuous, painful fistulae of difficult cannulation were submitted to the BH

  11. Swimming upstream: faculty and staff members from urban middle schools in low-income communities describe their experience implementing nutrition and physical activity initiatives.

    Science.gov (United States)

    Bauer, Katherine W; Patel, Aarti; Prokop, Lisa A; Austin, S Bryn

    2006-04-01

    Addressing childhood overweight has become a top priority in the United States. Modification of school policies and practices has been used in an attempt to address the overweight epidemic among children and adolescents. Culturally diverse urban schools in low-income communities attempting to improve nutrition and increase physical activity may face unique challenges in the school environment. A better understanding is needed about school environments and how they may affect the implementation, efficacy, and sustainability of initiatives designed to improve nutrition and physical activity. We carried out a qualitative study in five urban middle schools in low-income communities that had recently implemented Planet Health, a nutrition and physical activity intervention, to assess which aspects of the schools' physical, social, and policy environments were facilitating or impeding the implementation of health promotion initiatives. Thirty-five faculty and staff members participated. We conducted one focus group per school, with an average of seven participants per group. We analyzed focus group transcripts using the thematic analysis technique to identify key concepts, categories, and themes. Teachers and staff members in our study identified many school-related environmental barriers to successful implementation of nutrition and physical activity initiatives in their schools. School personnel recommended that classroom-based nutrition interventions such as Planet Health be coordinated with school food services so that the healthy messages taught in the classroom are reinforced by the availability of healthy, culturally appropriate cafeteria food. They identified household food insufficiency and overly restrictive eligibility criteria of the federally subsidized meal program as critical barriers to healthy nutritional behaviors. They also identified weight-related teasing and bullying and unhealthy weight-control behaviors as challenges to promotion of healthy

  12. Soil life in reconstructed ecosystems: initial soil food web responses after rebuilding a forest soil profile for a climate change experiment

    Science.gov (United States)

    Paul T. Rygiewicz; Vicente J. Monleon; Elaine R. Ingham; Kendall J. Martin; Mark G. Johnson

    2010-01-01

    Disrupting ecosystem components, while transferring and reconstructing them for experiments can produce myriad responses. Establishing the extent of these biological responses as the system approaches a new equilibrium allows us more reliably to emulate comparable native systems. That is, the sensitivity of analyzing ecosystem processes in a reconstructed system is...

  13. The Si Huan Playgroup: An Initiative to Provide Non-Formal Early Childhood Education Experiences to Children of Migrants in Beijing

    Science.gov (United States)

    Nyland, Berenice; Nyland, Chris; Gao, Yang; Ng, Josephine; Zeng, Xiaodong

    2016-01-01

    This paper is about an experiment in non-formal early childhood education for migrant children in Beijing. The Si Huan Playgroup was set up by a group of volunteers in 2004 and is built on ideas of early childhood pedagogy, equity, life-long learning and non-formal education. Non-formal education has implications for policy makers as this is a…

  14. Initial Study

    DEFF Research Database (Denmark)

    Torp, Kristian

    2009-01-01

    increased. In the initial study presented here, the time it takes to pass an intersection is studied in details. Two major signal-controlled four-way intersections in the center of the city Aalborg are studied in details to estimate the congestion levels in these intersections, based on the time it takes...

  15. Influence of local crystallographic configuration on microcrack initiation in fatigued 316LN stainless steel: Experiments and crystal plasticity finite elements simulations

    Energy Technology Data Exchange (ETDEWEB)

    Signor, L., E-mail: loic.signor@ensma.fr [Institut Pprime (UPR3346) CNRS/ISAE-ENSMA/Poitiers University (France); Villechaise, P.; Ghidossi, T.; Lacoste, E.; Gueguen, M. [Institut Pprime (UPR3346) CNRS/ISAE-ENSMA/Poitiers University (France); Courtin, S. [AREVA NP (France)

    2016-01-01

    Local crystallographic configurations (also referred to as local micro-texture) which promote transgranular micro-crack initiation in 316LN stainless steel in low cycle fatigue are studied. Specimens were subjected to tension-compression with constant plastic strain amplitude, in air, at room temperature, during 5000 cycles (i.e. about 20% of the fatigue life). The first part of this work is devoted to a statistical analysis of slip marks and cracks observed at surface of one fatigued specimen using scanning electron microscope (SEM), in a region composed of about 1000 grains. 95 micro-cracks initiated along persistent slip markings detected in this region are analyzed with respect to different characteristics of grains, especially crystallographic orientation, measured using electron backscatter diffraction (EBSD). From the detailed analysis of the numerous data derived from these observations and measurements performed only at surface, the two main significant factors which are found to favour crack formation are the grain size and the orientation of the activated slip system with respect to the surface. Indeed, the mean size of grains which contain cracks is almost twice the one of the remaining grains. Moreover, for most grains in which cracks are observed, the angle between the normal to the surface and the activated Burgers vector (resp. the normal to the activated slip plane) lies in the range [30°, 50°] (resp. [55°, 70°]). No other characteristic was found to provide significant and direct information in order to identify initiation sites. Thus, in the second part of this work, the analysis of initiation sites is performed using additional information relative to three-dimensional (3D) aspects of the microstructure. 3D characterisation of the polycrystalline microstructure and some cracks in one fatigued specimen was achieved using serial-sectioning technique combined with SEM and EBSD. As an example, the study of one specific crack and its surrounding

  16. Using multidetector-row CT in neonates with complex congenital heart disease to replace diagnostic cardiac catheterization for anatomical investigation: initial experiences in technical and clinical feasibility

    International Nuclear Information System (INIS)

    Lee, Tain; Tsai, I.C.; Chen, Min-Chi; Fu, Yun-Ching; Jan, Sheng-Lin; Wang, Chung-Chi; Chang, Yen

    2006-01-01

    Echocardiography is the first-line modality for the investigation of neonatal congenital heart disease. Diagnostic cardiac catheterization, which has a small but recognized risk, is usually performed if echocardiography fails to provide a confident evaluation of the lesions. To verify the technical and clinical feasibilities of replacing diagnostic cardiac catheterization with multidetector-row CT (MDCT) in neonatal complex congenital heart disease. Over a 1-year period we prospectively enrolled all neonates with complex congenital heart disease referred for diagnostic cardiac catheterization after initial assessment by echocardiography. MDCT was performed using a 40-detector-row CT scanner with dual syringe injection. A multidisciplinary congenital heart disease team evaluated the MDCT images and decided if further diagnostic cardiac catheterization was necessary. The accuracy of MDCT in detecting separate cardiovascular anomalies and bolus geometry of contrast enhancement were calculated. A total of 14 neonates were included in the study. No further diagnostic cardiac catheterization was needed in any neonate. The accuracy of MDCT in diagnosing separate cardiovascular anomalies was 98% (53/54) with only one atrial septal defect missed in a patient with coarctation syndrome. The average cardiovascular enhancement in evaluated chambers was 471 HU. No obvious beam-hardening artefact was observed. The technical and clinical feasibility of MDCT in complex congenital heart disease in neonates is confirmed. After initial assessment with echocardiography, MDCT could probably replace diagnostic cardiac catheterization for further anatomical clarification in neonates. (orig.)

  17. Experiência cirúrgica inicial com a operação de Ross (auto-enxerto pulmonar Initial surgical experience with the Ross procedure (pulmonary autograft

    Directory of Open Access Journals (Sweden)

    Francisco Diniz Affonso da Costa

    1996-06-01

    e livres de eventos. Três pacientes, com tempo de evolução superior a seis meses, realizaram ecocardiograma, que demonstrou normalização da função e massa ventricular, assim como manutenção do adequado desempenho hemodinâmico dos enxertos. CONCLUSÕES: A operação de Ross pode ser realizada em nosso meio com baixa mortalidade e resultados satisfatórios a curto prazo. Acreditamos que será amplamente empregada.BACKGROUND: After the excelent long term results reported with the Ross operation, its use increased worldwide. OBJECTIVE: Report our initial surgical experience with this procedure. METHODS: From may/95 trough february/96, 24 patients (mean age 28.3 years were submitted to Ross procedure with the root replacement method. Reconstrution of the right ventricular outflow tract was achieved by 17 pulmonary and 7 aortic homografts stored in nutrient-antibiotic media. All patients were submitted to angiographic and echocardiographic Doppler flow studies at the immediate postoperative period to assess ventricular function and hemodynamic performance of the homografts. Three patients with follow-up longer than 6 months had a second ecocardiographic study. RESULTS: Hospital mortality was 4%. All hospital survivors were discharged in synus rhytm and with no diastolic murmur of aortic insufficiency. Hemodynamic performance of the autografts was excellent with low peak systolic gradients (4.0 ± 1.3 mmHg by echocardiography and 2.8 ± 1.2 mmHg by cardiac catheterism. Twenty-one patients had none or trivial autograft insufficiency and two presented with mild insufficiency. None had moderate or severe regurgitation. Peak systolic gradients in the homografts were also low (3.0 ± 0.9 mmHg by echocardiography and 4,3 ± 1,4 mmHg by catheterism and only two had mild insufficiency. There was a significant reduction in left ventricular mass in the early postoperative period. After a mean follow-up of 5,1 months (1-9 months all patients were in NYHA functional class I

  18. Revascularização do miocárdio sem circulação extracorpórea: experiência e resultados iniciais Myocardial revascularization without cardiopulmonary bypass: experience and initial results

    Directory of Open Access Journals (Sweden)

    Luiz Antônio BRASIL

    2000-03-01

    insufficiency. OBJECTIVE: To present our experience with this procedure describing the technique used and our initial results. MATERIAL AND METHODS: Twenty-three patients were submitted to myocardial revascularization without CPB. The patients selected for this study had lesions in the coronary arteries of the anterodiaphragmatic cardiac region. The main surgical indication was chronic coronary insufficiency (78.3%. 65% of the patients were male, with age between 44-80 (mean - 59.6 years. The surgical approach in all patients was through median sternotomy. He grafts used were internal thoracic arteries, saphenous vein and radial artery. RESULTS: Mean surgical time was 3:15 hours. There were no intra-operative occurences. The number of grafts was 1 to 3 in each patient (mean 1.56 graft/patient out of a total of 36 grafts. The left internal thoracic artery was the most used graft (41.7%. The most frequently revascularized coronary arteries were the anterior interventricular branch (52.8% and the right coronary (30.5%. Hospital mortality and post-operative infarct were 4.3%. There were no neurological, pulmonary, renal, hemorragic or infectious complications. The mean hospital stay was 7 days. CONCLUSION: Myocardial revascularization without cardiopulmonary bypass is an effective and safe technique that can be utilized in selected cases with low morbidity and mortality, reducing costs and hospital stay.

  19. Collective commitment for local bio energy projects. Motives and experiences of the initiators: An interview study of German renewable energy projects; Kollektives Engagement fuer kommunale Bioenergieprojekte. Motive und Erfahrungen der Initiatoren: Eine Interviewstudie deutschlandweiter erneuerbarer Energieprojekte

    Energy Technology Data Exchange (ETDEWEB)

    Rehatschek, Anja

    2009-07-01

    With the help of a sustainable power production, local bio energy projects connect ecological, economic and social solutions for the climate protection and the environment protection, for the support of the agriculture and forestry as well as for living together in the rural area. Past investigations concern primarily consider the collective commitment and the effects of such projects on the population. Under this aspect, the contribution under consideration is occupied with the acting of the initiators of the bio energy projects during the management of their tasks: Which conditions and motives of the initiators affect the conversion process? Under which conditions do the initiators arrive their goal? Which cognitive abilities, strategies of motivation and experiences particularly are important? For the qualitative investigation of these questions, five initiators of German local bio energy projects were interviewed. The results of these interviews are presented by means of paradigm models. It could be shown that both the person of the initiator and the relation of the person to the environment crucially contribute to the conversion of local bio energy projects.

  20. Finding of experience of the use of computer-integrated forms and methods of teaching in the process of preparation of future teachers of initial school

    Directory of Open Access Journals (Sweden)

    Sinopalnikova N.N.

    2010-06-01

    Full Text Available Theoretically grounded and experimentally examined that one of the trends of future teachers training for the integrated activity is gaining experience in using the integrated organization forms of learning. It is realized in the process of specially organized student's learning and during their pedagogical practice. It was promoted by conducting the special course The integrated forms of learning organization in primary school with the use of interactive forms and methods of learning, fulfilling the aimed tasks while passing pedagogical practice.

  1. "Ico-Alone" single nocturnal exchange to initiate peritoneal dialysis in patients with residual renal function-Five year, single centre experience

    Directory of Open Access Journals (Sweden)

    T Jeloka

    2013-01-01

    Full Text Available We analyzed the outcome of incremental dialysis with single nocturnal icodextrin exchange peritoneal dialysis (PD as the initial treatment for end-stage kidney failure in patients who have significant residual renal function. All adult patients opting for PD as renal replacement therapy, having residual renal function, and urinary KT/V of 1.0 were offered incremental dialysis with single nocturnal icodextrin exchange as initial treatment. Adequacy of dialysis was calculated at 1, 3, and 6 months and then 6 monthly. Patients were shifted to conventional PD if short of adequacy or if clinically indicated. Median period on "Ico-alone," peritonitis, exit site infection rates, and patient survival, while on this protocol, were calculated. These outcomes were compared with the cohort of contemporary patients on conventional PD. Thirteen patients were initiated on "Ico-alone" dialysis between October 2006 and October 2011. The baseline characteristics were similar when compared with cohort of conventional PD patients, except urine volume, which was more in "Ico-alone" group (1265 ± 316 vs. 551 ± 504, P = 0.000. Total KT/V at 3 months (1.63 ± 0.6 vs. 1.7 ± 0.2, P = 0.6 and at 1 year (1.64 ± 0.5 vs. 1.53 ± 0.3, P = 0.6 was similar to the cohort of conventional PD patients. Median period on "Ico-alone" was 9.6 months. Peritonitis rate was 1 episode in 56.22 vs 25.29 patient-months and exit site infection was 1 episode in 56.2 vs 189.71 patient-months in "Ico-alone" and conventional group, respectively. Patient survival was 42.84 months in "Ico-alone′ vs 25.29 months in conventional dialysis ( P = 0.01. In conclusion, single icodextrin exchange offers adequate dialysis in patients with residual renal function (KT/V = 1 for a median period of 9 months.

  2. Experience with low-power x86 processors (Atom) for HEP usage. An initial analysis of the Intel® dual core Atom™ N330 processor

    CERN Document Server

    Balazs, G; Nowak, A; CERN. Geneva. IT Department

    2009-01-01

    In this paper we compare a system based on an Intel Atom N330 low-power processor to a modern Intel Xeon® dual-socket server using CERN IT’s standard criteria for comparing price-performance and performance per watt. The Xeon server corresponds to what is typically acquired as servers in the LHC Computing Grid. The comparisons used public pricing information from November 2008. After the introduction in section 1, section 2 describes the hardware and software setup. In section 3 we describe the power measurements we did and in section 4 we discuss the throughput performance results. In section 5 we summarize our initial conclusions. We then go on to describe our long term vision and possible future scenarios for using such low-power processors, and finally we list interesting development directions.

  3. Interplay of demographic variables, birth experience, and initial reactions in the prediction of symptoms of posttraumatic stress one year after giving birth

    Directory of Open Access Journals (Sweden)

    Julia König

    2016-10-01

    Full Text Available Background: There has been increasing research on posttraumatic stress disorder (PTSD following childbirth in the last two decades. The literature on predictors of who develops posttraumatic stress symptoms (PSS suggests that both vulnerability and birth factors have an influence, but many studies measure predictors and outcomes simultaneously. Objective: In this context, we aimed to examine indirect and direct effects of predictors of PSS, which were measured longitudinally. Method: We assessed women within the first days (n=353, 6 weeks, and 12 months (n=183 after having given birth to a healthy infant. The first assessment included questions on demographics, pregnancy, and birth experience. The second and third assessments contained screenings for postpartum depression, PTSD, and general mental health problems, as well as assessing social support and physical well-being. We analysed our data using structural equation modelling techniques (n=277. Results: Our final model showed good fit and was consistent with a diathesis-stress model of PSS. Women who had used antidepressant medication in the 10 years before childbirth had higher PSS at 6 weeks, independent of birth experiences. Subjective birth experience was the early predictor with the highest total effect on later PSS. Interestingly, a probable migration background also had a small but significant effect on PSS via more episiotomies. The null results for social support may have been caused by a ceiling effect. Conclusions: Given that we measured predictors at different time points, our results lend important support to the etiological model, namely, that there is a vulnerability pathway and a stress pathway leading to PSS. PSS and other psychological measures stayed very stable between 6 weeks and 1 year postpartum, indicating that it is possible to identify women developing problems early.

  4. Initial experience with the 3.3 Fr Mongoose® pigtail catheter for aortic angiography during patent ductus arteriosus closure in small patients.

    Science.gov (United States)

    Hena, Zachary; Sutton, Nicole J; Gates, Gregory J; Taragin, Benjamin H; Pass, Robert H

    2017-01-01

    Smaller femoral arterial sheaths may be associated with fewer vascular complications. The 3.3 Fr Mongoose ® Pediavascular pigtail catheter is a catheter that allows higher flow rates, potentially resulting in improved angiographic quality. We reviewed our experience with this small catheter during patent ductus arteriosus (PDA) closure. Review of patients ≤20 kg in whom the Mongoose ® catheter was used during PDA closure from 12/13 to 4/15. Angiographic efficacy and procedural details were compared to ten 4 Fr catheter cases. Comparisons were performed using Mann-Whitney U-test; P closure in small children.

  5. Initiating events frequency determination

    International Nuclear Information System (INIS)

    Simic, Z.; Mikulicic, V.; Vukovic, I.

    2004-01-01

    The paper describes work performed for the Nuclear Power Station (NPS). Work is related to the periodic initiating events frequency update for the Probabilistic Safety Assessment (PSA). Data for all relevant NPS initiating events (IE) were reviewed. The main focus was on events occurring during most recent operating history (i.e., last four years). The final IE frequencies were estimated by incorporating both NPS experience and nuclear industry experience. Each event was categorized according to NPS individual plant examination (IPE) initiating events grouping approach. For the majority of the IE groups, few, or no events have occurred at the NPS. For those IE groups with few or no NPS events, the final estimate was made by means of a Bayesian update with general nuclear industry values. Exceptions are rare loss-of-coolant-accidents (LOCA) events, where evaluation of engineering aspects is used in order to determine frequency.(author)

  6. Initial Experience of Tomosynthesis-Guided Vacuum-Assisted Biopsies of Tomosynthesis-Detected (2D Mammography and Ultrasound Occult) Architectural Distortions.

    Science.gov (United States)

    Patel, Bhavika K; Covington, Matthew; Pizzitola, Victor J; Lorans, Roxanne; Giurescu, Marina; Eversman, William; Lewin, John

    2018-03-23

    As experience and aptitude in digital breast tomosynthesis (DBT) have increased, radiologists are seeing more areas of architectural distortion (AD) on DBT images compared with standard 2D mammograms. The purpose of this study is to report our experience using tomosynthesis-guided vacuum-assisted biopsies (VABs) for ADs that were occult at 2D mammography and ultrasound and to analyze the positive predictive value for malignancy. We performed a retrospective review of 34 DBT-detected ADs that were occult at mammography and ultrasound. We found a positive predictive value of 26% (nine malignancies in 34 lesions). Eight of the malignancies were invasive and one was ductal carcinoma in situ. The invasive cancers were grade 1 (4/8; 50%), grade 2 (2/8; 25%), or grade 3 (1/8; 13%); information about one invasive cancer was not available. The mean size of the invasive cancers at pathologic examination was 7.5 mm (range, 6-30 mm). Tomosynthesis-guided VAB is a feasible method to sample ADs that are occult at 2D mammography and ultrasound. Tomosynthesis-guided VAB is a minimally invasive method that detected a significant number of carcinomas, most of which were grade 1 cancers. Further studies are needed.

  7. Protonium spectrosopy and identification of P-wave and S-wave initial states of p-p annihilations at rest with the ASTERIX experiment at LEAR

    International Nuclear Information System (INIS)

    Gastaldi, U.; Ahmad, S.; Amsler, C.

    1984-01-01

    This chapter discusses an experiment designed to study the general features of p - p interactions at rest, to extend work done in the spectroscopy of light mesons produced in p - p annihilations at rest, and to search with high sensitivity for gluonium, qq - qq baryonium structures and NN states bound by strong interactions. The effect of using a gas target and a large acceptance X-ray detector is examined. The rate and the signature of antiprotons stopping in the gas target are investigated. Topics covered include the protonium cascade and spectroscopy; a comparison of S-wave and P-wave p - p annihilations at rest; - p stop and the formation of p - p atoms; the x-ray detector (projection chamber, electronics, tests); and examples of estimations of signal and background (protonium spectroscopy, search of resonances in P-wave annihilations, search of resonances in S-wave annihilations). The distinctive features of the ASTERIX experiment are the use of a gaseous H 2 target instead of a conventional liquid H 2 one; an X-ray detector of large overall detection efficiency, low energy threshold and low background rate that enables identification of P-wave and S-wave annihilation events from 2P and 1S levels of protonium; a detection system for the products of p - p annihilations; and a trigger system that enables filtration of the acquisition of events by means of two independent chains of processors working in parallel

  8. Intensified Local Resource Mobilization for the Polio Eradication Initiative: The Experience of World Health Organization in Nigeria During 2008-2015.

    Science.gov (United States)

    Yehualashet, Yared G; Horton, Janet; Mkanda, Pascal; Vaz, Rui G; Afolabi, Oluwole; Gashu, Sisay G; Banda, Richard; O'Malley, Helena; Nsubuga, Peter

    2016-05-01

    Since the World Health Assembly (WHA) resolved in 1988 to eradicate poliovirus, several rounds of immunization campaigns have been conducted by member states. By 2000, with the support of the Global Polio Eradication Initiative (GPEI) partners, the number of polio cases decreased by 99%. Eradicating the remaining 1% proved to be more challenging. Although the GPEI, being the largest public health project, required >$9 billion between 1988 and 2012, economic analysis showed the estimated incremental net benefits of $40 billion-$50 billion between 1988 and 2035. In 2012, the WHA declared that the completion of poliovirus eradication is a programmatic emergency for global public health. Nigeria, as one of 3 remaining polio-endemic countries, developed an emergency plan to interrupt the transmission of poliovirus. The plan included the introduction or scale-up of various new innovations and strategies, which had substantial financial implication. This is a retrospective study to document the intensified resource mobilization efforts made by the World Health Organization (WHO) in Nigeria to meet the increased financial requirements and bridge the remaining gap in funding. In addition to the established coordination platforms, the WHO Nigeria Country Office team directly engaged with national authorities, donors, and partners throughout the process of resource requirement analysis, project appraisals, proposal development, and implementation of activities, joint monitoring, and evaluation exercises. The office strengthened its capacity for direct funds disbursement and systematic implementation of a rigorous accountability framework. Between 2008 and May 2015, $538 million was mobilized locally, of which 82% was mobilized since 2012. The percentage of the total funding requirements that were locally mobilized averaged 31% between 2008 and 2011 and increased to 70% between 2012 and May 2015. During the same period, the WHO Nigeria Country Office team produced and

  9. Intensified Local Resource Mobilization for the Polio Eradication Initiative: The Experience of World Health Organization in Nigeria During 2008–2015

    Science.gov (United States)

    Yehualashet, Yared G.; Horton, Janet; Mkanda, Pascal; Vaz, Rui G.; Afolabi, Oluwole; Gashu, Sisay G.; Banda, Richard; O'Malley, Helena; Nsubuga, Peter

    2016-01-01

    Background. Since the World Health Assembly (WHA) resolved in 1988 to eradicate poliovirus, several rounds of immunization campaigns have been conducted by member states. By 2000, with the support of the Global Polio Eradication Initiative (GPEI) partners, the number of polio cases decreased by 99%. Eradicating the remaining 1% proved to be more challenging. Although the GPEI, being the largest public health project, required >$9 billion between 1988 and 2012, economic analysis showed the estimated incremental net benefits of $40 billion–$50 billion between 1988 and 2035. In 2012, the WHA declared that the completion of poliovirus eradication is a programmatic emergency for global public health. Nigeria, as one of 3 remaining polio-endemic countries, developed an emergency plan to interrupt the transmission of poliovirus. The plan included the introduction or scale-up of various new innovations and strategies, which had substantial financial implication. Methods. This is a retrospective study to document the intensified resource mobilization efforts made by the World Health Organization (WHO) in Nigeria to meet the increased financial requirements and bridge the remaining gap in funding. In addition to the established coordination platforms, the WHO Nigeria Country Office team directly engaged with national authorities, donors, and partners throughout the process of resource requirement analysis, project appraisals, proposal development, and implementation of activities, joint monitoring, and evaluation exercises. The office strengthened its capacity for direct funds disbursement and systematic implementation of a rigorous accountability framework. Results. Between 2008 and May 2015, $538 million was mobilized locally, of which 82% was mobilized since 2012. The percentage of the total funding requirements that were locally mobilized averaged 31% between 2008 and 2011 and increased to 70% between 2012 and May 2015. During the same period, the WHO Nigeria

  10. Positron emission tomography with 2-[18F]-Fluoro-2-Deoxy-D-Glucose for initial staging of hodgkin lymphoma: a single center experience in Brazil

    Directory of Open Access Journals (Sweden)

    Juliano Julio Cerci

    2009-06-01

    Full Text Available BACKGROUND: 2-[18F]-Fluoro-2-Deoxy-D-Glucose (FDG-PET is a well established functional imaging modality for the initial staging of Hodgkin lymphoma (HL in patients from Western Europe and North America. The reliability of FDG-PET in populations of different ethnic groups is unclear, as all investigations published to date have come from developed countries. PURPOSE: The aim of the present study was to investigate the effectiveness of FDG-PET in the initial staging of HL patients in a Brazilian population. METHODS: Eighty-two patients with newly diagnosed HL were prospectively included in the study. All patients were staged with both conventional clinical staging (CCS methods, including computed tomography (CT and whole-body FDG-PET methods. A standard of reference for the nodal regions and the extranodal organs was determined using all available information, including the CCS methods, FDG-PET, the diagnostic histology and the follow-up examinations. The results of the CCS were then compared to the FDG-PET results. RESULTS: The sensitivity of FDG-PET was higher for nodal staging than that of CT (87.8% vs. 61.6%, respectively. FDG-PET was also more sensitive than CT in regard to evaluating the extranodal organs for lymphomatous involvement (96.2% vs. 40.0%, respectively. FDG-PET detected all 16 patients who were characterized by a positive bone marrow biopsy and identified an additional 4 patients with bone marrow disease. The incorporation of FDG-PET coupled with CCS in the staging procedure upstaged 20% (17/82 of the patients and downstaged 11% (9/82 of the patients. As a result of these changes in staging, 15% (13/82 of the patients would have received a different therapeutic regimen. CONCLUSIONS: The FDG-PET method is superior to CT for the detection of nodal and extra-nodal HL. The observation that the FDG-PET method upstaged the disease was the most common result (20% of patients brought about by the addition of PET to the staging algorithm

  11. Assessment of the acute toxicity of eutrophic sediments after the addition of calcium nitrate (Ibirité reservoir, Minas Gerais-SE Brazil: initial laboratory experiments

    Directory of Open Access Journals (Sweden)

    H. Janke

    Full Text Available This study evaluated the acute toxicity of sediment in a eutrophic reservoir after remediation with a calcium nitrate solution to retain phosphorus. The study involved microcosms of surface sediments and water from the sediment-water interface in the Ibirité reservoir. This reservoir, located in the vicinity of metropolitan Belo Horizonte (Minas Gerais, SE Brazil, is a water body that receives treated effluents from an oil refinery (REGAP-Petrobras, as well as high loads of untreated urban effluents from the city of Ibirité and surrounding areas and industrial effluents from a major industrial park. Incubation times of the treatment experiments were: t = 0, t = 5, t = 10, t = 25, t = 50, t = 85 and t = 135 days. One control microcosm and three treated microcosms were analysed in each time interval. Acute toxicity of water samples was assessed with Ceriodaphnia silvestrii Daday, 1902 and that of bulk sediment samples with Chironomus xanthus Rempel, 1939. Toxicity tests were carried out concomitantly with chemical analyses of dissolved inorganic nitrogen species (ammonia, nitrate and nitrite, sulfate and metals in the water samples of the microcosms. Acid volatile sulfides (AVS, simultaneously extracted metal (SEM and potentially bioavailable metal were analyzed in bulk sediment samples. Neither of the tested organisms showed toxicity in the control microcosm samples. The water column of the treated microcosm showed toxicity to C. silvestrii, starting at t = 10 days, while the sediment pore water toxicity started at t = 0 day. However, toxicity was found to decline from t = 85 days to t = 135 days. Sediments showed toxicity to C. xanthus during the entire experiment, except at the longest incubation time (t = 135 days. The overall results indicate that nitrate, which reached concentrations exceeding 1,200 mg N-NO3- L-1 in the sediment pore water of the treated microcosms, was most probably responsible for the toxicity of the samples. Although

  12. Net-VISA used as a complement to standard software at the CTBTO: initial operational experience with next-generation software.

    Science.gov (United States)

    Le Bras, R. J.; Arora, N. S.; Kushida, N.; Kebede, F.; Feitio, P.; Tomuta, E.

    2017-12-01

    The International Monitoring System of the Comprehensive Nuclear-Test-Ban Treaty Organization (CTBTO) has reached out to the broader scientific community through a series of conferences, the later one of which took place in June 2017 in Vienna, Austria. Stemming out of this outreach effort, after the inception of research and development efforts in 2009, the NET-VISA software, following a Bayesian modelling approach, has been elaborated to improve on the key step of automatic association of joint seismic, hydro-acoustic, and infrasound detections. When compared with the current operational system, it has been consistently shown on off-line tests to improve the overlap with the analyst-reviewed Reviewed Event Bulletin (REB) by ten percent for an average of 85% overlap, while the inconsistency rate is essentially the same at about 50%. Testing by analysts in realistic conditions on a few days of data has also demonstrated the software performance in finding additional events which qualify for publication in the REB. Starting in August 2017, the automatic events produced by the software will be reviewed by analysts at the CTBTO, and we report on the initial evaluation of this introduction into operations.

  13. Quality of Colonoscopy Performed in Rural Practice: Experience From the Clinical Outcomes Research Initiative and the Oregon Rural Practice-Based Research Network.

    Science.gov (United States)

    Holub, Jennifer L; Morris, Cynthia; Fagnan, Lyle J; Logan, Judith R; Michaels, LeAnn C; Lieberman, David A

    2018-02-01

    Colon cancer screening is effective. To complete screening in 80% of individuals over age 50 years by 2018 will require adequate colonoscopy capacity throughout the country, including rural areas, where colonoscopy providers may have less specialized training. Our aim was to study the quality of colonoscopy in rural settings. The Clinical Outcomes Research Initiative (CORI) and the Oregon Rural Practice-based Research Network (ORPRN) collaborated to recruit Oregon rural practices to submit colonoscopy reports to CORI's National Endoscopic Database (NED). Ten ORPRN sites were compared to non-ORPRN rural (n = 11) and nonrural (n = 43) sites between January 2009 and October 2011. Established colonoscopy quality measures were calculated for all sites. No ORPRN physicians were gastroenterologists compared with 82% of nonrural physicians. ORPRN practices reached the cecum in 87.4% of exams compared with 89.3% of rural sites (P = .0002) and 90.9% of nonrural sites (P 9mm 16.6% vs 18.7% (P = .106). ORPRN sites performed well on most colonoscopy quality measures, suggesting that high-quality colonoscopy can be performed in rural settings. © 2016 National Rural Health Association.

  14. Food and nutrition security public initiatives from a human and socioeconomic development perspective: mapping experiences within the 1996 World Food Summit signatories.

    Science.gov (United States)

    Aliaga, Marie Agnès; Chaves-Dos-Santos, Sandra Maria

    2014-03-01

    Food security exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life. In a global scenario where hunger and obesity affect millions of people, public actions have been developed towards Food and Nutrition Security (FNS). In 1996 during the World Food Summit, 186 countries signed the Rome Declaration, committing themselves to assess and address Food and Nutrition Insecurity. In this exploratory study, we compile secondary internet data using keywords in four languages to map the global distribution, among signatories, of FNS public initiatives and assess their association with key national-level socioeconomic indicators. As a result, we found FNS public policies in 123 countries, reports on the state of FNS in 139 countries, and the presence of both in 114 countries (61%). The proportion of countries with any type of, as well as with specific, FNS policy or diagnostic was higher in least developed countries. There was a statistically significant association between these proportions and selected national-level socioeconomic variables. The results are discussed along with population vulnerability, international cooperation mechanisms and political discourse and how these factors impact the existence of FNS public actions. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Coronary CT angiography-derived fractional flow reserve correlated with invasive fractional flow reserve measurements - initial experience with a novel physician-driven algorithm

    International Nuclear Information System (INIS)

    Baumann, Stefan; Wang, Rui; Schoepf, U.J.; Steinberg, Daniel H.; Spearman, James V.; Bayer, Richard R.; Hamm, Christian W.; Renker, Matthias

    2015-01-01

    The present study aimed to determine the feasibility of a novel fractional flow reserve (FFR) algorithm based on coronary CT angiography (cCTA) that permits point-of-care assessment, without data transfer to core laboratories, for the evaluation of potentially ischemia-causing stenoses. To obtain CT-based FFR, anatomical coronary information and ventricular mass extracted from cCTA datasets were integrated with haemodynamic parameters. CT-based FFR was assessed for 36 coronary artery stenoses in 28 patients in a blinded fashion and compared to catheter-based FFR. Haemodynamically relevant stenoses were defined by an invasive FFR ≤0.80. Time was measured for the processing of each cCTA dataset and CT-based FFR computation. Assessment of cCTA image quality was performed using a 5-point scale. Mean total time for CT-based FFR determination was 51.9 ± 9.0 min. Per-vessel analysis for the identification of lesion-specific myocardial ischemia demonstrated good correlation (Pearson's product-moment r = 0.74, p < 0.0001) between the prototype CT-based FFR algorithm and invasive FFR. Subjective image quality analysis resulted in a median score of 4 (interquartile ranges, 3-4). Our initial data suggest that the CT-based FFR method for the detection of haemodynamically significant stenoses evaluated in the selected population correlates well with invasive FFR and renders time-efficient point-of-care assessment possible. (orig.)

  16. Advancing the education in molecular diagnostics: the IFCC-Initiative "Clinical Molecular Biology Curriculum" (C-CMBC); a ten-year experience.

    Science.gov (United States)

    Lianidou, Evi; Ahmad-Nejad, Parviz; Ferreira-Gonzalez, Andrea; Izuhara, Kenji; Cremonesi, Laura; Schroeder, Maria-Eugenia; Richter, Karin; Ferrari, Maurizio; Neumaier, Michael

    2014-09-25

    Molecular techniques are becoming commonplace in the diagnostic laboratory. Their applications influence all major phases of laboratory medicine including predisposition/genetic risk, primary diagnosis, therapy stratification and prognosis. Readily available laboratory hardware and wetware (i.e. consumables and reagents) foster rapid dissemination to countries that are just establishing molecular testing programs. Appropriate skill levels extending beyond the technical procedure are required for analytical and diagnostic proficiency that is mandatory in molecular genetic testing. An international committee (C-CMBC) of the International Federation for Clinical Chemistry (IFCC) was established to disseminate skills in molecular genetic testing in member countries embarking on the respective techniques. We report the ten-year experience with different teaching and workshop formats for beginners in molecular diagnostics. Copyright © 2014 Elsevier B.V. All rights reserved.

  17. In-line monitoring of Li-ion battery electrode porosity and areal loading using active thermal scanning - modeling and initial experiment

    Science.gov (United States)

    Rupnowski, Przemyslaw; Ulsh, Michael; Sopori, Bhushan; Green, Brian G.; Wood, David L.; Li, Jianlin; Sheng, Yangping

    2018-01-01

    This work focuses on a new technique called active thermal scanning for in-line monitoring of porosity and areal loading of Li-ion battery electrodes. In this technique a moving battery electrode is subjected to thermal excitation and the induced temperature rise is monitored using an infra-red camera. Static and dynamic experiments with speeds up to 1.5 m min-1 are performed on both cathodes and anodes and a combined micro- and macro-scale finite element thermal model of the system is developed. It is shown experimentally and through simulations that during thermal scanning the temperature profile generated in an electrode depends on both coating porosity (or area loading) and thickness. It is concluded that by inverting this relation the porosity (or areal loading) can be determined, if thermal response and thickness are simultaneously measured.

  18. Treatment of localized prostate cancer using a combination of high dose rate lridium-192 brachytherapy and external beam irradiation: Initial Australian